This article is more than 5 years old. Information may no longer be current.

Coping by avoidance may lead to PTSD among family decision makers of ICU patients

Avoidant coping strategies predicted PTSD symptom severity among individuals who made decisions for adult family members in the ICU, according to results from a longitudinal correlational study.

“Some family members of critically ill patients experience tremendous psychological distress during the ICU experience. Lemiale et al reported in a French cohort that 36% of ICU family members are taking anxiolytic or antidepressant drugs on discharge or death of their family member,” Amy B. Petrinec, PhD, RN, of Case Western University, and colleagues wrote. “In the months following the ICU experience, family members are at risk for ongoing psychological distress, including symptoms of generalized anxiety disorder, depression, panic disorder, posttraumatic stress disorder (PTSD), and complicated grief.”

Researchers sought to assess coping strategies used by family decision makers of adult critical care patients and the relationship between coping strategies and PTSD. The study comprised 77 family decision makers of incapacitated adult ICU patients. The participants completed the Brief COPE instrument 5 days after ICU admission and 30 days after hospital discharge or death of patient and completed the Impact Event Scale-Revised to determine PTSD symptoms 60 days after hospital discharge.

Use of problem-focused (P = .01) and emotion-focused (P < .01) coping decreased over time, whereas avoidant coping (P = .2) remained stable.

When controlling for patient and decision-maker characteristic, coping strategies 30 days after hospitalization (P < .001) were stronger predictors of future PTSD symptoms than coping strategies 5 days after admission (P = .001).

The role of decision maker for a parent and patient death were the only non-coping predictors of PTSD symptoms.

Use of avoidant coping 30 days after hospitalization mediated the relationship between patient death and future PTSD severity.

“The relationship between coping strategy and PTSD symptoms is important for several reasons. It may provide a mechanism that helps to explain the effect of [family decision makers] and ICU variables on subsequent development of PTSD symptoms. Second, it may provide an opportunity for focused interventions that target maladaptive coping strategies to diminish later PTSD symptoms. Coping strategies are amenable to treatment interventions, and interventions to diminish avoidant coping use have been associated with reductions in PTSD symptoms,” Petrinec and colleagues concluded. – by Amanda Oldt

Disclosure: Petrinec reports receiving research support from the NIH. Please see the full study for a list of all other authors’ relevant financial disclosures.