Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 15 , ISSUE 3 ( July, 2011 ) > List of Articles

RESEARCH ARTICLE

Comparison of anxiety, depression, and post-traumatic stress symptoms in relatives of ICU patients in an American and an Indian public hospital

Antara Mallampalli, Hrishikesh S. Kulkarni, Karishma R. Kulkarni, Shubhangi R. Parkar, Dilip R. Karnad, Kalpalatha K. Guntupalli

Keywords : Anxiety, depression, family, psychological, stress disorders, stress, traumatic

Citation Information : Mallampalli A, Kulkarni HS, Kulkarni KR, 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

License: CC BY-ND 3.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2011; The Author(s).


Abstract

Context: An intensive care unit (ICU) admission of a patient causes considerable stress among relatives. Whether this impact differs among populations with differing sociocultural factors is unknown. Aims: The aim was to compare the psychological impact of an ICU admission on relatives of patients in an American and Indian public hospital. Settings and Design: A cross-sectional study was carried out in ICUs of two tertiary care hospitals, one each in major metropolitan cities in the USA and India. Materials and Methods: A total of 90 relatives visiting patients were verbally administered a questionnaire between 48 hours and 72 hours of ICU admission that included the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory-II (BDI-II) and Impact of Events Scale-Revised (IES-R) for post-traumatic stress response. Statistical Analysis: Statistical analysis was done using the Mann-Whitney and chi-square tests. Results: Relatives in the Indian ICU had more anxiety symptoms (median HADS-A score 11 [inter-quartile range 9-13] vs. 4 [1.5-6] in the American cohort; P<0.0001), more depression symptoms (BDI-II score 14 [8.5-19] vs. 6 [1.5-10.5], P<0.0001) but a comparable post-traumatic stress response (IES-R score>30). 55% of all relatives had an incongruous perception regarding “change in the patient′s condition” compared to the objective change in severity of illness. “Change in worry” was incongruous compared to the “perception of improvement of the patient′s condition” in 78% of relatives. Conclusions: Relatives of patients in the Indian ICU had greater anxiety and depression symptoms compared to those in the American cohort, and had significant differences in factors that may be associated with this psychological impact. Both groups showed substantial discordance between the perceived and objective change in severity of illness.


