Publication date: Jul 23, 2025

The COVID-19 pandemic required unprecedented measures including visitation restrictions. To assess their impact on psychological symptoms (anxiety-depression, posttraumatic stress disorder (PTSD)) among ICU family members. In this prospective multicentre quasi-experimental study, family members of patients with invasive mechanical ventilation with or without COVID-19, were enrolled during one of three periods (March 15 – June 5) subject to visitation restriction policies mandated by French health authorities: forbidden (2020, n= 304), restricted (2021, n= 294) and unrestricted (2022, n= 213). Primary outcome was prevalence of anxiety-depression symptoms in family members 90 days after ICU discharge. Among 811 members, prevalence of anxiety-depression symptoms did not significantly differ across the three periods (57. 2%, 56. 8% and 61. 5%, P= 0. 52; unrestricted vs restricted visitations: Relative Risk (RR), 1. 08 (95%CI, 0. 94‒1. 25), P= 0. 28; unrestricted vs forbidden visitations: RR, 1. 08 (0. 93‒1. 24), P= 0. 33). Similar findings were observed for PTSD risk (36. 5%, 40. 8% and 34. 3%, P= 0. 29). Anxiety-depression symptoms were associated with female relatives of patients (adjusted RR, 1. 78 (1. 28‒2. 46), P= 0. 001), dissatisfaction with ICU team’s communication (aRR, 1. 83 (1. 22‒2. 74), P= 0. 004), and spouses of patients (aRR, 2. 15 (1. 42‒3. 26), P< 0. 001). For PTSD, these risk factors were also significant, in addition to COVID-19 disease (aRR, 1. 52 (1. 10‒2. 10), P= 0. 01) and patient death in ICU (aRR, 2. 59 (1. 91‒3. 51], P< 0. 001). This study does not support the hypothesis that visitation restriction policies during the COVID-19 pandemic exacerbated high prevalence of long-term psychological symptoms among ICU family members. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4. 0 (http://creativecommons. org/licenses/by-nc-nd/4. 0/).

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