by Fur-Hsing Wen, Wen-Chi Chou, Chung-Chi Huang, Tsung-Hui
Hu, Ming Chu Chiang, Li-Pang Chuang and Siew Tzuh Tang
Critical Care volume 26,
Published: 11
April 2022
Background/objective
Bereaved ICU family surrogates’ psychological distress,
e.g., anxiety, depression, and post-traumatic stress disorder (PTSD), is
usually examined independently, despite the well-recognized comorbidity of
these symptoms. Furthermore, the few studies exploring impact of psychological
distress on development of prolonged grief disorder (PGD) did not consider the
dynamic impact of symptom evolution. We identified surrogates’ distinct
patterns/states of comorbid psychological distress and their evolution over the
first 3 months of bereavement and evaluated their associations with PGD at
6-month postloss.
Methods
A longitudinal observational study was conducted on 319
bereaved surrogates. Symptoms of anxiety, depression, PTSD, and PGD were
measured by the anxiety and depression subscales of the Hospital Anxiety and
Depression Scale, Impact of Event Scale-Revised scale, and the PGD-13,
respectively. Distinct psychological-distress states and their evolution were
examined by latent transition analysis. Association between
psychological-distress states and PGD symptoms was examined by logistic
regression.
Results
Three distinct comorbid psychological-distress states
(prevalence) were initially identified: no distress (56.3%),
severe-depressive/borderline-anxiety distress (30.5%), and
severe-anxiety/depressive/PTSD distress (13.3%). Except for those in the stable
no-distress state, surrogates tended to regress to states of less psychological
distress at the subsequent assessment. The proportion of participants in each psychological-distress
state changed to no distress (76.8%), severe-depressive/borderline-anxiety
distress (18.6%), and severe-anxiety/depressive/PTSD distress (4.6%) at 3-month
postloss. Surrogates in the severe-depressive/borderline-anxiety distress and severe-anxiety/depressive/PTSD-distress
state at 3-month postloss were more likely to develop PGD at 6-month postloss
(OR [95%] = 14.58 [1.48, 143.54] and 104.50 [10.45, 1044.66], respectively).
Conclusions
A minority of family surrogates of ICU decedents suffered
comorbid severe-depressive/borderline-anxiety distress and
severe-anxiety/depressive/PTSD symptoms during early bereavement, but they were
more likely to progress into PGD at 6-month postloss.
