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Published ahead of print on January 21, 2005, doi:10.1164/rccm.200409-1295OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 9, May 2005, 987-994

A more recent version of this article appeared on May 1, 2005
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Submitted on October 8, 2004
Accepted on January 12, 2005

Risk of Posttraumatic Stress Symptoms in Family Members of Intensive Care Unit Patients

Elie Azoulay1*, Frederic Pochard1, Nancy Kentish-Barnes1, Sylvie Chevret1, Jerome Aboab1, Christophe Adrie1, Djilali Annane1, Gerard Bleichner1, Pierre Edouard Bollaert1, Michael Darmon1, Thomas Fassier1, Richard Galliot1, Maite Garrouste-Orgeas1, Cyril Goulenok1, Dany Goldgran-Toledano1, Jan Hayon1, Merce Jourdain1, Michel Kaidomar1, Christian Laplace1, and Jerome Larche1

1 Service de Reanimation Medicale, Hopital Saint-Louis, Paris, France

* To whom correspondence should be addressed. E-mail: elie.azoulay{at}sls.ap-hop-paris.fr.

Rationale: ICU admission of a relative is a stressful event that may cause symptoms of posttraumatic stress disorder (PTSD). Objectives: Factors associated with these symptoms need to be identified. Methods: For patients admitted to 21 ICUs from March to November 2003, we studied the family member with the main potential decision-making role. Measurements: Ninety days after ICU discharge or death, family members completed the Impact of Event Scale (which evaluates the severity of posttraumatic stress reactions), Hospital Anxiety and Depression Scale, and 36-item Short-Form General Health Survey, during a telephone interview. Linear regression was used to identify factors associated with the risk of posttraumatic stress symptoms. Main results: Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Posttraumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision-making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe posttraumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life. Conclusion: Posttraumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.
Key words: Burden; decison making; paternalism; autonomy; end of life.




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