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

Timothy Amass, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Lauren Jodi Van Scoy, Departments of Medicine, Humanities and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
May Hua, Department of Anesthesiology, Columbia University, New York, New York.
Melanie Ambler, Department of Anesthesiology, Columbia University, New York, New York.
Priscilla Armstrong, Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle.
Matthew R. Baldwin, Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University, New York, New York.
Rachelle Bernacki, Dana Farber Cancer Institute, Boston, Massachusetts.
Mansoor D. Burhani, Division of Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Jennifer Chiurco, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
Zara Cooper, Center for Geriatric Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Hope Cruse, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Nicholas Csikesz, South Shore Health, Weymouth, Massachusetts.
Ruth A. Engelberg, Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle.
Laura D. Fonseca, Department of Anesthesiology, Columbia University, New York, New York.
Karin Halvorson, Department of Pulmonary Critical Care, Tulane University School of Medicine, New Orleans, Louisiana.
Rachel Hammer, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
Joanna Heywood, Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle.
Sarah Hochendoner Duda, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania.
Jin Huang, University of Colorado School of Medicine, Aurora.
Ying Jin, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Laura Johnson, Evergreen Health Care, Kirkland, Washington.
Masami Tabata-Kelly, Center for Geriatric Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Emma Kerr, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Trevor Lane, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Melissa Lee, Evergreen Health Care, Kirkland, Washington.
Keely Likosky, Evergreen Health Care, Kirkland, Washington.
Donald McGuirl, Maine Medical Center
Tijana Milinic, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle.
Marc Moss, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Elizabeth Nielsen, Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle.
Ryan Peterson, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
Sara J. Puckey, Evergreen Health Care, Kirkland, Washington.

Document Type

Article

Publication Date

6-2022

Institution/Department

Psychiatry

Journal Title

JAMA internal medicine

MeSH Headings

COVID-19 (epidemiology); Child; Cohort Studies; Family (psychology); Female; Humans; Intensive Care Units; Male; Middle Aged; Pandemics; Prospective Studies; Stress Disorders, Post-Traumatic (psychology)

Abstract

Importance: The 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 Relevance: In 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.

Comments

Donald McGuirl- Resident

First Page

624

Last Page

633

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