Risk of post-traumatic stress symptoms in family members of intensive care unit patients.
BACKGROUND
Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD).


OBJECTIVE
Factors associated with these symptoms need to be identified.


METHODS
For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role.


METHODS
Ninety days after ICU discharge or death, family members completed the Impact of Event Scale (which evaluates the severity of post-traumatic stress reactions), Hospital Anxiety and Depression Scale, and 36-item Short-Form General Health Survey during a telephone interview. Linear regression was used to identify factors associated with the risk of post-traumatic stress symptoms.


RESULTS
Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Post-traumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe post-traumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life.


CONCLUSIONS
Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.
Azoulay
Elie
E
Service de Réanimation Médicale, Hôpital Saint-Louis, Paris, France. elie.azoulay@sls.ap-hop-paris.fr
Pochard
Frédéric
F
Kentish-Barnes
Nancy
N
Chevret
Sylvie
S
Aboab
Jérôme
J
Adrie
Christophe
C
Annane
Djilali
D
Bleichner
Gérard
G
Bollaert
Pierre Edouard
PE
Darmon
Michael
M
Fassier
Thomas
T
Galliot
Richard
R
Garrouste-Orgeas
Maité
M
Goulenok
Cyril
C
Goldgran-Toledano
Dany
D
Hayon
Jan
J
Jourdain
Mercé
M
Kaidomar
Michel
M
Laplace
Christian
C
Larché
Jérôme
J
Liotier
Jérôme
J
Papazian
Laurent
L
Poisson
Catherine
C
Reignier
Jean
J
Saidi
Fayçal
F
Schlemmer
Benoît
B
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003142:Communication; D016638:Critical Illness; D003657:Decision Making; D003863:Depression / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005192:Family Health; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D026706:Paternalism; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*