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Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members After Patient Death in the ICU

2009; Elsevier BV; Volume: 137; Issue: 2 Linguagem: Inglês

10.1378/chest.09-1291

1931-3543

Cynthia Gries, Ruth A. Engelberg, Erin K. Kross, Doug Zatzick, Elizabeth L. Nielsen, Lois Downey, J. Randall Curtis,

Grief, Bereavement, and Mental Health

Background Patients' deaths in the ICU have been associated with a high burden of psychologic symptoms in families. This study identifies characteristics associated with psychologic symptoms in family members. Methods Families of patients dying in the ICU or within 30 h of ICU discharge in 11 hospitals previously participated in a randomized trial. In the current study, we assessed these families for symptoms of posttraumatic stress disorder (PTSD) and depression with follow-up surveys. Outcomes included validated measures of PTSD (PTSD Checklist) and depressive (Patient Health Questionnaire) symptoms. Predictors included family member mental-health history, involvement in decision making, and demographics. Results Surveys were completed by 226 families. Response rate was 46% in the original randomized trial and 82% in this study. Prevalence (95% CI) of PTSD and depressive symptoms were 14.0% (9.7%–19.3%) and 18.4% (13.5%–24.1%), respectively. Family characteristics associated with increased symptoms included: female gender (PTSD, P = .020; depression, P = .005), knowing the patient for a shorter duration (PTSD, P = .003; depression, P = .040), and discordance between family members' preferences for decision making and their actual decision-making roles (PTSD, P = .005; depression, P = .049). Depressive symptoms were also associated with lower educational level ( P = .002). Families with psychologic symptoms were more likely to report that access to a counselor (PTSD, P < .001; depression, P = .003) and information about spiritual services might have been helpful while the patient was in the ICU (PTSD, P = .024; depression, P = .029). Conclusions Families demonstrated a high prevalence of psychologic symptoms after a death in the ICU. Characteristics associated with symptoms may help target interventions to reduce these symptoms. Trial registration clinicaltrials.gov; Identifier: NCT00685893.