title: Trauma- and distress-associated mental illness symptoms in close relatives of patients with severe traumatic brain injury and high-grade subarachnoid hemorrhage.
abstract: BACKGROUND
  Close relatives (CR) of patients with severe traumatic brain injury (TBI) and high-grade subarachnoid hemorrhage (SAH) suffer extraordinary distress during the treatment: Distress may lead to persisting mental illness symptoms within the spectrum of post-traumatic stress disorder (PTSD), anxiety disorders, and depression. The primary goal of this study was to determine the prevalence and severity of these symptoms in CR. The secondary goal was identification of associated factors.
  
  
  METHODS
  Standardized interviews were conducted with 53 CR (mean age of 57.7 ± 11.4 years) of patients with TBI °III (n = 27) and high-grade SAH H&H °III-V (n = 26) between 5 and 15 months after the event. The interviews contained a battery of surveys to quantify symptoms of PTSD, anxiety disorders, and depression, i.e., Impact of Event Scale (IES-R), 36-item Short-Form General Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Fixed and modifiable possibly influencing factors were correlated.
  
  
  RESULTS
  Twenty-eight CR (53 %) showed IES-R scores indicating a probable diagnosis of PTSD. Twenty-five CR (47 %) showed an increased anxiety score and 18 (34 %) an increased depression score using HADS. Mean physical component summary of SF-36 was not abnormal (49.1 ± 9.1), whereas mean mental component summary was under average (41.0 ± 13.2), indicating a decreased quality of life caused by mental effects. Perception of the interaction quality with the medical staff and involvement into medical decisions correlated negatively with severity of mental illness symptoms. Evasive coping strategies were highly significantly associated with symptoms.
  
  
  CONCLUSIONS
  This study quantifies an extraordinarily high prevalence of mental illness symptoms in CR of patients with critical acquired brain injury due to SAH and TBI. Modifiable factors were associated with severity of mental illness symptoms. Prospective studies testing efficiency of early psychotherapeutic interventions are needed.
authors.affiliation: Department of Neurosurgery, University Hospital Wuerzburg, Josef-Schneider-Strasse 11, 97080, Wuerzburg, Germany, rueckriege_s@ukw.de.
authors.forename: Stefan Mark
authors.initials: SM
authors.lastname: Rueckriegel
authors.forename: Marianne
authors.initials: M
authors.lastname: Baron
authors.forename: Katharina
authors.initials: K
authors.lastname: Domschke
authors.forename: Silke
authors.initials: S
authors.lastname: Neuderth
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Kunze
authors.forename: Almuth Friederike
authors.initials: AF
authors.lastname: Kessler
authors.forename: Robert
authors.initials: R
authors.lastname: Nickl
authors.forename: Thomas
authors.initials: T
authors.lastname: Westermaier
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D013345:Subarachnoid Hemorrhage / Q000523:psychology*