Visitation restrictions linked to PTSD in relatives of deceased patients with COVID-19
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Key takeaways:
- PTSD was seen in a higher proportion of individuals whose family member died due to COVID-19 vs. survived.
- The stress in relatives of deceased patients stemmed from visitation restrictions.
More relatives of deceased vs. alive ICU patients with COVID-19 reported PTSD symptoms and negative impacts of visitation restriction, according to a research letter published in CHEST.
“Most families remembered that restrictive visitation policies made their ICU experience more challenging,” Jared A. Greenberg, MD, associate professor in the department of internal medicine at Rush University, told Healio. “However, the perceived impact of the restrictive visitation policies depended on the patient outcome.”
In this study, Greenberg and colleagues evaluated 90 family members (80% women; 54% Hispanic; 20% Black non-Hispanic) of ICU patients with COVID-19 to find out if relatives with vs. without symptoms of PTSD had stronger memories of challenges linked to visitor restrictions after hospital discharge (median time from discharge, 158 days).
Researchers collected this information from participants through the Impact of Events Scale-Revised questionnaire, which measured PTSD symptoms due to the ICU setting, and a phone interview (n = 80).
Notably, more family members reported being children of the ICU patient than spouses (52% vs. 27%).
A higher proportion of family members of deceased vs. alive patients experienced PTSD symptoms (59% vs. 41%).
Between the two groups, researchers found a higher average Impact of Events Scale-Revised questionnaire score among those related to a deceased patient (mean score, 36.1 vs. 21.7; P < .001).
After talking to all participants, researchers noted three main challenges related to visitor restrictions:
- “The patient lacked comfort and communication from family.
- The family member was unable to witness events in real time.
- The family member could not use visual cues to realize the severity of the patient’s condition.”
Visitation restrictions had a greater impact on relatives of patients who died vs. survived in the ICU, with their PTSD symptoms arising from the thought that they may have been able to prevent death if they could have visited them.
Another belief among individuals related to a patient who died was that since visitation restrictions prevented them from seeing worsening conditions, they could not advocate for their sick family member or make decisions with them.
Individuals related to a patient who survived reported fewer consequences of visitation restrictions. Further, Greenberg said PTSD symptoms did not arise from these reported beliefs.
“If we are in a similar situation in the future, we should search for ways to help families feel actively involved in the patient’s care; they need to learn about clinical changes and help make decisions in real time,” Greenberg said. “Families often feel that patients must be motivated to get better. It will be helpful for nurses to reassure families that they are not only addressing a patient’s medical needs, but also providing the comfort and motivation the family would have if they were present.”
As a final note, Greenberg said his hospital is no longer seeing many patients with COVID-19, and there are no visitor restrictions in place for these patients.
Perspective
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The authors present very interesting research in which they qualitatively explore the experience of the family members of ICU patients early in the COVID-19 pandemic, focusing on the impact of visitation restrictions. In this research letter, they stratified the experiences based on the patient mortality outcome and evaluated the participants at about 5.5 months after the hospitalization for symptoms of PTSD. They present higher rates of symptoms of PTSD in those family members of patients who died.
What is most interesting in their findings is that the bereaved family members who experienced symptoms of PTSD held the belief that if they had been able to visit the patient, the patient’s death may have been prevented. This is a striking finding that highlights the importance of providing family members the opportunity to visit with their loved ones and, as the authors point out, be involved in the care and decision-making for the patient in the ICU. This is a very interesting addition to previous literature by Sarah J. Hochendoner and colleagues that described that, particularly in those who self-identify as Hispanic, participants with increased symptoms of PTSD described more distrust in the health care providers.
The authors should be commended on a diverse population enrolled in the study, with more than half identifying as Hispanic (54%), as underrepresented populations are often difficult to enroll in trials such as this. In as much, this significantly adds to the understanding of their experience, especially during the pandemic. Finally, as more research begins to explore the relationship between personality types of family members and their stress responses, the findings here pave the way to explore any relationship between the behaviors they identify as “self-blame” and “perceived helplessness” in future research.
Reference:
Hochendoner SJ, et al. Ann Am Thorac Soc. 2022;doi:10.1513/AnnalsATS.202105-629OC.
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