Learned helplessness among families and surrogate decision-makers of patients admitted to medical, surgical, and trauma ICUs.
BACKGROUND
We sought to determine the prevalence of and clinical variables associated with learned helplessness, a psychologic state characterized by reduced motivation, difficulty in determining causality, and depression, in family members of patients admitted to ICUs.


METHODS
We conducted an observational survey study of a prospectively defined cohort of family members, spouses, and partners of patients admitted to surgical, medical, and trauma ICUs at a large academic medical center. Two validated instruments, the Learned Helplessness Scale and the Perceived Stress Scale, were used, and self-report of patient clinical characteristics and subject demographics were collected.


RESULTS
Four hundred ninety-nine family members were assessed. Of these, 238 of 460 (51.7%) had responses consistent with a significant degree of learned helplessness. Among surrogate decision-makers, this proportion was 50% (92 of 184). Characteristics associated with significant learned helplessness included grade or high school education (OR, 3.27; 95% CI, 1.29-8.27; P = .01) and Perceived Stress Scale score > 18 (OR, 4.15; 95% CI, 2.65-6.50; P < .001). The presence of a patient advance directive or do not resuscitate (DNR) order was associated with reduced odds of significant learned helplessness (OR, 0.56; 95% CI, 0.32-0.98; P = .05).


CONCLUSIONS
The majority of family members of patients in the ICU experience significant learned helplessness. Risk factors for learned helplessness include lower educational levels, absence of an advance directive or DNR order, and higher stress levels among family members. Significant learned helplessness in family members may have negative implications in the collaborative decision-making process.
Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR.
Donald R
DR
Sullivan
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Xinggang
X
Liu
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
Douglas S
DS
Corwin
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
Avelino C
AC
Verceles
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
Michael T
MT
McCurdy
Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
Drew A
DA
Pate
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
Jennifer M
JM
Davis
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. Electronic address: gnetzer@medicine.umaryland.edu.
Giora
G
Netzer
D000328:Adult; D016223:Advance Directives / Q000523:psychology; D000368:Aged; D015331:Cohort Studies; D003625:Data Collection; D003657:Decision Making; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D004522:Educational Status; D005190:Family / Q000523:psychology*; D005260:Female; D006380:Helplessness, Learned; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011581:Psychological Tests; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires