Factors associated with significant post-traumatic-stress symptoms among bereaved family members of patients who died in intensive care units

Abstract

Objective: Few studies comprehensively investigate factors associated with significant post-traumatic-stress-disorder (PTSD) symptoms among family members of ICU decedents. We aimed to identify factors associated with significant PTSD symptoms among bereaved ICU family members, focusing on those modifiable through high-quality end-of-life ICU care.

Methods: A cohort study of 321 bereaved family members of critically ill patients assessed PTSD symptoms at 1, 3, 6, 13, 18, and 24 months postloss using the Impact of Event Scale-Revised (IES-R). Family-rated quality of dying and death (QODD) and ICU care satisfaction were assessed 1 month postloss using the ICU-QODD and Family Satisfaction in the ICU (FS-ICU) scales, respectively. Multivariable logistic regression with generalized estimating equations examined associations between significant PTSD symptoms and intrapersonal (demographics, vulnerabilities), interpersonal (perceived social support measured by the Medical Outcome Study Social Support Survey), bereavement-related (patient demographics, clinical characteristics), and death-circumstance (ICU-QODD and FS-ICU scores) factors identified from significant univariate analyses.

Results: Prevalence of significant PTSD symptoms decreased substantially over time (from 11.0 % at 1 month to 0 % at 24 months post loss). Financial insufficiency (adjusted odds ratio [AOR][95 % CI] = 3.281[1.306, 8.244]) and use of antidepressants in the year prior to the patient's critical illness (AOR[95 % CI] = 6.406 [1.868, 21.967]) increased the likelihood of significant PTSD symptoms. Stronger family-perceived social support (AOR[95 % CI] = 0.964 [0.941, 0.988]) and higher family-judged patient QODD in ICUs (AOR[95 % CI] = 0.632 [0.435, 0.918]) lowered the odds of significant PTSD symptoms.

Conclusions: Modifiable end-of-life ICU care factors, i.e. higher family-judged patient QODD and family-perceived social support, reduced bereaved ICU family members' likelihood of significant PTSD symptoms.

Implications for clinical practice: To reduce the likelihood of significant PTSD symptoms in bereaved family members, ICU clinicians should provide high-quality end-of-life care to improve patient QODD and leverage social support, particularly for at-risk groups with financial challenges or prior antidepressant use.

Keywords: Critical care medicine; Family members; Intensive care units; Quality of ICU care; Quality of death and dying; Significant PTSD symptom.