Acute psychological reactions in relatives of patients treated in the intensive care unit (ICU)

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Objective

The objective of the present work was the investigation of the impact of admission and treatment of patients in the intensive care unit (ICU) on their relatives, by measuring their acute psychological reactions. More explicitly, to disclose if ICU treatment acts as a stressor of a potentially traumatic nature to the patient's relatives.

Material and methods

The sample comprised of 48 subjects (24 males/24 females) who were close relatives of patients treated in the ICU of Agios Savvas and KAT General Hospitals for various reasons over a six-month period. Demographic data regarding both the patients and their relatives were collected. Information on the physical condition of patients (type of operation, APACHE II Score, assisted ventilation etc.) was obtained from their medical report. The instruments applied to assess the psychological impact of ICU admission on the patient's relatives were the Center for Epidemiological Studies Depression Scale (CES-D), the Spielberger's State-Trait Anxiety Inventory (STAI) and the Impact of Event Scale (IES), which is a measure of intrusion and avoidance. Subjects were assessed one week± one day after their relative's admission to the ICU.

Results

Patients were admitted to the ICU for various reasons (injuries, 11; head injury, 12; postoperative care, 8; various emergencies, 17). Mean age of patients was 48.6± 19.5 years (min, 17; max, 81); mean APACHE II Score upon admission was 12.8± 5.0 (min, 2; max, 24). Mean age of relatives was 40.5± 12.3 years (min, 21; max, 73). They were first degree relatives; 70% were married and had children. Mean scores± SD on the psychometric scales were as follows: CES-D=29.8± 8.9, STAI-State=60.4± 13.2, STAI-Trait=39.8± 9.0, IES-Total= 26.15± 7.9, IES-Intrusion=16.0± 4.7, IES-Avoidance= 10.1± 4.8. These scores indicate the presence of severe depressive symptoms, high levels of subjective tension and apprehension, and moderate levels of intrusion and avoidance. Females scored significantly higher than males on all scales (Mean ± SD and t-test 2-tail sig: CES-D= 32.8± 7.4 vs 26.8± 9.2 P=0.02; STAI-State= 65.5± 10.8 vs 55.3± 13.5 P=0.006; STAI-Trait=42.6± 8.6 vs 36.8± 8.7 P=0.025; IES-Intrusion=17.6± 3.6 vs 14.5± 5.2 P=0.02; IES-Avoidance=11.1± 5.0 vs 9.0± 4.5 P=0.13). Spearman correlation coefficients were also computed between the different scales that were found to be highly correlated (level of sig. >0.01). Stepwise multiple linear regression of CES-D upon various independent variables (i.e. age of patient, ICU diagnosis, APACHE II Score, age and gender of relative, degree of kinship, relative's socioeconomic and marital status, and the score on STAI-Trait inventory) showed that the severity of the depressive symptomatology depends significantly solely on the relatives STAI-Trait score.

Conclusions

The main findings of the present study are: a) treatment in the ICU acts as a high impact stressor for the patient's relatives, equivalent to other traumatic events of an exceptionally threatening nature; b) females are significantly more prone than males to develop a severe anxiety-depressive reaction; they also experience more intense intrusive symptoms; and c) individuals with higher pre-exposure anxiety levels, particularly females, are more vulnerable to the development of an acute stress reaction-type symptomatology.