How Families of Critically Ill Fared During COVID-19

ICU families report more symptoms of depression in pandemic
Chaplain holds patient's hand

Having a loved one in the intensive care unit is difficult at any time. But the COVID-19 pandemic created additional burdens on families, from visitor restrictions to the uncertainties of a new contagious virus.

A study by researchers at Rush University Medical Center found that families of ICU patients admitted during the pandemic reported significantly more symptoms of depression than those admitted before COVID-19. Yet, the study results, shared in a research letter in the June issue of Chest, showed the two groups reported similar levels of clinically significant anxiety and acute stress.

“Prior to COVID-19, we really tried to make the ICU seem like a welcoming place for families as a way of alleviating some of the stress of having a critically ill loved one,” says Jared Greenberg, MD, a pulmonology and critical care physician at Rush University Medical Center. “So, we hypothesized that the lack of direct contact with the patient and the medical team would increase their distress.”

The study surveyed patient surrogates — the family members responsible for making decisions on behalf of ICU patients — by having them fill out two standardized questionnaires, the Hospital Anxiety and Depression Scale and the Impact of Events Scale Revised. Researchers compared the results of the family members of patients admitted to the ICU between March 18 and June 1, 2020, and those admitted in the months before the pandemic began.

More depression symptoms

During the pandemic period, 25% of patients’ family members experienced clinically significant symptoms of depression, compared to 13% before COVID-19. While the levels of anxiety and stress were similar, the symptoms of stress differed, with more reporting difficulty concentrating, an inability to think about anything else, trouble sleeping, being easily startled and/or feeling always on guard. 

Researchers say several factors likely contributed to the differences between the groups’ emotional states.

“Family members may have felt they didn’t fully understand the patient’s medical condition because it was a new virus, or because they couldn’t meet with the medical team face-to-face throughout the patient’s stay,” Greenberg says. 

The survey also asked families about patient care and communication from the medical team. “We were pleased to find that families still most often were very satisfied with the care being provided even though they never stepped foot in the ICU,” Greenberg adds.

ICU staff supports patients’ families, too

With or without a pandemic, it is very common for people to experience emotional distress when a family member is critically ill, and the ICU staff wants to and is able to be of help, says Crystal M Glover, PhD, a social psychologist and a co-author of the study.

Chaplains, grief counselors and psychologists are also available to provide support, so families should let the ICU staff know if they are struggling,” Glover says.

Their distress is a normal response to having a loved one in the ICU, Greenberg adds. “If families understand that, then they may feel more open to talking about their feelings with one another as well as with counselors and others who can be supportive,” he says.

Study shifts focus during pandemic

Originally, the research team didn’t intend to compare family members’ emotional states before and during the pandemic. Rather, they were studying whether written communications to family members helped them feel better informed than relying on in-person conversations with the medical team.

“One of the barriers to families understanding the patient’s condition is that they typically receive information verbally only,” Greenberg says. “We thought written communication would help reinforce the verbal communication and help them share the information with other family members.”

“When the study was started in June 2019, we did not envision a time when families would not be able to visit the hospital,” Greenberg says. In March 2020, Rush and other hospitals halted visiting hours to help slow the spread of coronavirus.

During the COVID-19 period of the study, the team continued sharing written communications with a randomized selection of patient families. 

“Those who received the daily written summaries demonstrated a better understanding of the patient’s condition and care options,” Greenberg says. “While more needs to be studied about how patients’ families can best be supported in the ICU, everyone could point to some aspect of the notes that was beneficial.”

In addition to Greenberg and Glover, the research team included Rush colleagues Santosh Basapur, PhD; Thomas Quinn, MD; Jeffrey Bulger, MD, and Raj Shah, MD.

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