A recent study shows that family members of patients hospitalized in the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 (COVID-19) have a higher risk of posttraumatic stress disorder (PTSD) compared to families of patients hospitalized with non-COVID associated ARDS, further highlighting the vast mental toll the respiratory disease takes on everybody. The findings appeared in JAMA.
Among patients hospitalized with COVID, one in five require treatment in the ICU. Those who survive often suffer physical, mental, and psychiatric symptoms. It is also known that family members of patients with ARDS incur a significant psychological burden, including anxiety, depression, and PTSD. However, as the study investigators noted, little is known about the specific experience of COVID-19 with respect to the mental well-being of family members.
Assessment and Findings
In this prospective cohort study, researchers focused on 23 ICUs in France from January 2020 to June 2020 (final follow-up concluded in October 2020). In total, the analysis enrolled 602 family members, and 307 patients. The primary endpoint of interest was stipulated as family member symptoms of PTSD at 90 days after ICU discharge, which they measured using the Impact of Events Scale-Revised scoring system, with 0 (best score) to 88 (worst score).
Secondary outcomes of interest were family member symptoms of anxiety and depression at 90 days, which was assessed utilizing the Hospital Anxiety and Depression Scale [0 (best) to 42 (worst)]. The investigators used to multivariable logistic regression models to discern the link between COVID-19 status and outcomes.
According to the results, compared with non–COVID-19 ARDS, family members of patients with COVID-19 ARDS had a markedly higher prevalence of symptoms of PTSD (35% vs 19%), symptoms of anxiety (41% vs 34%), and symptoms of depression (31% vs 18%). Subsequent to adjusting for age, sex, and level of social support, the investigators observed that COVID-19 ARDS was significantly associated with increased risk of PTSD-related symptoms in family members.
Limitations and Conclusion
The researchers noted five limitations to this analysis:
- First, being that the patients were admitted early on in pandemic, the results may not apply to subsequent seasons or family resilience as the pandemic persisted.
- Second, because all participating ICUs belong to a research network with significant experience in enhancing family care in the ICU, it may underestimate ICUs that don’t put as high an emphasis on family care.
- Third, the study exclusively focused on ICUs in France; therefore, the findings may not correlate to countries with different ICU staffing, COVID protocols, and cultural approaches.
- Fourth, not all patients met the strict criteria for ARDS.
- Fifth, the study did not analyze responses from ICU clinical staff, which limited responses to only patients and family members.
“Among family members of patients hospitalized in the ICU with ARDS, COVID-19 disease, as compared with other causes of ARDS, was significantly associated with increased risk of symptoms of PTSD at 90 days after ICU discharge,” the researchers concluded.
— Martijn A. Spruit (@pulmonary_rehab) February 18, 2022
The impact of Covid-19 on patients and families is felt long after discharge home. #PTSD
Association of COVID-19 Acute Respiratory Distress Syndrome With Symptoms of Posttraumatic Stress Disorder in Family Members After ICU Discharge | JAMA | JAMA Network https://t.co/UYLh1dwyp6
— Sarah Bernstein, MD, MHA, FAAP (@sbernsteinmd) February 18, 2022