Symptoms of Anxiety, Depression, and Stress among Families of Critically Ill Patients with COVID-19: A Longitudinal Clinical Trial

Abstract

Rationale Families of critically ill patients with coronavirus disease (COVID-19) may be at particularly high risk for anxiety, depression, and post-traumatic stress disorder after hospital discharge. Objectives To assess symptoms of anxiety, depression, and stress among families of patients with COVID-19 during and after intensive care unit (ICU) admissions and to use qualitative methods to determine the sources of emotional distress. Methods Families of patients with COVID-19 who participated in an ICU study were approached for participation in this post–hospital discharge study. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Impact of Events Scale–Revised (IES-R) at up to three points during the ICU stay and once after the ICU stay. Mixed-effects models were used to compare trajectories of HADS and IES-R scores over the ICU and post-ICU periods. Telephone interviews with participants were evaluated using thematic content analysis. Results Among the 90 families that participated from September 2020 to April 2021, 47 respective patients were alive and 43 were deceased. Average HADS anxiety, HADS depression, and IES-R scores after hospital discharge were significantly higher (greater symptom burden) among families of deceased versus surviving patients: 9.2 (95% confidence interval [CI], 7.8–10.6) versus 6.3 (95% CI, 4.9–7.6) ( P < 0.01), 7.1 (95% CI, 5.7–8.6) versus 3.2 (95% CI, 2.3–4.1) ( P < 0.001), and 36.1 (95% CI, 31.0–41.2) versus 20.4 (95% CI, 16.1–24.8) ( P < 0.001), respectively. HADS anxiety and HADS depression scores began to diverge during the ICU stay, whereas IES-R scores diverged after the stay for families of surviving versus deceased patients. Qualitative analysis confirmed a higher burden of psychological symptoms among families of deceased patients. Memories from the ICU stay became a focal point for participants who lost their loved ones, whereas families of surviving patients were able to look positively toward the future. In addition, families of deceased patients often viewed friends and family as sources of stress, whereas families of surviving patients typically viewed their community as a source of support. Conclusions Patient death was associated with symptoms of anxiety, depression, and post-traumatic stress disorder among families of ICU patients with COVID-19. Psychological support interventions may be most beneficial for families of patients who died of COVID-19. Clinical trial registered with www.clinicaltrials.gov (NCT 04501445).

Bienestar psicológico de las familias de pacientes COVID-19 tras la enfermedad: Revisión Sistemática

“…Ahora bien, en cuanto a los estudios de corte longitudinal, se examinaron 8 estudios los cuales llevaron a cabo un seguimiento de las familias de pacientes sobrevivientes de COVID-19 3, 4, 6 y 12 meses después del alta de la UCI en donde se midieron de igual manera las variables trastorno de estrés postraumático, ansiedad, depresión, calidad de vida, espiritualidad, estrés, resiliencia, funcionamiento familiar y variables demográficas (Azoulay et al, 2022;Heesakkers et al, 2022;van Veenendaal et al, 2021;Onrust et al, 2022;Amass et al, 2022;Sarigiannis et al, 2023;Vincent et al, 2021;Lovik et al, 2023) 3 de los estudios identificaron presencia de sintomatología de ansiedad, depresión y trastorno de estrés postraumático en los familiares a los 3 meses de seguimiento (Heesakkers et al, 2022;Azoulay et al, 2022;Vincent et al, 2021), de éstos uno realizó un seguimiento a los 12 meses y los resultados mostraron que hubo una prevalencia significativamente más alta de los síntomas de ansiedad y depresión en comparación al inicio, aunque la más alta fue a los 3 meses, lo mismos fue para la sintomatología de TEPT; estos factores de riesgo se correlacionaron negativamente con el nivel de calidad de vida de los familiares la cual fue significativamente más baja a los 3 y 12 meses de seguimiento (Heesakkers et al, 2022), de la misma manera Lovik et al, (2023) señalaron la presencia de ansiedad y depresión hasta 12 meses después del alta.…”

“…Los 26 artículos elegidos para este estudio representan los únicos trabajos realizados a nivel internacional hasta el momento sobre el análisis y descripción del impacto en el bienestar psicológico de las familias de sobrevivientes de COVID-19 durante y/o después de la recuperación de su familiar en la UCI o en el hogar. 3 de los 26 estudios se llevaron a cabo en Italia, (Bassi et al, 2021;Bartoli et al, 2021;Picardi et al, 2021) 3 en los Países Bajos (Heesakers et al, 2022;van Veenendaal et al, 2021;Onrust et al, 2022), 1 en Francia (Azoulay et al, 2022), 4 en Estados Unidos (Chen et al, 2021;Robinson-Lane et al, 2022;Amass et al, 2022;Sarigiannis et al, 2023) 1 en Japón (Shirasaki et al, 2022), 1 en Pakistán (Mansoor, Mansoor & Zubair, 2020) 6 en Irán (Jafari-Oori et al, 2021;Mirzaei et al, 2020;Rahimi, Dastyar & Rafati, 2021;Sheikhbardsiri et al, 2022;Akbarbegloo & Sanaeefar, 2022;Asgari et al, 2021), 1 en India (Prakash et al, 2021), 1 en España (Mestres-Soler et al, 2022), 1 en Perú (Chávez-Sosa et al, 2022), 1 en Suiza (Vincent et al, 2021) 1 estudió efectuado en 3 países: Reino Unido, India y los Emiratos Árabes Unidos (Sha et al, 2021) 1 estudio realizado en dos países: Estados Unidos e India (Sethi et al, 2022) y 1 estudio efectuado en 4 países: Islandia, Noruega, Suecia y Reino Unido (Lovik et al, 2023). 8 de los 26 estudios fueron estudios de cohortes, 9 estudios transversales y 9 estudios de corte cualitativo.…”

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

“…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.…”

“…Sarigiannis and colleagues (pp. 705–712 ) enrolled 90 families at one hospital and assessed depression, anxiety, and post-traumatic stress while their loved one was in the ICU as well as 6 months after discharge ( 2 ).…”