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Original Research: CRITICAL CARE MEDICINE |

Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members After Patient Death in the ICU

Cynthia J. Gries, MD, MSc; Ruth A. Engelberg, PhD; Erin K. Kross, MD; Doug Zatzick, MD; Elizabeth L. Nielsen, MPH; Lois Downey, MA; J. Randall Curtis, MD, MPH, FCCP
Author and Funding Information

From the University of Washington, Division of Pulmonary and Critical Care (Dr Gries); Division of Pulmonary and Critical Care (Drs Engelberg, Kross, and Curtis; Mss Nielsen and Downey), Department of Medicine, Department of Psychiatry and Behavioral Sciences (Dr Zatzick), the Harborview Medical Center, University of Washington, Seattle, WA

Correspondence to: J. Randall Curtis, MD, MPH, Harborview Medical Center, Box 359762, Seattle, WA 98104; e-mail: jrc@u.washington.edu


Funding/Support: This study was funded by a grant from the National Institute of Nursing Research [R01NR05226]; a grant from the National Center for Research Resources, a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research [5KL2RR025015-02]; and a grant from the Mills Family Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):280-287. doi:10.1378/chest.09-1291
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Background:  Patients’ deaths in the ICU have been associated with a high burden of psychologic symptoms in families. This study identifies characteristics associated with psychologic symptoms in family members.

Methods:  Families of patients dying in the ICU or within 30 h of ICU discharge in 11 hospitals previously participated in a randomized trial. In the current study, we assessed these families for symptoms of posttraumatic stress disorder (PTSD) and depression with follow-up surveys. Outcomes included validated measures of PTSD (PTSD Checklist) and depressive (Patient Health Questionnaire) symptoms. Predictors included family member mental-health history, involvement in decision making, and demographics.

Results:  Surveys were completed by 226 families. Response rate was 46% in the original randomized trial and 82% in this study. Prevalence (95% CI) of PTSD and depressive symptoms were 14.0% (9.7%-19.3%) and 18.4% (13.5%-24.1%), respectively. Family characteristics associated with increased symptoms included: female gender (PTSD, P = .020; depression, P = .005), knowing the patient for a shorter duration (PTSD, P = .003; depression, P = .040), and discordance between family members’ preferences for decision making and their actual decision-making roles (PTSD, P = .005; depression, P = .049). Depressive symptoms were also associated with lower educational level (P = .002). Families with psychologic symptoms were more likely to report that access to a counselor (PTSD, P < .001; depression, P = .003) and information about spiritual services might have been helpful while the patient was in the ICU (PTSD, P = .024; depression, P = .029).

Conclusions:  Families demonstrated a high prevalence of psychologic symptoms after a death in the ICU. Characteristics associated with symptoms may help target interventions to reduce these symptoms.

Trial registration:  clinicaltrials.gov; Identifier: NCT00685893.

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