References

Białek K, Sadowski M Stress, anxiety, depression and basic hope in family members of patients hospitalised in intensive care units – preliminary report. Anaesthesiol Intensive Ther. 2021; 53:(2)134-140 https://doi.org/10.5114/ait.2021.105728

Bolosi M, Peritogiannis V, Tzimas P, Margaritis A, Milios K, Rizos DV Depressive and anxiety symptoms in relatives of intensive care unit patients and the perceived need for support. J Neurosci Rural Pract. 2018; 9:(4)522-528 https://doi.org/10.4103/jnrp.jnrp_112_18

Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. [Mood disorders among medical in-patients: a validation study of the hospital anxiety and depression scale (HAD).]. Rev Saúde Pública. 1995; 29:(5)359-363 https://doi.org/10.1590/s0034-89101995000500004

Cattelan J, Castellano S, Merdji H Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic. J Intensive Care. 2021; 9:(1) https://doi.org/10.1186/s40560-020-00520-w

Coelho AC, Lopes CT, Lopes JDL, Santos VB, Barros ALBLD Needs of family members of patients in a coronary care unit. Einstein. 2022; 20 https://doi.org/10.31744/einstein_journal/2022ao6258

De Cezar AG, Del Castanhel F, Grosseman S Needs of family members of patients in intensive care and their perception of medical communication. Critical Care Science. 2023; 35:(1)73-82 https://doi.org/10.5935/2965-2774.20230374-en

Edeer AD, Bilik Ö, Kankaya EA Thoracic and cardiovascular surgery patients: Intensive care unit experiences. Nurs Crit Care. 2020; 25:(4)206-213 https://doi.org/10.1111/nicc.12484

Eugênio CS, Haack TDSR, Teixeira C, Rosa RG, Souza END Comparison between the perceptions of family members and health professionals regarding a flexible visitation model in an adult intensive care unit: a cross-sectional study. Rev Bras Ter Intensiva. 2022; 34:(3) https://doi.org/10.5935/0103-507X.20220114-pt

Fonseca GM, Freitas KS, Filho AMDS, Portela PP, Fontoura EG, Oliveira MAN Anxiety and depression in family members of people hospitalized in an intensive care unit. Psicologia: Teoria E Prática. 2019; 21:(1) https://doi.org/10.5935/1980-6906/psicologia.v21n1p328-343

Freitas KS, Kimura M, Ferreira KASL Family members' needs at intensive care units: comparative analysis between a public and a private hospital. Rev Lat Am Enfermagem. 2007; 15:(1)84-92 https://doi.org/10.1590/S0104-11692007000100013

Fumis RRL, Deheinzelin D Family members of critically ill cancer patients: assessing the symptoms of anxiety and depression. Intensive Care Med. 2009; 35:(5)899-902 https://doi.org/10.1007/s00134-009-1406-7

Gurbuz H, Demir N Anxiety and depression symptoms of family members of intensive care unit patients: a prospective observational study and the lived experiences of the family members. Avicenna J Med. 2023; 13:(2)89-96 https://doi.org/10.1055/s-0043-1769933

Hout MC, Papesh MH, Goldinger SD Multidimensional scaling. Wiley Interdiscip Rev Cogn Sci. 2013; 4:(1)93-103 https://doi.org/10.1002/wcs.1203

Hugelius K, Harada N, Marutani M Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. Int J Nurs Stud. 2021; 121 https://doi.org/10.1016/j.ijnurstu.2021.104000

Kang J, Cho YJ, Choi S State anxiety, uncertainty in illness, and needs of family members of critically ill patients and their experiences with family-centered multidisciplinary rounds: A mixed model study. PLOS One. 2020; 15:(6) https://doi.org/10.1371/journal.pone.0234296

Katz MH Multivariable analysis: a practical guide for clinicians and public health researchers, 3rd edn. : Cambridge University Press; 2011

