title: ICU care associated with symptoms of depression and posttraumatic stress disorder among family members of patients who die in the ICU.
abstract: BACKGROUND
  Psychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions.
  
  
  METHODS
  We performed a cohort study of family members of patients who died in the ICU or within 30 h of ICU transfer. Outcomes included self-reported symptoms of PTSD and depression. Predictors included patient demographics and elements of palliative care.
  
  
  RESULTS
  Two hundred twenty-six patients had chart abstraction and family questionnaire data. Family members of older patients had lower scores for PTSD (P = .026). Family members that were present at the time of death (P = .021) and family members of patients with early family conferences (P = .012) reported higher symptoms of PTSD. When withdrawal of a ventilator was ordered, family members reported lower symptoms of depression (P = .033). There were no other patient characteristics or elements of palliative care associated with family symptoms.
  
  
  CONCLUSIONS
  Family members of younger patients and those for whom mechanical ventilation is not withdrawn are at increased risk of psychologic symptoms and may represent an important group for intervention. Increased PTSD symptoms among family members present at the time of death may reflect a closer relationship with the patient or more involvement with the patient's ICU care but also suggests that family should be offered the option of not being present.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA. Electronic address: ekross@u.washington.edu.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Kross
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, University of Washington Medical Center, University of Washington, Seattle, WA.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Gries
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Nielsen
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000368:Aged; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014861:Washington / Q000453:epidemiology