Family intensive care unit (ICU) syndrome, a comorbid response to another person’s stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue.


This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU.


The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline.


The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7.


Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care.

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