{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T02:07:18Z","timestamp":1767233238834,"version":"3.48.0"},"reference-count":38,"publisher":"AACN Publishing","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n Background<\/jats:title>\n Patient death caused by COVID-19 in an intensive care unit (ICU) may be a risk factor for posttraumatic stress disorder (PTSD) in family members.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine if bereaved family members of ICU patients with COVID-19 were more likely than those of patients without COVID-19 to experience PTSD and prolonged grief disorder and find the death unexpected.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this cross-sectional survey study with embedded qualitative analysis conducted during the Omicron wave of the COVID-19 pandemic, family members of ICU patients at an academic medical center were enrolled at least 6 months after a patient\u2019s death. Participants completed Impact of Event Scale\u2013Revised (IES-R) and Prolonged Grief Disorder-13-Revised (PG-13-R) and rated how unexpected the death was on a 5-point Likert scale. A subset participated in individual interviews.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 162 total participants, 37 respective patients (23%) died of COVID-19. Family members of COVID-19 patients had significantly higher IES-R scores than did those of non-COVID-19 patients (32.4 vs 24.9, P = .03) but similar PG-13-R scores (26.1 vs 24.7, P = .43). Score on IES-R was associated with greater perception that death was unexpected (P &lt; .001). Mediation analysis revealed a significant indirect effect between patient\u2019s COVID-19 status and family member\u2019s IES-R score via greater perceived unexpectedness of death (B = 2.27 [95% CI, 0.22-4.97]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Among bereaved family members of ICU patients, perceiving the patient\u2019s death as unexpected was greater when death was due to COVID-19 versus other causes and was associated with PTSD symptoms.<\/jats:p>\n <\/jats:sec>","DOI":"10.4037\/ajcc2026749","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T02:03:39Z","timestamp":1767233019000},"page":"45-53","source":"Crossref","is-referenced-by-count":0,"title":["Perceived Unexpectedness of Death and PTSD Among Family Members of Intensive Care Patients With COVID-19 or Not"],"prefix":"10.4037","volume":"35","author":[{"given":"Katherine R.","family":"White","sequence":"first","affiliation":[{"name":"Katherine R. White is a resident physician, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia R.","family":"Ramsey","sequence":"additional","affiliation":[{"name":"Olivia R. Ramsey is a resident physician, Department of Internal Medicine, Rush University Medical Center."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatima S.","family":"Osman","sequence":"additional","affiliation":[{"name":"Fatima S. Osman is a medical student, Rush Medical College, Chicago."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan S.","family":"Wong","sequence":"additional","affiliation":[{"name":"Ethan S. Wong is a student, Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gina M.","family":"Piscitello","sequence":"additional","affiliation":[{"name":"Gina M. Piscitello is an assistant professor, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pennsylvania."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Gerhart","sequence":"additional","affiliation":[{"name":"James Gerhart is an associate professor, Department of Psychology, Central Michigan University, Mount Pleasant, Michigan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared A.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Jared A. 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