Decision-making Preferences and Levels of Anxiety and Depression in Family Members of Patients Admitted to the ICU
Dinesh Krishnamoorthy, Senthilkumar, Ramesh Venkataraman, Nagarajan Ramakrishnan, Vignesh C
Keywords :
Anxiety, Decision making, Decision making preferences, Depression, Hospital anxiety and depression scale score
Citation Information :
Krishnamoorthy D, Senthilkumar, Venkataraman R, Ramakrishnan N, C V. Decision-making Preferences and Levels of Anxiety and Depression in Family Members of Patients Admitted to the ICU. Indian J Crit Care Med 2025; 29 (2):155-163.
Objectives: We aimed to study decision-making preferences and levels of anxiety and depression in family members of patients admitted to the intensive care unit (ICU).
Materials and methods: This was a prospective observational study done in the mixed medical-surgical ICU. About 127 patients were recruited in first analysis and 100 patients were recruited in second analysis. Decision-making preferences were obtained only during first analysis. Hospital anxiety and depression scale (HADS) scores were calculated during both times. Hospital anxiety and depression scale scores more than or equal to 11 were found to have anxiety and depression. We also aimed to study the association between decision-making preferences and levels of anxiety and depression.
Results: Around 27 relatives did not give consent during second time analysis. About 61% preferred shared decision-making and 27 and 12% preferred active and passive decision-making respectively. About 63% of the relatives had anxiety during first analysis and 54% had anxiety during second analysis. 66.9% had symptoms of depression during first analysis and 62% had depression during second analysis. There was a significant association between decision-making preferences and level of anxiety and depression.
Conclusion: In our study, the majority of the relatives preferred shared decision-making, and the incidence of anxiety and depression seems to be high in the Indian population. A significant association was found between decision-making preferences and level of anxiety and depression, with passive decision-making being associated with a higher risk of anxiety and depression.
Thompson DR, Meddis R. Wives’ responses to counselling early after myocardial infarction. J Psychosom Res 1990;34(3):249–258. DOI: 10.1016/0022-3999(90)90081-e.
Rukholm E, Bailey P, Coutu-Wakulczyk G, Bailey WB. Needs and anxiety levels in relatives of intensive care unit patients. J Adv Nurs 1991;16(8):920–928. DOI: 10.1111/j.1365-2648.1991.tb01796.x.
Mayou R, Foster A, Williamson B. The psychological and social effects of myocardial infarction on wives. Br Med J 1978;1(6114):699–701. DOI: 10.1136/bmj.1.6114.699.
Bedsworth JA, Molen MT. Psychological stress in spouses of patients with myocardial infarction. Heart Lung J Crit Care 1982;11(5):450–456. PMID: 6921193.
Skelton M, Dominian J. Psychological stress in wives of patients with myocardial infarction. Br Med J 1973;2(5858):101–103. DOI: 10.1136/bmj.2.5858.101.
Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, et al. Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Crit Care Med 2001;29(10):1893–1897. DOI: 10.1097/00003246-200110000-00007.
Pochard F, Darmon M, Fassier T, Bollaert PE, Cheval C, Coloigner M, et al. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care 2005;20(1):90–96. DOI: 10.1016/j.jcrc.2004.11.004.
Young E, Eddleston J, Ingleby S, Streets J, McJanet L, Wang M, et al. Returning home after intensive care: A comparison of symptoms of anxiety and depression in ICU and elective cardiac surgery patients and their relatives. Intensive Care Med 2005;31(1):86–91. DOI: 10.1007/s00134-004-2495-y.
Çelik S, Genç G, Kinetli Y, Aşılıoğlı M, Sarı M, Madenoğlu Kıvanç M. Sleep problems, anxıety, depressıon and fatıgue on famıly members of adult intensıve care unıt patıents. Int J Nurs Pract 2016;22(5):512–522. DOI: 10.1111/ijn.12451.
Kose I, Zincircioglu C, Ozturk YK, Cakmak M, Guldogan EA, Demir HF, et al. Factors affecting anxiety and depression symptoms in relatives of intensive care unit patients. J Intensive Care Med 2016;31(9):611–617. DOI: 10.1177/0885066615595791.
Tilden VP, Tolle SW, Nelson CA, Fields J. Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nurs Res 2001;50(2):105–115. DOI: 10.1097/00006199-200103000-00006.
Halm MA, Titler MG, Kleiber C, Johnson SK, Montgomery LA, Craft MJ, et al. Behavioral responses of family members during critical illness. Clin Nurs Res 1993;2(4):414–437. DOI: 10.1177/105477389300200405.
Delva D, Vanoost S, Bijttebier P, Lauwers P, Wilmer A. Needs and feelings of anxiety of relatives of patients hospitalized in intensive care units: Implications for social work. Soc Work Health Care 2002;35(4):21–40. DOI: 10.1300/J010v35n04_02.
Kentish-Barnes N, Lemiale V, Chaize M, Pochard F, Azoulay E. Assessing burden in families of critical care patients. Crit Care Med 2009;37(10 Suppl):S448–S456. DOI: 10.1097/CCM.0b013e3181b6e145.
Kulkarni HS, Kulkarni KR, Mallampalli A, Parkar SR, Karnad DR, Guntupalli KK. Comparison of anxiety, depression, and post-traumatic stress symptoms in relatives of ICU patients in an American and an Indian public hospital. Indian J Crit Care Med 2011;15(3):147–156. DOI: 10.4103/0972-5229.84891.
Jacob DA. Family members experiences with decision making for incompetent patients in the ICU: A qualitative study. Am J Crit Care 1998;7(1):30–36. PMID: 9429681.
Baker R, Strosberg MA, Bynum J, editors. Deciding to Forego life-sustaining treatment (1983) excerpted. In: Legislating Medical Ethics: A Study of the New York State Do-Not-Resuscitate Law [Internet]. Dordrecht: Springer Netherlands; 1995 [cited 2025 Jan 9]. pp. 371–379. Available from: https://doi.org/10.1007/978-94-015-8593-4_26
Vincent JL. Ethical principles in end-of-life decisions in different European countries. Swiss Med Wkly 2004;134(5–6):65–68. DOI: 10.4414/smw.2004.10363.
Azoulay E, Pochard F, Chevret S, Adrie C, Annane D, Bleichner G, et al. Half the family members of intensive care unit patients do not want to share in the decision-making process: A study in 78 French intensive care units. Crit Care Med 2004;32(9):1832–1838. DOI: 10.1097/01.ccm.0000139693.88931.59.
Anderson WG, Arnold RM, Angus DC, Bryce CL. Passive decision-making preference is associated with anxiety and depression in relatives of patients in the intensive care unit. J Crit Care 2009;24(2):249–254. DOI: 10.1016/j.jcrc.2007.12.010.
Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005;171(9):987–994. DOI: 10.1164/rccm.200409-1295OC.
Wall RJ, Curtis JR, Cooke CR, Engelberg RA. Family satisfaction in the ICU: Differences between families of survivors and nonsurvivors. Chest 2007;132(5):1425–1433. DOI: 10.1378/chest.07-0419.
Hermann C. International experiences with the hospital anxiety and depression scale – a review of validation data and clinical results. J Psychosom Res 1997;42(1):17–41. DOI: 10.1016/s0022-3999(96)00216-4.
Degner LF, Sloan JA. Decision- making during serious illness: What role do patients really want to play. J Clin Epidemiol 1992;45(9):941–950. DOI: 10.1016/0895-4356(92)90110-9.