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Prolonged Grief Disorder in the Next of Kin of Adult Patients Who Die During or After Admission to Intensive CareProlonged Grief Disorder and Intensive Care FREE TO VIEW

Sancho Rodríguez Villar, LMS; Marcelino Sánchez Casado, LMS, PhD; Holly G. Prigerson, MD, PhD; Silvia Mesa García, NS; María Rodríguez Villar, NS; Victoria A. Hortigüela Martín, LMS; Carlos M. Marco Schulke, LMS; Rafael Barrientos Vega, LMS; Manolo Quintana, LMS, PhD
Author and Funding Information

From the Hospital Provincial de la Misericordia (Dr S. Rodríguez Villar); Virgen de la Salud Hospital (Drs Sánchez Casado, Hortigüela Martín, Marco Schulke, and Barrientos Vega and Mss Mesa García and M. Rodríguez Villar); University Hospital La Paz (Dr Quintana); and Dana-Farber Cancer Institute and Harvard MedicalSchool (Dr Prigerson), Center for Psychooncology and Palliative Care Research, Harvard Medical School.

Correspondence to: Sancho Rodríguez Villar, LMS, Intensive Care Department, Hospital Ntra. Sña. Del Prado, Talavera de la Reina, Ctra, Madrid Km116, 45600, Toledo, Spain; e-mail: sancho.rodvil@hotmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1635-1636. doi:10.1378/chest.11-3099
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To the Editor:

Although loss and grief are ubiquitous human experiences, prolonged grief disorder (PGD) stands apart as a serious psychiatric condition.1,2 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.1,2

Given the elevated prevalence of psychiatric symptoms in next of kin (NOK) during and after a patient’s stay in the ICU,3,4 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.1,5,6

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.

Table Graphic Jump Location
Table 1 Comparison Between NOK With and Without PGD

Data are presented as No. (%) or mean ± SD. NOK = next of kin; NS = not significant; PGD = prolonged grief disorder.

Prigerson HG, Horowitz MJ, Jacobs SC, et al. Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med. 2009;68:e1000121. [CrossRef] [PubMed]
 
Boelen 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;2578:444-452. [CrossRef] [PubMed]
 
Chen 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;292:367-380. [CrossRef] [PubMed]
 
Pochard F, Darmon M, Fassier T, et al; French FAMIREA study group French FAMIREA study group 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;201:90-96. [CrossRef] [PubMed]
 
Prigerson 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;521:16
 
Prigerson HG, Maciejewski PK, Reynolds CF III, et al. Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995;591-2:65-79. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 Comparison Between NOK With and Without PGD

Data are presented as No. (%) or mean ± SD. NOK = next of kin; NS = not significant; PGD = prolonged grief disorder.

References

Prigerson HG, Horowitz MJ, Jacobs SC, et al. Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med. 2009;68:e1000121. [CrossRef] [PubMed]
 
Boelen 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;2578:444-452. [CrossRef] [PubMed]
 
Chen 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;292:367-380. [CrossRef] [PubMed]
 
Pochard F, Darmon M, Fassier T, et al; French FAMIREA study group French FAMIREA study group 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;201:90-96. [CrossRef] [PubMed]
 
Prigerson 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;521:16
 
Prigerson HG, Maciejewski PK, Reynolds CF III, et al. Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995;591-2:65-79. [CrossRef] [PubMed]
 
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