Association of COVID-19 Acute Respiratory Distress Syndrome With Symptoms of Posttraumatic Stress Disorder in Family Members After ICU Discharge

Abstract

IMPORTANCE Persistent physical and mental disorders are frequent in survivors of COVID-19-related acute respiratory distress syndrome (ARDS). However, data on these disorders among family members are scarce.OBJECTIVE To determine the association between patient hospitalization for COVID-19 ARDS vs ARDS from other causes and the risk of posttraumatic stress disorder (PTSD)-related symptoms in family members. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study in 23 intensive care units (ICUs) in France (January 2020 to June 2020 with final follow-up ending in October 2020). ARDS survivors and family members (1 family member per patient) were enrolled. EXPOSURES Family members of patients hospitalized for ARDS due to COVID-19 vs ARDS due to other causes. MAIN OUTCOMES AND MEASURES The primary outcome was family member symptoms of PTSD at 90 days after ICU discharge, measured by the Impact of Events Scale-Revised (score range, 0 [best] to 88 [worst]; presence of PTSD symptoms defined by score >22). Secondary outcomes were family member symptoms of anxiety and depression at 90 days assessed by the Hospital Anxiety and Depression Scale (score range, 0 [best] to 42 [worst]; presence of anxiety or depression symptoms defined by subscale scores Ն7). Multivariable logistic regression models were used to determine the association between COVID-19 status and outcomes. RESULTS Among 602 family members and 307 patients prospectively enrolled, 517 (86%) family members (median [IQR] age, 51 [40-63] years; 72% women; 48% spouses; 26% bereaved because of the study patient's death; 303 [50%] family members of COVID-19 patients) and 273 (89%) patients (median [IQR] age, 61 [50-69] years; 34% women; 181 [59%] with COVID-19) completed the day-90 assessment. Compared with non-COVID-19 ARDS, family members of patients with COVID-19 ARDS had a significantly higher prevalence of symptoms of PTSD (35% [103/293] vs 19% [40/211]; difference, 16% [95% CI, 8%-24%]; P < .001), symptoms of anxiety (41% [121/294] vs 34% [70/207]; difference, 8% [95% CI, 0%-16%]; P= .05), and symptoms of depression (31% [91/291] vs 18% [37/209]; difference, 13% [95% CI, 6%-21%]; P< .001). In multivariable models adjusting for age, sex, and level of social support, COVID-19 ARDS was significantly associated with increased risk of PTSD-related symptoms in family members (odds ratio, 2.05 [95% CI, 1.30 to 3.23]).CONCLUSIONS AND RELEVANCE Among family members of patients hospitalized in the ICU with ARDS, COVID-19 disease, as compared with other causes of ARDS, was significantly associated with increased risk of symptoms of PTSD at 90 days after ICU discharge.

The COVID-19 continuum of illness

“… 13 Post-traumatic stress disorder (PTSD) has been reported in 35% of caregivers and independently associated with COVID-19-related ARDS. 14 Younger children are rarely studied but are at considerable risk for PTSD. 15 COVID-19 illness was often clustered within families, leading to multiple family members in hospital or the ICU simultaneously.…”

Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection

“…Restoring speech has long been a priority for patients with tracheostomy [45] , [46] , but placement of one-way valves and decannulation were often delayed during the pandemic. The vulnerability inherent in relying on others for care also may have increased anxiety, as impaired communication in this population increases anxiety, depression, and stress for both HCP and patients [47] . Few studies have specifically explored patients and families' survivorship challenges [48] which can affect mental health, physical impairments, and cognitive impairments.…”

Mental health morbidity, self-harm, and suicide in ICU survivors and caregivers

“…In a population-based cohort of spouses of critically ill patients with sepsis and septic shock, the incidence of new mental illness among spouses was 23.5%, which was in excess of the general population during the same time period [ 11 ]. Finally, very recent prospective data from France showed that caregivers of patients with acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19) had higher incidence of PTSD symptoms compared to not only the general public, but caregivers of patients with ARDS from other causes [ 12 ]. This underscores the role of the pandemic, which has clearly heightened concerns of post-discharge mental health morbidity among ICU survivors and their caregivers.…”