Depressive symptoms among surrogate decision makers in Lebanese ICUs

Surrogate decision making is advocated to protect the vulnerable patient. Family members of patients in intensive care units (ICUs) are prone to develop depressive symptoms which may undermine their decisional capacity. Lebanon is a multicultural country where paternalism still dominates the physician-patient relationship and ethics are far from being the subject of research and studies. This multicenter observational study in the Greater Beirut area attempts to estimate the prevalence of depressive symptoms among surrogates deciding on behalf of ICU patients and to correlate their severity with sociodemographic factors. During the period March-May 2011, direct interviews were conducted and the Patient Health Questionnaire-9 (PHQ-9) was administered to 56 family members who had given consent, regarding therapeutic options, on behalf of ICU patients in seven university hospitals. We looked for relationships, in these surrogates, between severity of depression and age, sex, marital status, level of education, religion and status as the patient's spouse. The prevalence of major depression among surrogates was 61% using a cutoff of 10 on the PHQ-9 scale. Among the surrogates with depression, 15% had untreated moderate-to-severe depression. Severity of depression and suicidal ideation were not related to any of the studied factors. Depressive symptoms are prevalent among family members deciding on behalf of ICU patients, rendering them vulnerable. Appropriate measures should be taken to identify and treat them.