Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients

Abstract

Aim: Prognostic uncertainty and surrogate decision-making demands associated with prolonged unconsciousness in out-of hospital cardiac arrest (OHCA) patients in the intensive care unit (ICU) may increase post-traumatic stress disorder (PTSD) risk in their relatives. Our aim was to study PTSD frequency and risk factors in relatives of OHCA patients.

Methods: In this observational study 101 consecutive eligible adult relatives of OHCA patients were interviewed using validated questionnaires, the "Impact of Event Scale-Revised" to detect PTSD and the "Family-Satisfaction with Care in the ICU" to assess potential PTSD risk factors.

Results: PTSD was detected in 40/101 relatives (40%). Multivariate logistic regression identified three significant PTSD predictors [odds ratio, 95% confidence interval]: female gender [3.30, 1.08-10.11], history of depression [3.63, 1.02-12.96], family perception of the patient's therapy as insufficient [18.40, 1.52-224.22]. Three other predictors were not significantly associated with PTSD (hypothermia treatment of the patient [2.86, 0.96-8.48]), delayed delivery of prognostic information by ICU staff [2.11, 0.83-5.38], family-ICU staff conflict [3.61, 0.71-18.40]). A prediction rule including six factors (p<0.15 each) showed high discrimination (area under the receiver-operating characteristic curve 0.74) with a stepwise increase in risk for PTSD from 0% (no risk factor) to 63% (≥3 risk factors). There was no evidence for effect modification either by survival status or neurological outcome.

Conclusion: Relatives of OHCA patients treated in the ICU are at increased risk of PTSD, which can be predicted based on six factors, three ICU-related and potentially at least partly modifiable. Further research is needed to validate our findings and to develop strategies to prevent PTSD in OHCA patients' relatives.

Keywords: Critical care; Family satisfaction; Hypothermia; Out-of-hospital cardiac arrest; Post-traumatic stress disorder (PTSD); Prediction; Risk.