Hospital visitation was restricted during the COVID-19 pandemic, policies that may have added significant stress for patients, family members, and clinicians. A prospective, observational cohort study examined the psychological consequences of visitation restrictions and pandemic stress for the families of patients who were admitted to the ICU critically ill with COVID.

All patients with increased oxygen requirements and a COVID diagnosis admitted to ICUs at 12 U.S. hospitals from February to July of 2020 were eligible for this study. A total of 330 of the 955 eligible family members (34.6%) responded to a survey three months after the patient's ICU admission.

The mean score on the Impact of Events Scale 6 (IES-6) was 11.9 at three months, with 63.6% of respondents having scores of 10 or higher, indicating significant symptoms of posttraumatic stress disorder. At six months, the mean score was 10.1, with 48.4% of respondents scoring 10 or higher.

Mean scores were 2.6 points higher for women than men, 2.7 points higher for Hispanic than non-Hispanic patients, and 3 points higher for participants who had used psychiatric medication in the year before the ICU admission compared with those who had not. Higher levels of education were associated with lower IES-6 scores. Family members who had scores of 10 or higher expressed more distrust in clinicians.

Only about one-third of eligible family members enrolled in the study, introducing a risk of nonresponse bias. Because questionnaires were completed three months after the ICU admission, there is also a risk of recall bias. In addition, because the study was observational, no causal relationships can be assumed, and unmeasured confounders may have affected findings.

Visitation restrictions may lead to an increase in stress-related disorders in the family members of ICU patients, the authors write, and research is needed to determine how to improve family members' experiences when they cannot visit a loved one in the ICU.