PTSD symptoms common in families of COVID-19 patients

The pandemic has significantly affected the mental health of family members of patients with COVID-19, including high rates of posttraumatic stress disorder (PTSD), anxiety, and depression, new research suggests.

In a prospective cohort study of more than 500 individuals, those related to intensive care unit patients with COVID-19 acute respiratory distress syndrome (ARDS) had a significantly higher prevalence of, and were at increased risk for, PTSD-related symptoms 90 days after discharge compared with their peers who were related to ICU patients with non-COVID ARDS.

Dr. Elie Azoulay

They also had a higher prevalence of depression and anxiety symptoms.

The results illustrate how the mental health of families has been adversely affected by strict isolation measures instituted at the height of the COVID pandemic, lead author Elie Azoulay, MD, PhD, professor of medicine at Diderot University and director of the Medical Intensive Care Unit, Saint Louis Hospital, Paris, told this news organization.

Such restrictions were unnecessary, Dr. Azoulay noted, adding that everyone, including health care professionals, benefits when families are allowed to interact with their loved ones in the ICU.

He added the study findings also emphasize the importance of social supports.

“We need to develop and really increase what we can do for family members” of patients staying in the ICU, said Dr. Azoulay.

The findings were published online Feb. 18 in JAMA.

Twenty-three ICUs in France

The study included adult family members of patients admitted with ARDS to 23 ICUs in France from January to October 2020.

Patients had a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO₂/FiO₂) of less than 300, and bilateral opacities on chest radiography not fully explained by cardiac failure or fluid overload.

Two trained clinical psychologists interviewed family members and patients by telephone a median of 112 days after ICU discharge. During this interview, participants completed the Impact of Event Scale Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS).

The IES-R score ranges from 0 (best) to 88 (worst) with a score of more than 22 indicating presence of PTSD-related symptoms of clinical concern. The HADS has separate subscales for anxiety and depression, with a score of 7 or greater on a 21-point scale indicating symptoms of anxiety or depression.

Family members also rated social supports on a scale from 0 (extremely limited) to 10 (extremely effective). Dr. Azoulay noted that social support is the subjective perception of the extent to which friends, mental health specialists, and others are available and helpful.

Investigators divided patients into two groups depending on whether or not the cause of ARDS was COVID-19. Causes other than COVID-19 mainly included community-acquired pneumonia and influenza.

The primary outcome was the prevalence of PTSD-related symptoms among family members. Secondary outcomes were the prevalence of anxiety and depression in family members.

The analysis included 303 family members of patients with COVID-19 ARDS and 214 family members of patients with non–COVID-19 ARDS. Almost half of the family members were spouses.

Those with family members with COVID-19 were younger than the non-COVID group (median age, 50 vs. 55 years). They were less frequently allowed to visit the ICU (35% vs. 88%) and more commonly received patient information by phone (84% vs. 20%).