Impact of Visitation Restrictions in ICU on Psychological Symptoms in Family Members: Experience of the COVID-19 Pandemic

Am J Respir Crit Care Med. 2025 Jul 23. doi: 10.1164/rccm.202412-2470OC. Online ahead of print.

ABSTRACT

RATIONALE: The COVID-19 pandemic required unprecedented measures including visitation restrictions.

OBJECTIVES: To assess their impact on psychological symptoms (anxiety-depression, posttraumatic stress disorder (PTSD)) among ICU family members.

METHODS: In this prospective multicentre quasi-experimental study, family members of patients with invasive mechanical ventilation with or without COVID-19, were enrolled during one of three periods (March 15 – June 5) subject to visitation restriction policies mandated by French health authorities: forbidden (2020, n= 304), restricted (2021, n= 294) and unrestricted (2022, n= 213). Primary outcome was prevalence of anxiety-depression symptoms in family members 90 days after ICU discharge.

MEASUREMENTS AND MAIN RESULTS: Among 811 members, prevalence of anxiety-depression symptoms did not significantly differ across the three periods (57.2%, 56.8% and 61.5%, P= 0.52; unrestricted vs restricted visitations: Relative Risk (RR), 1.08 (95%CI, 0.94‒1.25), P= 0.28; unrestricted vs forbidden visitations: RR, 1.08 (0.93‒1.24), P= 0.33). Similar findings were observed for PTSD risk (36.5%, 40.8% and 34.3%, P= 0.29). Anxiety-depression symptoms were associated with female relatives of patients (adjusted RR, 1.78 (1.28‒2.46), P= 0.001), dissatisfaction with ICU team’s communication (aRR, 1.83 (1.22‒2.74), P= 0.004), and spouses of patients (aRR, 2.15 (1.42‒3.26), P< 0.001). For PTSD, these risk factors were also significant, in addition to COVID-19 disease (aRR, 1.52 (1.10‒2.10), P= 0.01) and patient death in ICU (aRR, 2.59 (1.91‒3.51], P< 0.001).

CONCLUSIONS: This study does not support the hypothesis that visitation restriction policies during the COVID-19 pandemic exacerbated high prevalence of long-term psychological symptoms among ICU family members. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

PMID:40700730 | DOI:10.1164/rccm.202412-2470OC