Science & Technology

Post-traumatic Stress Endures Over Time in Family Members Of ICU Patients, Pitt Study Finds

Family members may experience post-traumatic stress as many as six months after a loved one’s stay in the intensive care unit (ICU), according to a study by researchers at the University of Pittsburgh School of Medicine and University of California, San Francisco. The study, published online in the Journal of General Internal Medicine, found that symptoms of anxiety and depression in family members of ICU patients diminished over time, but high rates of post-traumatic stress and complicated grief remained.

“Our findings suggest that family members of patients in the intensive care unit are at risk for serious psychological disorders that may require treatment,” said Cindy L. Bryce, a professor of medicine and health policy and management in Pitt’s School of Medicine. “Unfortunately, it may be difficult to identify these family members while their loved one is in the hospital because the symptoms that we can observe and measure early—anxiety and depression—do not seem to be associated with the longer-term outcomes like post-traumatic stress disorder and complicated grief. This tells us that screening family members after hospitalization is crucial.”

Cindy L. Bryce

The study included 50 family members of patients who were admitted to the ICU. Researchers measured family members’ level of anxiety and depression in the ICU and at one- and six-month follow-up interviews. They also measured symptoms of post-traumatic stress disorder and complicated grief during the six-month follow-up interview.
Forty-two percent of family members exhibited symptoms of anxiety in the ICU. This percentage dropped to 15 percent six months later. Likewise, 16 percent of family members displayed depression in the ICU; that dropped to six percent at six months.

At six-month follow-up, 35 percent of all family members had post-traumatic stress, while 46 percent of family members of patients who died had complicated grief. Surprisingly, post-traumatic stress was not more common in bereaved than nonbereaved family members.

“As doctors, we tend to think only of the patient in an intensive care situation,” said Wendy Anderson, lead author and assistant professor, Division of Hospital Medicine, University of California, San Francisco. “Our results show that family members can be greatly influenced by a patient’s ICU stay, and that this impact persists after the patient leaves the ICU.”

Support for the study was provided by the University of Pittsburgh’s Institute for Doctor-Patient Communication and The Greenwall Foundation. Coauthors are professors Robert Arnold and Derek Angus in Pitt’s School of Medicine.

—Clare Collins

Genetic Profile Reveals Susceptibility To Cleft Palate, Pitt Study Finds

For the first time, researchers from the University of Pittsburgh School of Dental Medicine have identified a series of genetic mutations that appear to be linked to significant risk for cleft palate and other dental abnormalities. These are devastating conditions that can cause tremendous social isolation and also are associated with decreased lifespan, a higher risk of cancer, and increased susceptibility to psychiatric disorders, even after surgical repair.

The findings were reported in the September issue of Genetics in Medicine.

Alexandre Vieira, an assistant professor in Pitt dental school’s Department of Oral Biology, and his colleagues collected and evaluated genetic material from the saliva and blood of more than 500 individuals in family groups with two or more siblings affected with cleft lip or palate and an additional 100 people from unrelated families whose samples were used for general-population comparison data. The researchers analyzed 1,489 variations in DNA sequences, known as single-nucleotide polymorphisms, in 150 genes.

“We found a group of more than a dozen gene mutations that appear to be significantly associated with cleft lip and palate, as well as other dental abnormalities—predominantly at the locations for ERBB2, CDH2, and IRF6,” said Vieira, a pediatric dental specialist. “Here we report, for the first time, an extensive candidate gene analysis for cleft susceptibility, a crucial step that may allow for better estimates of recurrence risk in individual families.”

Collecting the genetic data from members of extended family groups living among the 7,000 islands in the Philippines presented its own challenges. Field researchers faced typhoons and severe tropical storms, at least one major landslide, and frequently thorny local political conditions that restricted areas to which they could safely travel. The researchers were stranded for more than a week and pitched in to help emergency rescue personnel following a massive mudslide on Southern Leyte that caused widespread damage and loss of life in February 2006.

“In some cases, it would be two entire days of travel by boat, car, and foot to reach just one family in a remote village,” said Vieira, first author of the study. “It took us about three years to finish the project.”

The gene ERBB2 has been associated with aggressive breast cancer, while IRF6 is linked to formation of the connective tissue, such as the palate. CDH2 is a gene associated with left-right asymmetry. Other genes of interest that were identified include MSX1, PVR, PVRL, and TGFA.

Associated tooth abnormalities studied included families where people had extra teeth or teeth that were tiny or missing. Missing teeth was the most frequently observed abnormality, the researchers noted.

Cleft lip and palate is a common birth defect, on average affecting about one in 700 live births worldwide. In general, Asian populations have a higher prevalence of cleft lip and palate, at about one in 500 births. Among Caucasians, the rate is one in 1,100, and African populations have the lowest rate, at one in 2,500 births.

“In the Philippines, affected people can be completely isolated socially, miserable, alcoholic, and heavy smokers with a hard time speaking. Access to care is very difficult,” said Vieira. “The hope is to be able to narrow down the genes that cause clefts and to screen for that risk—and, eventually, to possibly lead to gene therapy targets, although that may not happen in my lifetime.”

The study was funded by the National Institute of Dental and Craniofacial Research of the National Institutes of Health.

—Michele D. Baum