Association between the clinical status of patients admitted to Intensive Care and the emotional state of their next of kin: a cross-sectional study.

backgroundAdmission to an Intensive Care Unit (ICU) constitutes a sudden and emotionally impactful event for both the critically ill patient and their family. Prognostic uncertainty is frequently associated with elevated levels of anxiety, depression, and stress within the family. In the Portuguese context, the association between the patient's clinical status and the emotional state of their next of kin remains insufficiently explored. This study aimed to analyze that relationship.

methodsA cross-sectional study was conducted in an adult ICU in central Portugal, using a convenience sample of 130 dyads of critically ill patients and their next of kin. Data were collected between September 2024 and February 2025. The emotional state of the next of kin was assessed using the Depression, Anxiety, and Stress Scales-21 (DASS-21), validated for the Portuguese population. The patients' clinical status was evaluated using the Coma Recovery Assessment Instrument of the University of Aveiro, the Glasgow Coma Scale, the Richmond Agitation-Sedation Scale, and pain scales. Statistical analysis included Spearman's rank correlation, Mann-Whitney U tests, Kruskal-Wallis H tests, and linear regression.

resultsThe mean age of the patients was 65.7 ± 13.0 years, and 56.2% were male. The next of kin had a mean age of 53.3 ± 14.5 years, and 63.8% were female. Stress was the most frequently reported symptom, followed by depression and anxiety. Statistically significant negative associations were found between the emotional state of next of kin and the patients' clinical consciousness scores (p < 0.001). Next of kin of patients undergoing invasive mechanical ventilation or receiving therapeutic infusions showed higher levels of emotional distress. Furthermore, female next of kin, spouses, and direct descendants were associated with higher emotional vulnerability. Ventilatory support and the relationship to the patient were identified as factors independently associated with emotional distress, together accounting for approximately 27% of the observed variability in emotional symptoms.

conclusionsThe emotional state of the next of kin is significantly associated with the clinical status of the critically ill patient. These findings highlight vulnerable subgroups and underscore the potential role of nursing professionals in the early identification of emotional distress. Such identification may facilitate the planning of targeted supportive strategies, which have been associated in the literature with an attenuated emotional burden and a potential reduction in the risk of Post-Intensive Care Syndrome-Family and long-term psychological problems.