Can we predict intensive care relatives at risk for posttraumatic stress disorder?

Abstract

Aims:To identify the relatives of the intensive care unit (ICU) patients at risk for developing symptoms of posttraumatic stress disorders.Setting:A multidisciplinary hospital ICU.Design:Prospective single center observational study.Material and Methods:Relatives of patients admitted in the ICU (May06-Nov06) who consented to answer the questionnaire participated in the study. Anxiety was assessed by using the Hospital Anxiety and Depression Scale (HAD) and vulnerability to posttraumatic disorder (PTSD) by using the Impact of Event Scale Revised (IES-R) which was administered on the fifth day of admission and at two months following discharge or death.Results:During admission, 48% of the relatives had a HAD score >11 and 72% showed IES-R score >26. There was no association of HAD with gender, patient outcome, working status, age of the patient, or mode of payment of the bills. There was significant association of IES-R >26 with trauma admission, HAD score >11 and mode of payment with the relatives of insured being more stressed as compared to those who settled their bills personally. A total of 35% relatives showed symptoms of posttraumatic stress reaction consistent with a high risk of PTSD after two months. Death in the hospital resulted in elevated HAD and IES-R score during admission and at the two month follow-up. Persistence of stress symptoms was more in school drop outs, working relatives, parents and those with initial anxiety score >11.Conclusions:HAD score greater than 11 was the only factor at admission which could statistically predict a higher PTSD score on follow-up. Adequate counseling of this group of relatives may prevent lasting psychological sequelae of an ICU admission in the relatives of critically ill.

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers*

“…Using the data and recommendations published by Creamer et al (40), 23% of FDMs had IES-R scores highly predictive of PTSD (IES-R > 33) and 42% had scores that demonstrate clinically significant symptoms of PTSD (IES-R > 24). Several investigators have reported PTSD symptom prevalence rates ranging from 33% to 69% within the first 6 months after ICU hospitalization (7–10, 13–18). However, comparison between studies is difficult due to differences in sample populations, instruments used to measure PTSD symptoms, timing of symptom measurement, and analysis of instrument score.…”

“…However, this relationship is less clear in other ICU family populations. Some studies investigating post-ICU family PTSD symptoms do not differentiate between family members who did or did not participate in the decision-making process (9, 10, 14, 17, 18). Gries et al (9) reported that discordance between decision-making preferences and actual decision-making role was associated with increased PTSD symptoms, and thus, the impact of the role of FDM may be a significant risk factor.…”

“…In the months following the ICU experience, family members are at risk for ongoing psychological distress, including symptoms of generalized anxiety disorder, depression, panic disorder, posttraumatic stress disorder (PTSD), and complicated grief (7–12). Specifically, the prevalence and severity of PTSD symptoms in post-ICU family members have been increasingly recognized in the literature (7–10, 13–18). …”

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers

“…In the months following the ICU experience, family members are at risk for ongoing psychological distress, including symptoms of generalized anxiety disorder, depression, panic disorder, posttraumatic stress disorder (PTSD), and complicated grief (7)(8)(9)(10)(11)(12). Specifically, the prevalence and severity of PTSD symptoms in post-ICU family members have been increasingly recognized in the literature (7)(8)(9)(10)(13)(14)(15)(16)(17)(18).…”

“…However, this relationship is less clear in other ICU family populations. Some studies investigating post-ICU family PTSD symptoms do not differentiate between family members who did or did not participate in the decision-making process (9,10,14,17,18). Gries et al (9) reported that discordance between decision-making preferences and actual decision-making role was associated with increased PTSD symptoms, and thus, the impact of the role of FDM may be a significant risk factor.…”