title: Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients.
abstract: OBJECTIVE
  Prognostic uncertainty and surrogate decision-making demands associated with prolonged unconsciousness in out-of hospital cardiac arrest (OHCA) patients in the intensive care unit (ICU) may increase post-traumatic stress disorder (PTSD) risk in their relatives. Our aim was to study PTSD frequency and risk factors in relatives of OHCA patients.
  
  
  METHODS
  In this observational study 101 consecutive eligible adult relatives of OHCA patients were interviewed using validated questionnaires, the "Impact of Event Scale-Revised" to detect PTSD and the "Family-Satisfaction with Care in the ICU" to assess potential PTSD risk factors.
  
  
  RESULTS
  PTSD was detected in 40/101 relatives (40%). Multivariate logistic regression identified three significant PTSD predictors [odds ratio, 95% confidence interval]: female gender [3.30, 1.08-10.11], history of depression [3.63, 1.02-12.96], family perception of the patient's therapy as insufficient [18.40, 1.52-224.22]. Three other predictors were not significantly associated with PTSD (hypothermia treatment of the patient [2.86, 0.96-8.48]), delayed delivery of prognostic information by ICU staff [2.11, 0.83-5.38], family-ICU staff conflict [3.61, 0.71-18.40]). A prediction rule including six factors (p<0.15 each) showed high discrimination (area under the receiver-operating characteristic curve 0.74) with a stepwise increase in risk for PTSD from 0% (no risk factor) to 63% (≥3 risk factors). There was no evidence for effect modification either by survival status or neurological outcome.
  
  
  CONCLUSIONS
  Relatives of OHCA patients treated in the ICU are at increased risk of PTSD, which can be predicted based on six factors, three ICU-related and potentially at least partly modifiable. Further research is needed to validate our findings and to develop strategies to prevent PTSD in OHCA patients' relatives.
authors.affiliation: Medical Intensive Care Unit, University Hospital Basel, Switzerland.
authors.forename: Marius
authors.initials: M
authors.lastname: Zimmerli
authors.affiliation: Medical Intensive Care Unit, University Hospital Basel, Switzerland.
authors.forename: Kai
authors.initials: K
authors.lastname: Tisljar
authors.affiliation: Medical Intensive Care Unit, University Hospital Basel, Switzerland.
authors.forename: Gian-Marco
authors.initials: GM
authors.lastname: Balestra
authors.affiliation: Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.
authors.forename: Wolf
authors.initials: W
authors.lastname: Langewitz
authors.affiliation: Medical Intensive Care Unit, University Hospital Basel, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.affiliation: Medical Intensive Care Unit, University Hospital Basel, Switzerland. Electronic address: SabinaHunziker@gmail.com.
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005192:Family Health; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
keywords: Critical care; Family satisfaction; Hypothermia; Out-of-hospital cardiac arrest; Post-traumatic stress disorder (PTSD); Prediction; Risk