Stress-Related Disorders Prevalent In Relatives Of COVID-19 ICU Patients: A 'Secondary Public Health Crisis'

Many people with severe COVID-19 landed in the intensive care unit (ICU) during the pandemic, but how did this impact their family members who were waiting at their homes? A new study found that many of them were experiencing stress-related disorders months after the ordeal, suggesting that restricting visitations may generate a "secondary public health crisis."

In the new study, published Monday in JAMA Internal Medicine, a team of researchers sought to find the psychological impacts of having a family member with COVID-19 in the ICU. Amid the pandemic, hospitals limited visitations to the ICU. This was to prevent the transmission of the virus and also because of the shortage in-personal protective equipment, the University of Colorado Anschutz Medical Campus (CU Anschutz) noted in a news release.

"These measures may have added significant stress for patients, family members, and clinicians," the researchers wrote.

For their study, the researchers examined the prevalence of stress-related disorders, particularly post-traumatic stress disorder (PTSD) among 330 family members of COVID-19 patients admitted to the ICU some 90 days after they were admitted.

The patients were admitted between Feb. 1 and July 31, 2020 to eight academic-affiliated and four community-based hospitals in Colorado, Washington, Louisiana, New York and Massachusetts. Most of the participants were the patients' children, spouses or partners.

The results showed that 63.6% of the participants displayed "significant symptoms of PTSD." That's double the rates of stress-related disorder among family members of ICU patients before the pandemic, which was at around 30%.

"Our findings suggest that visitation restrictions may have inadvertently contributed to a secondary public health crisis, an epidemic of stress-related disorders among family members of ICU patients," study first author Timothy Amass, of CU School of Medicine, said in the news release.

According to the researchers, it appears that the visitation restrictions may have led to distrust since the relatives didn't get a chance to "build bedside relationships" with the clinicians.

"(T)his loss of trust may translate to an increase in stress-related disorders," the researchers wrote. "As such, establishing rapport with family members in creative and innovative ways may help to offset the physical distance."

Experts who were not involved in the study were not surprised by the findings.

"I think that the difference with the pandemic is that it involved not only illness and death, but also social isolation, employment changes, and significant changes in everyday life," Thomas J. Jameson, a licensed therapist at the Ohana Luxury Drug Rehab in Hawaii, told Healthline. "These things add to psychological distress and are more likely to trigger PTSD symptoms."

There's also the fact that the family members couldn't be by their loved ones' bedside in ICU. The novel nature of the virus also "made this a bit more complex," Tomanika Perry-Witherspoon, a clinical social worker, told the outlet.

According to the authors of the study, their work supports the hypothesis that restricting visitation "plays a role in increasing stress-related disorders in family members who could not be present at the bedside of their critically ill family member." However, they note that further studies are needed to confirm the hypothesis, determine the degree to which the symptoms are experienced and find ways to possibly improve family members' experiences.

"As the pandemic and visitation rules of hospitals continue to shift, our results should also alert the health care community to the diverse factors associated with significant psychological distress in family members of patients in the ICU," the researchers wrote. "In addition, these data may inform us of the risks assumed by family members who cannot, for reasons beyond their control (eg, geography, work, or childcare), visit their loved one during an ICU stay."