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Posttraumatic Stress and Complicated Grief in Family Members of Patients in the Intensive Care Unit

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Abstract

Background

Family members of patients in intensive care units (ICUs) are at risk for mental health morbidity both during and after a patient’s ICU stay.

Objectives

To determine prevalences of and factors associated with anxiety, depression, posttraumatic stress and complicated grief in family members of ICU patients.

Design

Prospective, longitudinal cohort study.

Participants

Fifty family members of patients in ICUs at a large university hospital participated.

Measurements

We used the Control Preferences Scale to determine participants’ role preferences for surrogate decision-making. We used the Hospital Anxiety and Depression Scale, Impact of Event Scale, and Inventory of Complicated Grief to measure anxiety and depression (at enrollment, 1 month, 6 months), posttraumatic stress (6 months), and complicated grief (6 months).

Results

We interviewed all 50 participants at enrollment, 39 (78%) at 1 month, and 34 (68%) at 6 months. At the three time points, anxiety was present in 42% (95% CI, 29–56%), 21% (95% CI, 10–35%), and 15% (95% CI, 6–29%) of participants. Depression was present in 16% (95% CI, 8–28%), 8% (95% CI, 2–19%), and 6% (95% CI, 1–18%). At 6 months, 35% (95% CI, 21–52%) of participants had posttraumatic stress. Of the 38% who were bereaved, 46% (95% CI, 22–71%) had complicated grief. Posttraumatic stress was not more common in bereaved than nonbereaved participants, and neither posttraumatic stress nor complicated grief was associated with decision-making role preference or with anxiety or depression during the patient’s ICU stay.

Conclusions

Symptoms of anxiety and depression diminished over time, but both bereaved and nonbereaved participants had high rates of posttraumatic stress and complicated grief. Family members should be assessed for posttraumatic stress and complicated grief.

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Acknowledgements

The University of Pittsburgh’s Institute for Doctor–Patient Communication and The Greenwall Foundation supported this project. The Open Society Institute and the Senator H. John Heinz III Fellowship in Palliative Medicine at the University of Pittsburgh’s Institute to Enhance Palliative Care funded Dr. Anderson’s salary. The authors would like to thank Sharon Maddox for her critical review of the manuscript.

Conflict of interest statement

None disclosed.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, San Francisco, CA, USA

    Wendy G. Anderson MD, MS

  2. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Robert M. Arnold MD & Cindy L. Bryce PhD

  3. Institute for Doctor-Patient Communication, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Robert M. Arnold MD

  4. Institute to Enhance Palliative Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Robert M. Arnold MD

  5. Department of Critical Care Medicine and Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Derek C. Angus MD, MPH

  6. Center for Research on Health Care and the Section for Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Derek C. Angus MD, MPH & Cindy L. Bryce PhD

Authors
  1. Wendy G. Anderson MD, MS
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  2. Robert M. Arnold MD
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  3. Derek C. Angus MD, MPH
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  4. Cindy L. Bryce PhD
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Corresponding author

Correspondence to Wendy G. Anderson MD, MS.

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Anderson, W.G., Arnold, R.M., Angus, D.C. et al. Posttraumatic Stress and Complicated Grief in Family Members of Patients in the Intensive Care Unit. J GEN INTERN MED 23, 1871–1876 (2008). https://doi.org/10.1007/s11606-008-0770-2

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  • DOI: https://doi.org/10.1007/s11606-008-0770-2

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