Konstanti Zoe, Tatsis Fotios, Stamatis Konstantinos, Veroniki Foteini, Papathanakos Georgios, Koulouras Vasilios, Gouva Mary
Scientific Laboratory of Psychology & Person-Centered Care, University of Ioannina, 45500 Ioannina, Greece.
Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece.
Healthcare (Basel). 2025 Oct 21;13(20):2650. doi: 10.3390/healthcare13202650.
Families of ICU patients endure intense psychological strain. While anxiety and depression are well documented, less attention has been given to hostility-expressed both outwardly as anger and inwardly as guilt or self-criticism. Hostility, however, often shapes the climate of the ICU waiting room and the collaboration between families and staff. This study examined the levels and forms of hostility among ICU relatives, focusing on demographic predictors that may influence extrapunitive and intropunitive reactions. A cross-sectional study was conducted between June 2018 and December 2019 with 215 family members of ICU patients. Hostility was assessed using the Hostility and Direction of Hostility Questionnaire (HDHQ). Descriptive statistics, -tests, ANOVAs, and multivariate regression analyses were performed to examine the effects of age, gender, and education on hostility subscales. Male relatives exhibited higher acting-out hostility (M = 4.80, SD = 2.63) compared with female relatives (M = 4.12, SD = 2.21; t(216) = 1.96, = 0.05, Cohen's d = 0.28). Relatives with lower educational attainment showed significantly higher total hostility (β = -1.23, 95% CI [-1.78, -0.67], < 0.001) and greater self-criticism (β = -0.44, 95% CI [-0.84, -0.03], = 0.037). Younger age was associated with increased acting-out hostility (β = -0.029, 95% CI [-0.055, -0.002], = 0.035). The regression models explained 12-26% of the variance across subscales (R range = 0.12-0.26). These findings suggest two vulnerability trajectories: an externalized (extrapunitive) pattern in younger men and a broad internalized (intropunitive) pattern in relatives with lower education. Hostility in ICU families emerges in two distinct trajectories: externalized anger among young men and broad hostility in relatives with lower education. Recognizing these patterns is vital for preventing conflict, addressing hidden guilt and self-blame, and developing subgroup-sensitive interventions. The ICU waiting room is a space not only of fear and uncertainty but also of anger, guilt, and fragile attempts at psychological survival-dimensions that deserve systematic attention in both clinical practice and research.
重症监护病房（ICU）患者的家属承受着巨大的心理压力。虽然焦虑和抑郁有充分的文献记载，但人们对敌意的关注较少——敌意既表现为外在的愤怒，也表现为内在的内疚或自我批评。然而，敌意往往会影响重症监护病房候诊室的氛围以及家属与医护人员之间的协作。本研究调查了重症监护病房患者家属的敌意程度和形式，重点关注可能影响外罚性和内罚性反应的人口统计学预测因素。2018年6月至2019年12月期间，对215名重症监护病房患者的家属进行了一项横断面研究。使用敌意与敌意指向问卷（HDHQ）评估敌意程度。进行了描述性统计、t检验、方差分析和多元回归分析，以检验年龄、性别和教育程度对敌意分量表的影响。与女性亲属（M = 4.12，标准差 = 2.21；t(216) = 1.96，p = 0.05，科恩d值 = 0.28）相比，男性亲属表现出更高的外化敌意（M = 4.80，标准差 = 2.63）。教育程度较低的亲属表现出显著更高的总体敌意（β = -1.23，95%置信区间[-1.78，-0.67]，p < 0.001）和更强的自我批评（β = -0.44，95%置信区间[-0.84，-0.03]，p = 0.037）。年龄较小与外化敌意增加有关（β = -0.029，95%置信区间[-0.055，-0.002]，p = 0.035）。回归模型解释了各分量表12%至26%的方差变异（R范围 = 0.12至0.26）。这些发现表明了两种易损轨迹：年轻男性的外化（外罚性）模式和教育程度较低的亲属广泛的内化（内罚性）模式。重症监护病房患者家属的敌意呈现出两种不同的轨迹：年轻男性的外化愤怒和教育程度较低的亲属的广泛敌意。认识到这些模式对于预防冲突、解决隐藏的内疚和自责以及制定针对亚组的敏感干预措施至关重要。重症监护病房候诊室不仅是一个充满恐惧和不确定性的空间，也是一个充满愤怒、内疚以及心理求生脆弱尝试的空间——这些维度在临床实践和研究中都值得系统关注。
