Does the ICU experience predict psychological symptoms in relatives of patients with severe sepsis and end-of-life decisions?

Background

Severe sepsis is the main cause of death in the ICU. Relatives are at risk for post-traumatic stress disorder (PTSD) or anxiety and depression [1]. The objective is to assess whether the ICU experience may predict these psychological symptoms of relatives at 90 days after the patient's death or discharge.

Materials and methods

Prospective observational study in four ICUs of one university hospital, including all patients with severe sepsis and end-of-life-decisions. At 90 days, the main relative was interviewed with the Impact of Event Scale (to measure PTSD), the Hospital Anxiety and Depression Scale and self-developed items on satisfaction with the ICU experience, including medical care and communication in general as well as specifically in the end-of-life context, and decision-making. Three multiple linear regression models were calculated to predict anxiety, depression and post-traumatic stress each.

Results

Eighty-four relatives were included. They were mostly female (74%), spouse (42%) or child (42%), median age was 57 years. Seventy-seven percent acted as proxies. After 90 days, 51% relatives were at risk for PTSD, 48% for anxiety and 33% for depression. Overall satisfaction with the ICU experience was high. Relatives' satisfaction with medical care and communication in general predicted lower anxiety (P = 0.025).

Conclusions

Relatives of patients with sepsis have a high psychological burden. Improving communication between ICU staff and relatives may reduce their symptoms of anxiety.