Posttraumatic stress and complicated grief in family members of patients in the intensive care unit
Open accessAbstract
Background Family members of patients in intensive care units (ICUs) are at risk for mental health morbidity both during and after a patient's ICU stay.Objectives To determine prevalences of and factors associated with anxiety, depression, posttraumatic stress and complicated grief in family members of ICU patients.Design Prospective, longitudinal cohort study.Participants Fifty family members of patients in ICUs at a large university hospital participated.Measurements We used the Control Preferences Scale to determine participants' role preferences for surrogate decision-making. We used the Hospital Anxiety and Depression Scale, Impact of Event Scale, and Inventory of Complicated Grief to measure anxiety and depression (at enrollment, 1 month, 6 months), posttraumatic stress (6 months), and complicated grief (6 months).Results We interviewed all 50 participants at enrollment, 39 (78%) at 1 month, and 34 (68%) at 6 months. At the three time points, anxiety was present in 42% (95% CI, 29-56%), 21% (95% CI, 10-35%), and 15% (95% CI, 6-29%) of participants. Depression was present in 16% (95% CI, 8-28%), 8% (95% CI, 2-19%), and 6% (95% CI, 1-18%). At 6 months, 35% (95% CI, 21-52%) of participants had posttraumatic stress. Of the 38% who were bereaved, 46% (95% CI, 22-71%) had complicated grief. Posttraumatic stress was not more common in bereaved than nonbereaved participants, and neither posttraumatic stress nor complicated grief was associated with decision-making role preference or with anxiety or depression during the patient's ICU stay.Conclusions Symptoms of anxiety and depression diminished over time, but both bereaved and nonbereaved participants had high rates of posttraumatic stress and complicated grief. Family members should be assessed for posttraumatic stress and complicated grief.
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The circumstances of ICU family surrogates heighten their risk of anxiety, depression, PTSD, Prolonged Grief Disorder, and decisional regret about the care the patient received.
“These circumstances heighten surrogates' risk of anxiety, depression, Posttraumatic Stress Disorder (PTSD), Prolonged Grief Disorder, and decisional regret about the care that the patient received (2-10).”
From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [5]
The Results and Discussion report anxiety, depression, posttraumatic stress symptoms, and complicated grief among ICU patients’ family members. The paper measures symptoms rather than establishing PTSD or Prolonged Grief Disorder diagnoses, and it does not report decisional regret about the care patients received. (LLM, conf=0.88)
Experimental — accuracy not yet measuredICU surrogates are at heightened risk for poor psychological outcomes.
“Given that ICU surrogates are at heightened risk for poor psychological outcomes [3, 4], there have been calls for interventions that can help ICU surrogates cope throughout the illness course, from ICU admission through discharge or bereavement, in order to improve surrogate mental health [5].”
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Impact of Event Scale: A Measure of Subjective Stress
Horowitz, M., Wilner, N., & Alvarez, W. (1979) · Psychosomatic Medicine · doi:10.1097/00006842-197905000-00004 · Cited by 7,813 · see citing works
Herrmann, C. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00216-4 · Cited by 2,885 · see citing works
Inventory of complicated grief: a scale to measure maladaptive symptoms of loss.
Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J., & Miller, M. (1995) · Psychiatry Research · doi:10.1016/0165-1781(95)02757-2 · Cited by 1,582 · see citing works
Structured Clinical Interview for DSM-III-R Personality Disorders
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2012) · PsycTESTS Dataset · doi:10.1037/t07827-000 · Cited by 1,403 · see citing works
Risk of post-traumatic stress symptoms in family members of intensive care unit patients
Azoulay, E., Pochard, F., Kentish-Barnes, N., Chevret, S., Aboab, J., Adrie, C., Annane, D., Bleichner, G., Bollaert, P. E., Darmon, M., et al. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200409-1295oc · Cited by 1,332 · see citing works
A communication strategy and brochure for relatives of patients dying in the ICU.
Lautrette, A., Darmon, M., Megarbane, B., Joly, L. M., Chevret, S., Adrie, C., Barnoud, D., Bleichner, G., Bruel, C., Choukroun, G., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa063446 · Cited by 1,279 · see citing works
Treatment of Complicated Grief: A Randomized Controlled Trial
Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005) · JAMA · doi:10.1001/jama.293.21.2601 · Cited by 1,097 · see citing works
Decision making during serious illness: What role do patients really want to play?
Degner, L. F., & Sloan, J. A. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90110-9 · Cited by 1,012 · see citing works
Degner, L. F., Sloan, J. A., & Venkatesh, P. (1997) · PsycTESTS Dataset · doi:10.1037/t22188-000 · Cited by 919 · see citing works
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.1.22 · Cited by 736 · see citing works
Pochard, F., Azoulay, É., Chevret, S., Lemaire, F., Hubert, P., Canouï, P., Grassin, M., Zittoun, R., Gall, J. L., Dhainaut, J. F., et al. (2001) · Critical Care Medicine · doi:10.1097/00003246-200110000-00007 · Cited by 714 · see citing works
Impact of Event Scale: psychometric properties
Sundin, E., & Horowitz, M. J. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.180.3.205 · Cited by 689 · see citing works
The Control Preferences Scale.
