title: Posttraumatic stress and complicated grief in family members of patients in the intensive care unit.
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.
  
  
  OBJECTIVE
  To determine prevalences of and factors associated with anxiety, depression, posttraumatic stress and complicated grief in family members of ICU patients.
  
  
  METHODS
  Prospective, longitudinal cohort study.
  
  
  METHODS
  Fifty family members of patients in ICUs at a large university hospital participated.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, San Francisco, CA 94143-0903, USA. anderson.wg@gmail.com
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Anderson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Bryce
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005190:Family; D005260:Female; D006117:Grief; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
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