Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit With COVID-19

Abstract

IMPORTANCEThe psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined.OBJECTIVE To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission.DESIGN, SETTING, AND PARTICIPANTS This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states.EXPOSURE Having a family member in the ICU with COVID-19.MAIN OUTCOMES AND MEASURES Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6). RESULTS A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients' child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners. CONCLUSIONS AND RELEVANCEIn this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.

Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia

“…Visitor access to Australian hospitals was initially prohibited when the first cases of COVID-19 appeared in March 2020, with limited exceptions for patients at end-of-life. A duality of harm was caused to patients, families and staff by rigid visitation policies consistent with findings in other research ( [18] , [19] , [20] , [21] ). In the following months, as the number of cases in the community decreased, restrictions were eased in line with World Health Organization recommendations ( 22 ).…”

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

“…The individual possibility of attending either a FamHC or SGC is also important for recovery and maintaining family functioning. Even if the family is a unit, it is also defined by individuals having different needs for support during and after ICU care (Amass et al, 2022;de Ridder et al, 2021b;Rydwik et al, 2021). The quantitative analysis in studies II and IV showed that family functioning was mostly healthy two months after the ICU care, as well as family hardiness in study II.…”

“…A higher risk at developing PTSD was also seen in family members of COVID-19 ICU patients (Azoulay et al, 2022). Three months after the patient's admission with COVID-19 to the ICU the family members with higher scores of PTSD described feelings of distrust and concern about the need to take clinicians' information at face value without being present to see for themselves how the patient was feeling and if the care was successful (Amass et al, 2022).…”

The Adverse Outcome Pathway Framework Applied to Neurological Symptoms of COVID-19

“…Stress has had a profound effect on family members, workers, and communities affected by the suffering or loss of life brought about by the pandemic. A recent study found that family members had significant symptoms of posttraumatic stress disorder (PTSD) months after the admission of a loved one to an intensive care unit and that these neuropsychological symptoms were significantly associated with ethnicity and gender [ 159 ]. Thus, considering psychosocial stress could help elucidate how disparities can contribute to the neuropathogenesis of COVID-19 and to outcomes in both patients and their communities.…”