Avoiding effects of ICU decisions for relatives could lead to PTSD

26 Jul

It can be difficult when people are forced to make crucial treatment decisions for family members who are in intensive care units, but they could face severe post-traumatic stress disorder if they attempt to cope with the burden through avoidance, according to the findings of a new study.

Man with a breathing mask in an emergency room.
The study investigates the relationship between coping strategies and post-traumatic stress disorder.

The study, published in Critical Care Medicine, assesses the different coping strategies used by family decision-makers and how they might influence post-traumatic stress disorder (PTSD) symptoms 60 days after a relative’s hospitalization.

Amy Petrinec, lead researcher and a postdoctoral fellow at Case Western Reserve University’s Frances Payne Bolton School of Nursing, explains that a stay in an intensive care unit (ICU) does not just affect a patient – it can also affect family members who may need to make important care decisions on behalf of their relative.

In order to cope with the impact of decisions with long-term consequences that they may not understand or not wish to question, family decision-makers can adopt strategies to make the situation better for them.

Avoidant coping is one of three coping styles analyzed by the researchers for the study. This strategy involves not engaging with the decision at all, sometimes using alcohol or drugs to escape from the reality of the situation.

The other coping styles investigated were emotion-focused coping – seeking emotional support from others, making jokes to lighten the mood or attempting to view the situation from a different perspective – and problem-focused coping, whereby the individual seeks further information, makes plans and asks for help.

“We use all of these coping skills to one level or another in different situations,” states Petrinec, “but people usually employ one predominant coping strategy in a particular situation.”

Avoidant coping strategy found to influence PTSD severity

For the study, a total of 77 participants making decisions for adult family members incapacitated and admitted to ICU completed two surveys designed to assess their use of coping strategies. Family members were admitted to medical, surgical or neurological ICUs in a large, urban hospital.

The first survey was completed 5 days after ICU admission and the second 30 days after the patient was either discharged or had died. This way, the researchers could assess whether the participants’ coping strategies changed over time.

The researchers then tested the participants for the symptoms of PTSD 60 days after hospital discharge or their relative’s death. They found that while adoption of emotion-focused and problem-focused coping decreased over time, the use of avoidant coping remained stable.

Around 42% of the participants exhibited clinically significant PTSD symptoms. The coping strategies adopted 30 days after hospitalization were found to predict later symptoms of PTSD much more effectively than the strategies adopted within days of ICU admission. Death of the relative in question was also a strong predictor of PTSD, regardless of coping style.

In particular, the researchers found using an avoidant coping strategy mediated the relationship between the death of a patient and the severity of PTSD symptoms.

Petrinec believes that family members placed into a situation where they must make difficult care decisions for relatives in ICU should deal with the experience rather than avoiding it, for the benefit of their own health.

Through avoidance, she states, they could end up struggling with guilt about whether they had made the right decision for their relative.

The study also illustrates the importance of making known the wishes of individuals in case of major illness, be that through the provision of living wills or by discussing matters with friends and family.

Previously, Medical News Today reported on a systematic review that the risk of dying after being admitted to ICU is doubled in patients who become delirious.

Written by James McIntosh

Copyright: Medical News Today