Association of COVID-19 Acute Respiratory Distress Syndrome With Symptoms of Posttraumatic Stress Disorder in Family Members After ICU Discharge
Authors: Elie Azoulay, Matthieu Resche-Rigon, Bruno Megarbane, Danielle Reuter, Vincent Labbé, Alain Cariou, Guillaume Géri, Guillaume Van der Meersch, Achille Kouatchet, Olivier Guisset, Fabrice Bruneel, Jean Reignier, Virginie Souppart, François Barbier, Laurent Argaud, Jean-Pierre Quenot, Laurent Papazian, Bertrand Guidet, Guillaume Thiéry, Kada Klouche, Olivier Lesieur, Alexandre Demoule, Christophe Guitton, Gilles Capellier, Bruno Mourvillier, Lucie Biard, Frédéric Pochard, Nancy Kentish-Barnes
Journal: JAMA (2022)

<h3>Importance</h3> Persistent physical and mental disorders are frequent in survivors of COVID-19–related acute respiratory distress syndrome (ARDS). However, data on these disorders among family members are scarce. <h3>Objective</h3> To determine the association between patient hospitalization for COVID-19 ARDS vs ARDS from other causes and the risk of posttraumatic stress disorder (PTSD)–related symptoms in family members. <h3>Design, Setting, and Participants</h3> Prospective cohort study in 23 intensive care units (ICUs) in France (January 2020 to June 2020 with final follow-up ending in October 2020). ARDS survivors and family members (1 family member per patient) were enrolled. <h3>Exposures</h3> Family members of patients hospitalized for ARDS due to COVID-19 vs ARDS due to other causes. <h3>Main Outcomes and Measures</h3> The primary outcome was family member symptoms of PTSD at 90 days after ICU discharge, measured by the Impact of Events Scale-Revised (score range, 0 [best] to 88 [worst]; presence of PTSD symptoms defined by score &gt;22). Secondary outcomes were family member symptoms of anxiety and depression at 90 days assessed by the Hospital Anxiety and Depression Scale (score range, 0 [best] to 42 [worst]; presence of anxiety or depression symptoms defined by subscale scores ≥7). Multivariable logistic regression models were used to determine the association between COVID-19 status and outcomes. <h3>Results</h3> Among 602 family members and 307 patients prospectively enrolled, 517 (86%) family members (median [IQR] age, 51 [40-63] years; 72% women; 48% spouses; 26% bereaved because of the study patient's death; 303 [50%] family members of COVID-19 patients) and 273 (89%) patients (median [IQR] age, 61 [50-69] years; 34% women; 181 [59%] with COVID-19) completed the day-90 assessment. Compared with non–COVID-19 ARDS, family members of patients with COVID-19 ARDS had a significantly higher prevalence of symptoms of PTSD (35% [103/293] vs 19% [40/211]; difference, 16% [95% CI, 8%-24%];<i>P</i> &lt; .001), symptoms of anxiety (41% [121/294] vs 34% [70/207]; difference, 8% [95% CI, 0%-16%];<i>P</i>= .05), and symptoms of depression (31% [91/291] vs 18% [37/209]; difference, 13% [95% CI, 6%-21%];<i>P</i>&lt; .001). In multivariable models adjusting for age, sex, and level of social support, COVID-19 ARDS was significantly associated with increased risk of PTSD-related symptoms in family members (odds ratio, 2.05 [95% CI, 1.30 to 3.23]). <h3>Conclusions and Relevance</h3> Among family members of patients hospitalized in the ICU with ARDS, COVID-19 disease, as compared with other causes of ARDS, was significantly associated with increased risk of symptoms of PTSD at 90 days after ICU discharge. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT04341519