Admission to the Intensive Care Unit is a very stressful event for the family of the critically ill patient. It is even more stressful when the patient is doing poorly and is at a higher risk of dying. Physicians rely on the family members to make important decisions when the patient is unable to communicate. If you ever been present at a meeting with the family of the critically ill patient, you would notice that the level of stress and anxiety is extremely high among the family members.

Functioning under significant amount of stress is hard enough. Not to mention that making life and death decisions for their loved ones puts a tremendous amount of pressure on the family members. As physicians we should be aware of the significant psychological symptoms burden in family members. Several techniques, like using associations and repetition, previously described in this blog, might facilitate the family’s understanding of the disease process and treatment options.

A recent study published in the April issue of the Critical Care Medicine Journal attempts to quantify the prevalence of psychological symptoms among family members of the critically ill patients with a high risk of dying. This is only a small study, yet it offers invaluable insights into the psychological state of the family members.

The investigators documented the symptoms of traumatic stress in 56.8%, anxiety in 79.7% and depression in 70.3% of the family members 3 to 5 days after the patient’s admission to the ICU. Many family members reported fear, worry, exhaustion, helplessness, sadness and anger according to this study. Factors associated with higher traumatic stress levels were younger patient’s age, younger family member age and female gender of the family member.

This study primarily focuses on the short term psychological consequences after the admission to the ICU. Previous studies found that 34% of the surrogate decision makers met criteria for complicated grief, major depression and anxiety disorder 3 to 12 months after the ICU experience.

Post traumatic stress disorder was documented in 35% of family members 6 months after the ICU experience. 46% of family members had complicated grief.

It is important to appreciate the psychological state of the family members after their loved one has been admitted to the ICU. As clinicians, we have a chance to intervene and relieve the psychological burden by conducting structured family conferences and acknowledging family’s feelings and emotions. It is also extremely important to be aware of the family’s psychological status when end of life decisions are to be made.