Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU

Chest. 2010 Feb;137(2):280-7. doi: 10.1378/chest.09-1291. Epub 2009 Sep 17.


Background: Patients' deaths in the ICU have been associated with a high burden of psychologic symptoms in families. This study identifies characteristics associated with psychologic symptoms in family members.

Methods: Families of patients dying in the ICU or within 30 h of ICU discharge in 11 hospitals previously participated in a randomized trial. In the current study, we assessed these families for symptoms of posttraumatic stress disorder (PTSD) and depression with follow-up surveys. Outcomes included validated measures of PTSD (PTSD Checklist) and depressive (Patient Health Questionnaire) symptoms. Predictors included family member mental-health history, involvement in decision making, and demographics.

Results: Surveys were completed by 226 families. Response rate was 46% in the original randomized trial and 82% in this study. Prevalence (95% CI) of PTSD and depressive symptoms were 14.0% (9.7%-19.3%) and 18.4% (13.5%-24.1%), respectively. Family characteristics associated with increased symptoms included: female gender (PTSD, P = .020; depression, P = .005), knowing the patient for a shorter duration (PTSD, P = .003; depression, P = .040), and discordance between family members' preferences for decision making and their actual decision-making roles (PTSD, P = .005; depression, P = .049). Depressive symptoms were also associated with lower educational level (P = .002). Families with psychologic symptoms were more likely to report that access to a counselor (PTSD, P < .001; depression, P = .003) and information about spiritual services might have been helpful while the patient was in the ICU (PTSD, P = .024; depression, P = .029).

Conclusions: Families demonstrated a high prevalence of psychologic symptoms after a death in the ICU. Characteristics associated with symptoms may help target interventions to reduce these symptoms.

Trial registration:; Identifier: NCT00685893.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Death*
  • Depression / epidemiology*
  • Depression / etiology
  • Depression / psychology
  • Family / psychology*
  • Female
  • Follow-Up Studies
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • United States / epidemiology

Associated data