Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study

Abstract

Background The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future. Methods The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score. Results Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment ( p = .008), smoking/drinking habits ( p = .036) and personal history of psychopathology ( p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09–6.93). No association was found between the patients’ characteristics and emotional distress in the family members. Conclusions The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members’ positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient’s ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.

Post-intensive care syndrome (PICS) – complications after ICU stay: selected issues

“…In addition, it is critical to implement strategies in the course of PICS that are relevant to facilitating the patients' return to life after hospitalisation in the intensive care unit [60]. When confronted with a difficult situation related to the hospitalisation of a loved one, the family may develop PICS-F, especially concerning the mental state [86,87], and therefore the interventions taken should not only concern the patient, but also the family.…”

The Experiences of Family Members of Patients Discharged from Intensive Care Unit: A Systematic Review of Qualitative Studies

“…Going back to everyday life implies adapting to a new lifestyle, including increasing awareness of the patient’s limitations and reorganizing the home environment. The difficulties and challenges faced by family members after patients’ discharge from the ICU are well-documented in the literature, but may vary depending on the historical and socio-economic context, and the characteristics of the population [ 9 ]. Indeed, many family members feel lonely, disoriented, and confused in managing the physical and psychological needs of a patient who suffered a critical illness.…”