PURPOSE: To evaluate the prevalence of anxiety, depression, and post-traumatic stress reactions among relatives of patients admitted to intensive care units (ICUs) in an inner-city hospital.
METHODS: Prospective observational study utilizing three well-validated instruments, the Beck Depression Inventory (BDI-II), Hospital Anxiety and Depression Scale (HADS), and Impact of Events Scale –Revised (IES-R). Questionnaires were administered to relatives at ≥ 48 hours following patient admission to our medical or surgical ICUs. Patients’ APACHE II scores and respondents’ demographic data were collected also.
RESULTS: Questionnaires were completed by a total of 164 relatives. The mean APACHE II score (for n=79) of the patients was 20.5 (range 7–36). The overall prevalence of anxiety symptoms (HADS-A score > 10) was 36.6%, while 35.4% had symptoms of at least mild depression (BDI-II > 13). The IES-R contains three domains and a total of 22 questions; responses range 0 to 4 for each and higher scores indicate more symptoms of acute stress reaction. Mean IES-R totals for each domain were 10.9 for intrusive thoughts, 9.1 for avoidance, and 7.3 for hyperarousal states, and mean cumulative score was 27.4. There was a trend toward a higher rate of depression in relatives of more severely ill patients (27.6% vs 42.9% for APACHE II < 25 vs ≥ 25, respectively), but this difference was not statistically significant.
CONCLUSION: Symptoms of anxiety and depression are common among relatives of ICU patients. The lack of a significant association between depressive symptoms in the relatives and patients’ APACHE scores may have been due to insufficient sample size, or to changes in APACHE II score from time of measurement (on admission) to time of the survey (≥ 48 hrs from admission). Additionally, other factors such as individual coping skills, prior experience with critical illness, or established support systems may play a greater role in predicting family members’ reactions.
CLINICAL IMPLICATIONS: Additional studies are needed to identify specific risk factors for, and interventions to reduce levels of, psychological distress in relatives of ICU patients.
DISCLOSURE: Kalpalatha Guntupalli, No Financial Disclosure Information; No Product/Research Disclosure Information