title: Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers.
abstract: OBJECTIVE
  To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization.
  
  
  METHODS
  A single-group descriptive longitudinal correlational study.
  
  
  METHODS
  Medical, surgical, and neurological ICUs in a large tertiary care university hospital.
  
  
  METHODS
  Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p=0.01) and emotion-focused (p<0.01) coping decreased over time while avoidant coping (p=0.20) use remained stable. Coping strategies 30 days after hospitalization (R2=0.50, p<0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2=0.30, p=0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity.
  
  
  CONCLUSIONS
  Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.
authors.affiliation: 1Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. 2Department of Neurosurgery, University Hospitals of Cleveland, Cleveland, OH.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Petrinec
authors.forename: Polly M
authors.initials: PM
authors.lastname: Mazanec
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Burant
authors.forename: Alan
authors.initials: A
authors.lastname: Hoffer
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Daly
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000208:ethnology / Q000523:psychology; D003657:Decision Making; D003863:Depression / Q000208:ethnology / Q000523:psychology; D004644:Emotions; D005006:Ethnicity; D005190:Family / Q000523:psychology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology / Q000523:psychology*