PDF Share
  1. 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):S448-56.
  2. Anderson WG, Arnold RM, Angus DC, Bryce CL. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 2008;23:1871-6.
  3. Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med 2008;36:1722-8.
  4. Guntupalli KK, Rebbapragada VR, Lodhi MH, Bradford S, Burruss J, McCabe D, et al. Anxiety, depression and post-traumatic stress reactions in relatives of intensive care unit patients. Chest 2007;132 (4 Suppl):549-50S.
  5. 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 multicentric study. J Crit Care 2005;20:90-6.
  6. Jayaram R, Ramakrishnan N. Cost of intensive care in India. Indian J Crit Care Med 2008;12:55-61.
  7. Pillai LV, Ambike D, Husainy S, Vaidya N, Kulkarni SD, Aigolikar S. The prevalence of post-traumatic stress disorder symptoms in relatives of severe trauma patients admitted to the intensive care unit. Indian J Crit Care Med 2006;10:181-6.
  8. Pillai L, Aigalikar S, Vishwasrao SM, Husainy SM. Can we predict intensive care relatives at risk for posttraumatic stress disorder? Indian J Crit Care Med 2010;14:83-7.
  9. Kulkarni HS. Less-obvious predictors of post-ICU informal caregiver burden. Chest 2010;138:1024-5.
  10. Azoulay E, Chevret S, Leleu G, Pochard F, Barboteu M, Adrie C, et al. Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000;28:3044-9.
  11. 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;171:987-94.
  12. UNICEF - India - Statistics. New York: United Nations Children′s Fund. 2010 Mar 2. Available from: http://www.unicef.org/infobycountry/india_statistics.html. [Last cited on 2011 Apr 28].
  13. noneUNICEF - At a glance: United States of America - Statistics. New York: United Nations Children′s Fund 2010 Mar 2. Available from: http://www.unicef.org/infobycountry/usa_statistics.html. [Last cited on 2011 Apr 28].
  14. Kapadia F, Singh M, Divatia J, Vaidyanathan P, Udwadia FE, Raisinghaney SJ, et al. Limitations and withdrawal of intensive therapy at the end of life: practices in intensive care units in Mumbai, India. Crit Care Med 2005;33:1272-5.
  15. Danis M, Linde-Zwirble WT, Astor A, Lidicker JR, Angus DC. How does lack of insurance affect use of intensive care? A population-based study. Crit Care Med 2006;34:2043-8.
  16. Blank RH, Merrick JC. End-of-life decision making: a cross-national study. Cambridge (MA): MIT Press; 2005.
  17. Munnur U, Karnad DR, Bandi VD, Lapsia V, Suresh MS, Ramshesh P, et al. Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes. Intensive Care Med 2005;31:1087-94.
  18. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.
  19. Snaith RP. The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes 2003;1:29.
  20. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio (TX): Psychological Corporation; 1996.
  21. Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979;41:209-18.
  22. Lane DA, Jajoo J, Taylor RS, Lip GY, Jolly K; Birmingham Rehabilitation Uptake Maximisation (BRUM) Steering Committee. Cross-cultural adaptation into Punjabi of the English version of the Hospital Anxiety and Depression Scale. BMC Psychiatry 2007;7:5.
  23. Thomas BC, Devi N, Sarita GP, Rita K, Ramdas K, Hussain BM, et al. Reliability and validity of the Malayalam hospital anxiety and depression scale (HADS) in cancer patients. Indian J Med Res 2005;122:395-9.
  24. Smarr KL. Measures of depression and depressive symptoms: The Beck Depression Inventory (BDI), Center for Epidemiological Studies-Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Primary Care Evaluation of Mental Disorders-Mood Module (PRIME-MD). Arthritis Care Res 2003;49:S134-46.
  25. Basker M, Moses PD, Russell S, Russell PS. The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care pediatric setting in India. Child Adolesc Psychiatry Ment Health 2007;1:8.
  26. Gupta R, Dahiya S, Bhatia MS. Effect of depression on sleep: Qualitative or quantitative? Indian J Psychiatry 2009;51:117-21.
  27. Paparrigopoulos T, Melissaki A, Efthymiou A, Tsekou H, Vadala C, Kribeni G, et al. Short-term psychological impact on family members of intensive care unit patients. J Psychosom Res 2006;61:719-22.
  28. Parikh CR, Karnad DR. Quality, cost, and outcomes of intensive care in a public hospital in Bombay, India. Crit Care Med 1999;27:1754-9.
  29. Merchant M, Karnad DR, Kanbur AA. Incidence of nosocomial pneumonia in a medical intensive care unit and general medical ward patients in a public hospital in Bombay, India. J Hosp Infect 1998;39:143-8.
  30. Agrawal R, Gupta D, Ray P, Aggarwal AN, Jindal SK. Epidemiology, risk factors and outcome of nosocomial infections in a Respiratory Intensive Care Unit in North India. J Infect 2006;53:98-105.
  31. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a US database. Chest 2002;122:2115-21.
  32. Milbrandt EB, Watson RS, Mayr FB, Angus DC, Hartman E, Wunsch H, et al. How big is critical care in the US? Crit Care Med 2008;36(12 Suppl):A77.
  33. National Family Health Survey. Mumbai, India: International Institute for Population Sciences. Available from: http://www.nfhsindia.org/factsheet.html. [Last cited 2011 Apr 28].
  34. Soneja S, Nagarkar AK, Dey AB. Indian elderly: coping with chronic illness. J Hong Kong Geriatr Soc 1999;9:10-3.
  35. United States - Fact Sheet - American Fact Finder. Suitland (MD): United States Census Bureau 2008 Dec 9. Available from: http://factfinder.census.gov/servlet/SAFFFacts. [Last cited on 2011 Apr 28].
  36. Pandya SK. End-of-life decision making in India. In: Blank RH, Merrick JC, editors. End-of-life decision making: a cross-national study. Cambridge (MA): MIT Press; 2005. p. 79-96.
  37. Revenson TA, Schiaffino KM, Majerovitz SD, Gibofsky A. Social support as a double-edged sword: the relation of positive and problematic support to depression among rheumatoid arthritis patients. Soc Sci Med 1991;33:807-13.
  38. Deshpande O, Reid MC, Rao AS. Attitude of Asian-Indian Hindus towards end-of-life care. J Am Geriatr Soc 2005;53:131-5.
  39. Searight HR, Gafford J. Cultural diversity at the end of life: issues and guidelines for family physicians. Am Fam Physician 2005;71:515-22.
  40. Chadda RK, Agarwal V, Singh MC, Raheja D. Help seeking behavior of psychiatric patients before seeking care at a mental hospital. Int J Soc Psychiatry 2001;47:71-8.
  41. Groeger JS, Strosberg MA, Halpern NA, Raphaely RC, Kaye WE, Guntupalli KK, et al. Descriptive analysis of critical care units in the United States. Crit Care Med 1992;20:846-63.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.