The acute psychobiological impact of the intensive care experience on relatives

Abstract

There is a growing awareness amongst critical care practitioners that the impact of intensive care medicine extends beyond the patient to include the psychological impact on close family members. Several studies have addressed the needs of relatives within the intensive care context but the psychobiological impact of the experience has largely been ignored. Such impact is important in respect to health and well-being of the relative, with potential to influence patient recovery. The current feasibility study aimed to examine the acute psychobiological impact of the intensive care experience on relatives. Using a mixed methods approach, quantitative and qualitative data were collected simultaneously. Six relatives of patients admitted to the intensive care unit (ICU) of a District General Hospital, were assessed within 48 h of admission. Qualitative data were provided from semi-structured interviews analysed using interpretative phenomenological analysis. Quantitative data were collected using a range of standardised self-report questionnaires measuring coping responses, emotion, trauma symptoms and social support, and through sampling of diurnal salivary cortisol as a biomarker of stress. Four themes were identified from interview: the ICU environment, emotional responses, family relationships and support. Questionnaires identified high levels of anxiety, depression and trauma symptoms; the most commonly utilised coping techniques were acceptance, seeking support through advice and information, and substance use. Social support emerged as a key factor with focused inner circle support relating to family and ICU staff. Depressed mood and avoidance were linked to greater mean cortisol levels across the day. Greater social network and coping via self-distraction were related to lower evening cortisol, indicating them as protective factors in the ICU context. The experience of ICU has a psychological and physiological impact on relatives, suggesting the importance of identifying cost-effective interventions with evaluations of health benefits to both relatives and patients.

Symptoms of Cardiac Anxiety in Family Members of Intensive Care Unit Patients

“…Of note, family members of critically ill patients experienced cardiac anxiety during the first 3 days of the patient's hospitalization, and this anxiety should be taken into account by ICU doctors and nurses. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] To some extent, our results support previous findings 9-11 that family members of ICU patients experience acute stress, anxiety, depression, and stress-related disorders. Indeed, having a loved one close to death is a great burden and increases the psychological symptoms among the family members of patients in critical care units.…”

“…Indeed, having a loved one close to death is a great burden and increases the psychological symptoms among the family members of patients in critical care units. [5][6][7][8][9][10][11][12][13][14][15] These psychological symptoms are explained in terms of severity of the patient's illness and the family members' fear of the patient's death. 10 However, our findings provide additional information on the biopsychological reactions among families of ICU patients.…”

“…11 However, despite the efforts to establish the psychological distress of family members within the context of the ICU, the psychobiological distress of this experience has been ignored to a great degree. 15 Because of the potential seriousness of the physical and psychological stress, a specific subtype of anxiety, heart-focused anxiety (HFA), might affect family members of critical care patients. HFA is defined as "a fear of cardiac-related events and sensations based on perceived harmful consequences."…”

Family members’ experiences in adult intensive care units: a systematic review

“…Kentish‐Barnes's study conducted in France contributed majority of the participants; it involved 242 family members from 22 ICUs across France. The results in this review were based on findings primarily from qualitative research designs with some results from mixed methods studies using semi‐structured interviews and questionnaire (see Table ).…”

Endovascular therapy after acute ischaemic stroke—Experiences and needs of relatives

“…In line with that, Brereton concludes that a framework for the preparation of carers needs to be developed in order to enable caregivers to feel recognised as important in the caregiving role (Brereton & Nolan, 2000). Although researchers recognise that hospitalisation is a stressful event for the implicated (Eggenberger & Nelms, 2007;Turner-Cobb, Smith, Ramchandani, Begen, & Padkin, 2016;Vandall-Walker, Jensen, & Oberle, 2007), no recent studies and only a few were found that focused on the immediate emotional and social needs of relatives of stroke patients in hospital. Relatives of hospitalised stroke patients need information, counselling and access to health professionals according to Van der Smagt-Duijnstee, Hamers, and Abu-Saad (2000), and Brereton adds that during the early stages, the relatives needs for information were most apparent but also least well addressed (Brereton & Nolan, 2000); yet, Smagt-Duijnstee et al based their conclusion on a qualitative study raising questions like "Did you have contact with nurses on the ward?…”