Elie Azoulay1, Matthieu Resche-Rigon2, Bruno Megarbane3, Danielle Reuter4, Vincent Labbé5, Alain Cariou6, Guillaume Géri7, Guillaume Van der Meersch8, Achille Kouatchet9, Olivier Guisset10, Fabrice Bruneel11, Jean Reignier12, Virginie Souppart1, François Barbier13, Laurent Argaud14, Jean-Pierre Quenot15, Laurent Papazian16, Bertrand Guidet17, Guillaume Thiéry18, Kada Klouche19, Olivier Lesieur20, Alexandre Demoule21, Christophe Guitton22, Gilles Capellier23, Bruno Mourvillier24, Lucie Biard2, Frédéric Pochard25, Nancy Kentish-Barnes1. 1. Famirea Study Group, Medical Intensive Care Unit, APHP, Saint Louis University Hospital, Paris, France. 2. Clinical Research Unit, APHP, Saint Louis University Hospital, Paris, France. 3. Medical Intensive Care Unit, APHP, Lariboisière University Hospital, Paris, France. 4. Medical-Surgical Intensive Care Unit, CH Sud Francilien, Corbeil, France. 5. Medical-Surgical Intensive Care Unit, APHP, Tenon University Hospital, Paris, France. 6. Medical Intensive Care Unit, Cochin University Hospital, APHP, Centre - Université de Paris, Paris, France. 7. Medical-Surgical Intensive Care Unit, APHP, Ambroise Paré University Hospital, Boulogne, France. 8. Medical-Surgical Intensive Care Unit, APHP, Avicenne University Hospital, Bobigny, France. 9. Medical Intensive Care Unit, Angers Teaching Hospital, Angers, France. 10. Medical Intensive Care Unit, Saint-André Hospital, Bordeaux, France. 11. Intensive Care Unit, André Mignot Hospital, Le Chesnay, France. 12. Medical Intensive Care Unit, University Hospital Centre, Nantes, France. 13. Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France. 14. Medical Intensive Care Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 15. Medical Intensive Care Department, University Hospital, Dijon, France. 16. Respiratory and Infectious Diseases Intensive Care Unit, APHM Hôpital Nord, Marseille, France. 17. Medical Intensive Care Unit, APHP, Saint-Antoine University Hospital, Paris, France. 18. Medical Intensive Care Unit, Saint-Etienne, University Hospital, Paris, France. 19. Department of Intensive Care Medicine, Lapeyronie Hospital, Montpellier, France. 20. Medical-Surgical Intensive Care Unit, La Rochelle Hospital, La Rochelle, France. 21. AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Pitié-Salpêtrière site, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S) and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France. 22. Medical Intensive Care Unit, Le Mans Hospital, Le Mans, France. 23. Medical Intensive Care Unit, Besançon, University Hospital, Besançon, France. 24. Medical Intensive Care Unit, Reims University Hospital, Reims, France. 25. Psychiatry Department, Lariboisière Fernand-Widal University Hospital, Paris, France.
Abstract
IMPORTANCE: 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. OBJECTIVE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. EXPOSURES: Family members of patients hospitalized for ARDS due to COVID-19 vs ARDS due to other causes. MAIN OUTCOMES AND MEASURES: 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 >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. RESULTS: 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%]; P < .001), symptoms of anxiety (41% [121/294] vs 34% [70/207]; difference, 8% [95% CI, 0%-16%]; P= .05), and symptoms of depression (31% [91/291] vs 18% [37/209]; difference, 13% [95% CI, 6%-21%]; P< .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]). CONCLUSIONS AND RELEVANCE: 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04341519.
IMPORTANCE: 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. OBJECTIVE: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. EXPOSURES: Family members of patients hospitalized for ARDS due to COVID-19 vs ARDS due to other causes. MAIN OUTCOMES AND MEASURES: 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 >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. RESULTS: 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%]; P < .001), symptoms of anxiety (41% [121/294] vs 34% [70/207]; difference, 8% [95% CI, 0%-16%]; P= .05), and symptoms of depression (31% [91/291] vs 18% [37/209]; difference, 13% [95% CI, 6%-21%]; P< .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]). CONCLUSIONS AND RELEVANCE: 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04341519.
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