Degner, L. F., Sloan, J. A., & Venkatesh, P. (1997) · PubMed · Cited by 555 · see citing works
Pochard, F., Darmon, M., Fassier, T., Bollaert, P., Cheval, C., Coloigner, M., Merouani, A., Moulront, S., Pigné, E., Pingat, J., et al. (2005) · Journal of critical care · doi:10.1016/j.jcrc.2004.11.004 · Cited by 458 · see citing works
Posttraumatic Stress Disorder: Etiology, Epidemiology, and Treatment Outcome
Keane, T. M., Marshall, A. D., & Taft, C. T. (2006) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.2.022305.095305 · Cited by 368 · see citing works
Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C. F., Shear, M. K., Newsom, J. T., & Jacobs, S. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.11.1484 · Cited by 350 · see citing works
Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care
Jones, C., Skirrow, P. M., Griffiths, R. D., Humphris, G., Ingleby, S., EDDLESTON, J. M., Waldmann, C. S., & Gager, M. (2004) · Intensive Care Medicine · doi:10.1007/s00134-003-2149-5 · Cited by 340 · see citing works
A case for establishing complicated grief as a distinct mental disorder in DSM-V
Lichtenthal, W. G., Cruess, D. G., & Prigerson, H. G. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.07.002 · Cited by 331 · see citing works
Decision-making in the ICU: perspectives of the substitute decision-maker
Heyland, D. K., Cook, D. J., Rocker, G. M., Dodek, P., Kutsogiannis, D. J., Peters, S., Tranmer, J. E., & O'Callaghan, C. J. (2003) · Intensive Care Medicine · doi:10.1007/s00134-002-1569-y · Cited by 293 · see citing works
Psychiatric illness in the next of kin of patients who die in the intensive care unit
Siegel, M. D., Hayes, E., Vanderwerker, L. C., Loseth, D. B., & Prigerson, H. G. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e318174da72 · Cited by 292 · see citing works
Family Decision-Making to Withdraw Life-Sustaining Treatments From Hospitalized Patients
Tilden, V. P., Tolle, S. W., Nelson, C. A., & Fields, J. (2001) · Nursing Research · doi:10.1097/00006199-200103000-00006 · Cited by 233 · see citing works
Caring for Bereaved Patients: "All the Doctors Just Suddenly Go"
Prigerson, H. G., & Jacobs, S. C. (2001) · JAMA · doi:10.1001/jama.286.11.1369 · Cited by 200 · see citing works
Heyland, D. K., Rocker, G. M., O'Callaghan, C. J., Dodek, P., & Cook, D. J. (2003) · CHEST Journal · doi:10.1378/chest.124.1.392 · Cited by 197 · see citing works
Influence of traumatic grief on suicidal ideation among young adults
Prigerson, H. G., Bridge, J., Maciejewski, P. K., Beery, L. C., Rosenheck, R. A., Jacobs, S. C., Bierhals, A. J., Kupfer, D. J., & Brent, D. A. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.12.1994 · Cited by 190 · see citing works
Informal Caregiver Burden among Survivors of Prolonged Mechanical Ventilation
Pelt, D. C. V., Milbrandt, E. B., Li, Q., Weissfeld, L. A., Rotondi, A. J., Schulz, R., Chelluri, L., Angus, D. C., & Pinsky, M. R. (2006) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200604-493oc · Cited by 173 · see citing works
Self-citationAnderson, W. G., Arnold, R. M., Angus, D. C., & Bryce, C. L. (2009) · Journal of Critical Care · doi:10.1016/j.jcrc.2007.12.010 · Cited by 156 · see citing works
Self-citationTraumatic Grief Treatment: A Pilot Study
Shear, M. K., Frank, E., Foa, E. B., Cherry, C., Reynolds, C. F., Bilt, J. V., & Masters, S. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.9.1506 · Cited by 156 · see citing works
Vanderwerker, L. C., Jacobs, S., Parkes, C. M., & Prigerson, H. G. (2006) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000198146.28182.d5 · Cited by 120 · see citing works
Tylee, A. T., & Walters, P. (2007) · PubMed · Cited by 85 · see citing works
Assessing and Treating Depression in Primary Care Medicine
Gelenberg, A. J., & Hopkins, H. S. (2007) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.05.059 · Cited by 42 · see citing works
Development and Validation of an Instrument for the Assessment of Dependency Among Bereaved Persons
Johnson, J. G., Vanderwerker, L. C., Bornstein, R. F., Zhang, B., & Prigerson, H. G. (2006) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-005-9016-3 · Cited by 32 · see citing works
The Management of Post Traumatic Stress Disorder (PTSD) in the Primary Care Setting
Bobo, W. V., Warner, C. H., & Warner, C. M. (2007) · Southern Medical Journal · doi:10.1097/smj.0b013e31812f6ee5 · Cited by 17 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [33]33. First M, Spitzer R, Gibbon M. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-1/P, Version 2.0). New York: Bio- metrics Research Department, New York State Psychiatric Institute; 1995
