Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU.
BACKGROUND
Patients' deaths in the ICU have been associated with a high burden of psychologic symptoms in families. This study identifies characteristics associated with psychologic symptoms in family members.


METHODS
Families of patients dying in the ICU or within 30 h of ICU discharge in 11 hospitals previously participated in a randomized trial. In the current study, we assessed these families for symptoms of posttraumatic stress disorder (PTSD) and depression with follow-up surveys. Outcomes included validated measures of PTSD (PTSD Checklist) and depressive (Patient Health Questionnaire) symptoms. Predictors included family member mental-health history, involvement in decision making, and demographics.


RESULTS
Surveys were completed by 226 families. Response rate was 46% in the original randomized trial and 82% in this study. Prevalence (95% CI) of PTSD and depressive symptoms were 14.0% (9.7%-19.3%) and 18.4% (13.5%-24.1%), respectively. Family characteristics associated with increased symptoms included: female gender (PTSD, P = .020; depression, P = .005), knowing the patient for a shorter duration (PTSD, P = .003; depression, P = .040), and discordance between family members' preferences for decision making and their actual decision-making roles (PTSD, P = .005; depression, P = .049). Depressive symptoms were also associated with lower educational level (P = .002). Families with psychologic symptoms were more likely to report that access to a counselor (PTSD, P < .001; depression, P = .003) and information about spiritual services might have been helpful while the patient was in the ICU (PTSD, P = .024; depression, P = .029).


CONCLUSIONS
Families demonstrated a high prevalence of psychologic symptoms after a death in the ICU. Characteristics associated with symptoms may help target interventions to reduce these symptoms.


BACKGROUND
clinicaltrials.gov; Identifier: NCT00685893.
Gries
Cynthia J
CJ
University of Washington, Division of Pulmonary and Critical Care, Seattle, WA 98104, USA. jrc@u.washington.edu
Engelberg
Ruth A
RA
Kross
Erin K
EK
Zatzick
Doug
D
Nielsen
Elizabeth L
EL
Downey
Lois
L
Curtis
J Randall
JR
D001293:Attitude to Death; D003863:Depression / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D014481:United States / Q000453:epidemiology