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High Morning Cortisol Tied to Long-term Anxiety in Family Members of ICU Patients

High Morning Cortisol Tied to Long-term Anxiety in Family Members of ICU Patients

When a patient enters intensive care for critical illness, his or her family members often suffer from long-term anxiety, depression, post-traumatic stress, or other negative effects.

A new study published in the journal Critical Care Medicine finds that a biomarker may help identify which family members will be most emotionally impacted by their loved one’s ICU stay. In particular, family members who showed a morning spike in cortisol were more likely to still be suffering from anxiety three months later.

Cortisol is known as the “stress hormone,” because it can spike during stressful times, such as when a loved one is critically ill.

Study leader Elliotte L. Hirshberg, M.D., MS, a critical care physician at Intermountain Medical Center and director of the Center for Humanizing Critical Care asserts that family members need time to adjust to their new roles, situations, and responsibilities.

“This study confirms the long-held belief that family members are experiencing stress during an ICU stay. This is important,” said Hirshberg. “The next step we hope to take in the future is to study support interventions that can reduce this stress and the associated anxiety, depression, and PTSD that may follow.”

For the study, the researchers followed the family members of patients who’d been admitted to Intermountain Medical Center’s medical/surgical intensive care unit. Three months after the patient was discharged, the researchers found that 32 percent of the family members in the study suffered from anxiety, 16 percent had symptoms of depression, and 15 percent reported signs of post-traumatic stress.

Researchers also discovered an increase of about 50 percent in family members’ cortisol levels first thing in the morning, which was associated with anxiety in family members three months after hospital discharge.

Unlike the surge in cortisol shortly after awakening, general cortisol levels weren’t found to predict long-term symptoms of mood disorders among study participants.

Researchers focused on family members because they’re an important part of a patient’s recovery team and often have their own unmet needs. After an ICU discharge, family members must face new challenges, including caring for a sick loved one, learning how to provide medical care, and perhaps experiencing a change in employment.

Post-intensive care syndrome in families, sometimes called PICS-F, is a widely recognized syndrome and can impact up to 60 percent of family members. PICS-F includes anxiety, depression, PTSD, and difficulty transitioning to a new state of well-being, according to Hirshberg.

There’s likely a link between family member wellness and a patient’s trajectory for recovery, said Hirshberg.

For the study, researchers enrolled families of patients who were gravely ill. Some groups were excluded, including those with a history of PTSD, dementia, or schizophrenia and those on medications containing steroids, which impacts cortisol secretion.

Besides confirming a link between mood disorders and cortisol, the researchers also found that having a history of anxiety is associated with anxiety three months after the hospitalization. Depression and anxiety are likely to co-exist, so more work needs to be done to identify interventions that can decrease the symptoms of PICS in family members.

Of the 100 participants registered for the study, 92 continued through the follow-up at three months. The average age was 54 and nearly two-thirds were female, while 71 percent lived with the patient before the ICU admission. Fifty-three percent of participants were married to the patient.

Cortisol was measured using saliva samples at five predetermined times over 24 hours. The study had some limitations: The link between general cortisol secretion and chronic stress is unclear, and the levels reported in the study may have reflected a combination of chronic and acute stress. In addition, the study did not account for stresses unrelated to the ICU.

“Because participants had to leave the patient’s room briefly and some declined, it’s possible that those family members have higher stress and they were not included in the study,” said  Hirshberg.

Source: Intermountain Medical Center

High Morning Cortisol Tied to Long-term Anxiety in Family Members of ICU Patients

Traci Pedersen

Traci Pedersen is a professional writer with over a decade of experience. Her work consists of writing for both print and online publishers in a variety of genres including science chapter books, college and career articles, and elementary school curriculum.

APA Reference
Pedersen, T. (2018). High Morning Cortisol Tied to Long-term Anxiety in Family Members of ICU Patients. Psych Central. Retrieved on September 27, 2020, from
Scientifically Reviewed
Last updated: 8 Aug 2018 (Originally: 12 Dec 2017)
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
Published on Psych All rights reserved.