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Journal of General Internal Medicine

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01-11-2008 | Original Article

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

Authors: Wendy G. Anderson, MD, MS, Robert M. Arnold, MD, Derek C. Angus, MD, MPH, Cindy L. Bryce, PhD

Published in: Journal of General Internal Medicine | Issue 11/2008

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.

Pochard F, Azoulay E, Chevret S, et al. Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Crit Care Med. 2001;29:1893–1897.PubMedCrossRef

Pochard F, Darmon M, Fassier T, et al. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care. 2005;20:90–96.PubMedCrossRef

Azoulay E, Pochard F, Kentish-Barnes N, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005;171:987–994.PubMedCrossRef

Jones C, Skirrow P, Griffiths RD, et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med. 2004;30:456–460.PubMedCrossRef

Tilden VP, Tolle SW, Nelson CA, Fields J. Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nurs Res. 2001;50:105–115.PubMedCrossRef

Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next-of-kin of patients who die in the intensive care unit. Crit Care Med. 2008;36:1722–1728.PubMedCrossRef

Anderson WG, Arnold RM, Angus DC, Bryce CL. Passive decision-making preference is associated with anxiety and depression in relatives of patients in the intensive care unit. Journal of Critical Care. in press

Degner LF, Sloan JA. decision-making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45:941–950.PubMedCrossRef

Degner LF, Sloan JA, Venkatesh P. The control preferences scale. Can J Nurs Res. 1997;29:21–43.PubMed

10.

Heyland DK, Rocker GM, O’Callaghan CJ, Dodek PM, Cook DJ. Dying in the ICU: Perspectives of family members. Chest. 2003;124:392–397.PubMedCrossRef

11.

Heyland DK, Cook DJ, Rocker GM, et al. Decision-making in the ICU: perspectives of the substitute decision-maker. Intensive Care Med. 2003;29:75–82.PubMed

12.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370.PubMedCrossRef

13.

Herrmann C. International experiences with the Hospital Anxiety and Depression Scale-A review of validation data and clinical results. J Psychosom Res. 1997;42:17–41.PubMedCrossRef

14.

Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356:469–478.PubMedCrossRef

15.

Sundin EC, Horowitz MJ. Impact of Event Scale: psychometric properties. Br J Psychiatry. 2002;180:205–209.PubMedCrossRef

16.

Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209–218.PubMed

17.

Prigerson HG, Bierhals AJ, Kasl SV, et al. Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry. 1996;153:1484–1486.PubMed

18.

Prigerson HG, Frank E, Kasl SV, et al. Complicated grief and bereavement-related depression as distinct disorders: Preliminary empirical validation in elderly bereaved spouses. Am J Psychiatry. 1995;152:22–30.PubMed

19.

Prigerson HG, Maciejewski PK, Reynolds CFr, et al. Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995;59:65–79.PubMedCrossRef

20.

Shear MK, Frank E, Foa E, et al. Traumatic grief treatment: a pilot study. Am J Psychiatry. 2001;158:1506–1508.PubMedCrossRef

21.

Shear K, Frank E, Houck PR, Reynolds CF 3rd. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005;293:2601–2608.PubMedCrossRef

22.

Prigerson HG, Bridge J, Maciejewski PK, et al. Influence of traumatic grief on suicidal ideation among young adults. Am J Psychiatry. 1999;156:1994–1995.PubMed

23.

Prigerson HG, Jacobs SC. Perspectives on care at the close of life. Caring for bereaved patients: “All the doctors just suddenly go”. JAMA. 2001;286:1369–1376.PubMedCrossRef

24.

Keane TM, Marshall AD, Taft CT. Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annu Rev Clin Psychol. 2006;2:161–197.PubMedCrossRef

25.

Tylee A, Walters P. Underrecognition of anxiety and mood disorders in primary care: why does the problem exist and what can be done? J Clin Psychiatry. 2007;68Suppl 227–30.PubMed

26.

Gelenberg AJ, Hopkins HS. Assessing and treating depression in primary care medicine. Am J Med. 2007;120:105–108.PubMedCrossRef

27.

Bobo WV, Warner CH, Warner CM. The management of post traumatic stress disorder (PTSD) in the primary care setting. South Med J. 2007;100:797–802.PubMed

28.

Lichtenthal WG, Cruess DG, Prigerson HG. A case for establishing complicated grief as a distinct mental disorder in DSM-V. Clin Psychol Rev. 2004;24:637–662.PubMedCrossRef

29.

Vanderwerker LC, Jacobs SC, Parkes CM, Prigerson HG. An exploration of associations between separation anxiety in childhood and complicated grief in later life. J Nerv Ment Dis. 2006;194:121–123.PubMedCrossRef

30.

Johnson JG, Vanderwerker LC, Bornstein RF, Zhang B, Prigerson HG. Development and validation of an instrument for the assessment of dependency among bereaved persons. J Psychopath Beh Ass. 2006;28:263–272.

31.

Van Pelt DC, Milbrandt EB, Qin L, et al. Informal caregiver burden among survivors of prolonged mechanical ventilation. Am J Respir Crit Care Med. 2007;175:167–173.PubMedCrossRef

32.

Census Pittsburgh Census data, http://www.hellopittsburgh.com/Census.Cfm. Accessed June, 2008.

33.

First M, Spitzer R, Gibbon M. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-1/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute; 1995

Title: Posttraumatic Stress and Complicated Grief in Family Members of Patients in the Intensive Care Unit
Authors: Wendy G. Anderson, MD, MS
Robert M. Arnold, MD
Derek C. Angus, MD, MPH
Cindy L. Bryce, PhD
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 11/2008
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-008-0770-2

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

Abstract

Background

Objectives

Design

Participants

Measurements

Results

Conclusions

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