Prolonged Grief Disorder in the Next of Kin of Adult Patients Who Die During or After Admission to Intensive Care

Abstract

To the EditorAlthough loss and grief are ubiquitous human experiences, prolonged grief disorder (PGD) stands apart as a serious psychiatric condition.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 2Boelen PA Prigerson HG The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study.Eur Arch Psychiatry Clin Neurosci. 2007; 257: 444-452Crossref PubMed Scopus (206) Google Scholar Individuals with PGD are more likely to have worse quality of life, be impaired at work and in their social lives, suffer psychologically, and be suicidal.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 2Boelen PA Prigerson HG The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study.Eur Arch Psychiatry Clin Neurosci. 2007; 257: 444-452Crossref PubMed Scopus (206) Google ScholarGiven the elevated prevalence of psychiatric symptoms in next of kin (NOK) during and after a patient's stay in the ICU,3Chen JH Bierhals AJ Prigerson HG Kasl SV Mazure CM Jacobs S Gender differences in the effects of bereavement-related psychological distress in health outcomes.Psychol Med. 1999; 29: 367-380Crossref PubMed Scopus (198) Google Scholar, 4Pochard F Darmon M Fassier T French FAMIREA study group et al.Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study.J Crit Care. 2005; 20: 90-96Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar we hypothesized that following the death of a loved one, NOK would be at particular risk of developing diagnosable PGD. We sought to determine the point prevalence rate of PGD in NOK during the 1- to 2-year period following the death of an adult with multiorgan failure who had been admitted to an ICU. In our prospective cohort study conducted at a tertiary referral hospital in Toledo, Spain, we assessed all NOK of patients who subsequently died in the ICU or on hospital wards or in the first 6 months after discharge from the ICU. In order to include NOK of those dying in a nonhospital setting, patients were followed up for 6 months after discharge. We used the psychometrically validated consensus criteria for PGD.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 5Prigerson HG Maciejewski PK A call for sound empirical testing and evaluation of criteria for complicated grief proposed for the DSM-V. Symposium on Complicated Grief.Omega. 2005; 52: 16Google Scholar, 6Prigerson HG Maciejewski PK Reynolds III, CF et al.Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss.Psychiatry Res. 1995; 59: 65-79Abstract Full Text PDF PubMed Scopus (1068) Google ScholarA total of 151 NOK were assessed for an average of 22.1 (SD, 5.3) months after the patient's death. In 62.8% of cases, the NOK was the deceased's son or daughter, in 17% the partner/spouse, in 12.8% a sibling, and in 5.3% a parent; in 2.1% of cases another relative was contacted or a friend/neighbor was the NOK. Eleven NOK of patients who died in the ICU (10.3%) met the criteria for PGD (Table 1). NOK who met the criteria for PGD significantly accessed psychiatric services more frequently (72.7%; P < .01) than did those who did not meet the criteria for PGD (8.3%). They were also significantly more dissatisfied (57.1% vs 27.6%; P < .05) with the care received in the ICU. Following deaths among patients who had been admitted to an ICU in a Spanish hospital, PGD appears to occur in approximately 10% of NOK 1 to 2 years after death and is associated with accessing psychiatric services and a greater dissatisfaction with ICU care.Table 1Comparison Between NOK With and Without PGDVariableNOK Without PGD (n =96)NOK With PGD (n =11)P ValueDeceased patient data Male61 (63.5)10 (90.9)NS Modified Rankin Scale1.7±1.21.3±1.2NS Place of death ICU59 (63.4)8 (88.9)… Ward21 (22.6)1 (11.1)… Home4 (4.3)0 (0)… ICU readmission3 (3.2)0 (0)… Ward readmission6 (6.5)0 (0)NSNOK data Person contacted Parent4 (5.2)1 (9.1)… Partner/spouse12 (15.6)4 (36.4)… Child (>18 y old)50 (64.9)5 (45.5)… Sibling9 (11.7)1 (9.1)… Other2 (2.6)0 (0)NS Existence of financial dependent(s) (including minors or disabled or elderly persons)26 (27.1)6 (54.5)NS NOK having accessed psychiatric services since the patient's death8 (8.3)8 (72.7)<.001 NOK's perceptions of the ICU experience Satisfaction55 (72.4)3 (42.9)… Dissatisfaction21 (27.6)4 (57.1)< .05Data are presented as No. (%) or mean ± SD. NOK = next of kin; NS = not significant; PGD = prolonged grief disorder. Open table in a new tab To the EditorAlthough loss and grief are ubiquitous human experiences, prolonged grief disorder (PGD) stands apart as a serious psychiatric condition.