ABSTRACT
RATIONALE: Family members of intensive care unit (ICU) patients are at high risk of developing the postintensive care syndrome - family (PICS-F), which includes increased post-traumatic stress, depression, anxiety, and complicated grief. The COVID-19 pandemic has created a number of unique and potentially traumatic stressors both during and after the ICU stay, which may have amplified the burden of psychological symptoms among families of critically ill COVID-19 patients. METHODS: Surrogate decision makers of critically ill COVID-19 patients enrolled in an ongoing clinical trial were contacted 6 months after the hospitalization and enrolled in a follow up study. Post ICU-discharge, they completed the 14-question Hospital Anxiety and Depression scale (HADS) and the 22-question Impact of Events-Revised scale (IES-R), a measure of post-traumatic stress disorder symptoms. Scores were reported as medians with interquartile ranges. They also participated in a semistructured phone interview regarding their mental health and coping. Interviews were transcribed and coded using thematic content analysis. RESULTS: Of the 58 participants enrolled from September 2020 to December 2020, 23 (40%) respective patients were deceased. Participants with deceased patients had significantly higher median HADS-anxiety, HADS-depression, and IES-R scores compared to those with patients who were alive (higher scores indicating increased severity of symptoms): 12 [7-13] vs. 6 [2-9] p=0.001, 7 [4-11] vs. 3 [1-5] p<0.001, 36 [24-53] vs. 14 [7-34] p=0.001, respectively. Regardless of patient outcome, participants reported multiple different types of stressors since hospital discharge including emotional distress, sleep disturbance, and financial concerns. Some stressors were specific to COVID-19 such as the concern for contracting COVID-19, infection among family members, and being unable to visit patients at rehabilitation facilities. The most common coping methods participants described utilizing included faith/spirituality, emotional support, and instrumental support (eg assistance or advice from others). Many participants mentioned they had referenced friends or family who were healthcare providers to better understand the patients' condition which helped to reduce their stress. Although few participants had sought out mental health services, many thought it could be beneficial. CONCLUSION: Families of critically ill patients with COVID-19 report a high prevalence of psychological symptoms after ICU discharge, particularly for patients who were deceased. Family focused interventions both during and after the ICU-stay may help lessen this burden.