Predicting intensive care relatives at risk of post traumatic stress disorder

Abstract

The aim of this study was to look at the proportion of relatives still anxious at 2 and 6 months post ICU discharge and the incidence of post traumatic stress disorder (PTSD). Anxiety amongst relatives of intensive care (ICU) patients is understandable while patients’ remain critically ill and 60% of relatives remain anxious at 2 weeks post ICU discharge.1 However the longer term psychological consequences of this degree of prolonged stress have not been examined. The closest relative of recovering ICU patients was approached once it was clear the patient was recovering and expected to survive to 6 months. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HAD) and vulnerability to PTSD using the Impact of Event Scale (IES). Fifty-four ICU patients and their closest relative were interviewed at 2 months, but only 38 relatives completed questionnaires at 6 months. All the patients had been intubated and had had an ICU stay ≥48 h with a median APACHE II score 16. While the level of anxiety amongst relatives was reduced from that seen at 2 weeks a third still remained very anxious at 2 and 6 months (see Table 13). IES scores at 6 months were predicted by the IES scores at 2 months and anxiety at 2 weeks and at 2 months (ANOVAP = 0.0001, 0.007, 0.05 respectively). Of the 20 relatives with high IES scores at 6 months, all reported intrusive memories of ICU and avoided reminders of the experience. All these relatives had been very anxious at 2 weeks post ICU; however 60% of relatives were anxious at this point. To increase the predictive power relatives with HAD anxiety scores of >13 at 2 weeks were examined; of these 12 had high IES scores at 6 months and three did not. This study suggests that anxiety levels amongst close relatives of ICU patients remains high for several months after discharge from ICU. The predictive power of early anxiety, particularly HAD scores >13, and the IES at 2 months for later psychological morbidity could allow the targeting of an intervention, such as counselling, with the aim of preventing the development of established PTSD in relatives of ICU patients.