Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic

Abstract

Background: During COVID-19 pandemic, visits have been prohibited in most French ICUs. Psychological effects, for reference persons (RPs), of remote-only communication have been assessed.

Methods: All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death, and 3 months. At 3 months, a psychologist provided a qualitative description of RPs' psychological distress.

Results: Eighty-eight RPs were included. Prevalence of anxiety and depression was 83% and 73% respectively. At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p < 0.01). Ninety-nine percent RPs felt the patient was safe (9 [7; 10]/10 points, Likert-type scale), confident with caregivers (10 [9; 10]/10 points), and satisfied with information provided (10 [9; 10]/10 points). All RPs stressed the specific-type of "responsibility" associated with being an RP in a remote-only context, leading RPs to develop narrow diffusion strategies (67%) and restrict the array of contacted relatives to a very few and/or only contacting them rarely. 10 RPs (30%) related the situation to a prior traumatic experience.

Conclusion: RPs experienced psychological distress and reported that being an RP in a remote-only communication context was a specific responsibility and qualified it as an overall negative experience.

Trial registration: NCT04385121 . Registered 12 May 2020. https://clinicaltrials.gov/ .

Keywords: COVID-19; Reference person; Relative; Anxiety; Depression; Distress.

Fig. 1

Anxiety and depression symptoms in reference persons at ICU admission and discharge. a Prevalence of anxiety and depression symptoms in reference persons (RPs) at ICU admission and discharge. b Evolution of total Hospital Anxiety and Depression Scale (HADS) between ICU admission and discharge in the 88 RPs, represented by whisker boxes (horizontal line inside the box: median, upper, and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively). c Evolution of the HAD anxiety and depression subscales between ICU admission and discharge in the 88 RPs. Scores of 8 points or more in each subscale were used for definite cases (gray dashed line) of anxiety and/or depression. Whisker boxes (horizontal line inside the box: median, upper and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively)

Fig. 2

Sleep quality in reference persons at 3 months. Sleep quality was evaluated on a 10 points Likert-type scale at 3 months: 1 being a very bad quality of sleep and 10 a very good one

Fig. 3

Evaluation of reference persons’ feelings at 3 months. Feelings of (i) safety, (ii) confidence in intensive care unit (ICU) caregivers, therapeutic decisions and information, (iii) satisfaction toward ICU care and information modalities, and (iv) comprehension of diagnosis, therapeutic, and prognosis during ICU stay. These were evaluated on a 10 points Likert-type scale at 3 months: 1 being a very bad feeling of security/confidence/satisfaction/comprehension and 10 a very good one

Fig. 4

Anxiety and depression symptoms in reference persons at ICU admission, discharge and at 3 months. Hospital Anxiety and Depression Scale (HADS) evolution between admission, discharge/death, and 3 months later, in 33 RPs, represented by whisker boxes (horizontal line inside the box: median, upper and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively)

Fig. 5

Post-traumatic stress disorder in reference persons at 3 months. a Impact of Event Scale-revised (IES-R) represented by whisker boxes (horizontal line inside the box: median, upper, and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively). Scores exceeding 32 points (dashed line) on IES-R scale were considered as indicating a PTSD. b Prevalence of post-traumatic Stress Disorder (PTSD) in reference persons (RPs) at 3 months