Family visitation during ICU stay matters a lot for critical illness survivors

Having an in-person family visit in the intensive care unit (ICU) makes a difference in the long-term mental health of patients, with a recent study suggesting that it lowers the risk of psychiatric disorders up to 1 year after hospital discharge.

In a cohort of 14,344 critically illness survivors, about one-third (34.9 percent) were diagnosed with a clinically relevant psychiatric disorder within 1 year of hospital discharge. Most of the diagnoses were anxiety (17.5 percent) and depressive disorders (17.2 percent). [Chest 2022;doi:g/10.1016/j.chest.2022.02.051]

There seemed to be no difference in the incidence of postdischarge psychiatric conditions among patients who were (n=13,771) vs were not (n=573) visited by a family during their ICU stay (34.9 percent vs 34.0 percent; p=0.65). However, inverse probability weighting of 13,731 patients showed that in-person family visitation was protective against the development of any psychiatric disorder within 1-year postdischarge (risk ratio, 0.79, 95 percent confidence interval, 0.68–0.92).

Toll of psychiatric disorders

Already, psychiatric disorders among ICU patients are quite prevalent, with depression (32–40 percent), anxiety (19–37 percent), and post-traumatic stress disorder (PTSD; 19–22 percent) being reported to last up to 8 years after hospital discharge. These conditions can cause problems for survivors.

Indeed, prevalent psychiatric disorders among critical illness survivors up the risk hospital readmission, with 37 percent being readmitted to hospital within 1 year after discharge. This number is 10 percentage points higher as compared to those initially admitted to the ICU without pre-existing psychiatric conditions. Readmissions may also increase among survivors who develop depression or anxiety after their discharge. [Am J Geriatr Psychiatry 2019;27:446-454; Crit Care Med 2016;44:1744-1753; Gen Hosp Psychiatry 2016;43:23-29]

That being said, the long-term mental health consequence associated with the lack of family visitation in the ICU among critical illness survivors must be significant not only on the patient level but also within the healthcare system, according to the investigators.

“It is expected that any intervention that can [reduce] the substantial burden of psychiatric disorders in survivors of critical illness could potentially be relevant,” they added.

In sickness and in health

Acting as surrogate decision makers and emotional supports during and after critical illness, family members (ie, relatives and friends) are indispensable in ICU care. In fact, guidelines encourage regular visitation between family members and patients in the ICU, which can occur in many ways such as during family meetings, patient care rounds, and informal updates. [Qual Health Res 2012;22:157-173; Crit Care Med 2018;46:1175-1180; J Crit Care 2019;54:235-238]

“Including family members in provision of care improves communication and builds trust,” the investigators pointed out.

A meaningful in-person family visitation provides comfort and familiarity to the ICU patient and may reduce their disturbances and distress as a result, they said. Additionally, “families know patients best and may recognize subtle changes earlier than healthcare professionals, especially when the patient cannot actively participate in discussion. [Crit Care Med 2016;44:1744-1753; BMC Health Serv Res 2019;19:867; Crit Care Med 2017;45:1751-1761]

“Therefore, engaging in-person visitation may be an important component of preventive strategies that aim to mitigate the risk of negative patient outcomes related to long-term psychiatric disorders,” they added.