PURPOSE:We hypothesized that the response of families to critical illness in their loved one may be different in different parts of the world. We therefore compared the prevalence of anxiety, depression and post-traumatic stress disorder in relatives of critically ill patients in intensive care units (ICUs) of a public hospital in two different countries, India (KEMH) and the United States (BTGH).
METHODS:A prospective observational study utilizing the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI-II) and Impact of Events Scale-Revised (IES-R). Questionnaires were orally administered to relatives of patients between 48 and 72 hours after admission to the ICU.
RESULTS:We interviewed 43 relatives in BTGH and 47 relatives in KEMH. Median (interquartile range) day one APACHE II scores were 15 (8.25–18) and 12 (11–14) respectively (p= 0.04). The median age of the relatives was 45 (40–57.5) and 37 (33–48.5) respectively (p=0.01). 9 of the 90 relatives had prior history of ICU admission. Anxiety and/or depression were more prevalent in relatives of Indian ICU patients (87.23%) than in a similar cohort in the US (18.6%; p<0.0001). 4.7% relatives in BTGH had symptoms of anxiety (HADS-A score >10) while 18.6% had symptoms of depression (BDI-II >13). In comparison, 63.8% (p=0.0001) of Indian relatives showed anxiety and 42.6% (p=0.009) depression symptoms. Median IES-R score was significantly higher in BTGH versus KEMH for the avoidance and hyperarousal domains (P<0.0001). Scores on intrusive thoughts were comparable (p=0.3).
CONCLUSION:Responses to acute stress in relatives of ICU patients in these two countries is significantly different with higher prevalence of anxiety and depression in Indians despite slightly lower median APACHE II scores.
CLINICAL IMPLICATIONS:The prevalence of post-admission symptoms of psychological distress is high among relatives of ICU patients, but differs significantly between these two populations. Further studies correlating these responses to cultural as well as patient-related, family-related, and ICU environment-related factors can help ICU staff to better understand these differences and to provide better targeted support and coping strategies to affected families.
DISCLOSURE:Hrishikesh Kulkarni, None.