ICU care associated with symptoms of depression and posttraumatic stress disorder among family members of patients who die in the ICU

Psychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions. We performed a cohort s...

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Vydáno v:	Chest Ročník 139; číslo 4; s. 795
Hlavní autoři:	Kross, Erin K, Engelberg, Ruth A, Gries, Cynthia J, Nielsen, Elizabeth L, Zatzick, Douglas, Curtis, J Randall
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.04.2011
Témata:	Aged Depression - epidemiology Depression - psychology Family - psychology Female Hospital Mortality Humans Intensive Care Units Male Middle Aged Retrospective Studies Risk Factors Stress Disorders, Post-Traumatic - epidemiology Stress Disorders, Post-Traumatic - psychology Surveys and Questionnaires Washington - epidemiology Washington
ISSN:	1931-3543, 1931-3543
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Abstract	Psychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions. We performed a cohort study of family members of patients who died in the ICU or within 30 h of ICU transfer. Outcomes included self-reported symptoms of PTSD and depression. Predictors included patient demographics and elements of palliative care. Two hundred twenty-six patients had chart abstraction and family questionnaire data. Family members of older patients had lower scores for PTSD (P = .026). Family members that were present at the time of death (P = .021) and family members of patients with early family conferences (P = .012) reported higher symptoms of PTSD. When withdrawal of a ventilator was ordered, family members reported lower symptoms of depression (P = .033). There were no other patient characteristics or elements of palliative care associated with family symptoms. Family members of younger patients and those for whom mechanical ventilation is not withdrawn are at increased risk of psychologic symptoms and may represent an important group for intervention. Increased PTSD symptoms among family members present at the time of death may reflect a closer relationship with the patient or more involvement with the patient's ICU care but also suggests that family should be offered the option of not being present.
AbstractList	Psychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions.BACKGROUNDPsychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions.We performed a cohort study of family members of patients who died in the ICU or within 30 h of ICU transfer. Outcomes included self-reported symptoms of PTSD and depression. Predictors included patient demographics and elements of palliative care.METHODSWe performed a cohort study of family members of patients who died in the ICU or within 30 h of ICU transfer. Outcomes included self-reported symptoms of PTSD and depression. Predictors included patient demographics and elements of palliative care.Two hundred twenty-six patients had chart abstraction and family questionnaire data. Family members of older patients had lower scores for PTSD (P = .026). Family members that were present at the time of death (P = .021) and family members of patients with early family conferences (P = .012) reported higher symptoms of PTSD. When withdrawal of a ventilator was ordered, family members reported lower symptoms of depression (P = .033). There were no other patient characteristics or elements of palliative care associated with family symptoms.RESULTSTwo hundred twenty-six patients had chart abstraction and family questionnaire data. Family members of older patients had lower scores for PTSD (P = .026). Family members that were present at the time of death (P = .021) and family members of patients with early family conferences (P = .012) reported higher symptoms of PTSD. When withdrawal of a ventilator was ordered, family members reported lower symptoms of depression (P = .033). There were no other patient characteristics or elements of palliative care associated with family symptoms.Family members of younger patients and those for whom mechanical ventilation is not withdrawn are at increased risk of psychologic symptoms and may represent an important group for intervention. Increased PTSD symptoms among family members present at the time of death may reflect a closer relationship with the patient or more involvement with the patient's ICU care but also suggests that family should be offered the option of not being present.CONCLUSIONSFamily members of younger patients and those for whom mechanical ventilation is not withdrawn are at increased risk of psychologic symptoms and may represent an important group for intervention. Increased PTSD symptoms among family members present at the time of death may reflect a closer relationship with the patient or more involvement with the patient's ICU care but also suggests that family should be offered the option of not being present. Psychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions. We performed a cohort study of family members of patients who died in the ICU or within 30 h of ICU transfer. Outcomes included self-reported symptoms of PTSD and depression. Predictors included patient demographics and elements of palliative care. Two hundred twenty-six patients had chart abstraction and family questionnaire data. Family members of older patients had lower scores for PTSD (P = .026). Family members that were present at the time of death (P = .021) and family members of patients with early family conferences (P = .012) reported higher symptoms of PTSD. When withdrawal of a ventilator was ordered, family members reported lower symptoms of depression (P = .033). There were no other patient characteristics or elements of palliative care associated with family symptoms. Family members of younger patients and those for whom mechanical ventilation is not withdrawn are at increased risk of psychologic symptoms and may represent an important group for intervention. Increased PTSD symptoms among family members present at the time of death may reflect a closer relationship with the patient or more involvement with the patient's ICU care but also suggests that family should be offered the option of not being present.
Author	Gries, Cynthia J Nielsen, Elizabeth L Engelberg, Ruth A Kross, Erin K Zatzick, Douglas Curtis, J Randall
Author_xml	– sequence: 1 givenname: Erin K surname: Kross fullname: Kross, Erin K email: ekross@u.washington.edu organization: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA. Electronic address: ekross@u.washington.edu – sequence: 2 givenname: Ruth A surname: Engelberg fullname: Engelberg, Ruth A organization: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA – sequence: 3 givenname: Cynthia J surname: Gries fullname: Gries, Cynthia J organization: Department of Medicine, Division of Pulmonary and Critical Care, University of Washington Medical Center, University of Washington, Seattle, WA – sequence: 4 givenname: Elizabeth L surname: Nielsen fullname: Nielsen, Elizabeth L organization: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA – sequence: 5 givenname: Douglas surname: Zatzick fullname: Zatzick, Douglas organization: Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, WA – sequence: 6 givenname: J Randall surname: Curtis fullname: Curtis, J Randall organization: Department of Medicine, Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA
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SubjectTerms	Aged Depression - epidemiology Depression - psychology Family - psychology Female Hospital Mortality Humans Intensive Care Units Male Middle Aged Retrospective Studies Risk Factors Stress Disorders, Post-Traumatic - epidemiology Stress Disorders, Post-Traumatic - psychology Surveys and Questionnaires Washington - epidemiology
Title	ICU care associated with symptoms of depression and posttraumatic stress disorder among family members of patients who die in the ICU
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