Khalil A, Gul RB Family caregivers' expectations and needs in Critical Care Units. JSTMU–Journal of Shifa Tameer-e-Millat University. 2021; 4:(2)87-94 https://doi.org/10.32593/jstmu/Vol4.Iss2.144

Leong E-L, Chew C-C, Ang J-Y, Lojikip S-L, Devesahayam P-R, Foong K-W The needs and experiences of critically ill patients and family members in intensive care unit of a tertiary hospital in Malaysia: a qualitative study. BMC Health Serv Res. 2023; 23:(1) https://doi.org/10.1186/s12913-023-09660-9

Machado EM, Brusamarello T Nível de conforto na dimensão segurança de familiares de pacientes internados em unidade de terapia intensive [Comfort level in the safety dimension of families of patients hospitalized in the intensive care unit]. Enfermagem Em Foco. 2020; 11:(3) https://doi.org/10.21675/2357-707X.2020.v11.n3.3198

Maestri E, Nascimento ERPD, Bertoncello KCG, Martins JDJ Avaliação das estratégias de acolhimento na Unidade de Terapia Intensiva. [Evaluation of welcoming strategies in the intensive care unit.]. Rev Esc Enferm USP. 2012; 46:(1)75-81 https://doi.org/10.1590/S0080-62342012000100010

Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFPD Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. [STROBE initiative: guidelines for reporting observational studies]. Rev Saúde Pública. 2010; 44:(3)559-565 https://doi.org/10.1590/S0034-89102010000300021

Maruiti MR, Galdeano LE, Farah OGD Ansiedade e depressão em familiares de pacientes internados em unidade de cuidados intensivos. [Anxiety and depression in families of patients hospitalized in the intensive care unit.]. Acta Paul Enferm. 2008; 21:(4)636-642 https://doi.org/10.1590/S0103-21002008000400016

Meneguin S, Pollo CF, Benichel CR, Cunha LK, Miot HA Comfort and religious-spiritual coping of intensive care patients' relatives. Intensive Crit Care Nurs. 2020; 58 https://doi.org/10.1016/j.iccn.2020.102805

Midega TD, Oliveira HSBD, Fumis RRL Satisfaction of family members of critically ill patients admitted to a public hospital intensive care unit and correlated factors. Rev Bras Ter Intensiva. 2019; 31:(2) https://doi.org/10.5935/0103-507x.20190024

Morgon FH, Guirardello EDB Validação da escala de razão das necessidades de familiares em unidade de terapia intensive. [Validation of a ratio scale for family needs at an intensive care unit.]. Rev Lat Am Enfermagem. 2004; 12:(2)198-203 https://doi.org/10.1590/S0104-11692004000200008

Norup A, Welling KL, Qvist J, Siert L, Mortensen EL Depression, anxiety and quality-of-life among relatives of patients with severe brain injury: The acute phase. Brain Inj. 2012; 26:(10)1192-200 https://doi.org/10.3109/02699052.2012.672790

Pardavila Belio MI, Vivar CG Necesidades de la familia en las unidades de cuidados intensivos. Revisión de la literatura. [Needs of the family in intensive care units: review of the literature.]. Enferm Intensiva. 2012; 23:(2)51-67 https://doi.org/10.1016/j.enfi.2011.06.001

Schober P, Boer C, Schwarte LA Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018; 126:(5)1763-1768 https://doi.org/10.1213/ane.0000000000002864

Souza ACD, Alexandre NMC, Guirardello EDB, Souza ACD, Alexandre NMC, Guirardello EDB Propriedades psicométricas na avaliação de instrumentos: avaliação da confiabilidade e da validade. [Psycometric properties in the evaluation of instruments: evaluation of confidence and validity.]. Epidemiol Serv Saúde. 2017; 26:(3)649-659 https://doi.org/10.5123/S1679-49742017000300022

