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Original Research: Critical Care |

Learned Helplessness Among Families and Surrogate Decision-Makers of Patients Admitted to Medical, Surgical, and Trauma ICUsLearned Helplessness in the ICU

Donald R. Sullivan, MD; Xinggang Liu, MD; Douglas S. Corwin, MD; Avelino C. Verceles, MD, FCCP; Michael T. McCurdy, MD, FCCP; Drew A. Pate, MD; Jennifer M. Davis, BS, RRT; Giora Netzer, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Sullivan), Oregon Health and Science University, Portland, OR; and the Department of Epidemiology and Public Health (Drs Liu and Netzer), the Department of Medicine (Dr Corwin), the Division of Pulmonary and Critical Care Medicine (Drs Verceles, McCurdy, and Netzer and Ms Davis), the Department of Emergency Medicine (Dr McCurdy), and the Department of Psychiatry (Dr Pate), University of Maryland School of Medicine, Baltimore, MD.

Correspondence to: Giora Netzer, MD, FCCP, 110 S Paca St, 2nd Floor, Baltimore, MD 21201; e-mail: gnetzer@medicine.umaryland.edu


Funding/Support: This work was supported by the National Institutes of Health [5K12RR023250-04] to Dr Netzer.

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


Chest. 2012;142(6):1440-1446. doi:10.1378/chest.12-0112
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Background:  We sought to determine the prevalence of and clinical variables associated with learned helplessness, a psychologic state characterized by reduced motivation, difficulty in determining causality, and depression, in family members of patients admitted to ICUs.

Methods:  We conducted an observational survey study of a prospectively defined cohort of family members, spouses, and partners of patients admitted to surgical, medical, and trauma ICUs at a large academic medical center. Two validated instruments, the Learned Helplessness Scale and the Perceived Stress Scale, were used, and self-report of patient clinical characteristics and subject demographics were collected.

Results:  Four hundred ninety-nine family members were assessed. Of these, 238 of 460 (51.7%) had responses consistent with a significant degree of learned helplessness. Among surrogate decision-makers, this proportion was 50% (92 of 184). Characteristics associated with significant learned helplessness included grade or high school education (OR, 3.27; 95% CI, 1.29-8.27; P = .01) and Perceived Stress Scale score > 18 (OR, 4.15; 95% CI, 2.65-6.50; P < .001). The presence of a patient advance directive or do not resuscitate (DNR) order was associated with reduced odds of significant learned helplessness (OR, 0.56; 95% CI, 0.32-0.98; P = .05).

Conclusions:  The majority of family members of patients in the ICU experience significant learned helplessness. Risk factors for learned helplessness include lower educational levels, absence of an advance directive or DNR order, and higher stress levels among family members. Significant learned helplessness in family members may have negative implications in the collaborative decision-making process.

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