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Observational Study
. 2022 Jun 1;182(6):624-633.
doi: 10.1001/jamainternmed.2022.1118.

Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit With COVID-19

Timothy Amass  1   2 , Lauren Jodi Van Scoy  3 , May Hua  4   5 , Melanie Ambler  4 , Priscilla Armstrong  6 , Matthew R Baldwin  7 , Rachelle Bernacki  8   9 , Mansoor D Burhani  10 , Jennifer Chiurco  11 , Zara Cooper  9   12 , Hope Cruse  1 , Nicholas Csikesz  13 , Ruth A Engelberg  6 , Laura D Fonseca  4 , Karin Halvorson  14 , Rachel Hammer  11   15 , Joanna Heywood  6 , Sarah Hochendoner Duda  16 , Jin Huang  17 , Ying Jin  1   18 , Laura Johnson  19 , Masami Tabata-Kelly  9   12 , Emma Kerr  12 , Trevor Lane  1 , Melissa Lee  19 , Keely Likosky  19 , Donald McGuirl  20 , Tijana Milinic  21 , Marc Moss  1 , Elizabeth Nielsen  6 , Ryan Peterson  1   18 , Sara J Puckey  19 , Olivia Rea  6 , Sarah Rhoads  1 , Christina Sheu  12 , Wendy Tong  22 , Pamela D Witt  3 , James Wykowski  23 , Stephanie Yu  17 , Renee D Stapleton  24 , J Randall Curtis  6
Affiliations
Observational Study

Stress-Related Disorders of Family Members of Patients Admitted to the Intensive Care Unit With COVID-19

Timothy Amass et al. JAMA Intern Med. .

Abstract

Importance: The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined.

Objective: To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission.

Design, setting, and participants: This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states.

Exposure: Having a family member in the ICU with COVID-19.

Main outcomes and measures: Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6).

Results: A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients' child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners.

Conclusions and relevance: In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hua reported receiving grants from the National Institute on Aging and the American Federation for Aging Research during the conduct of the study and funding from the National Cancer Institute unrelated to submitted work. Dr Stapleton reported receiving grants from the National Institutes of Health outside the submitted work. Dr Curtis reported receiving grants from the National Institutes of Health, serving on the Cambia Health Foundation Advisory Board, and serving on the Francis Family Foundation Advisory Board outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Eligibility and Enrollment
aAllowing for more than 1 eligible family member per patient. bMore than 1 family member per patient surveyed; second family member excluded. cConsecutive sample approached until enrollment goal was met. dNot analyzed, administrative error.
Figure 2.
Figure 2.. Impact of Events 6 (IES-6) and Hospital Anxiety and Depression Scale (HADS) Scores at 3 and 6 Months After Admission of Patient to the Intensive Care Unit (ICU)
A, The ends of the boxes represent the IQRs, horizontal lines are the means, and the whiskers are the range. HADS-a indicates HADS anxiety; HADS-d, HADS depression. B, Each cutoff score indicates significant symptoms of posttraumatic stress, anxiety, or depression.
See this image and copyright information in PMC

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