Souza SFD, Ferreira IDS, Lopes GDS Fatores relacionados ao estresse em enfermeiros que atuaram durante a pandemia da COVID-19. [Stress-related factors in nurses working during the pandemic of COVID-19.]. Res Soc Dev.. 2022a; 11:(15) https://doi.org/10.33448/rsd-v11i15.37799

Souza LMD, Freitas KS, Silva Filho AMD Prevalência e fatores associados a sintomas de depressão em familiares de pessoas hospitalizadas em unidade de terapia intensiva. [Prevalence and factors associated with symptoms of depression in family members of people hospitalized in the intensive care unit.]. Revista Brasileira de Terapia Intensiva. 2022b; 34:(4) https://doi.org/10.5935/0103-507X.20220080-pt

Tabah A, Elhadi M, Ballard E Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey. J Crit Care. 2022; 71 https://doi.org/10.1016/j.jcrc.2022.154050

Taber KS The use of Cronbach's Alpha when developing and reporting research instruments in science education. Res Sci Educ. 2018; 48:(6)1273-1296

Modelos lineares generalizados - da teoria à prática.[Generalised linear models: from theory to practice.] Short course. 2000. https://www.spestatistica.pt/publicacoes/publicacao/modelos-lineares-generalizados-da-teoria-pratica

Zigmond AS, Snaith RP The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983; 67:(6)361-370 https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Critical Care

Association between needs and anxiety/depression in family of intensive care patients

08 May 2025
Professional
02 May 2025
Volume 34 · Issue 9

Abstract

Background:

When a loved one is hospitalised in the intensive care unit (ICU), the family members' attention is on the patient's condition. This can interfere with family members' own needs and affect psychological wellbeing.

Aims:

To investigate the needs and stressors of family members of patients in ICU and their associations with symptoms of anxiety and depression during the COVID-19 pandemic.

Methods:

A cross-sectional study was conducted with 340 family members of patients admitted to the ICU of a public hospital in São Paulo state, Brazil, between January 2020 and August 2022. Data on sociodemographic characteristics were collected. The Critical Care Family Needs Inventory (CCFNI) and the Hospital Anxiety and Depression Scale (HADS) were administered.

Results:

Family members of patients in the ICU placed a very high level of importance on their needs (median=172). Although the family members were satisfied, not all their needs were met (median=116). In the multivariate analysis, the variables that influenced the CCFNI Importance/Satisfaction score were age (P<0.001), marital status (P<0.001), education level (P<0.001), Catholic religion (P<0.001), previous hospitalisation experience (P<0.001), and HADS depression (P=0.026/P=0.002). The variables that influenced the HADS score included female sex (P<0.001), age (P<0.001), direct relation to the patient (P<0.001), Catholic religion (P<0.001), living with the patient (P<0.001), and CCFNI Importance/Satisfaction (P<0.001).

Conclusions:

Family members of patients in the ICU have essential, but not completely satisfied, needs. HADS was positively associated with the importance of needs and inversely related to the satisfaction of needs. Age and the Catholic religion were the only common variables affecting the variations in needs constructs.

The intensive care unit (ICU) is distinguished from other hospital units by its complex technological arsenal, essential in caring for critically ill patients (Edeer et al, 2020). Admission to the ICU generally occurs abruptly, with insufficient time for family reorganisation, which contributes to a feeling of helplessness and the emergence of different types of needs (Machado and Brusamarello, 2020).

Understanding that the family is a critical element in this context is fundamental. The family should not be dissociated from the patient but rather seen as unique in care strategies, because support offered to family members positively affects the patient. Treatment provided to patients in the ICU commonly overlooks family members who are experiencing stress related to the uncertainty of the disease, injury and trauma, the fear of loss, and restrictions imposed on visits, all of which were nearly wholly interrupted during the COVID-19 pandemic (Souza et al, 2022a; Tabah et al, 2022; Gurbuz et al, 2023).

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Anxiety
Depression
Family members
Intensive care unit
Critical care nursing