One Year Later: Family Members of Patients with COVID-19 Experience Persistent Symptoms of Posttraumatic Stress Disorder

Abstract

Rationale Family members of critically ill patients with coronavirus disease (COVID-19) have described increased symptoms of posttraumatic stress disorder (PTSD). Little is known about how these symptoms may change over time. Objectives We studied changes in PTSD symptoms in family members of critically ill patients with COVID-19 over 12 months. Methods This prospective, multisite observational cohort study recruited participants at 12 hospitals in five states. Calls were made to participants at 3–4 months, 6 months, and 12 months after patient admission to the intensive care unit. Results There were 955 eligible family members, of whom 330 (53.3% of those reached) consented to participate. Complete longitudinal data was acquired for 115 individuals (34.8% consented). PTSD symptoms were measured by the IES-6 (Impact of Events Scale-6), with a score of at least 10 identifying significant symptoms. At 3 months, the mean IES-6 score was 11.9 ± 6.1, with 63.6% having significant symptoms, decreasing to 32.9% at 1 year (mean IES-6 score, 7.6 ± 5.0). Three clusters of symptom evolution emerged over time: persistent symptoms (34.8%, n = 40), recovered symptoms (33.0%, n = 38), and nondevelopment of symptoms (32.2%, n = 37). Although participants identifying as Hispanic demonstrated initially higher adjusted IES-6 scores (2.57 points higher [95% confidence interval (CI), 1.1–4.1; P < 0.001]), they also demonstrated a more dramatic improvement in adjusted scores over time (4.7 greater decrease at 12 months [95% CI, 3.2–6.3; P < 0.001]). Conclusions One year later, some family members of patients with COVID-19 continue to experience significant symptoms of PTSD. Further studies are needed to better understand how various differences contribute to increased risk for these symptoms.

Comorbid Prolonged Grief, PTSD, and Depression Trajectories for Bereaved Family Surrogates

“…Most existing studies among adults focus on symptom trajectories for PGD, 12 , 13 , 14 , 15 , 16 , 17 PTSD, 18 , 19 , 20 , 21 and depression 22 , 23 , 24 , 25 , 26 individually without considering concurrent changes in emotional distress from bereavement and traumatic events. However, distressed psychological grief reactions cooccur as the norm rather than the exception, 27 and resilience in 1 outcome (eg, PGD) may often coexist with deficits in other important outcomes (eg, PTSD or depression).…”

Our Fears Have Been Confirmed about Intensive Care Unit Families in 2020

“…This echoes an earlier study of ICU families conducted in 2020 that found that the prevalence of significant PTSD symptoms at 3 months was also 64% ( 3 ). Although the authors had previously reported that PTSD is highly prevalent among ICU family members at 3 months, the new study ( 1 ) reveals that the impact on many family members is sustained far beyond the ICU stay. Worse, although methodological differences make a direct comparison difficult, studies conducted before the pandemic reported prevalences of significant PTSD symptoms in ICU families of only 14% at discharge ( 4 ) and 19% at 3-month follow-up ( 5 ).…”

“…In this issue of AnnalsATS , there are two prospective cohort studies that assessed mental health symptoms in family members of adult intensive care unit (ICU) patients with COVID-19 in 2020 ( 1 , 2 ). Ambler and colleagues (pp.…”

“…Ambler and colleagues (pp. 713–720 ) assessed symptoms of post-traumatic stress disorder (PTSD) using the Impact of Event Scale-6 at 3, 6, and 12 months after death or ICU discharge among 115 family members at 12 U.S. hospitals ( 1 ). Sarigiannis and colleagues (pp.…”

“…These studies confirm what many of us feared during the initial phase of the COVID-19 pandemic: that the family members who no longer filled hospital halls and waiting rooms were quietly experiencing real and lasting harm. Ambler and colleagues observed significant symptoms of PTSD in 64%, 48%, and 33% of participating family members at 3-, 6-, and 12-month follow-up, respectively ( 1 ). In adjusted analyses, the people most likely to experience long-term PTSD symptoms were women with fewer years of formal education whose loved ones had long ICU stays and ultimately died.…”