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Cited by 61COVID-19 and Mental HealthFamily and Patient Care in Intensive Care UnitsPosttraumatic Stress Disorder Research

Stress-related disorders of family members of patients admitted to the intensive care unit with COVID-19

Open access
Amass, Timothy, Van Scoy, Lauren Jodi, Hua, May, Ambler, Melanie, Armstrong, Priscilla, Baldwin, Matthew R., Bernacki, Rachelle, Burhani, Mansoor D. +33 more·2022·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2022.1118PMC PMC9039825
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Abstract

Importance: The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined. Objective: To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission. Design, Setting, and Participants: This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states. Exposure: Having a family member in the ICU with COVID-19. Main Outcomes and Measures: Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6). Results: A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients' child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners. Conclusions and Relevance: In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.

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  • The COVID-19 pandemic further exacerbated the long-lasting mental health challenges among family surrogate decision-makers.

    “The growing body of research on Post Intensive Care Syndrome-Family (PICS-F) among family surrogate decision-makers acknowledges the long-lasting mental health challenges that result from this experience (3, 11), circumstances further exacerbated by the COVID-19 pandemic (8, 12).”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [12]

    The Conclusions report significant PTSD symptoms in family members 3 and 6 months after a COVID-19 ICU admission, more than in prepandemic populations. The Study Design defines participants as adult family members, not specifically surrogate decision-makers, so the source does not establish the claim for that narrower group. (LLM, conf=0.84)

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Cited by

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Authors
Amass, T., Van Scoy, L. J., Hua, M., Ambler, M., Armstrong, P., Baldwin, M. R., Bernacki, R., Burhani, M. D., Chiurco, J., Cooper, Z., Cruse, H., Csikesz, N., Engelberg, R. A., Fonseca, L. D., Halvorson, K., Hammer, R., Heywood, J., Duda, S. H., Huang, J., Jin, Y., Johnson, L., Tabata-Kelly, M., Kerr, E., Lane, T., Lee, M., Likosky, K., McGuirl, D., Milinic, T., Moss, M., Nielsen, E., Peterson, R., Puckey, S. J., Rea, O., Rhoads, S., Sheu, C., Tong, W., Witt, P. D., Wykowski, J., Yu, S., Stapleton, R. D., & Curtis, J. R.
Affiliations
  • VA Eastern Colorado Health Care System (US)
  • Departments of Medicine, Humanities and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
  • Columbia University (US)
  • University of Washington (US)
  • Columbia University Irving Medical Center (US)
  • Brigham and Women's Hospital (US)
  • University of Colorado Anschutz (US)
  • Tulane University (US)
  • South Shore Hospital (US)
  • Pennsylvania State University (US)
  • Colorado School of Public Health (US)
  • Evergreen Health Medical Center (US)
  • Center for Geriatric Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • Tufts University (US)
  • University of Vermont (US)
Corresponding author
Amass, Timothy
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2022-06-01
Volume
182
Issue
6
Pages
624
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2022.1118
PMC
PMC9039825
OpenAlex
W4224612672
Cited by
61
References
6
Citations by year
2026: 9 · 2025: 13 · 2024: 14 · 2023: 18 · 2022: 7
FWCI
11.87
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
post-traumatic stress disorder, family caregivers, family members of ICU patients, COVID-19 pandemic, intensive care unit, stress-related disorders, Impact of Event Scale, caregiver burden, gender differences, Hispanic caregivers, educational attainment, mental health during pandemic, coping strategies, social support
MeSH terms
COVID-19, Child, Family, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Stress Disorders, Post-Traumatic, Cohort Studies, Pandemics

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