Family members of patients hospitalized in the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) from COVID-19 have an elevated risk of post-traumatic stress disorder (PTSD)-related symptoms, according to a study published in February in the Journal of the American Medical Association. The risk is higher than that posed by other causes of ARDS.
The prospective cohort study took place in 23 ICUs in France from January 2020 to June 2020, with final follow-up occurring in October 2020. Family member symptoms of PTSD at 90 days after ICU discharge was the primary outcome, measured by the Impact of Events Scale-Revised (score range, 0 [best] to 88 [worst]; presence of PTSD symptoms defined by score >22). Secondary outcomes included family member signs of anxiety and depression at 90 days evaluated by the Hospital Anxiety and Depression Scale at 90 days after ICU discharge.
Of 602 family members prospectively enrolled, 517 (86%, median interquartile range [IQR] age, 51 [40-63] years; 72% women; 48% spouses; 26% bereaved due to study patient’s death; 303 [50%] relatives of COVID-19 patients) completed the evaluation at 90 days. Among 307 patients, 273 (89%, median IQR age, 61 [50-69] years; 34% women; 181 [59%] with COVID-19) finished the assessment. Compared with family members of patients without COVID-19 ARDS, those of patients with COVID-19 ARDS experienced a significantly higher incidence of PTSD symptoms (35% [103/293] vs 19% [40/211]; difference, 16% [95% CI, 8%-24%]; P <.001), anxiety (41% [121/294] vs 34% [70/207]; difference, 8% [95% CI, 0%-16%]; P =.05), and depression (31% [91/291] vs 18% [37/209]; difference, 13% [95% CI, 6%-21%]; P <.001). In multivariable models adjusting for age, sex, and degree of social support, COVID-19 ARDS was associated significantly with a heightened risk of PTSD-related symptoms in family members (odds ratio [OR], 2.05 [95% CI, 1.30-3.23]). Multiple sensitivity analyses yielded similar results.
Additional factors independently associated with PTSD symptoms included male sex (OR, 0.39 [95% CI, 0.23-0.67]), age (OR, 0.83 per 10-year increase [95% CI, 0.72-0.96]), and degree of social support reported on a 10-point scale [OR, 0.82 [95% CI, 0.74-0.90]). The average age of family members in the COVID-19 cohort was younger (median age, 50 vs 55 years). They were less frequently permitted to visit the ICU (35% vs 88%) and more commonly obtained patient information by telephone call (84% vs 20%) rather than in person.
Limitations of the study include obtaining results from early in the pandemic only; lacking results from ICUs not dedicated to improving family care; limiting participation to hospitals only in France; failing to have all patients meet strict consensus criteria for ARDS; and not involving ICU clinical staff, who may have contributed to different patient and family experiences.
The researchers said that, because of the need to comply with strict isolation measures during the pandemic and the strain put on ICU staff due to the surge, a breakdown in social support for family members may have contributed to their findings. “When ICUs are perceived as closed departments, visitors may feel unwelcome, and these closed ICUs can generate stress and symptoms of anxiety, depression, or PTSD in the family members,” the authors explained.
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Azoulay E, Resche-Rigon M, Megarbane B, et al. Association of COVID-19 acute respiratory distress syndrome with symptoms of posttraumatic stress disorder in family members after ICU discharge. JAMA. Published online February 18, 2022. doi:10.1001/jama.2022.2017