Nearly two-thirds of adult relatives of people admitted to the intensive care unit (ICU) with COVID-19 continued to experience significant symptoms of posttraumatic stress disorder (PTSD) months later, according to a report in JAMA Internal Medicine.
The study also found that those with significant symptoms of PTSD “more commonly described feelings of distrust and concern about taking clinicians’ information at face value without being present to see for themselves,” wrote Timothy Amass, M.D., Sc.M., of the University of Colorado School of Medicine and colleagues.
“As the COVID-19 pandemic continues to challenge the ability of family members to build bedside relationships with clinicians, this loss of trust may translate to an increase in stress-related disorders. … [E]stablishing rapport with family members in creative and innovative ways may help to offset the physical distance,” they wrote.
The researchers assessed 330 family members of patients admitted to the ICU with COVID-19 at 12 U.S. hospitals in Colorado, Louisiana, Massachusetts, New York, and Washington from February 1 through July 31, 2020. Most of the relatives were children of COVID patients (n=129) or spouses/partners (n=81). The rest were siblings, parents, or other relatives.
Family members were assessed for symptoms of PTSD at three and six months after their relatives’ ICU admission using The Impact of Events Scale (IES). The researchers also invited family members to participate in a follow-up interview during which they were asked to rate their satisfaction with the health care their relative received in the ICU (for example, they were asked “How satisfied were you with the level or amount of health care your family member received in the ICU?” and asked to rate the compassion they felt their family member received in the ICU).
The average IES score at three months was 11.9, with 63.6% of family members having scores of 10 or higher, indicating significant symptoms of PTSD. At the six-month follow-up, the average IES score was 10.1, with 48.4% scoring 10 or higher.
Female family members had an average score 2.6 points higher than male family members, and Hispanic family members scored an average of 2.7 points higher than non-Hispanic family members.
“It is possible that receiving or perceiving fewer acts of compassion may help explain the association of increased IES scores or that bedside exclusion prevented families from engaging in culturally important bedside care rituals,” the researchers wrote. “Prior studies highlight that those identifying as Hispanic are more likely to use touch at the bedside and be involved in patient care and that bedside care rituals may help reduce psychological distress.”
Information from follow-up interviews was collected from 74 family members. “Of those 49 with IES-6 scores of 10 or higher, 18 (36.7%) mentioned distrust, whereas 2 of the 25 (8.0%) with IES-6 scores less than 10 mentioned distrust; Hispanic participants more commonly reported distrust,” they wrote.
Amass and colleagues concluded, “[W]hen patients or families experience loss of control, they may be more prone to develop PTSD … [O]ur results should … alert the health care community to the diverse factors associated with significant psychological distress in family members of patients in the ICU.”
For related information, see the Psychiatric News article “COVID-19 and Psychotherapy: Addressing Blocked Mourning.”
(Image: iStock/baona)
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