Highlights
- •This review examined risk factors for post-intensive care syndrome-family, and history of mental illness had the largest effect size that increased the risk of post-intensive care syndrome-family.
- •Poor communication with intensive care unit staff was identified as a risk factor attributable to the psychosocial experiences of families, many such modifiable risk factors have not been identified.
- •Additional studies are needed to further clarify and identify modifiable risk factors for the post-intensive care syndrome-family to provide stronger evidence.
Abstract
Background
Families of patients admitted to ICUs often experience post-intensive care syndrome-family,
and previous studies have reported several possible risk factors. However, to date,
no meta-analyses have been conducted on the numerous risk factors associated with
the development of post-intensive care syndrome-family and how strongly these factors
are in association with post-intensive care syndrome-family.
Objectives
To identify risk factors for post-intensive care syndrome-family and determine the
effect size of individual risk factors.
Methods
This systematic review used MEDLINE, CINAHL, PsycINFO, and EMBASE databases to search
all studies through December 1, 2021, that reported risk factors for anxiety, depression,
PTSD, and prolonged grief disorder in the families of adult patients in ICUs. A meta-analysis
was conducted to calculate an overall estimate for key risk factors, and odds ratio
and 95% confidence intervals were used as summary statistics using the random-effects
model.
Results
Of 2964 identified studies, 17 were included. Nine factors for anxiety, eight for
depression, and three for PTSD were assessed using results from 13 studies. The risk
factor with the largest effect size was “history of mental illness,” which, along
with “female sex,” was a significant risk factor common to anxiety, depression, and
PTSD. “Poor communication with ICU staff,” “severely ill patient,” and “patients’
spouse” were common risk factors for anxiety and depression.
Conclusions
We identified several risk factors related to patient and family demographic characteristics.
Further research is required to identify and validate modifiable risk factors for
the psychosocial experiences of families of ICU patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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; 20 (1.): 90-96https://doi.org/10.1016/j.jcrc.2004.11.004
- Risk of post-traumatic stress symptoms in family members of intensive care unit patients.Am J Respir Crit Care Med. 2005; 171: 987-994https://doi.org/10.1164/rccm.200409-1295OC
- Role incongruence and psychological stress symptoms in substitute decision makers of intensive care patients.Am J Crit Care. 2020; 29: 301-310https://doi.org/10.4037/ajcc2020307
- Posttraumatic stress disorder in close Relatives of intensive care unit patients’ Evaluation (PRICE) study.Aust Crit Care. 2014; 27: 183-187https://doi.org/10.1016/j.aucc.2014.04.003
- Complicated grief after death of a relative in the intensive care unit.Eur Respir J. 2015; 45: 1341-1352https://doi.org/10.1183/09031936.00160014
- Post-traumatic stress disorder and complicated grief are common in caregivers of neuro-ICU patients.Neurocrit Care. 2017; 26: 436-443https://doi.org/10.1007/s12028-016-0372-5
- ICU bereaved surrogates’ comorbid psychological-distress states and their associations with prolonged grief disorder.Crit Care. 2022; 26: 102https://doi.org/10.1186/s13054-022-03981-7
- Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference.Crit Care Med. 2012; 40: 502-509https://doi.org/10.1097/CCM.0b013e318232da75
- Patient and family post-intensive care syndrome.AACN Adv Crit Care. 2016; 27: 184-186https://doi.org/10.4037/aacnacc2016132
- Families and post-intensive care syndrome.Am Nurse Today. 2018; 13: 6-11
- Psychological sequelae in family caregivers of critically ill intensive care unit patients. A systematic review.Ann Am Thorac Soc. 2019; 16: 894-909https://doi.org/10.1513/AnnalsATS.201808-540SR
- Post-intensive care syndrome: its pathophysiology, prevention, and future directions.Acute Med Surg. 2019; 6: 233-246https://doi.org/10.1002/ams2.415
- Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity.Crit Care Med. 2001; 29: 1893-1897https://doi.org/10.1097/00003246-200110000-00007
- Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients.Resuscitation. 2014; 85: 801-808https://doi.org/10.1016/j.resuscitation.2014.02.022
- Limited family members/staff communication in intensive care units in the Czech and Slovak Republics considerably increases anxiety in patients’ relatives—The DEPRESS study.BMC Psychiatry. 2014; 14: 21https://doi.org/10.1186/1471-244X-14-21
- Interventions in post-intensive care syndrome-family: a systematic literature review.Crit Care Med. 2020; 48: e835-e840https://doi.org/10.1097/CCM.0000000000004450
- A communication strategy and brochure for relatives of patients dying in the ICU.N Engl J Med. 2007; 356: 469-478https://doi.org/10.1056/NEJMoa063446
- A randomized trial of a family-support intervention in intensive care units.N Engl J Med. 2018; 378: 2365-2375https://doi.org/10.1056/NEJMoa1802637
- A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial.Lancet. 2022; 399: 656-664https://doi.org/10.1016/S0140-6736(21)02176-0
- The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021; 372: n71https://doi.org/10.1136/bmj.n71
- Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.JAMA. 2000; 283 (Anal Obs Stud Epidemiol (Moose) Group): 2008-2012https://doi.org/10.1001/jama.283.15.2008
National Heart Lung and Blood Institute. Study quality assessment tools: quality assessment tool for observational, cohort and cross-sectional studies. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools Accessed September 1 2022,; 2021.
