Family members of patients admitted to intensive care units (ICU) with Covid-19 are vulnerable to develop posttraumatic stress disorder (PTSD), anxiety and/or depression, according to findings of a study published in JAMA Internal Medicine.¹

Researchers conducted a survey of 330 persons who had a family member admitted to the ICU with Covid-19 in 12 hospitals across five states in the United States between February 1 and July 31, 2020. Forty percent of those surveyed were the children of the patients, while 25% were their spouse or partner. Nearly 70% of the participants were women and ~30% were of Hispanic ethnicity. About 41% of the patients died during hospitalization; many of them had limited access to their patient. The objective of the study was to find out the prevalence of symptoms of stress-related disorders, PTSD in particular, in family members of hospitalized patients at 3 months after admission.

The Impact of Events Scale 6 (IES-6) was used to screen for the symptoms of PTSD among the families of patients in ICU. The Hospital Anxiety and Depression Scale (HADS) was used to assess the symptoms of anxiety (HADS-a) and depression (HADS-d).

The study found that the mean IES-6 score at three months was 11.9 and 201 of the 316 (63.6%) who responded to the survey had scores of ≥10 indicative of significant symptoms of PTSD. Women respondents had higher PTSD symptom scores with an adjusted mean IES-6 score of 2.6 points higher compared to the male participants. Hispanic participants and those who had a history of medication for mental health disorders also had higher PTSD symptom scores.

The adjusted mean score was 3.3 points lower among participants who had graduate level education and those with college degrees had a mean IES-6 score of 2.3 points lower than those who just had a high school degree.

The mean HADS-a score at 3 months was 7.3 and the mean HADS-d score was 5.4. Out of 314 respondents, 141 (~45%) had a HADS-a score of ≥8 and 97 of 313 (31.0%) had a HADS-d score of ≥8 suggesting significant presence of symptoms of anxiety or depression. Family members of patients who died showed higher scores for depression, but not higher scores for PTSD or anxiety.

Participants with higher scores had high levels of distrust of physicians and also were concerned “about taking clinicians’ information at face value without being present to see for themselves”.

Compared to those with IES-6 scores of ≥10 or those who were Hispanic, participants with lower IES-6 scores (below 10) and who were non-Hispanic were more likely to report acts of compassion on the hospital staff such as “Extremely supportive” physician who enquired about the well-being of the family member, hospital staff setting up video chats with the patients and providing daily updates for their patients. “Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores”.

Around 48% of the respondents still had an IES-6 score of ≥10 and at least 25% had significant symptoms of anxiety and depression on follow-up at 6 months.

The unprecedented Covid-19 pandemic has taken a heavy toll of life and has left a great deal of tragedy in its wake. Besides physical health, the pandemic has had a huge adverse impact on the mental health of people. This multicenter study has attempted to examine the impact of seriously ill patients with Covid-19 who were in hospital on family members through a survey. It demonstrates a high prevalence of symptoms of PTSD in persons who had a family member with Covid-19 in the ICU even 3 to 4 months after their admission to the ICU.

This study highlights the likely emergence of another “epidemic of stress-related disorders” among family members of patients in ICUs close on the heels of the ongoing Covid-19 pandemic. The restrictions of the pandemic including restrictions from visiting their patients in the hospitals could have played a contributory role. Communication is key to fostering a healthy patient-doctor relationship, particularly in case of ICU patients, where visitation has been limited, even prepandemic. A collaborative approach will help engage the family members in the care of the patient and in turn reduce their stress.

Reference 

1. Amass T, et al. Stress-related disorders of family members of patients admitted to the intensive care unit with COVID-19. JAMA Intern Med. 2022 Apr 25. doi: 10.1001/jamainternmed.2022.1118.