Emotional disorders in pairs of patients and their family members during and after ICU stay

Renata Rego Lins Fumis, Otavio T Ranzani, Paulo Sérgio Martins, Guilherme Schettino, Renata Rego Lins Fumis, Otavio T Ranzani, Paulo Sérgio Martins, Guilherme Schettino

Abstract

Introduction: Patients and family members undergo different experiences of suffering from emotional disorders during ICU stay and after ICU discharge. The purpose of this study was to compare the incidence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in pairs (patient and respective family member), during stay at an open visit ICU and at 30 and 90-days post-ICU discharge. We hypothesized that there was a positive correlation with the severity of symptoms among pairs and different patterns of suffering over time.

Methods: A prospective study was conducted in a 22-bed adult general ICU including patients with >48 hours stay. The Hospital Anxiety and Depression Scale (HADS) was completed by the pairs (patients/respective family member). Interviews were made by phone at 30 and 90-days post-ICU discharge using the Impact of Event Scale (IES) and the HADS. Multivariate models were constructed to predict IES score at 30 days for patients and family members.

Results: Four hundred and seventy one family members and 289 patients were interviewed in the ICU forming 184 pairs for analysis. Regarding HADS score, patients presented less symptoms than family members of patients who survived and who deceased at 30 and 90-days (p<0.001). However, family members of patients who deceased scored higher anxiety and depression symptoms (p = 0.048) at 90-days when compared with family members of patients who survived. Patients and family members at 30-days had a similar IES score, but it was higher in family members at 90-days (p = 0.019). For both family members and patients, age and symptoms of anxiety and depression during ICU were the major determinants for PTSD at 30-days.

Conclusions: Anxiety, depression and PTSD symptoms were higher in family members than in the patients. Furthermore, these symptoms in family members persisted at 3 months, while they decreased in patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of the study.
Figure 1. Flow chart of the study.
Figure 2. HADS score over time distributed…
Figure 2. HADS score over time distributed between groups.
Figure 3. Correlation between patients and family…
Figure 3. Correlation between patients and family members anxiety and depression scores considering values from ICU, 30 and 90-days after ICU discharge.
HADS denotes Hospital Anxiety and Depression Scale. The x- and y-axis were logarithmic transformed.

