Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity

Pochard, Frédéric MD; Azoulay, Elie MD; Chevret, Sylvie MD; Lemaire, François MD; Hubert, Philippe MD; Canoui, Pierre MD; Grassin, Marc MD; Zittoun, Robert MD; le Gall, Jean-Roger MD; Dhainaut, Jean François MD; Schlemmer, Benoît MD


Objective Anxiety and depression may have a major impact on a person’s ability to make decisions. Characterization of symptoms that reflect anxiety and depression in family members visiting intensive care patients should be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues.

Design Prospective multicenter study.

Setting Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days.

Patients Six hundred thirty-seven patients and 920 family members.

Interventions Intensive care unit characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression.

Measurements and Main Results Of 920 Hospital Anxiety and Depression Scale questionnaires that were completed by family members, all items were completed in 836 questionnaires, which formed the basis for this study. The prevalence of symptoms of anxiety and depression in family members was 69.1% and 35.4%, respectively. Symptoms of anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors associated with symptoms of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by general practitioner), and caregiver-related factors (absence of regular physician and nurse meetings, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors associated with symptoms of depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers).

Conclusions More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.

From service de réanimation médicale (FP, JFD), hôpital Cochin, Paris, France; service de réanimation médicale (EA, J-RG) et service de biostatistique (SC), hôpital Saint-Louis, Paris; service de réanimation médicale (FL), hôpital Henri Mondor, Creteil, France; service de réanimation pédiatrique (PH, PC), hôpital Necker, Paris; département de Philosophie et d’Histoire de la médecine (RZ), Paris; and laboratoire d’éthique médicale et de santé publique (MG), UFR Necker Enfants Malades, Paris.

More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression.

Supported, in part, by a grant from the French Society for Critical Care.

*Members of the FAMIREA group: Djillali Annane, MD, Garches; Corinne Appere, MD, Bernard de Jonghe, MD, Poissy; Gerard Bleichner, MD, Argenteuil; Pierre Edouard Bollaert, MD, Nancy; Caroline Bornstain, MD; Yves Bouffard, MD, Lyon; Thierry Boulain, MD, Orléans; Frederic Brun, MD, Auxerre; Sylvain Cantagrel, MD, Tours Clocheville; Alain Cariou, MD, Paris Cochin; Isabelle Cattaneo, MD, Bry sur Marne; Jean Luc Chagnon, MD, Valenciennes; Jean Chastre, MD, Jocelyne Vaysse, Michel Wolff, MD, Paris Bichat; Christine Cheval, MD, Luc Montuclard, MD, Jean-François TImsit, MD, Paris Saint Joseph; Yves Cohen, MD, Bobigny; Michel Djibre, MD, Guy Meyer, MD, Paris Laënnec; Sandrine EssourI, MD, Le Kremlin Bicètre; Muriel Fartoukh, MD, Thomas Similowski, Paris Pitié-Salpétrière; Bruno Francois, MD, Limoges; Philippe Hubert, MD, Pierre Canoui, MD, Isabelle Leveque, Paris Necker; Edouard Ferrand, MD, Poitiers; Fazia Hallalel, MD, Paris Trousseau; Mustapha Mokhtari, MD, Catherine Huon, MD, Paris Saint Vincent de Paul; Mercé Jourdain, MD, Lille Salengro; Christine Lebert, MD, Frederic Bontemps, MD, La Roche Sur Yon; Françis Leclerc, MD, Marie Jo Delfosse, Lille Jeanne de Flandre; François Lemaire, MD, Nadine Soubrier, Créteil; Thierry Mathevon, MD, Bertrand Souweine, MD, Clermont Ferrand; Françoise Nicolas, MD, Nantes; Antoine Parrot, MD, Doris Berdugho, Paris Tenon; Laurent Papazian, MD, Marseilles; Catherine Poisson, MD, Didier Thevenin, MD, Lens; Jean Louis Ricome, MD, Saint Germain en Laye; Amar Salah, MD, Colombes; Umberto Simeoni, MD, Pascale Frosio, Hautepierre, Strasbourg; Fabienne Saulnier, MD, Lille Calmette; Jerome Tayoro, MD, Tours; Rémi Thomas, MD, Rennes; Marie Thuong, MD, Saint Denis.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins