Anxiety, depression and distress in family members of people who have experienced a critical care admission: a systematic review and Bayesian meta-analysis

Abstract

Background: Family members of adults who experience a critical care admission often experience significant strain and emotional distress following discharge. This meta-analysis aimed to synthesise the levels of distress, anxiety, and depression in family members of people who have experienced a critical care admission. Methods: Medline, PsycINFO, Scopus, CINAHL and Web of Science databases were searched for articles (2000–2024) that measured distress using the Impact of Events Scale—Revised (IES-R), or anxiety or depression using the Hospital Anxiety and Depression Scale subscales (HADS-A and HADS-D) 3 months after critical care. Bayesian meta-analyses estimated the pooled average, and meta-regression examined whether the inclusion of bereaved relatives influenced the pooled outcome estimates. Anxiety and depression models estimated the pooled proportion of participants with HADS scores >7. Results: Fifty articles were included (45 cohorts). Seventeen studies were from the USA and the median sample size at baseline assessment was 94.0. The pooled estimate of the IES-R at 3 months was 18.16 points [95% credible interval (CrI): 12.26–26.23, 15 studies]. The pooled estimate of the HADS-A at 3 months was 5.98 points (CrI: 5.29–6.73, 35 studies). The estimated proportion of family members with clinically meaningful levels of anxiety (HADS-A > 7) was 0.38 (95% CrI: 0.30–0.47; 11 studies). The pooled estimate of the HADS-D at 3 months was 3.91 points (95% CrI: 3.39–4.50; 33 studies). The estimated proportion of family members with clinically meaningful levels of depression (HADS-D > 7) was 0.20 (95% CrI: 0.15–0.26; 11 studies). Meta-regression found no significant effect of including non-bereaved participants only with the HADS subscales and was not possible due to insufficient studies with the IES-R. Conclusions: Levels of distress, anxiety and depression appear to be comparable between individuals who experience a critical care admission and their family members. An estimated 38% and 20% of family members have clinically important levels of anxiety and depression, respectively. PROSPERO registration: CRD42022302735.