References

    1. Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, et al. (2007) Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 11(1):R27 10.1186/cc5707
    1. Myhren H, Ekeberg O, Tøien K, Karlsson S, Stokland O (2010) Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care 14(1):R14 10.1186/cc8870
    1. Paparrigopoulos T, Melissaki A, Tzavellas E, Karaiskos D, Ilias I, et al. (2014) Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: A two-year follow-up study. Int J Psychiatry Clin Pract 2014, 18(1):25–31. 10.3109/13651501.2013.855793
    1. Fumis RR, Deheinzelin D (2009) Family members of critically ill cancer patients:assessing the symptoms of anxiety and depression. Intensive Care Med 35(5):899–902. 10.1007/s00134-009-1406-7
    1. Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, et al. French FAMIREA Group (2001) Symptoms of anxiety and depression in family members of intensive care unit patients:ethical hypothesis regarding decision-making capacity. Crit Care Med 29(10):1893–7. 10.1097/00003246-200110000-00007
    1. Pochard F, Darmon M, Fassier T, Bollaert PE, Cheval C, et al. French FAMIREA study group (2005) Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care 20(1):90–6. 10.1016/j.jcrc.2004.11.004
    1. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, et al. FAMIREA Study Group (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171(9):987–94. 10.1164/rccm.200409-1295OC
    1. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, et al. (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356(5):469–78. Erratum in: N Engl J Med 2007, 357(2):203 10.1056/NEJMoa063446
    1. Wall RJ, Curtis JR, Cooke CR, Engelberg RA (2007) Family satisfaction in the ICU:differences between families of survivors and nonsurvivors. Chest 132(5):1425–33. 10.1378/chest.07-0419
    1. Curtis JR, Engelberg RA, Wenrich MD, Nielsen EL, Shannon SE, et al. (2002) Studying communication about end-of-life care during the ICU family conference: development of a framework. J Crit Care 17(3):147–60. 10.1053/jcrc.2002.35929
    1. Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, et al. (2007) American College of Critical Care Medicine Task Force 2004–2005, Society of Critical Care Medicine.Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med 35(2):605–22. 10.1097/01.CCM.0000254067.14607.EB
    1. Berwick DM, Kotagal M (2004) Restricted visiting hours in ICUs: time to change. JAMA 292(6):736–7. 10.1001/jama.292.6.736
    1. Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, et al. (2007) Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med 35(2):497–501. 10.1097/
    1. Vandijck DM, Labeau SO, Geerinckx CE, De Puydt E, Bolders AC, et al. (2010) Executive Board of the Flemish Society for Critical Care Nurses, Ghent and Edegem, Belgium. An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: a multicenter survey. Heart Lung 39(2):137–46. 10.1016/j.hrtlng.2009.06.001
    1. da Silva Ramos FJ, Fumis RR, Azevedo LC, Schettino G (2013) Perceptions of an open visitation policy by intensive care unit workers. Ann Intensive Care 3(1):34 10.1186/2110-5820-3-34
    1. Fumagalli S, Boncinelli L, Lo Nostro A, Valoti P, Baldereschi G, et al. (2006) Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial. Circulation 113(7):946–52. 10.1161/CIRCULATIONAHA.105.572537
    1. Garrouste-Orgeas M, Philippart F, Timsit JF, Diaw F, Willems V, et al. (2008) Perceptions of a 24-hour visiting policy in the intensive care unit. Crit Care Med 36(1):30–5. 10.1097/01.CCM.0000295310.29099.F8
    1. Rosendahl J, Brunkhorst FM, Jaenichen D, Strauss B (2013) Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor-Partner Interdependence Model. Crit Care Med 41(1):69–75. 10.1097/CCM.0b013e31826766b0
    1. Azoulay E, Pochard F (2003) Communication with family members of patients dying in the intensive care unit. Curr Opin Crit Care 9(6):545–50. 10.1097/00075198-200312000-00014
    1. Jones C, Bäckman C, Capuzzo M, Flaatten H, Rylander C, et al. (2007) Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med 33(6):978–85. 10.1007/s00134-007-0600-8
    1. Tramm R, Hodgson C, Ilic D, Sheldrake J, Pellegrino V (2014) Identification and prevalence of PTSD risk factors in ECMO patients: A single centre study. Aust Crit Care. pii: S1036-7314(14)00034-4.
    1. Young E, Eddleston J, Ingleby S, Streets J, McJanet L, et al. (2005) Returning home after intensive care: a comparison of symptoms of anxiety and depression in ICU and elective cardiac surgery patients and their relatives. Intensive Care Med 31(1):86–91. 10.1007/s00134-004-2495-y
    1. de Miranda S, Pochard F, Chaize M, Megarbane B, Cuvelier A, et al. (2011) Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study. Crit Care Med 39(1):112–8. 10.1097/CCM.0b013e3181feb824
    1. Fumis RR, Nishimoto IN, Deheinzelin D (2006) Measuring satisfaction in family members of critically ill cancer patients in Brazil. Intensive Care Med 32(1): 124–8. 10.1007/s00134-005-2857-0
    1. Botega NJ, Bio MR, Zomignani MA, Garcia C Jr, Pereira WA (1995) [Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD]. Rev Saude Publica 29(5):355–63. 10.1590/S0034-89101995000500004
    1. Oliveira e Silva AC, Nardi AE, Horowitz M (2010) Brazilian version of the Impact of Event Scale (IES): translation and cross-cultural adaptation. Rev Psiquiatr Rio Gd Sul 32(3): 86–93.
    1. Sukantarat K, Greer S, Brett S, Williamson R (2007) Physical and psychological sequelae of critical illness. Br J Health Psychol 12:65–74. 10.1348/135910706X94096
    1. McKercher C, Sanderson K, Jose MD (2013) Psychosocial factors in people with chronic kidney disease prior to renal replacement therapy. Nephrology 18(9):585–91. 10.1111/nep.12138
    1. Janiszewska J, Lichodziejewska-Niemierko M, Gołębiewska J, Majkowicz M, Rutkowski B (2013) Determinants of anxiety in patients with advanced somatic disease: differences and similarities between patients undergoing renal replacement therapies and patients suffering from cancer. Int Urol Nephrol 45(5):1379–87. 10.1007/s11255-012-0326-6
    1. Peris A, Bonizzoli M, Iozzelli D, Migliaccio ML, Zagli G, et al. (2011) Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care 15(1):R41 10.1186/cc10003
    1. McCoubrie RC, Davies AN (2006) Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Support Care Cancer 14(4):379–85. 10.1007/s00520-005-0892-6
    1. Boscaglia N, Clarke DM, Jobling TW, Quinn MA (2005) The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer. Int J Gynecol Cancer 15(5):755–61. 10.1111/j.1525-1438.2005.00248.x
    1. Schleder LP, Parejo LS, Puggina AC, Silva MJP (2013) Spirituality of relatives of patients hospitalized in intensive care unit. Acta paul enferm 26(1):71–78.
    1. Fumis RR, Martins P, Schettino G (2013) Unrestricted hours visiting policy at ICU: does it matter for families? In: 26th Annual Congress, 2013, Paris-França. Intensive Care Med Suppl 2. New York: Springer 2013, 39: 324.
    1. Steyerberg EW (2009) Clinical prediction models: a practical approach to development, validation, and updating. Springer, New York.

Source: PubMed

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