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Critical Care Medicine

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
JAMA Internal Medicine
June 1, 2022
Original Investigation
Timothy Amass, MD, ScM1,2;
Lauren Jodi Van Scoy, MD3;
May Hua, MD, MS4,5;
Melanie Ambler, BS, MSc4;
Priscilla Armstrong, BA6;
Matthew R. Baldwin, MD, MS7;
Rachelle Bernacki, MD8,9;
Mansoor D. Burhani, MD10;
Jennifer Chiurco, MD11;
Zara Cooper, MD, MSc9,12;
Hope Cruse, MS1;
Nicholas Csikesz, MD13;
Ruth A. Engelberg, PhD6;
Laura D. Fonseca, MS4;
Karin Halvorson, MD14;
Rachel Hammer, MD, MFA11,15;
Joanna Heywood, BA6;
Sarah Hochendoner Duda, MD16;
Jin Huang, BS17;
Ying Jin, MA1,18;
Laura Johnson, MD19;
Masami Tabata-Kelly, MA9,12;
Emma Kerr, BS12;
Trevor Lane, MD1;
Melissa Lee, MD19;
Keely Likosky19;
Donald McGuirl, MD20;
Tijana Milinic, MD21;
Marc Moss, MD1;
Elizabeth Nielsen, MPH6;
Ryan Peterson, PhD1,18;
Sara J. Puckey, MSW19;
Olivia Rea, BS6;
Sarah Rhoads, MD1;
Christina Sheu, BA12;
Wendy Tong, BA22;
Pamela D. Witt, AA3;
James Wykowski, MD23;
Stephanie Yu, BA17;
Renee D. Stapleton, MD, PhD24;
J. Randall Curtis, MD, MPH6
Author Affiliations
  • 1Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
  • 2Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
  • 3Departments of Medicine, Humanities and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
  • 4Department of Anesthesiology, Columbia University, New York, New York
  • 5Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
  • 6Division of Pulmonary, Critical Care, and Sleep Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle
  • 7Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University, New York, New York
  • 8Dana Farber Cancer Institute, Boston, Massachusetts
  • 9Center for Geriatric Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 10Division of Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
  • 11Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
  • 12Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
  • 13South Shore Health, Weymouth, Massachusetts
  • 14Department of Pulmonary Critical Care, Tulane University School of Medicine, New Orleans, Louisiana
  • 15Department of Psychiatry, Tulane University School of Medicine, New Orleans, Louisiana
  • 16Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
  • 17University of Colorado School of Medicine, Aurora
  • 18Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
  • 19Evergreen Health Care, Kirkland, Washington
  • 20Department of Vascular Surgery, Tufts University School of Medicine, Maine Medical Center, Portland
  • 21Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle
  • 22Columbia University Vagelos College of Physicians and Surgeons, New York, New York
  • 23Department of Medicine, University of Washington, Seattle
  • 24Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington
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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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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Critical Care Medicine Psychiatry and Behavioral Health Trauma- and Stressor-Related Psychiatric Disorders Coronavirus (COVID-19)
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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