Symptoms of post-traumatic stress disorder (PTSD) in next of kin during suspension of ICU visits during the COVID-19 pandemic: a prospective observational study

Abstract

Background During the COVID-19 pandemic, suspension of visits by next of kin to patients in intensive care units (ICU), to prevent spread of the SARS-CoV-2 virus, has been a common practice. This could impede established family-centered care and may affect the mental health of the next of kin. The aim of this study was to explore symptoms of post-traumatic stress syndrome (PTSD) in the next of kin of ICU patients. Methods In this prospective observational single-center study, next of kin of ICU patients were interviewed by telephone, using the Impact of Event Scale-Revised (IES-R), to assess symptoms of acute stress disorder during the ICU stay and PTSD symptoms at 3 months after the ICU stay. The primary outcome was the prevalence of severe PTSD symptoms (IES-R score ≥ 33) at 3 months. The secondary outcomes comprised the IES-R scores during the ICU stay, at 3 months, and the prevalence of severe symptoms of acute stress disorder during ICU stay. An inductive content analysis was performed of the next of kin’s comments regarding satisfaction with patient care and the information they were given. Results Of the 411 ICU patients admitted during the study period, 62 patients were included together with their next of kin. An IES-R score > 33 was observed in 90.3% (56/62) of next of kin during the ICU stay and in 69.4% (43/62) 3 months later. The median IES-R score was 49 (IQR 40–61) during the ICU stay and 41 (IQR 30–55) at 3 months. The inductive content analysis showed that communication/information (55%), support (40%), distressing emotions (32%), and suspension of ICU visits (24%) were mentioned as relevant aspects by the next of kin. Conclusions During the suspension of ICU visits in the COVID-19 pandemic, high prevalence and severity of both symptoms of acute stress disorder during the ICU stay and PTSD symptoms 3 months later were observed in the next of kin of ICU patients.

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

“…Follow-ups of these patients in post-ICU clinics and in primary care are paramount and, in many cases, must be performed with virtual visits, and support of patients and families must be provided through the internet [137]. PICS-F can also be aggravated during the pandemic due to distancing from loved ones during hospitalization, loss of social support, and inability to "say goodbye" if bereaved [138].…”

A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial)

“…Given the increased prevalence of critically ill patients due to the COVID-19 pandemic, who have a high prevalence of post-intensive care syndrome [ 129 , 130 ], more families are affected by the health impact of critical illness. In addition, pandemic-related access restrictions increase family suffering and risk for negative health outcomes [ 12 , 13 , 19 ].…”

“…The impact of critical illness on family members’ health and well-being and the need to increase family access, inclusion, and support are gaining recognition [ 10 , 14 – 16 ], even more so since the COVID-19 pandemic [ 13 , 17 – 19 ]. A move towards structured inclusion, communication, and support of family is recommended [ 20 ].…”

Family perspectives on facilitators and barriers to the set up and conduct of virtual visiting in intensive care during the COVID-19 pandemic: A qualitative interview study

“…Anxiety and depression prevalence in family members unable to visit the intensive care unit (ICU) in-person during the pandemic have been documented as high as 83% and 73% respectively ( Cattelan et al, 2021 ), far exceeding those previously documented among pre-pandemic, in-person family visitors ( Rosa et al, 2019 ). Post-traumatic stress disorder is also common and higher in family members of patients with COVID-19 compared to other ICU patients ( Azoulay et al, 2022 , Zante et al, 2021 ). Bereaved family members who were unable to visit report strong feelings of disbelief that may lead to complicated grief ( Kentish-Barnes et al, 2021 ).…”