Psychological Stress of Companions (Care givers) of Children in the Pediatric Intensive Care Unit

Sabih S Mehdi , Wejdan Abid Sebty
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Keywords : Psychological Stress of Companions , Care givers , Pediatric Intensive Care Unit
Medical Journal of Babylon  8:1 , 2014 doi:1812-156X-8-1
Published :2011


Background: Admission of a child to the Pediatric Intensive Care Unit (PICU) can create high parental and other companions psychological problems. Many factors contribute in a negative way to this abnormality. Hospital Anxiety and Depression Scale (HADS) has been used to help physicians to identify these care givers at risk and address contributing factors. Methods: The HADS has been administered to 42 care givers (26 in PICU and 16 as a control group in a general pediatric ward) in Babylon Gynecology and Children Teaching Hospital after their staying in hospital for 14 days. Factors which may have an effect on psychological status have been studied. Results: Fifteen care givers (57.7%) show depression and anxiety in the range of (11-21) according to HADS compared to only 2 (12.5%) of the control group<0.05. All care givers think their patients are in pain and all complained of noise in the PICU as causes of their distress. Twenty four patients were under ventilator, fourteen care givers (93.3%) fall in the (11-21) range according to HADS.. Conclusion: Care givers in the PICU were at more risk of psychological stress compared to the control group and there are stressful factors playing a significant role in aggravating this abnormality.


anxiety and depression are common psychological disorders among all ages and all societies, they reduce quality of life and from our medical interest they disturb doctor-patient relationship which is of extreme importance specially in the PICU(Pediatric Intensive Care Unit) setting. The intensive care unit is an emotional charged and highly stressful place. Sources of stress to caregivers in the PICU are many including noises from monitors, alarms of machines, staff noises, bright lights, frequent invasive procedures and deterioration of their child or other children in the unit. Studying emotions of care givers in PICU is important to define vulnerable individuals for early management and prevention. The Hospital Anxiety and Depression Scale ( HADS) is a selfreport rating scale. It is designed to measure anxiety and depression in inpatients and out-patients settings. It is not designed to diagnose psychiatric illnesses but it is a screening tool used to help physicians to study the behavior of patients or their care givers. There are 14 subscales 7 for each anxiety and depression.The sum of the 7 subscales ranges from 0-21 divided into 0- 7(normal) 8-10(borderline abnormal) 11- 21 (abnormal) for each abnormality [1]. Hospital Anxiety and Depression Scale has been used for this purpose and it has been found applicable for different nations [2, 3]. Acute stress has been studied on parents just on their admission to the PICU which can easily be managed , but cumulative stress can have a damaging effect which can last long after discharge from PICU. Depression clinical features should be present for 14 days according to ICD-10 classification(International Statistical Classification of Diseases and Related Health Problems)[4]. In order to fulfill the criteria for definition. children and their parents in the PICU are subjected to different stressful situations ranging from laboratory tests to invasive procedures and this in itself leave them with an abnormal psychological outcome affecting their life long after discharge from the PICU[5]. Other scales have been used to assess parental stress in different research papers[6] Even admission for a simple illness can create parental distress in some degree [7] which might be overlooked by an unworried physician. The aim of the study is to determine whether PICU admission of children is associated with a greater psychiatric morbidity in care givers as compared with general pediatric ward admission and to study contributing factors.

Materials and methods

A prospective cohort study was
performed over 10 months from August
2009 through October 2010 in the
Pediatric Intensive Care Unit (PICU)
which has been constructed recently in a
small space in the original building of
Babylon Gynecology and Children
Teaching Hospital. It is a 10 bed unit
staffed mainly by male nurses with no
official parental bed spaces but patients
companions are left to stay with their
patients. Almost all admissions are from
the emergency and pediatric wards and
some of them were referred from other
governorates. Neonates are also admitted
in a separate room as there is no NICU
(Neonatal Intensive Care Unit) in the
hospital at the time of the study. The
number of patients in the PICU during
the study period was 533; twenty six of
them fulfilled the criteria of staying in
PICU for 14 days. All care givers were interviewed after getting their verbal
consent by a pediatric consultant
according to HADS(Hospital Anxiety
and Depression Scale).Sixteen care
givers were taken as a control group in
the general pediatric ward matched for
the same period of hospital stay.
According to HADS, a score of 0-7 was
considered normal, 8-10=Borderline
abnormal, 11-21=Abnormal. Factors
thought to have an effect on
psychological status of care givers were
Data analysis was performed according
to ANOVA t-test
Among 533 PICU admissions, 26
patients fulfilled the inclusion criteria of
staying in hospital for 14 days, all
caregivers were interviewed.


Among 533 PICU admissions, 26 patients fulfilled the inclusion criteria of staying in hospital for 14 days, all caregivers were interviewed. Factors which affect the care givers in the PICU have been studied and related to their anxiety and depression in the range of( 11-21) which demonstrates the obvious abnormality excluding the borderline degree.The number of obvious depression and anxiety was 15 as it appears in table (3).


The study has been carried out in the PICU where parents or caregivers were left to stay with their patients day and night but without a private accommodation which is in a way a modified unit with parent bed spaces, a method used to lessen the stress on care givers[8]. In the obvious form of anxiety and depression(HADS 11-21) fifteen care givers in the studied group are represented(57.7%) compared to 2 care givers (12.5%) in the control group (P<0.05).These findings are in agreement with other studies [9,10,11]. Noises were a major cause of stress affecting 96.2% of caregivers. In a study constructed to assess the level of noise in Ab A&D % P 11-21 Group Caregivers PICU 15/26 57.7 <0.05 Control 2/16 12.5 a PICU found the limit was exceeding the accepted WHO recommendations [12].All care givers were worried that their children are suffering from pain which goes with a study done in neonatal intensive care units in the United Kingdom [13].All caregivers do not know for how long are they going to be in the unit and all of them got high grading on HADS. Conflicts arise in medical care if the patients stay for a long time in hospital affects psychological state of parents[14]. Although caregivers are left to stay with their children in the PICU still the level of stress is high which may be due to a hidden stress built over the years due to different stressful situations inflicted on these caregivers as part of the general disturbed situation of the country. Stress can be minimized if parental needs are met and their worries are addressed [15,16] Child being ventilated and less hours of sleep have an effect on the psychological status of caregivers as in table (3).


Care givers in the PICU were subjected to a higher level of stress than control. They are subjected to a number of avoidable stressful factors. (HADS) can be applied on our patients after being translated to Arabic language.


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