Symptoms of Anxiety, Depression, and Stress among Families of Critically Ill patients with COVID-19: A Longitudinal Study.

Abstract

Families of critically ill patients with COVID-19 may be at particularly high risk for anxiety, depression, and post-traumatic stress disorder after hospital discharge. To assess symptoms of anxiety, depression, and stress among families of patients with COVID-19 during and after an intensive care unit (ICU) admission and to use qualitative methods to determine the sources of emotional distress. Families of patients with COVID-19 who participated in an ICU study were approached for participation in this post-hospital discharge study. Participants completed the Hospital Anxiety and Depression (HADS) and Impact of Events-Revised (IES-R) measures at up to three points during the ICU stay and once after the ICU stay. Mixed effects models were used to compare trajectories HADS and IES-R scores over the ICU and post-ICU periods. Telephone interviews with participants were evaluated using thematic content analysis. Of the 90 families who participated from September 2020 to April 2021, there were 47 respective patients who were alive and 43 who were deceased. Average HADS-anxiety, HADS-depression, and IES-R scores after hospital discharge were significantly higher (greater symptom burden) among families of deceased vs. surviving patients: 9.2 (95% CI 7.8 - 10.6) vs. 6.3 (95% CI 4.9 - 7.6), p<0.01; 7.1 (95% CI 5.7 - 8.6) vs. 3.2 (95% CI 2.3 - 4.1), p<0.001; and 36.1 (95% CI 31.0 - 41.2) vs. 20.4 (95% CI 16.1 - 24.8) , p<0.001, respectively. HADS-anxiety and HADS depression scores began to diverge during the ICU stay whereas IES-R scores diverged after the stay. Qualitative analysis confirmed higher burden of psychological symptoms among families of deceased patients. Memories from the ICU stay became a focal point for participants who lost their loved ones, whereas families of surviving patients were able to look positively toward the future. In addition, families of deceased patients often viewed friends and family as sources of stress, whereas families of surviving patients typically viewed their community as a source of support. Patient death was associated with symptoms of anxiety, depression, and PTSD among families of ICU patients with COVID-19. Psychological support interventions may be most beneficial for families of patients who died from COVID-19. Clinical trial registered with ClinicalTrials.gov (NCT04501445).