Emotional Disorders in Pairs of Patients and Their Family Members during and after ICU Stay

Abstract

IntroductionPatients and family members undergo different experiences of suffering from emotional disorders during ICU stay and after ICU discharge. The purpose of this study was to compare the incidence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in pairs (patient and respective family member), during stay at an open visit ICU and at 30 and 90-days post-ICU discharge. We hypothesized that there was a positive correlation with the severity of symptoms among pairs and different patterns of suffering over time.MethodsA prospective study was conducted in a 22-bed adult general ICU including patients with >48 hours stay. The Hospital Anxiety and Depression Scale (HADS) was completed by the pairs (patients/respective family member). Interviews were made by phone at 30 and 90-days post-ICU discharge using the Impact of Event Scale (IES) and the HADS. Multivariate models were constructed to predict IES score at 30 days for patients and family members.ResultsFour hundred and seventy one family members and 289 patients were interviewed in the ICU forming 184 pairs for analysis. Regarding HADS score, patients presented less symptoms than family members of patients who survived and who deceased at 30 and 90-days (p<0.001). However, family members of patients who deceased scored higher anxiety and depression symptoms (p = 0.048) at 90-days when compared with family members of patients who survived. Patients and family members at 30-days had a similar IES score, but it was higher in family members at 90-days (p = 0.019). For both family members and patients, age and symptoms of anxiety and depression during ICU were the major determinants for PTSD at 30-days.ConclusionsAnxiety, depression and PTSD symptoms were higher in family members than in the patients. Furthermore, these symptoms in family members persisted at 3 months, while they decreased in patients.

"My (critically ill) patient has only a pneumonia" - the risk of oversimplification and the evidence of post-ICU syndrome

“…2,3 Looking for patient-centered outcomes, many endpoints, such as long term physical, psychological and cognitive domains, as well as patient, family, and ICU team satisfaction with therapy have all been investigated, disclosing how devastating can an ICU stay be for the critically ill 4 and their families. 5 Critically ill patients, both during their ICU stay and mainly after ICU discharge, are prone to experiencing pain, neuropathy, weakness, skin breakdowns, persistent organ function support, depression, anxiety, sleep disorders, post-traumatic stress disorder, confusion, concentration deficit, memory deficit, attention deficit, low processing speed, low visual spatial resolution ability, and low execution ability. 4,6 Within 1 to 5 years after ICU discharge, these factors ultimately result in difficult locomotion, falls, depression, poor social skills, and in up to 34% of patients a cognitive dysfunction compatible with mild Alzheimer's disease.…”

The Impact of Poor Prognostic Patients Admitted to the Intensive Care Unit on Family Member's Emotional Disorders

“…Communication about the goals of care in this setting should be a high priority as studies suggest that the effective ICU communication may diminish the psychological distress among family members of critically ill patients [10]. Many studies have shown that family members of patients who died in the ICU are at higher risk of developing PTSD [8,9,[22][23][24].…”

“…In agreement with previous reports, we used a cut-off score of 30 to indicate a significant risk of PTSD [9,10]. The same person (RRLF), a psychologist with ICU interviews experience [8], conducted all interviews.…”

“…Family members of patients with high risk of death suffer with symptoms of anxiety, depression and post-traumatic stress [8][9][10]. In addition, the earlier integration of Palliative Care with standard cancer care may improve the survival and the quality of life (QOL), and lessen psychological conditions, ICU length of stay, duration of mechanical ventilation and the use of unbeneficial treatments [11][12][13].…”

“…The HADS score for each subscale (anxiety and depression) ranges from 0-21 and a cut-off score of 10 was used to depict each condition [8]. Scores for the entire scale (emotional distress) range from 0-42, with higher scores indicating more distress.…”