Anxiety and depression in family members of ICU patients: ethical considerations regarding decision-making capacity

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Background

Anxiety and depression have a major impact on the ability to make decisions. Characterization of symptoms reflecting anxiety and depression in family members visiting ICU patients may be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues.

Methods

Prospective multi-center study in 43 French ICUs (37 adult and 6 pediatric). Each unit included 15 patients admitted for longer than two days. ICU characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale (HADS) to allow evaluation of the prevalence and potential predictors of anxiety and depression.

Findings

637 patients were included in the study and 920 family members completed the HADS. All items were completed in 836 HADS questionnaires, which formed the basis for this study. The prevalences of anxiety and depression in family members were 69.1% and 35.4%, respectively. Anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors predictive of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by usual doctor) and caregiver-related factors (absence of physician-nurse meetings on a regular basis, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors predicting depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers).

Interpretation and conclusion

More than two-thirds of family members visiting ICU patients suffer anxiety or depression. Their involvement in end-of-life decisions should be carefully discussed.