What happens to the medical and mental health, as well as the marriage, of family members when a loved one is sick or dying?

Impact of Family Illness on Medical, Mental, and Marital Health

When a family member is seriously ill or dying, other family members experience substantial psychological distress, with over half developing symptoms of depression, anxiety, or post-traumatic stress that can persist for months to years after the patient's death or discharge. 1

Mental Health Consequences

Depression and Anxiety

• Spousal partners of seriously ill patients show significantly elevated rates of major depressive disorder, generalized anxiety disorder, and panic disorder compared to those without an ill family member. 1
• More than 50% of family members exposed to a loved one's critical illness develop moderate to severe psychological distress symptoms. 2
• Depression and anxiety symptoms affect family members both during the illness and well after the patient's ICU discharge or death, with a significant proportion remaining at moderate to high risk for prolonged periods. 2, 3

Post-Traumatic Stress

• Family members of critically ill patients demonstrate high prevalence of post-traumatic stress disorder (PTSD) symptoms, particularly when the patient dies or when there is inadequate preparation for death. 1
• The inability to say goodbye before death significantly increases the risk of complicated grief and PTSD. 1
• Younger patient age and patient death are specifically associated with higher levels of depression and post-traumatic stress in family members. 4

Physical Health and Functional Decline

Stress-Related Medical Illness

• 12% of families caring for critically ill patients develop stress-related illness or loss of ability to function. 1
• Brain-related conditions (including mental illness and dementia) impose the most significant risk to the psychological well-being of all family members, with effects sometimes larger than the direct impact on the patient themselves. 5
• Chronic illness in one family member causes emotional distress throughout the entire family system, impairing the family's collective ability to support the patient. 5

Practical Life Disruptions

• More than half of families report major practical negative impacts, including having to quit work to provide care. 1
• Almost one-third of families lose most or all family savings. 1
• 29% of families experience loss of the family's major source of income. 1

Marital and Relationship Health

Couples-Specific Stressors

• Spousal partners of seriously ill patients are significantly more likely to suffer from major depressive disorder, generalized anxiety, and panic disorder compared to non-spousal family members. 1
• Mutual constructive communication between couples coping with serious illness is associated with less distress and more relationship satisfaction, while demand/withdraw communication or mutual avoidance patterns worsen outcomes for both partners. 1
• Couple-based interventions can improve depression, anxiety, and marital satisfaction compared to individual therapy alone or usual care. 1

Parents with Dependent Children

• Parents of dependent children facing serious illness represent the most vulnerable family subgroup, with the worst quality of life outcomes and highest rates of panic disorder. 1
• These parents are half as likely to feel peaceful about their situation (p=0.01) and much more likely to meet criteria for panic disorder (p=0.0004) compared to patients without dependent children. 1
• Their spousal partners show even higher rates of major depression, anxiety, and panic than spouses of patients without children. 1

Risk Factors for Worse Outcomes

Family-Level Vulnerabilities

• Economic distress directly increases the chance of emotional distress and reduces the family's collective ability to cope psychologically with chronic illness. 5
• Families lacking financial resources are at particularly high risk for psychological spillover effects from the patient's illness. 5
• Multiple losses due to illness in one family (such as during COVID-19) compound the risk of complicated grief. 1

Care-Related Factors

• Lower satisfaction with ICU care is strongly associated with higher levels of depression, anxiety, and post-traumatic stress in family members. 4
• Inadequate advance care planning places substantial negative emotional burden on family members serving as decision-makers, sometimes lasting for years. 1
• Social isolation during illness (such as isolation precautions) aggravates anxiety and psychological distress in family members. 1

Protective Factors

Resilience

• Resilient family members have significantly fewer symptoms of anxiety (14.2% vs 43.6%), depression (14.1% vs 44.9%), and acute stress (12.7% vs 36.3%) compared to non-resilient family members. 6
• Resilience remains independently protective even after adjusting for patient severity of illness and family member demographics. 6
• Resilient family members report higher satisfaction with care delivered in the ICU. 6

Advance Care Planning

• Good advance care planning substantially relieves family members of decision-making burden and reduces long-term negative emotional effects. 1
• Knowing what the patient would have chosen for themselves assists in reducing negative emotional burden on surrogate decision-makers. 1

Clinical Implications

Screening and Support

• Family members should be routinely screened for depression, anxiety, and PTSD symptoms during and after a loved one's serious illness. 2, 3
• Bereavement support should be offered to family members of deceased patients by healthcare professionals trained in palliative care or bereavement support. 1
• Priority for respite care and supportive services should be given to families with brain-related disorders in the patient, particularly families with limited financial resources. 5

Intervention Strategies

• Psychosocial care professionals should be part of the treatment team for seriously ill patients with persistent symptoms despite optimal disease treatment. 1
• Family and couples therapy may be beneficial when illness affects family dynamics, with evidence showing at least equivalent effectiveness to individual therapy. 1
• Written information materials (pamphlets, bereavement brochures) can reduce family member anxiety, stress, and PTSD symptoms. 1
• ICU diary programs may reduce post-traumatic stress in family members at 3 and 12 months after patient discharge or death. 1

Common Pitfalls to Avoid

• Do not assume family members are coping well simply because they appear functional during the acute illness phase—symptoms often persist or worsen after discharge or death. 2
• Avoid focusing solely on the patient while neglecting the psychological needs of family members, as their distress can impair their ability to support the patient and make rational treatment decisions. 2
• Do not underestimate the financial burden on families, as economic distress compounds psychological distress and reduces coping capacity. 1, 5