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560https://doi.org/10.1136/bmj.327.7414.557
- Conducting meta-analyses in R with the metafor package.J Stat Softw. 2010; 36: 1-48https://doi.org/10.18637/jss.v036.i03
- Course and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavement.Crit Care. 2021; 25: 282https://doi.org/10.1186/s13054-021-03719-x
- End-of-life-care quality in ICUs is associated with family surrogates’ severe anxiety and depressive symptoms during their first 6 months of bereavement.Crit Care Med. 2021; 49: 27-37https://doi.org/10.1097/CCM.0000000000004703
- Depression and anxiety in relatives of out-of-hospital cardiac arrest patients: results of a prospective observational study.J Crit Care. 2019; 51: 57-63https://doi.org/10.1016/j.jcrc.2019.01.026
- Novel risk factors for posttraumatic stress disorder symptoms in family members of acute respiratory distress syndrome survivors.Crit Care Med. 2019; 47: 934-941https://doi.org/10.1097/CCM.0000000000003774
- Acute physiologic stress and subsequent anxiety among family members of ICU patients.Crit Care Med. 2018; 46: 229-235https://doi.org/10.1097/CCM.0000000000002835
- Communication quality predicts psychological well-being and satisfaction in family surrogates of hospitalized older adults: an observational study.J Gen Intern Med. 2018; 33: 298-304https://doi.org/10.1007/s11606-017-4222-8
- Family members of critically ill cancer patients: assessing the symptoms of anxiety and depression.Intensiv Care Med. 2009; 35: 899-902https://doi.org/10.1007/s00134-009-1406-7
- Caesar: a new tool to assess relatives’ experience of dying and death in the ICU.Intensiv Care Med. 2016; 42: 995-1002https://doi.org/10.1007/s00134-016-4260-4
- Associations between caregiver-detected delirium and symptoms of depression and anxiety in family caregivers of critically ill patients: a cross-sectional study.BMC Psychiatry. 2021; 21: 187https://doi.org/10.1186/s12888-021-03200-7
- Anxiety and depression in family members of people hospitalized in an intensive care unit.Psicol Teor Prat. 2019; 21: 328-343https://doi.org/10.5935/1980-6906/psicologia.v21n1p328-343
- The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up.Am J Psychiatry. 1986; 143: 24-28https://doi.org/10.1176/ajp.143.1.24
- Risk factors for the onset of panic and generalised anxiety disorders in the general adult population: a systematic review of cohort studies.J Affect Disord. 2014; 168: 337-348https://doi.org/10.1016/j.jad.2014.06.021
- Factors associated with possible complicated grief and major depressive disorders.Psychooncology. 2018; 27: 915-921https://doi.org/10.1002/pon.4610
- Factors of complicated grief pre-death in caregivers of cancer patients.Psycho Oncol. 2008; 17: 105-111https://doi.org/10.1002/pon.1188
- Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National comorbidity Survey Replication.Arch Gen Psychiatry. 2005; 62: 593-602https://doi.org/10.1001/archpsyc.62.6.593
- Prevalence of depression among adults aged 20 and over: united States, 2013-2016.NCHS Data Brief. 2018; : 1-8
- Posttraumatic stress disorder in the National comorbidity Survey.Arch Gen Psychiatry. 1995; 52: 1048-1060https://doi.org/10.1001/archpsyc.1995.03950240066012
- Gender differences in threat biases: trauma type matters in posttraumatic stress disorder.J Trauma Stress. 2019; 32: 701-711https://doi.org/10.1002/jts.22439
- Psychological burden in inpatient relatives: the forgotten side of medical management.Q J Med. 2014; 107: 115-122https://doi.org/10.1093/qjmed/hct210
World Health Organization. International statistical classification of diseases and related health problems. 11th ed. https://icd.who.int/. Accessed September 1 2022,; 2018.
- Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder.BMJ. 2017; 357: j2016https://doi.org/10.1136/bmj.j2016
- Posttraumatic stress and complicated grief in family members of patients in the intensive care unit.J Gen Intern Med. 2008; 23: 1871-1876https://doi.org/10.1007/s11606-008-0770-2
- The desirability of an intensive care unit (ICU) clinician-led bereavement screening and support program for family members of ICU decedents (ICU Bereave).J Crit Care. 2014; 29311.e9-311.16https://doi.org/10.1016/j.jcrc.2013.11.024
- Risk factors for complicated grief among family members bereaved in intensive care unit settings: a systematic review.PLoS ONE. 2022; 17e0264971https://doi.org/10.1371/journal.pone.0264971
Article info
Publication history
Published online: January 13, 2023
Accepted:
January 8,
2023
Received in revised form:
December 5,
2022
Received:
November 2,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
