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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the psychological sequelae of having a family member with COVID-19 admitted to the intensive care unit (ICU)?

Findings  In this prospective, mixed-methods cohort study of 330 family members of patients admitted to the ICU with COVID-19, family members had significant symptoms of posttraumatic stress disorder (PTSD) 3 months after the patients’ admission to the ICU; higher PTSD symptoms scores were significantly associated with Hispanic ethnicity, female gender, and previous medication use for a psychiatric condition. Family members with higher scores more commonly described feelings of distrust and concern about the need to take clinicians’ information at face value without being present to see for themselves.

Meaning  Having a family member with COVID-19 in the ICU was associated with a high prevalence of symptoms of PTSD, and identified associations may guide future interventions.

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.

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Article Information

Accepted for Publication: March 1, 2022.

Published Online: April 25, 2022. doi:10.1001/jamainternmed.2022.1118

Corresponding Author: Timothy Amass, MD, ScM, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, 1700 N Wheeling St, Room H3-309, Aurora, CO 80045 (timothy.amass@cuanschutz.edu).

Author Contributions: Dr Amass had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Amass, Van Scoy, Cruse, McGuirl, Moss, Rhoads, Stapleton, Curtis.

Acquisition, analysis, or interpretation of data: Amass, Van Scoy, Hua, Ambler, Armstrong, Baldwin, Bernacki, Burhani, Chiurco, Cooper, Csikesz, Engelberg, Fonseca, Halvorson, Hammer, Heywood, Duda, Huang, Jin, Johnson, Tabata-Kelly, Kerr, Lane, Lee, Likosky, McGuirl, Milinic, Nielsen, Peterson, Puckey, Rea, Rhoads, Sheu, Tong, Witt, Wykowski, Yu, Stapleton, Curtis.

Drafting of the manuscript: Amass, Van Scoy, Baldwin, Huang, Kerr, Moss, Nielsen, Rhoads.

Critical revision of the manuscript for important intellectual content: Amass, Van Scoy, Hua, Ambler, Armstrong, Baldwin, Bernacki, Burhani, Chiurco, Cooper, Cruse, Csikesz, Engelberg, Fonseca, Halvorson, Hammer, Heywood, Duda, Jin, Johnson, Tabata-Kelly, Lane, Lee, Likosky, McGuirl, Milinic, Moss, Peterson, Puckey, Rea, Rhoads, Sheu, Tong, Witt, Wykowski, Yu, Stapleton, Curtis.

Statistical analysis: Amass, Baldwin, Huang, Jin, Kerr, Peterson, Curtis.

Obtained funding: Van Scoy, Johnson, Lee, Puckey, Curtis.

Administrative, technical, or material support: Amass, Van Scoy, Hua, Armstrong, Bernacki, Chiurco, Cruse, Engelberg, Fonseca, Halvorson, Hammer, Heywood, Duda, Tabata-Kelly, Kerr, Lee, Likosky, McGuirl, Nielsen, Puckey, Rea, Rhoads, Sheu, Witt, Wykowski.

Supervision: Amass, Van Scoy, Hua, Bernacki, Moss, Nielsen, Curtis.

Conflict of Interest Disclosures: Dr Hua reported receiving grants from the National Institute on Aging and the American Federation for Aging Research during the conduct of the study and funding from the National Cancer Institute unrelated to submitted work. Dr Stapleton reported receiving grants from the National Institutes of Health outside the submitted work. Dr Curtis reported receiving grants from the National Institutes of Health, serving on the Cambia Health Foundation Advisory Board, and serving on the Francis Family Foundation Advisory Board outside the submitted work. No other disclosures were reported.

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