Psychological Symptoms in Relatives of Critically Ill Patients: A Longitudinal Cohort Study

Abstract

OBJECTIVES: To explore the psychologic impact of an ICU stay on relatives and to determine patient and relative factors, including their pre-ICU mental health status, associated with psychologic symptoms 3 months after ICU admission. DESIGN: A prospective, exploratory, longitudinal cohort study. SETTING: A 12-bed ICU in a Dutch tertiary teaching hospital. PATIENTS: The relatives of ICU patients admitted between March 2018 and December 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Relatives completed the Hospital Anxiety and Depression Scale shortly after patients’ ICU admission referring to the week before ICU admission and 3 months later, together with the Impact of Event Scale-Revised, assessing posttraumatic stress. A total of 387 were eligible of which 78 (20%) responded. Almost a quarter reported an increase of anxiety (23.1%) and depression (24.4%) between baseline and 3 months follow-up. One in six (17.9%) reported posttraumatic stress. Anxiety, depression, and posttraumatic stress at 3 months follow-up were significantly associated with preexisting anxiety and depression. Patients’ factor associated with depression 3 months follow-up in relatives was length of ICU stay (odds ratio, 1.09; 95% CI, 1.02–1.16). CONCLUSIONS: Relatives with preexisting psychologic symptoms before ICU admission are at risk to develop anxiety, depression, or posttraumatic stress shortly after ICU discharge of the patient. Screening and identification in an early stage enables early interventions to prevent relatives from worsening mental health during and after ICU admission.

Being cared for in an Intensive Care Unit – family functioning and support

“…Family members and the critically ill ICU patient, as individuals, are affected by the critical illness and ICU care (Rydwik et al, 2021) but in different ways and with different timeframes (Ågren et al, 2019;Rengel et al, 2019). How the mental and physical life was before the ICU is of course crucial to the way the individuals are affected (de Ridder et al, 2021;Geense et al, 2020). The fact that family members as a unit affect each other mentally when something is happening within the unit, develops the family unit and protects it from major disruption (Epstein et al, 1978;McGoldrick et al, 2013).…”

Exploring family functioning and ‐ hardiness in families’ experiencing adult intensive care – A cross-sectional study

“…The family’s prior family functioning and family hardiness were not known in this study, important to acknowledge that all persons are individual and process their experience differently. As one study has shown, the need for follow-up has different timeframes and some need more follow-up than others [ 32 ] Studies have shown that families reporting increased symptoms of depression and anxiety due to their experience of the ICU reported symptoms of these issues even prior to admission [ 33 ]. Several studies have reported positive intervention effects of family-centered care, and nurses’ communication and psychosocial care were considered essential components of nursing interventions in the ICU [ 34 , 35 ].…”

“…depression and anxiety due to their experience of the ICU reported symptoms of these issues even prior to admission [33]. Several studies have reported positive intervention effects of family-centered care, and nurses' communication and psychosocial care were considered essential components of nursing interventions in the ICU [34,35].…”

Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial*

“…Furthermore, measurement of mental health symptoms among relatives only after 3 months may not have been sufficient, as patients’ rehabilitation trajectories vary. Similar studies collected longitudinal data before admission, as the mental health status of relatives before ICU admission may be an important predictor of mental health outcomes of relatives after the patient’s ICU stay ( 37 ) and following admission ( 18 , 38 , 39 ). Furthermore, as shown in this Dutch study, facilitating the process of participation was shown to increase the odds of a neutral to positive attitude toward participation, which probably will facilitate participation in daily ICU practice.…”