Efforts by hospitals to protect people from COVID-19 by restricting them from visiting family members in ICUs may have contributed to a significant increase in stress-related disorders, according to a study led by University of Colorado School of Medicine researchers.

The study, published today in JAMA Internal Medicine, reports that nearly two-thirds of those restricted from visiting were suffering from stress-related disorders three months after their family member was hospitalized.

"Our findings suggest that visitation restrictions may have inadvertently contributed to a secondary public health crisis, an epidemic of stress-related disorders among family members of ICU patients," says Timothy Amass, MD, ScM, assistant professor of medicine at the CU School of Medicine and first author of the article.

Visitation restrictions at hospitals were implemented to prevent the spread of an emerging highly infectious virus and deadly disease at a time when personal protective equipment was in short supply. Hospital and public health officials were also concerned about having enough capacity to provide care.

Amass and his co-authors found that the consequences of those restrictions had an enduring effect on many of the people who weren't allowed to visit their hospitalized family members. According to the study, having a family member admitted to the ICU with COVID-19 was associated with high levels of symptoms of post-traumatic stress disorder, such as depression and anxiety.

The study authors surveyed people three months after their family member was hospitalized, finding that 64% of the study participants recorded high scores on tests that measure symptoms of post-traumatic stress disorder. That's more than double from pre-pandemic levels, when about 30% of family members of ICU patients reported stress-related disorders.

To conduct their study, Amass and his colleagues surveyed 330 family members three months after their family members were admitted to the ICU with COVID-19. Those patients were admitted between Feb. 1 and July 31, 2020, in the early days of the pandemic, at eight academic-affiliated and four community-based hospitals in Colorado, Washington, Louisiana, New York, and Massachusetts.

The study authors said restrictions may have fostered distrust between patients' family members and health care providers. They write, "As the COVID-19 pandemic continues to challenge the ability of family members to build bedside relationships with clinicians, this loss of trust may translate into an increase in stress-related disorders."

One study participant who was surveyed described their painful experience: "They called us and said, 'Do you want us to pull the plug?'... I said how did it go from coming home to pulling the plug?... they say that her mouth was moving and her eyes was moving but they said she was dead... so, they went on and pulled the plug anyway."

Study authors added that additional studies would be needed to determine any links between visitation restriction policies and factors that caused distrust among family members.

The study lists 41 co-authors. In addition to Amass, authors affiliated with the CU School of Medicine are Hope Cruse; Ying Jin; Trevor Lane, MD; Marc Moss, MD; Ryan Peterson, PhD; Sarah Rhoads, MD; Jin Huang; and Stephanie Yu.