Cited by
Sorted by citations
Family response to critical illness: Postintensive care syndrome–family
Davidson, J. E., Jones, C., & Bienvenu, O. J. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e318236ebf9 · Cited by 936 · see citing works
Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis
Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O’Connor, M. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.01.030 · Cited by 876 · see citing works
Wright, A. A., Keating, N. L., Balboni, T. A., Matulonis, U. A., Block, S. D., & Prigerson, H. G. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.26.3863 · Cited by 797 · see citing works
Complicated grief after death of a relative in the intensive care unit
Kentish-Barnes, N., Chaize, M., Seegers, V., Legriel, S., Cariou, A., Jaber, S., Lefrant, J.-Y., Floccard, B., Renault, A., Vinatier, I., et al. (2015) · European Respiratory Journal · doi:10.1183/09031936.00160014 · Cited by 347 · see citing works
Complicated Grief: What to Expect After the Coronavirus Pandemic
Gesi, C., Carmassi, C., Cerveri, G., Carpita, B., Cremone, I. M., & Dell'Osso, L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00489 · Cited by 207 · see citing works
Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers
McCurley, J. L., Funes, C. J., Zale, E. L., Lin, A., Jacobo, M., Jacobs, J. M., Salgueiro, D., Tehan, T., Rosand, J., & Vranceanu, A.-M. (2019) · Neurocritical Care · doi:10.1007/s12028-018-0641-6 · Cited by 171 · see citing works
Wagner, B., Müller, J., & Maercker, A. (2012) · European Psychiatry · doi:10.1016/j.eurpsy.2010.12.003 · Cited by 67 · see citing works
Chen, C., Michaels, J., & Meeker, M. A. (2020) · Journal of Palliative Care · doi:10.1177/0825859719874767 · Cited by 34 · see citing works
Prigerson, H. G., Viola, M., Brewin, C. R., Cox, C., Ouyang, D., Rogers, M., Pan, C. X., Rabin, S., Xu, J., Vaughan, S., et al. (2019) · Trials · doi:10.1186/s13063-019-3515-0 · Cited by 23 · see citing works
Lichtenthal, W. G., Viola, M., Rogers, M., Roberts, K. E., Lief, L., Cox, C. E., Brewin, C. R., Xu, J. C., Maciejewski, P. K., Pan, C. X., et al. (2022) · Palliative and Supportive Care · doi:10.1017/s1478951521000626 · Cited by 23 · see citing works
“We highlight the role in coping of experiential avoidance, which is the natural tendency to avoid unpleasant feelings and consideration of negative outcomes (Plumb et al., 2004; Gamez et al., 2011, 2014) and which has been associated with PTSD and PGD (Marx and Sloan, 2005; Bishop et al., 2018; Williams et al., 2019;…”
InfluentialEMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU
Lichtenthal, W. G., Lief, L., Rogers, M., Russell, D., Viola, M., Winoker, H., Kakarala, S., Traube, C., Coats, T., Fadalla, C., et al. (2024) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2024.03.002 · Cited by 17 · see citing works
Surrogate end-of-life care decision makers' postbereavement grief and guilt responses
Lovell, G. P., Smith, T., & Kannis-Dymand, L. (2015) · Death Studies · doi:10.1080/07481187.2015.1047062 · Cited by 13 · see citing works
- Authors
- Anderson, W. G., Arnold, R. M., Angus, D. C., & Bryce, C. L.
- Affiliations
- University of California, San Francisco (US)
- University of Pittsburgh (US)
- Corresponding author
- Anderson, Wendy G.
- Venue
- Journal of General Internal Medicine
- Published
- 2008-09-09
- Volume
- 23
- Issue
- 11
- Pages
- 1871-1876
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2585673
- OpenAlex
- W2160980183
- Semantic Scholar
- 7aa41f577805a2a62e8b11dde2321e7ebcbf436c
- Cited by
- 373
- References
- 33
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 27 · 2023: 20 · 2022: 19 · 2021: 33 · 2020: 26 · 2019: 21 · 2018: 21 · 2017: 26 · 2016: 26 · 2015: 41 · 2014: 21 · 2013: 16 · 2012: 19
- FWCI
- 22.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Greenwall Foundation
- Open Society Institute
- University of Pittsburgh
- National Institutes of Health (UL1TR000005)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- post-traumatic stress, complicated grief, family caregivers, intensive care unit, anxiety, depression, bereavement, surrogate decision-making, family mental health
- MeSH terms
- Adult, Aged, Anxiety, Depression, Family, Female, Grief, Hospitals, University, Humans, Intensive Care Units, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Pennsylvania, Stress Disorders, Post-Traumatic, Prevalence
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