Psychiatric illness in the next of kin of patients who die in the intensive care unit.

OBJECTIVES

To determine the rates of psychiatric illness in next of kin following the death of a relative in a medical intensive care unit.

DESIGN

Cross-sectional survey.

SETTING

A university teaching hospital, New Haven, CT.

PATIENTS: Forty-one next of kin who had served as primary surrogate decision makers before the death of their loved one in the intensive care unit 3-12 months previously.

INTERVENTIONS: Structured Clinical Interviews for DSM-IV and the Inventory of Complicated Grief-Revised were used to determine prevalence of psychiatric illness. Formal questionnaires were used to evaluate key features of the intensive care unit experience. Bivariate statistics were used to identify factors associated with the presence of psychiatric illness.

MEASUREMENTS AND MAIN

RESULTS

Following 107 patient deaths, 51 next of kin were successfully contacted and 41 (80%) agreed to study participation. Thirty-four percent (95% confidence interval, 20% to 51%) met criteria for at least one psychiatric illness: major depressive disorder (27%), generalized anxiety disorder (10%), panic disorder (10%), or complicated grief disorder (5%). Disorders were more common in spouses than other kinship relations (63% vs. 16%, p = .002), those experiencing additional stressors after the loss (53% vs. 21%, p = .03), those who said the patient was ill <5 yrs (45% vs. 8%, p = .03), and those who said the patient's physician was not comforting (71% vs. 23%, p = .02).

CONCLUSIONS

In a cohort of bereaved next of kin of patients who died in the intensive care unit, we identified a high prevalence of psychiatric illness, particularly major depressive disorder. More work is needed to identify those at risk for psychiatric illness so that appropriate interventions may be targeted.