Perceived Unexpectedness of Death and PTSD Among Family Members of Intensive Care Patients With COVID-19 or Not

BACKGROUND: Patient death caused by COVID-19 in an intensive care unit (ICU) may be a risk factor for posttraumatic stress disorder (PTSD) in family members. OBJECTIVE: To determine if bereaved family members of ICU patients with COVID-19 were more likely than those of patients without COVID-19 to experience PTSD and prolonged grief disorder and find the death unexpected. METHODS: In this cross-sectional survey study with embedded qualitative analysis conducted during the Omicron wave of the COVID-19 pandemic, family members of ICU patients at an academic medical center were enrolled at least 6 months after a patient's death. Participants completed Impact of Event Scale-Revised (IES-R) and Prolonged Grief Disorder-13-Revised (PG-13-R) and rated how unexpected the death was on a 5-point Likert scale. A subset participated in individual interviews. RESULTS: Of 162 total participants, 37 respective patients (23%) died of COVID-19. Family members of COVID-19 patients had significantly higher IES-R scores than did those of non-COVID-19 patients (32.4 vs 24.9, P = .03) but similar PG-13-R scores (26.1 vs 24.7, P = .43). Score on IES-R was associated with greater perception that death was unexpected (P < .001). Mediation analysis revealed a significant indirect effect between patient's COVID-19 status and family member's IES-R score via greater perceived unexpectedness of death (B = 2.27 [95% CI, 0.22-4.97]). CONCLUSIONS: Among bereaved family members of ICU patients, perceiving the patient's death as unexpected was greater when death was due to COVID-19 versus other causes and was associated with PTSD symptoms.