COVID vs non-COVID ARDS: Are both mentally distressing for patients’ kin?

Mental health symptoms of family members of patients hospitalized for acute respiratory distress syndrome (ARDS) were similar at 12 months regardless of whether it was caused by COVID-19 or not, a prospective cohort study suggests.

Nearly half of family members of patients admitted for COVID-19 ARDS presented with symptoms related to post-traumatic stress disorder (PTSD) 6 months following discharge of their relative from the intensive care unit (ICU), and about 40 percent had persistent symptoms a year after ICU discharge. [JAMA Intern Med 2022;182:624-633; Intensive Care Med 2022;48:322-331]

“However, there is little long-term comparative data on the psychological well-being of family members of patients with COVID-19 ARDS compared with patients with non-COVID-19 ARDS,” said the researchers.

The investigators conducted the study at 23 ICUs in France. The study enrolled 602 family members of ICU patients hospitalized for ARDS due to COVID-19 or other causes. The 12-month follow-up completed in June 2022 included participants who had provided informed oral consent for the 3-month follow-up. [JAMA 2023;doi:10.1001/jama.2023.15879]

Of the 437 participants who completed the questionnaires at 12 months, 268 comprised the COVID-19 ARDS group, while the remaining 169 family members comprised the non-COVID-19 ARDS group. Median age for the respective groups were 50 and 54 years. More than half of the participants were female (73 percent and 66 percent, respectively).

At 12 months, the rates of PTSD symptoms were similar between the COVID-19 and non-COVID-19 ARDS groups (25 percent and 22 percent; p=0.71), as were the rates of depression (26 percent and 22 percent; p=0.41) and anxiety symptoms (37 percent and 39 percent; p=0.75).

The incidence of complicated grief was not significantly different either between the COVID-19 and non-COVID-19 ARDs groups (29 percent vs 30 percent; p=0.98).

In terms of scores, there were no significant between-group differences either in terms of median Revised Impact of Event Scale (10 vs 8), Hospital Anxiety and Depression Scale (HADS) depression subscale (3 for both), HADS anxiety subscale (5 for both), and Inventory of Complicated Grief symptom scores (16 vs 17).

Support is essential regardless of ARDS cause

Compared with other ARDS causes, COVID-19 was significantly associated with a higher incidence of PTSD, anxiety, and depression symptoms among family members 3 months following discharge or death of their relative. [JAMA 2022;327:1042-1050] The restrictions imposed during the COVID-19 pandemic may have been a driving factor, as this limited the relatives’ contact with their loved one admitted in the hospital.

However, the current findings appear to digress from the above-noted evidence. “The family members’ psychological symptoms may have eased over time as patients recovered,” the researchers explained. “Death caused by COVID-19 was also not associated with a higher risk of family members developing complicated grief, contrary to expectations.” [Front Psychiatry 2020;11:489]

Taken together, considering the lack of differences between groups, the findings imply that the kin of ICU patients admitted for COVID-19 and non-COVID-19 ARDS similarly deserve long-term support, the researchers said.