Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients
OBJECTIVES:. To determine the degree to which an ICU patient’s family member having an “anxious” psychologic attachment orientation is a risk factor for developing long-term posttraumatic stress disorder (PTSD) symptoms following patient ICU discharge or death. DESIGN:. Prospective cohort study. SET...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-09-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000753 |
| _version_ | 1811258554768687104 |
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| author | Qiang Zhang, BA Andrea K. Knies, Dr rer. Medic Jolanta Pach, BS Tara Kimbrough, MD Aida Martinez, MD Prerak Juthani, BA Stephanie Tu, BS Joan K. Monin, PhD Ana-Maria Vranceanu, PhD David Y. Hwang, MD |
| author_facet | Qiang Zhang, BA Andrea K. Knies, Dr rer. Medic Jolanta Pach, BS Tara Kimbrough, MD Aida Martinez, MD Prerak Juthani, BA Stephanie Tu, BS Joan K. Monin, PhD Ana-Maria Vranceanu, PhD David Y. Hwang, MD |
| author_sort | Qiang Zhang, BA |
| collection | DOAJ |
| description | OBJECTIVES:. To determine the degree to which an ICU patient’s family member having an “anxious” psychologic attachment orientation is a risk factor for developing long-term posttraumatic stress disorder (PTSD) symptoms following patient ICU discharge or death.
DESIGN:. Prospective cohort study.
SETTING:. Single academic neuroscience ICU from November 2017 to September 2020.
PARTICIPANTS:. Consecutively enrolled sample of family members, one for each ICU patient with a minimum length of stay of 24 hours.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. Near time of ICU discharge or patient death, we determined each participant’s psychologic attachment orientation as anxious versus nonanxious via a brief standard survey tool, the Relationship Questionnaire, and measured other participant and patient characteristics as potential covariates. Six months after discharge or death, each participant completed the Impact of Events Scale-Revised (IES-R) to measure PTSD symptoms, with a score of greater than 24 indicative of clinically significant symptoms. Among 162 total participants, 10 of 27 participants (37.0%) with an anxious attachment orientation reported 6-month PTSD symptoms, compared with 24 of 135 nonanxious participants (17.8%) (relative risk, 2.08; 95% CI, 1.13–3.84; p = 0.02; risk difference 19.2%). In a subsequent univariate analysis of participant and patient covariates, anxious attachment orientation, participant Hispanic ethnicity, prior experience as a care partner of a patient with a disability, and participation in 3 or more formal ICU family meetings were all associated with 6-month PTSD symptoms. In a multiple logistic regression, anxious attachment remained an independent predictor of 6-month PTSD symptoms (odds ratio [OR], 3.64; 95% CI, 1.35–9.77; p = 0.01), as did Hispanic ethnicity (OR, 4.72; 95% CI, 1.34–16.6; p = 0.01) and participation in three or more ICU family meetings (odds ratio, 2.97; 95% CI, 1.14–7.68; p = 0.02).
CONCLUSIONS:. An anxious psychologic attachment orientation is associated with double the risk of long-term PTSD symptoms among family members of ICU patients. Future interventions designed to decrease risk of adverse psychologic outcomes among ICU families could be initially tested for efficacy amongst those who fall into this high-risk category. |
| first_indexed | 2024-04-12T18:16:13Z |
| format | Article |
| id | doaj.art-ad136b1a40424fef97ce92416f13828e |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-12T18:16:13Z |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-ad136b1a40424fef97ce92416f13828e2022-12-22T03:21:38ZengWolters KluwerCritical Care Explorations2639-80282022-09-0149e075310.1097/CCE.0000000000000753202209000-00004Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU PatientsQiang Zhang, BA0Andrea K. Knies, Dr rer. Medic1Jolanta Pach, BS2Tara Kimbrough, MD3Aida Martinez, MD4Prerak Juthani, BA5Stephanie Tu, BS6Joan K. Monin, PhD7Ana-Maria Vranceanu, PhD8David Y. Hwang, MD91 Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT.2 Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT.3 Yale School of Medicine, Yale University, New Haven, CT.4 Ochsner Medical Center, New Orleans, LA.5 Harbor-UCLA Medical Center, Los Angeles, CA.3 Yale School of Medicine, Yale University, New Haven, CT.3 Yale School of Medicine, Yale University, New Haven, CT.6 Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT.7 Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.1 Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT.OBJECTIVES:. To determine the degree to which an ICU patient’s family member having an “anxious” psychologic attachment orientation is a risk factor for developing long-term posttraumatic stress disorder (PTSD) symptoms following patient ICU discharge or death. DESIGN:. Prospective cohort study. SETTING:. Single academic neuroscience ICU from November 2017 to September 2020. PARTICIPANTS:. Consecutively enrolled sample of family members, one for each ICU patient with a minimum length of stay of 24 hours. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Near time of ICU discharge or patient death, we determined each participant’s psychologic attachment orientation as anxious versus nonanxious via a brief standard survey tool, the Relationship Questionnaire, and measured other participant and patient characteristics as potential covariates. Six months after discharge or death, each participant completed the Impact of Events Scale-Revised (IES-R) to measure PTSD symptoms, with a score of greater than 24 indicative of clinically significant symptoms. Among 162 total participants, 10 of 27 participants (37.0%) with an anxious attachment orientation reported 6-month PTSD symptoms, compared with 24 of 135 nonanxious participants (17.8%) (relative risk, 2.08; 95% CI, 1.13–3.84; p = 0.02; risk difference 19.2%). In a subsequent univariate analysis of participant and patient covariates, anxious attachment orientation, participant Hispanic ethnicity, prior experience as a care partner of a patient with a disability, and participation in 3 or more formal ICU family meetings were all associated with 6-month PTSD symptoms. In a multiple logistic regression, anxious attachment remained an independent predictor of 6-month PTSD symptoms (odds ratio [OR], 3.64; 95% CI, 1.35–9.77; p = 0.01), as did Hispanic ethnicity (OR, 4.72; 95% CI, 1.34–16.6; p = 0.01) and participation in three or more ICU family meetings (odds ratio, 2.97; 95% CI, 1.14–7.68; p = 0.02). CONCLUSIONS:. An anxious psychologic attachment orientation is associated with double the risk of long-term PTSD symptoms among family members of ICU patients. Future interventions designed to decrease risk of adverse psychologic outcomes among ICU families could be initially tested for efficacy amongst those who fall into this high-risk category.http://journals.lww.com/10.1097/CCE.0000000000000753 |
| spellingShingle | Qiang Zhang, BA Andrea K. Knies, Dr rer. Medic Jolanta Pach, BS Tara Kimbrough, MD Aida Martinez, MD Prerak Juthani, BA Stephanie Tu, BS Joan K. Monin, PhD Ana-Maria Vranceanu, PhD David Y. Hwang, MD Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients Critical Care Explorations |
| title | Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients |
| title_full | Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients |
| title_fullStr | Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients |
| title_full_unstemmed | Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients |
| title_short | Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients |
| title_sort | psychological attachment orientation and long term posttraumatic stress symptoms among family members of icu patients |
| url | http://journals.lww.com/10.1097/CCE.0000000000000753 |
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