PTSD in Family Members of ICU Patients
Conditions
Keywords
Posttraumatic stress disorder (PTSD), ICU, visiting hours policies
Brief summary
This was a cluster randomized study of an ICU level intervention to reduce high risk of post-traumatic stress disorder (PTSD) in family members of ICU patients. Participating ICUs had restrictive visiting policies (i.e., \<6 hours/day) before randomization. After an observational period and a washout period, participating ICUs were randomized either to maintain their visiting policies or to liberalize their visiting policies (24 hours a day, 7 days a week.)
Detailed description
Family members of ICU patients are particularly exposed to anxiety, depressive, acute stress disorder, and posttraumatic stress disorder symptoms (PTSD). It is currently unknown what type of interventions/ strategies to cope with postintensive care syndrome family would produce the best improvement. Experts suggest that symptoms in family members are potentially amenable to intervention by ICU staff. One intervention to reduce PTSD could be a liberalization of the visiting hours. However, restrictions on visiting hours in the intensive care unit (ICU) are usually adopted worldwide.
Interventions
OTHERVisiting policies: 24 hours a day, 7 days a week
OTHERRestriction of visiting policies < 6 hours
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
: Patient and family member \> 18 years or older, * mechanical ventilation expected for more than 48 h and inclusion between day 3 and 5 from the beginning of mechanical ventilation, * patient having a family member speaking and understanding French, and with the ability to visit his/her relative during the ICU stay, * patient and his/her relative consenting to participate in the study, or obtention of family consent in case of patient incompetency
Exclusion criteria
: \- Patient without family available or family not speaking or understanding French
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Symptoms related to posttraumatic stress disorder (PTSD) | at day-90 from patient's ICU discharge | Impact event scale (IES). The Impact of Event scale (IES), which assesses symptoms related to post-traumatic stress disorder (PTSD); scores range from 0 (no PTSD-related symptoms) to 75 (severe PTSD-related symptoms). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Family member's needs | At inclusion | Critical Care Family Needs Inventory (CCFNI) Family needs and satisfaction was measured by a modified version of the Critical Care Family Needs Inventory (CCFNI). The satisfaction score was calculated as the sum of the scores on all items; the smallest possible score was 0 (extreme dissatisfaction) and the highest possible score was 14 (extreme satisfaction). |
| Family members' symptoms of anxiety and depression | At inclusion and Day-90 from patient's ICU discharge | Hospital and Anxiety Depression Scale (HADS) The Hospital and Anxiety and Depression Scale (HADS), subscale scores range from 0 (no distress) to 21 (severe distress), HADS subscales scores 5Anxiety and Depression) above 8 were considered to indicate clinically significant symptoms of anxiety or depression. |
| Beliefs and attitudes of healthcare workers toward visiting hours | 120 days | Beliefs and Attitudes toward Visitation in ICU Questionnaire (BAVIQ). Beliefs and attitudes of ICU staff members were recorded at the beginning of period 1 (observation period) and at the end of period 2 (intervention period) using a questionnaire named the Beliefs and Attitudes toward Visitation in ICU Questionnaire (BAVIQ). The Beliefs questionnaire contains both positively and negatively formulated questions. To calculate an overall score for nurses 'beliefs, we recoded the responses on the negatively formulated questions. Subsequently, we computed the average score over all the belief items. A score of zero corresponded with beliefs that are strongly opposed to open visitation and a score of 4 corresponded with beliefs that are strongly in favor of open visitation. |
| Patients' symptoms of anxiety and depression | At day-90 from patients'ICU discharge | Hospital and Anxiety Depression Scale (HADS) The Hospital and Anxiety and Depression Scale (HADS), subscale scores range from 0 (no distress) to 21 (severe distress), HADS subscales scores (Anxiety and Depression) above 8 were considered to indicate clinically significant symptoms of anxiety or depression. |
| the proportion of patients with High risk of PTSD occurrence | At day-90 from patients'ICU discharge | Score IES \> 30 points |
| the proportion of family members with High risk of PTSD occurrence | At day-90 from patients'ICU discharge | Score IES \> 30 points |
Outcome results
None listed