In order to cope with the impact of decisions with long-term consequences that they may not understand or not wish to question, family decision-makers can adopt strategies to make the situation better for them.
Avoidant coping is one of three coping styles analyzed by the researchers for the study. This strategy involves not engaging with the decision at all, sometimes using alcohol or drugs to escape from the reality of the situation.
The other coping styles investigated were emotion-focused coping - seeking emotional support from others, making jokes to lighten the mood or attempting to view the situation from a different perspective - and problem-focused coping, whereby the individual seeks further information, makes plans and asks for help.
"We use all of these coping skills to one level or another in different situations," states Petrinec, "but people usually employ one predominant coping strategy in a particular situation."
The researchers then tested the participants for the symptoms of PTSD 60 days after hospital discharge or their relative's death. They found that while adoption of emotion-focused and problem-focused coping decreased over time, the use of avoidant coping remained stable.
Around 42% of the participants exhibited clinically significant PTSD symptoms. The coping strategies adopted 30 days after hospitalization were found to predict later symptoms of PTSD much more effectively than the strategies adopted within days of ICU admission. Death of the relative in question was also a strong predictor of PTSD, regardless of coping style.
In particular, the researchers found using an avoidant coping strategy mediated the relationship between the death of a patient and the severity of PTSD symptoms.