Emotional Experiences and Coping Strategies of Family Members of Critically Ill Patients

Abstract

BACKGROUND: Two out of three family members experience symptoms of posttraumatic stress, depression, or anxiety lasting for months after the ICU stay. Interventions aimed at mitigating these symptoms have been unsuccessful.RESEARCH QUESTION: To understand the emotional experiences of family members of critically ill patients and to identify coping strategies used by family members during the ICU stay.STUDY DESIGN: and Methods: As part of a mixed methods study to understand sources of distress among ICU family members, semistructured interviews were conducted with ICU family members. Family members completed surveys at the time of interview and at 90 days to assess for symptoms of depression, anxiety, and posttraumatic stress.RESULTS: Semistructured interviews and baseline surveys were conducted with 40 ICU family members; 78% of participants (n ¼ 31) completed follow-up surveys at 90 days. At the time of interview, 65% of family members had symptoms of depression, anxiety, or posttraumatic stress. At 90 days, 48% of surveyed family members had symptoms of psychological distress. Three primary emotions were identified among ICU family members: sadness, anger, and fear. A diverse array of coping strategies was used by family members, including problemsolving, information seeking, avoidance/escape, self-reliance, support seeking, and accommodation.INTERPRETATION: This study emphasizes similarities in emotions but diversity in coping strategies used by family members in the ICU. Understanding the relationship between ICU experiences, emotional responses, and long-term psychological outcomes may guide targeted interventions to improve mental health outcomes of ICU family members.

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

“…This condition is termed PICS-F (family). PICS-F was observed in 48% of family members approximately 90 days after ICU stay with 13% of depression, 29% anxiety, and 39% PTSD [24]. The causes of PICS-F are classified into critical-illnessrelated, ICU-related, and healthcare system-related factors.…”

“…The causes of PICS-F are classified into critical-illnessrelated, ICU-related, and healthcare system-related factors. After critical illness, the family experiences negative psychological sequelae owing to the emotional change, such as sadness induced by seeing the patient critically ill, anger toward disease, and fear of losing the patient [24]. In these conditions, the decision-making role causes severe psychological stress, especially about end-of-life decisions [25].…”

Toward Personalizing Family Support in the ICU

“…Family coping strategies has been postulated as one potential mediator and mitigator of these adverse psychological outcomes in family caregivers. 10 In this issue of CHEST, Harlan et al 11 describe the emotional experiences and coping strategies of family members of critically ill adults within the context of psychological symptoms during and after the ICU. In a study sample of 40 adult family members of patients who had received at least 3 days of mechanical ventilation, the investigators conducted semistructured interviews to elicit the subjective experiences of the participants.…”

“…12 In their rigorous analysis of the semistructured interviews, the investigators coded three categories of emotions expressed by family members (sadness, anger, and fear), even though the experiences that produced the emotions were quite varied. 11 Much has been written previously about the importance of attending carefully to both the cognitive and affective domains during structured communication encounters with families. 13,14 Most cognitive roadmaps that teach physicians how to conduct family meetings during serious illness acknowledge the importance of tracking and explicitly attending to these emotional cues.…”

“…15 The behavioral, cognitive, and social effects of trauma in families challenge us to move toward approaches to support families that aspire to ensure psychological safety, build trust and solidarity, and sustain deep affective regard (positive feelings) for the families. 16 An important implication of the study by Harlan et al 11 is that many of the interventions aimed at improving psychological outcomes in ICU families may not be congruent with families' coping strategies. The investigators coded various coping strategies and distilled them into six key categories.…”