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 2Boelen PA Prigerson HG The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study.Eur Arch Psychiatry Clin Neurosci. 2007; 257: 444-452Crossref PubMed Scopus (206) Google Scholar Individuals with PGD are more likely to have worse quality of life, be impaired at work and in their social lives, suffer psychologically, and be suicidal.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 2Boelen PA Prigerson HG The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study.Eur Arch Psychiatry Clin Neurosci. 2007; 257: 444-452Crossref PubMed Scopus (206) Google ScholarGiven the elevated prevalence of psychiatric symptoms in next of kin (NOK) during and after a patient's stay in the ICU,3Chen JH Bierhals AJ Prigerson HG Kasl SV Mazure CM Jacobs S Gender differences in the effects of bereavement-related psychological distress in health outcomes.Psychol Med. 1999; 29: 367-380Crossref PubMed Scopus (198) Google Scholar, 4Pochard F Darmon M Fassier T French FAMIREA study group et al.Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study.J Crit Care. 2005; 20: 90-96Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar we hypothesized that following the death of a loved one, NOK would be at particular risk of developing diagnosable PGD. We sought to determine the point prevalence rate of PGD in NOK during the 1- to 2-year period following the death of an adult with multiorgan failure who had been admitted to an ICU. In our prospective cohort study conducted at a tertiary referral hospital in Toledo, Spain, we assessed all NOK of patients who subsequently died in the ICU or on hospital wards or in the first 6 months after discharge from the ICU. In order to include NOK of those dying in a nonhospital setting, patients were followed up for 6 months after discharge. We used the psychometrically validated consensus criteria for PGD.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 5Prigerson HG Maciejewski PK A call for sound empirical testing and evaluation of criteria for complicated grief proposed for the DSM-V. Symposium on Complicated Grief.Omega. 2005; 52: 16Google Scholar, 6Prigerson HG Maciejewski PK Reynolds III, CF et al.Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss.Psychiatry Res. 1995; 59: 65-79Abstract Full Text PDF PubMed Scopus (1068) Google ScholarA total of 151 NOK were assessed for an average of 22.1 (SD, 5.3) months after the patient's death. In 62.8% of cases, the NOK was the deceased's son or daughter, in 17% the partner/spouse, in 12.8% a sibling, and in 5.3% a parent; in 2.1% of cases another relative was contacted or a friend/neighbor was the NOK. Eleven NOK of patients who died in the ICU (10.3%) met the criteria for PGD (Table 1). NOK who met the criteria for PGD significantly accessed psychiatric services more frequently (72.7%; P < .01) than did those who did not meet the criteria for PGD (8.3%). They were also significantly more dissatisfied (57.1% vs 27.6%; P < .05) with the care received in the ICU. Following deaths among patients who had been admitted to an ICU in a Spanish hospital, PGD appears to occur in approximately 10% of NOK 1 to 2 years after death and is associated with accessing psychiatric services and a greater dissatisfaction with ICU care.Table 1Comparison Between NOK With and Without PGDVariableNOK Without PGD (n =96)NOK With PGD (n =11)P ValueDeceased patient data Male61 (63.5)10 (90.9)NS Modified Rankin Scale1.7±1.21.3±1.2NS Place of death ICU59 (63.4)8 (88.9)… Ward21 (22.6)1 (11.1)… Home4 (4.3)0 (0)… ICU readmission3 (3.2)0 (0)… Ward readmission6 (6.5)0 (0)NSNOK data Person contacted Parent4 (5.2)1 (9.1)… Partner/spouse12 (15.6)4 (36.4)… Child (>18 y old)50 (64.9)5 (45.5)… Sibling9 (11.7)1 (9.1)… Other2 (2.6)0 (0)NS Existence of financial dependent(s) (including minors or disabled or elderly persons)26 (27.1)6 (54.5)NS NOK having accessed psychiatric services since the patient's death8 (8.3)8 (72.7)<.001 NOK's perceptions of the ICU experience Satisfaction55 (72.4)3 (42.9)… Dissatisfaction21 (27.6)4 (57.1)< .05Data are presented as No. (%) or mean ± SD. NOK = next of kin; NS = not significant; PGD = prolonged grief disorder. Open table in a new tab Although loss and grief are ubiquitous human experiences, prolonged grief disorder (PGD) stands apart as a serious psychiatric condition.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 2Boelen PA Prigerson HG The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study.Eur Arch Psychiatry Clin Neurosci. 2007; 257: 444-452Crossref PubMed Scopus (206) Google Scholar Individuals with PGD are more likely to have worse quality of life, be impaired at work and in their social lives, suffer psychologically, and be suicidal.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 2Boelen PA Prigerson HG The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study.Eur Arch Psychiatry Clin Neurosci. 2007; 257: 444-452Crossref PubMed Scopus (206) Google Scholar Given the elevated prevalence of psychiatric symptoms in next of kin (NOK) during and after a patient's stay in the ICU,3Chen JH Bierhals AJ Prigerson HG Kasl SV Mazure CM Jacobs S Gender differences in the effects of bereavement-related psychological distress in health outcomes.Psychol Med. 1999; 29: 367-380Crossref PubMed Scopus (198) Google Scholar, 4Pochard F Darmon M Fassier T French FAMIREA study group et al.Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study.J Crit Care. 2005; 20: 90-96Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar we hypothesized that following the death of a loved one, NOK would be at particular risk of developing diagnosable PGD. We sought to determine the point prevalence rate of PGD in NOK during the 1- to 2-year period following the death of an adult with multiorgan failure who had been admitted to an ICU. In our prospective cohort study conducted at a tertiary referral hospital in Toledo, Spain, we assessed all NOK of patients who subsequently died in the ICU or on hospital wards or in the first 6 months after discharge from the ICU. In order to include NOK of those dying in a nonhospital setting, patients were followed up for 6 months after discharge. We used the psychometrically validated consensus criteria for PGD.1Prigerson HG Horowitz MJ Jacobs SC et al.Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11.PLoS Med. 2009; 6: e1000121Crossref PubMed Scopus (455) Google Scholar, 5Prigerson HG Maciejewski PK A call for sound empirical testing and evaluation of criteria for complicated grief proposed for the DSM-V. Symposium on Complicated Grief.Omega. 2005; 52: 16Google Scholar, 6Prigerson HG Maciejewski PK Reynolds III, CF et al.Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss.Psychiatry Res. 1995; 59: 65-79Abstract Full Text PDF PubMed Scopus (1068) Google Scholar A total of 151 NOK were assessed for an average of 22.1 (SD, 5.3) months after the patient's death. In 62.8% of cases, the NOK was the deceased's son or daughter, in 17% the partner/spouse, in 12.8% a sibling, and in 5.3% a parent; in 2.1% of cases another relative was contacted or a friend/neighbor was the NOK. Eleven NOK of patients who died in the ICU (10.3%) met the criteria for PGD (Table 1). NOK who met the criteria for PGD significantly accessed psychiatric services more frequently (72.7%; P < .01) than did those who did not meet the criteria for PGD (8.3%). They were also significantly more dissatisfied (57.1% vs 27.6%; P < .05) with the care received in the ICU. Following deaths among patients who had been admitted to an ICU in a Spanish hospital, PGD appears to occur in approximately 10% of NOK 1 to 2 years after death and is associated with accessing psychiatric services and a greater dissatisfaction with ICU care. Data are presented as No. (%) or mean ± SD. NOK = next of kin; NS = not significant; PGD = prolonged grief disorder.