COVID patients’ families suffer stress
Study finds nearly 64% face symptoms of PTSD
Leaving her husband at the hospital was one of the hardest things Michele Garza ever had to do.
Though he had COVID-19 and his blood oxygen level had dropped dangerously low, Henry Garza, 55, didn’t want to go.
“Look, people who go to the hospital don’t come home,” he told her. But he needed care, and that meant she couldn’t be with him. At the time in late 2020, hospital staff did not allow her to pass the entrance hallway due to COVID-19 restrictions. They got by on limited phone calls and Facetime.
Henry has been recovering at home since June after getting a lung transplant, yet the sound of a ringing phone still haunts Michelle.
“I developed some PTSD symptoms,” said Michelle, 47. “If I hear somebody’s phone going off and it’s the same ringtone I was using while he was in the hospital, that’s a (trigger). I have to shut that off and walk away.”
Garza isn’t alone. A study published Monday in JAMA Internal Medicine found nearly 64% of people who had a family member in the intensive care unit for COVID-19 experienced symptoms of post-traumatic stress disorder three months after admission.
It’s a stark increase from what was seen in similar studies conducted before the pandemic, said lead author, Dr. Tim Amass, assistant professor of medicine at the department of pulmonary sciences and critical care at the University of Colorado School of Medicine.
“In the study team, we had done research on this before and we were concerned what were the implications of visit restrictions,” he said. “I can’t directly compare the populations but before the pandemic, we saw 15% to 30% and now we’re seeing up to 64%.”
Researchers sent out a survey to family members of patients admitted to an ICU at 12 hospitals in Colorado, Washington,
Louisiana, New York and Massachusetts from February to July 2020. The survey was based on the Impact of Events Scale, a widely used questionnaire to screen for symptoms of PTSD in ICU survivors and their family members.
Of the 330 respondents, 201 scored a 10 or higher out of 24 points, indicating significant symptoms of PTSD. Women and Latinos were more likely to suffer from PTSD symptoms, with women scoring 2.6 points higher than men and Latinos scoring 2.7 points higher than their white peers.
“In my observation, some families will come in as a large family unit – particularly of those of Hispanic descent – and have a group grieving process at the bedside,” said Amass, who is also an ICU doctor. “That was meaningful and got totally stripped away” during COVID-19. Michelle Garza said she was discouraged by one doctor who seemed to dismiss her husband because of his Mexican heritage.
“He was basically like, ‘Your husband is Hispanic and overweight, you need to get your affairs in order,’ ” she said. “I pushed back hard at that partially because I didn’t understand what he was telling me.”
She saw news stories that reported Latinos were more likely to develop severe disease from COVID-19, she said, but were they giving up on her husband because he’s Mexican?
“That did concern me at first,” Garza said.
In addition to the Impact of Events Scale survey, researchers also interviewed about 75 participants whose scores were 10 or higher, about their experience and how they coped with stress. They found those with higher scores reported distrust in the health care system, Amass said, and spoke about the challenges of having to believe what the doctor was telling them over the phone without physically being there.
“These quantitative studies can be challenging because they just show numbers and no explanation,” he said. “It’s hard to identify strict causation but when you add the words to the participants’ scores, you get a richer understanding of the findings we were seeing.”
The timing of the survey could have also contributed to participants’ scores, said Dr. John Krystal, chief of psychiatry and behavioral health at Yale-new Haven Hospital.
“It is critical to understand that this was a particularly stressful period of the pandemic,” he said. “Our understanding of COVID-19 and its management was quite limited.”
Mortality rates for patients in the ICU were higher than they are now and medical centers were overwhelmed with critical patients, he said. Many hospitals had to create extra ICU beds and staff them with people who didn’t routinely work in that environment. They also lacked supplies, personal protective equipment and equipment, like ventilators, which were vital to keeping COVID-19 patients alive.
“This was a time of enormous stress for family members. They were stressed, powerless to help, and isolated,” Krystal said. “To make matters worse, they may have detected some of the stress, confusion and disorganization experienced by medical and hospital staff who were doing their utmost to manage the extraordinary challenges that they faced.”
Michelle Garza still suffers from some anxiety and PTSD symptoms but she’s worked hard to manage them and they’ve become less frequent as time passes.
She said counseling with her husband and her strong faith has helped. Last fall, her husband and his new lung were able to walk a mile for the first time since he was diagnosed with COVID-19 a milestone in a year-long journey.
“This was a time of enormous stress for family members. They were stressed, powerless to help, and isolated.”
Dr. John Krystal
Chief of psychiatry and behavioral health at Yale-new Haven Hospital