gms | German Medical Science

Objective: Close relatives (CR) of patients with severe traumatic brain injury (TBI) and high-grade subarachnoid hemorrhage (SAH) suffer extraordinary distress during the treatment: Distress may lead to lasting psychic symptoms within the spectrum of post-traumatic stress disorder (PTSD), anxiety disorders and depression. Primary goal of this study was to determine prevalence and severity of these symptoms in CR. Secondary goal was identification of associated factors.

Method: Standardized interviews were conducted with 53 CR (18 male, 35 female, mean age of 57.7 ± 11.4 years) of patients with TBI °III (n=27) and high-grade SAH H&H °III-V (n=26) between 3 and 15 months after onset of disease. The interviews contained a battery of surveys to quantify symptoms of PTSD, anxiety disorders and depression, i.e. Impact of Event Scale (IES-R), 36-item Short-Form General Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Prior psychological burden and coping strategies were collected (List of Threatening Experiences, LTE and Brief Cope). Perception of the quality of the interaction with the medical staff and involvement into medical decisions were inquired.

Results: 28 CR (53%) showed IES-R scores indicating a probable diagnosis of PTSD. 25 (47%) CR showed an increased anxiety score and 18 (34%) an increased depression score using HADS. Mean physical component summary of SF-36 (PCS) was 49.1 ± 9.1, mean mental component summary was 41.0 ± 13.2. Perception of the interaction correlated negatively with z-score of HADS subscales of anxiety (r=-0.29, p=0.034, Spearman correlation) and of depression (r=-0.32, p=0.021). Z-scores of anxiety (p=0.038, Mann-Whitney-U test) and depression (p=0.029) in HADS were significantly lower in CR that felt involved into medical decisions. Evasive Coping strategies were strongly associated with z-scores of anxiety (r=0.56, p<0.001) and depression in HADS (r=0.45 p=0.001), with the score of IES-R (r=0.34 p=0.012), and with PCS (r=-0.50, p<0.001), while focus on positive was negatively associated with depression in HADS (r=-0.29, p=0.033).

Conclusions: This study quantifies for the first time the incidence of psychic affliction in CR of patients with severe brain damage. Modifiable factors like perception of interaction with the medical staff, involvement into medical decisions and coping strategies were associated with severity of psychic symptoms. Prospective studies testing efficiency of early psychotherapeutic interventions are needed.