Original Investigation Caring for the Critically Ill PatientFebruary 18, 2022

Association of COVID-19 Acute Respiratory Distress Syndrome With Symptoms of Posttraumatic Stress Disorder in Family Members After ICU Discharge

Elie Azoulay, Matthieu Resche-Rigon, Bruno Megarbane, et al

JAMA. Published online February 18, 2022. doi:10.1001/jama.2022.2017

Key Points

Question  Is the risk of posttraumatic stress disorder (PTSD) symptoms in family members of intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) due to COVID-19 different from that of family members of patients with non–COVID-19 ARDS?

Findings  In a prospective cohort study of 517 family members of ICU patients, PTSD-related symptoms at 90 days after ICU discharge were significantly more common in family members of patients with COVID-19 ARDS compared with non–COVID-19 ARDS (35% vs 19%). In a multivariable analysis adjusting for age, sex, and level of social support, COVID-19 ARDS was independently associated with PTSD-related symptoms in family members (odds ratio, 2.05).

Meaning  ARDS due to COVID-19 was associated with a greater risk-adjusted rate of PTSD symptoms among family members compared with ARDS from other causes.Abstract

Importance  Persistent physical and mental disorders are frequent in survivors of COVID-19–related acute respiratory distress syndrome (ARDS). However, data on these disorders among family members are scarce.

Objective  To determine the association between patient hospitalization for COVID-19 ARDS vs ARDS from other causes and the risk of posttraumatic stress disorder (PTSD)–related symptoms in family members.

Design, Setting, and Participants  Prospective cohort study in 23 intensive care units (ICUs) in France (January 2020 to June 2020 with final follow-up ending in October 2020). ARDS survivors and family members (1 family member per patient) were enrolled.

Exposures  Family members of patients hospitalized for ARDS due to COVID-19 vs ARDS due to other causes.

Main Outcomes and Measures  The primary outcome was family member symptoms of PTSD at 90 days after ICU discharge, measured by the Impact of Events Scale-Revised (score range, 0 [best] to 88 [worst]; presence of PTSD symptoms defined by score >22). Secondary outcomes were family member symptoms of anxiety and depression at 90 days assessed by the Hospital Anxiety and Depression Scale (score range, 0 [best] to 42 [worst]; presence of anxiety or depression symptoms defined by subscale scores ≥7). Multivariable logistic regression models were used to determine the association between COVID-19 status and outcomes.

Results  Among 602 family members and 307 patients prospectively enrolled, 517 (86%) family members (median [IQR] age, 51 [40-63] years; 72% women; 48% spouses; 26% bereaved because of the study patient’s death; 303 [50%] family members of COVID-19 patients) and 273 (89%) patients (median [IQR] age, 61 [50-69] years; 34% women; 181 [59%] with COVID-19) completed the day-90 assessment. Compared with non–COVID-19 ARDS, family members of patients with COVID-19 ARDS had a significantly higher prevalence of symptoms of PTSD (35% [103/293] vs 19% [40/211]; difference, 16% [95% CI, 8%-24%]; P < .001), symptoms of anxiety (41% [121/294] vs 34% [70/207]; difference, 8% [95% CI, 0%-16%]; P= .05), and symptoms of depression (31% [91/291] vs 18% [37/209]; difference, 13% [95% CI, 6%-21%]; P< .001). In multivariable models adjusting for age, sex, and level of social support, COVID-19 ARDS was significantly associated with increased risk of PTSD-related symptoms in family members (odds ratio, 2.05 [95% CI, 1.30 to 3.23]).

Conclusions and Relevance  Among family members of patients hospitalized in the ICU with ARDS, COVID-19 disease, as compared with other causes of ARDS, was significantly associated with increased risk of symptoms of PTSD at 90 days after ICU discharge.

Trial Registration  ClinicalTrials.gov Identifier: NCT04341519