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Raised levels of PTSD in family of ICU COVID patients – US cohort study

A US study has found that having a relative with COVID-19 in the ICU is associated with a high prevalence of post-traumatic stress disorder (PTSD) symptoms for the family members.

In the research, published in JAMA Internal Medicine, the authors wrote that allowing family to be at the bedside during this time can reduce their anxiety and stress

The COVID-19 pandemic has tested the limits of healthcare systems, and among those with COVID-19 respiratory failure, mortality rates were initially as high as 60% to 80%. To avoid viral transmission during the early pandemic months, many hospitals eliminated visitors, and still limit visitation, to varying degrees. These measures may have added significant stress for patients, family members, and clinicians.

Symptoms of PTSD, among other stress-related symptoms such as depression and anxiety, have been described by relatives of patients admitted to intensive care units (ICUs), and the existence of any of these symptoms has been collectively named the post–intensive care syndrome family.

The prevalence of symptoms of PTSD, depression, and anxiety in this population vary widely but were approximately 15% to 30% before the pandemic, depending on the condition. Studies have demonstrated that active engagement of families at the bedside reduces stress-related symptoms, and specifically, a reduction in symptoms of PTSD has been associated with increased family member participation and control at the bedside.

Therefore, bedside engagement in the ICU is recommend by the Society of Critical Care Medicine. Developing an understanding of the effect on patients’ relatives may help identify mechanisms to mitigate the repercussions when family is unable to be at the bedside because of the pandemic or for other reasons. This study investigated the potential consequences of visitation restrictions and pandemic stress for families of critically ill patients with COVID-19, examining factors associated with relatives’ stress-related symptoms.

Our prospective, multisite, explanatory, sequential, mixed-methods, observational cohort study was performed at 12 US hospitals in Colorado, Washington, Louisiana, New York, and Massachusetts, and hypothesised that these relatives would have high levels of symptoms of PTSD, anxiety, and depression.

Study details

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

Timothy Amass, Lauren Jodi Van Scoy, May Hua, et al

Published in JAMA Internal Medicine on 25 April 2022.

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, relatives had significant symptoms of post-traumatic 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 relative with COVID-19 in the ICU was associated with a high prevalence of symptoms of PTSD, and identified associations may guide future interventions.


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.

To examine the prevalence of symptoms of stress-related disorders, primarily post- traumatic 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.

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).

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.


JAMA Internal Medicine article – Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit With COVID-19
 (Open access)


See more from MedicalBrief archives:


Survivors need PTSD screening — COVID Trauma Response Working Group guidelines


JAMA study: 35% of excess US deaths tied to causes other than COVID-19


India: The mental health emergency that comes after COVID-19


How death is handled in SA’s health facilities



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