title: Post-traumatic Stress Disorder and Complicated Grief are Common in Caregivers of Neuro-ICU Patients.
abstract: BACKGROUND
  To explore the effect of end of life and other palliative decision making scenarios on the mental health of family members of patients in the neuro-intensive care unit.
  
  
  METHODS
  Decision makers of patients in the neuro-ICU at a large, urban, academic medical center meeting palliative care triggers were identified from November 10, 2014, to August 27, 2015. Interviews were conducted at 1 and 6 months post-enrollment. At 1 month, the Inventory of Complicated Grief-Revised (ICG-R), Impact of Events Scale-Revised (IES-R), and the Family Satisfaction-ICU (FS-ICU) were performed along with basic demographic questionnaires. At 6 months, only the ICG-R and IES-R were repeated.
  
  
  RESULTS
  At 1 month, 9 (35%) subjects had significant symptoms in at least one of the three domains of traumatic response. Two (7.7%) subjects met full criteria for PTSD (IES-R ≥ 1.5). At 6 months, 5 (22%) subjects met criteria for PTSD and 5 (22%) for Complicated Grief (ICG-R ≥ 36). Fifteen (50%) had at least one domain of PTSD symptoms identified in follow-up. Time spent at bedside and lower household income were associated with PTSD at 1 and 6 months, respectively. In all, clinically significant psychological outcomes were identified in 9 (30%) of subjects.
  
  
  CONCLUSIONS
  Clinically significant grief and stress reactions were identified in 30% of decision makers for severely ill neuro-ICU patients. Though factors including time at bedside during hospitalization and total household income may have some predictive value for these disorders, further evaluation is required to help identify family members at risk of psychopathology following neuro-ICU admissions.
authors.affiliation: Division of Neurocritical Care, Department of Neurology, Northwestern University Mcgaw Medical Center, Chicago, IL, USA. Stephen.Trevick@Northwestern.edu.
authors.forename: Stephen A
authors.identifier: http://orcid.org/0000-0002-6250-6539
authors.initials: SA
authors.lastname: Trevick
authors.affiliation: Division of Neurocritical Care, Department of Neurology, NYU School of Medicine, New York, NY, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Lord
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000473:pathology; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006801:Humans; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology*; D020521:Stroke / Q000628:therapy; D055815:Young Adult
keywords: Bereavement; Family research; Grief; Intensive care units; Palliative care medicine; Post-traumatic stress disorder