Download PDF
CC BY 4.0 · Avicenna J Med 2023; 13(02): 089-096
DOI: 10.1055/s-0043-1769933
Original Article

Anxiety and Depression Symptoms of Family Members of Intensive Care Unit Patients: A Prospective Observational Study and the Lived Experiences of the Family Members

Hande Gurbuz 
1   Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa School of Medicine, Bursa City Hospital, Bursa, Turkey
2   Department of Anesthesiology and Reanimation. Formerly: University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Turkey
,
Nalan Demir 
2   Department of Anesthesiology and Reanimation. Formerly: University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Turkey
3   Department of Chest Diseases, Intensive Care Division, Ankara City Hospital, Ankara, Turkey
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The aim of this study is to investigate the factors affecting symptoms of anxiety and depression in the family members of critically ill patients.

Methods This prospective cohort study was conducted in an adult tertiary care mixed medical–surgical intensive care unit (ICU) at a tertiary-level teaching hospital. The symptoms of anxiety and depression of first-degree adult relatives were evaluated with the Hospital Anxiety and Depression Scale. Four family members were interviewed and asked about their experiences during the ICU process.

Results A total of 84 patients and their family members were included in the study. The symptoms of anxiety were present in 44/84 (52.4%), and depression was present in 57/84 (67.9%) family members. A nasogastric tube was found to be related to anxiety (p = 0.005) and depressive symptoms (p = 0.002). The family members of the patients with an acute developed illness had 3.9 (95% confidence interval [CI]: 1.4–10.9) times the odds of having the symptoms of anxiety and 6.2 (95% CI: 1.7–21.7) times the odds of having the symptoms of depression than the family members of the patients with an illness developed on a chronic basis. The family members of the patients who died in the ICU had 5.0 (95% CI: 1.0–24.5) times the odds of being depressed than the patients discharged from the ICU. All interviewees stated having difficulty understanding and remembering what was told. The common feelings of all the interviewees were desperation and fear.

Conclusions Awareness of the emotional stress of family members can help develop interventions and attitudes to alleviate symptom burden.

Keywords

anxiety - intensive care unit - critically ill - death - depression - depressive symptoms - family

Availability of Data and Materials

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.


Authors' Contributions

H.G. and N.D. contributed to protocol development, data collection, and management, data analysis, manuscript writing/editing.


Ethical Approval

The protocol of the study is approved by the institutional review board University of Health Sciences Kocaeli Derince Training and Research Hospital Clinical Trials Ethics Committee with a decree: 2019-131, date: 12.02.2019, and conducted in accordance with the Helsinki Declaration.




Publication History

Article published online:
16 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Pochard F, Darmon M, Fassier T. et al; French FAMIREA study group. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care 2005; 20 (01) 90-96
    CrossrefPubMedGoogle Scholar
  • 2 Pochard F, Azoulay E, Chevret S. et al; French FAMIREA Group. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 2001; 29 (10) 1893-1897
    CrossrefPubMedGoogle Scholar
  • 3 Anderson WG, Arnold RM, Angus DC, Bryce CL. Passive decision-making preference is associated with anxiety and depression in relatives of patients in the intensive care unit. J Crit Care 2009; 24 (02) 249-254
    CrossrefPubMedGoogle Scholar
  • 4 Azoulay E, Pochard F, Kentish-Barnes N. et al; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171 (09) 987-994
    CrossrefPubMedGoogle Scholar
  • 5 Schmidt M, Azoulay E. Having a loved one in the ICU: the forgotten family. Curr Opin Crit Care 2012; 18 (05) 540-547
    CrossrefPubMedGoogle Scholar
  • 6 Netzer G, Sullivan DR. Recognizing, naming, and measuring a family intensive care unit syndrome. Ann Am Thorac Soc 2014; 11 (03) 435-441
    CrossrefPubMedGoogle Scholar
  • 7 Saeid Y, Salaree MM, Ebadi A, Moradian ST. Family intensive care unit syndrome (FICUS): an integrative review. Iran J Nurs Midwifery Res 2020; 25 (05) 361-368
    CrossrefPubMedGoogle Scholar
  • 8 Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med 2012; 40 (02) 618-624
    CrossrefPubMedGoogle Scholar
  • 9 Davidson JE, Powers K, Hedayat KM. et al; American College of Critical Care Medicine Task Force 2004-2005, Society of Critical Care Medicine. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35 (02) 605-622
    CrossrefPubMedGoogle Scholar
  • 10 Kang J, Cho YJ, Choi S. State anxiety, uncertainty in illness, and needs of family members of critically ill patients and their experiences with family-centered multidisciplinary rounds: a mixed model study. PLoS One 2020; 15 (06) e0234296
    CrossrefPubMedGoogle Scholar
  • 11 Köse I, Zincircioğlu Ç, Öztürk YK. et al. Factors affecting anxiety and depression symptoms in relatives of intensive care unit patients. J Intensive Care Med 2016; 31 (09) 611-617
    CrossrefPubMedGoogle Scholar
  • 12 Aydemir O, Guvenir T, Kuey L, Kultur S. Validity and reliability of Turkish version of the hospital anxiety and depression scale. Turk Psikiyatr Derg 1997; 8: 280-287
    Google Scholar
  • 13 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
    CrossrefPubMedGoogle Scholar
  • 14 Kentish-Barnes N, Lemiale V, Chaize M, Pochard F, Azoulay E. Assessing burden in families of critical care patients. Crit Care Med 2009; 37 (10, Suppl): S448-S456
    CrossrefPubMedGoogle Scholar
  • 15 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13 (10) 818-829
    CrossrefPubMedGoogle Scholar
  • 16 Groenewald T. A phenomenological research design illustrated. Int J Qual Methods 2004; 3 (01) 42-55
    CrossrefGoogle Scholar
  • 17 McAdam JL, Fontaine DK, White DB, Dracup KA, Puntillo KA. Psychological symptoms of family members of high-risk intensive care unit patients. Am J Crit Care 2012; 21 (06) 386-393 , quiz 394
    CrossrefPubMedGoogle Scholar
  • 18 McAdam JL, Dracup KA, White DB, Fontaine DK, Puntillo KA. Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med 2010; 38 (04) 1078-1085
    CrossrefPubMedGoogle Scholar
  • 19 Anderson WG, Arnold RM, Angus DC, Bryce CL. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 2008; 23 (11) 1871-1876
    CrossrefPubMedGoogle Scholar
  • 20 Kleinman A. Culture and depression. N Engl J Med 2004; 351 (10) 951-953
    CrossrefPubMedGoogle Scholar
  • 21 Kirmayer LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry 2001; 62 (Suppl. 13) 22-28 , discussion 29–30
    PubMedGoogle Scholar
  • 22 Cooper RA, Segrin C. When goodbyes matter: the conditional relationship between final conversations and symptoms of depression. Death Stud 2023; 47 (05) 585-591
    CrossrefPubMedGoogle Scholar
  • 23 McKiernan M, McCarthy G. Family members' lived experience in the intensive care unit: a phenomenological study. Intensive Crit Care Nurs 2010; 26 (05) 254-261
    CrossrefPubMedGoogle Scholar
  • 24 Azoulay E, Chevret S, Leleu G. et al. Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000; 28 (08) 3044-3049
    CrossrefPubMedGoogle Scholar
  • 25 Kentish-Barnes N, Chaize M, Seegers V. et al. Complicated grief after death of a relative in the intensive care unit. Eur Respir J 2015; 45 (05) 1341-1352
    CrossrefPubMedGoogle Scholar