For a list of the authors' affiliations see the Acknowledgements section.
For a list of the authors' affiliations see the Acknowledgements section
Eur Respir J. 2015 May;45(5):1341-52. doi: 10.1183/09031936.00160014. Epub 2015 Jan 22.
An increased proportion of deaths occur in the intensive care unit (ICU). We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.
在重症监护病房（ICU）中，死亡人数比例增加。我们在 41 个 ICU 中进行了这项前瞻性研究，以确定 ICU 中亲人死亡后复杂悲伤的患病率和决定因素。对 475 名成年患者的亲属进行了随访。使用复杂悲伤量表（截断值>25）在 6 个月和 12 个月评估复杂悲伤。亲属还在 3 个月时完成了医院焦虑和抑郁量表，在 3、6 和 12 个月时完成了创伤后应激障碍症状修订后的事件影响量表。我们使用混合多变量逻辑回归模型来确定 6 个月后复杂悲伤的决定因素。在 475 名患者中，有 282 名（59.4%）患者的亲属在 6 个月时进行了评估。147 名（52%）亲属出现了复杂悲伤症状。复杂悲伤症状的独立决定因素要么无法改变（亲属为女性、亲属独居以及 2009 年之前的重症监护医师委员会认证），要么是潜在的改进目标（患者拒绝治疗、患者插管时死亡、亲属在死亡时在场、亲属没有与患者道别以及医生与亲属之间沟通不畅）。临终实践、悲伤亲属的沟通和孤独感可能需要改进。
