Bereaved people experience distinct trajectories of prolonged-grief-disorder (PGD) symptoms. A few studies from outside critical care investigated limited factors of PGD-symptom trajectories without a theoretical framework. We aimed to characterize factors associated with ICU bereaved surrogates’ PGD-symptom trajectories, drawing from the integrative framework of predictors for bereavement outcomes, emphasizing factors modifiable by ICU care. Prospective cohort study of 291 family surrogates. Multinomial logistic regression was used to determine associations of three previously identified PGD-symptom trajectories (resilient [n = 242, 83.2%] as reference group, recovery [n = 35, 12.0%], and chronic [n = 14, 4.8%]) with risk factors. Factors included intrapersonal (demographics, personal vulnerabilities), interpersonal (perceived social support), bereavement-related (patient demographics, clinical characteristics, and patient-surrogate relationship), and death-circumstance (surrogate-perceived quality of patient dying and death [QODD] in ICUs classified as high, moderate, poor-to-uncertain, and worst QODD classes) factors. Most surrogates were female (59.1%), the patient’s adult child (54.0%), and about (standard deviation) 49.63 (12.53) years old. As surrogate age increased, recovery-trajectory membership decreased (adjusted odds ratio [95% confidence interval] = 0.918 [0.849, 0.993]) and chronic-trajectory membership increased (1.230 [1.010, 1.498]). Being married decreased membership in the recovery (0.186 [0.047, 0.729]) trajectory. Higher anxiety symptoms 1 month post loss increased membership in recovery (1.520 [1.256, 1.840]) and chronic (2.022 [1.444, 2.831]) trajectories. Spouses were more likely and adult–child surrogates were less likely than other relationships to be in the two more profound PGD-symptom trajectories. Membership in the chronic trajectory decreased (0.779 [0.614, 0.988]) as patient age increased. The poor-to-uncertain QODD class was associated with a nearly significant increase (4.342 [0.980, 19.248]) in membership in the recovery trajectory compared to the high QODD class. Membership in the PGD-symptom trajectories was associated with factors modifiable by high-quality ICU care, including anxiety symptoms at early bereavement and surrogate-perceived QODD in the ICU. Clinicians should be sensitive to the psychological needs of at-risk family surrogates, provide high-quality end-of-life care to facilitate QODD, and promptly refer bereaved surrogates who suffer anxiety symptoms and profound and/or persistent PGD-symptoms for psychological support.

中文翻译：

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ICU 丧亲家属代孕者长期哀伤障碍症状轨迹的因素


失去亲人的人会经历不同的长期悲伤障碍 （PGD） 症状轨迹。一些来自重症监护以外的研究在没有理论框架的情况下调查了 PGD 症状轨迹的有限因素。我们旨在描述与 ICU 丧亲代理人的 PGD 症状轨迹相关的因素，借鉴丧亲结果预测因子的综合框架，强调 ICU 护理可改变的因素。291 个家庭代孕者的前瞻性队列研究。多项式 logistic 回归用于确定三个先前确定的 PGD 症状轨迹 （弹性 [n = 242， 83.2%] 作为参考组，恢复 [n = 35， 12.0%] 和慢性 [n = 14， 4.8%]）与危险因素的关联。因素包括人际（人口统计学、个人脆弱性）、人际关系（感知到的社会支持）、丧亲相关（患者人口统计学、临床特征和患者与代孕关系）和死亡情况（ICU 中患者死亡和死亡的代孕感知质量 [QODD] 分类为高、中、差到不确定和最差 QODD 类别）因素。大多数代孕者是女性 （59.1%），患者的成年子女 （54.0%） 和大约 （标准差） 49.63 （12.53） 岁。随着代孕年龄的增加，恢复轨迹隶属度降低 （调整后的比值比 [95% 置信区间] = 0.918 [0.849， 0.993]） 和慢性轨迹隶属度增加 （1.230 [1.010， 1.498]）。已婚减少了恢复 （0.186 [0.047， 0.729]） 轨迹的成员。失去 1 个月后更高的焦虑症状增加了恢复 （1.520 [1.256， 1.840]） 和慢性 （2.022 [1.444， 2.831]）轨迹的成员。 与其他关系相比，配偶更有可能和成人-儿童代孕者更有可能处于两种更深刻的 PGD 症状轨迹中。随着患者年龄的增加，慢性轨迹中的成员人数减少 （0.779 [0.614， 0.988]）。与高 QODD 等级相比，差到不确定的 QODD 等级与恢复轨迹中成员的近乎显着的增加 （4.342 [0.980， 19.248]） 相关。PGD 症状轨迹的成员资格与可通过高质量 ICU 护理改变的因素相关，包括早期丧亲时的焦虑症状和 ICU 中的代孕感知 QODD。临床医生应敏感于高危家庭代孕者的心理需求，提供高质量的临终关怀以促进 QODD，并及时将患有焦虑症状和严重和/或持续 PGD 症状的丧亲代孕者转介寻求心理支持。