Were you a family member, or a COVID-19 patient?

We have read with great interest the study by Shirasaki et al.¹ recently published in Acute Medicine and Surgery, where the authors studied the long-term outcomes of psychiatric disorders in families of COVID-19 patients admitted to the intensive care unit (ICU) of a single hospital in Tokyo, Japan. They described that as high as 39% of families suffered from anxiety and/or depression even more than a year after the patient's discharge. Notably, this is a valuable study that presents data on long-term post-intensive care syndrome—family (PICS-F) in Japan.

In the context of the prolonged COVID-19 pandemic, the high transmissibility of SARS-CoV-2 may pose an additional discussion in assessing the long-term psychological outcomes of family members of COVID-19 patients. According to the Japanese Ministry of Health, Labour, and Welfare, the prevalence of SARS-CoV-2 antibodies among Japanese adult population is as high as 56.4%, as of November 2023.² The fact suggests that many family members may have contracted COVID-19 themselves during the epidemic.

A crucial aspect to consider is the prevalence of “long COVID,” a condition characterized by persistent sequelae including psychiatric disorders, in a significant number of COVID-19 survivors.³ Notably, around 30% of COVID-19 patients who required mechanical ventilation in Japan exhibited symptoms of psychiatric disorders after discharge.⁴

Furthermore, while the Hospital Anxiety and Depression Scale (HADS) is a widely recognized tool for assessing anxiety and depression symptoms in PICS-F,⁵ it does not specifically determine whether these symptoms are directly linked to the ICU admission of a family member. As a result, the depressive and anxious symptoms described in this study could be attributed not only to PICS-F but also to the impacts of long COVID or post-intensive care syndrome (PICS) experienced by the patients themselves. Therefore, we feel it is essential to adopt a more nuanced approach to understand the complex effects of these conditions on the mental health of families affected by COVID-19.

Again, we would applaud the authors for performing such an important study, which suggests the need for support for both patient-centered and family-centered care during the remote period after the patient's discharge from the ICU.

The authors declare no conflicts of interest.

Approval of the research protocol: N/A.

Informed consent: N/A.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.