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

## TL;DR

This study finds that family members of critical care patients often experience anxiety and depression, with about 38% and 20% showing clinically significant levels, respectively.

## Contribution

The study uses Bayesian meta-analysis to quantify distress, anxiety, and depression in family members of critical care patients, revealing clinically meaningful proportions.

## Key findings

- 38% of family members showed clinically significant anxiety (HADS-A > 7) at 3 months.
- 20% of family members showed clinically significant depression (HADS-D > 7) at 3 months.
- Pooled IES-R score indicated moderate distress levels in family members post-discharge.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1186/s40560-025-00839-2.