Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, Grassin M, Zittoun R, le Gall J R, Dhainaut J F, Schlemmer B
Service de réanimation médicale, hôpital Cochin, Paris, France.
Crit Care Med. 2001 Oct;29(10):1893-7. doi: 10.1097/00003246-200110000-00007.
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.
Prospective multicenter study.
Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days.
Six hundred thirty-seven patients and 920 family members.
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.
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).
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.
焦虑和抑郁可能对一个人的决策能力产生重大影响。在探视重症监护患者的家庭成员中，对反映焦虑和抑郁症状的特征进行描述，对于让家庭成员参与决策，尤其是关于临终问题的决策伦理而言，应具有重大意义。
前瞻性多中心研究。
43个法国重症监护病房（37个成人病房和6个儿科病房）；每个病房纳入15名住院超过2天的患者。
637名患者及920名家庭成员。
收集重症监护病房特征以及患者和家庭成员的数据。家庭成员完成医院焦虑抑郁量表，以评估焦虑和抑郁症状的患病率及相关潜在因素。
在家庭成员完成的920份医院焦虑抑郁量表问卷中，836份问卷完成了所有项目，构成了本研究的基础。家庭成员中焦虑和抑郁症状的患病率分别为69.1%和35.4%。72.7%的家庭成员和84%的配偶存在焦虑或抑郁症状。多变量模型中与焦虑症状相关的因素包括患者相关因素（无慢性病）、家庭相关因素（配偶、女性、希望获得专业心理帮助、接受全科医生帮助）以及照料者相关因素（无定期医生和护士会议、无仅用于与家庭成员会面的房间）。多变量模型还确定了与抑郁症状相关的三组因素：患者相关因素（年龄）、家庭相关因素（配偶、女性、非法裔血统）以及照料者相关因素（无候诊室、认为照料者提供的信息存在矛盾）。
超过三分之二探视重症监护病房患者的家庭成员存在焦虑或抑郁症状。对于焦虑或抑郁的家庭成员参与临终决策，应进行审慎讨论。
