Effects of Resourcefulness on Sleep Disturbances, Anxiety, and Depressive symptoms in Family Members of Intensive Care Unit Patients

Disruptions in Sleep Health and Independent Associations with Psychological Distress in Close Family Members of Cardiac Arrest Survivors: A Prospective Study

Background

While recent guidelines have noted the deleterious effects of poor sleep on cardiovascular health, the upstream impact of cardiac arrest-induced psychological distress on sleep health metrics among families of cardiac arrest survivors remains unknown.

Methods

Sleep health of close family members of consecutive cardiac arrest patients admitted at an academic center (8/16/2021 - 6/28/2023) was self-reported on the Pittsburgh Sleep Quality Index (PSQI) scale. The baseline PSQI administered during hospitalization was cued to sleep in the month before cardiac arrest. It was then repeated one month after cardiac arrest, along with the Patient Health Questionnaire-8 (PHQ-8) to assess depression severity. Multivariable linear regressions estimated the associations of one-month total PHQ-8 scores with changes in global PSQI scores between baseline and one month with higher scores indicating deteriorations. A prioritization exercise of potential interventions categorized into family's information and well-being needs to alleviate psychological distress was conducted at one month.

Results

In our sample of 102 close family members (mean age 52±15 years, 70% female, 21% Black, 33% Hispanic), mean global PSQI scores showed a significant decline between baseline and one month after cardiac arrest (6.2±3.8 vs. 7.4±4.1; p<0.01). This deterioration was notable for sleep quality, duration, and daytime dysfunction components. Higher PHQ-8 scores were significantly associated with higher change in PSQI scores, after adjusting for family members' age, sex, race/ethnicity, and patient's discharge disposition [β=0.4 (95% C.I 0.24, 0.48); p<0.01]. Most (n=72, 76%) prioritized interventions supporting information over well-being needs to reduce psychological distress after cardiac arrest.

Conclusions

There was a significant decline in sleep health among close family members of cardiac arrest survivors in the acute phase following the event. Psychological distress was associated with this sleep disruption. Further investigation into their temporal associations is needed to develop targeted interventions to support families during this period of uncertainty.

WHAT IS KNOWN

Sleep health has been identified as a key element in maintaining cardiovascular health.Close family members of critically ill patients experience suboptimal sleep health and psychological distress may contribute to it.

WHAT THE STUDY ADDS

It is breaking new ground in understanding the sleep health dynamics of close family members of cardiac arrest survivors, a critical but often overlooked group of caregivers.The study highlights significant associations between psychological distress and poor sleep that further deteriorates within the first month after a loved one's cardiac arrest.Families of cardiac arrest survivors expressed a high priority for information-based interventions to help alleviate psychological distress during the initial month following the cardiac event emphasizing the need for targeted, accessible, resources to address their psychological and potentially sleep-related challenges.

Postintensive care syndrome family: A comprehensive review

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.

Application of Grey Relational Analysis to Predict Dementia Tendency by Cognitive Function, Sleep Disturbances, and Health Conditions of Diabetic Patients

Background: The number of elderly diabetic patients has been increasing recently, and these patients have a higher morbidity of dementia than those without diabetes. Diabetes is associated with an increased risk for the development of dementia in elderly individuals, which is a serious health problem. Objectives: The primary aim was to examine whether diabetes is a risk factor for dementia among elderly individuals. The secondary aim was to apply grey theory to integrate the results and how they relate to cognitive impairments in elderly diabetic patients and to predict which participants are at high risk of developing dementia. Methods: Two hundred and twenty patients aged 50 years or older who were diagnosed with diabetes mellitus were recruited. Information on demographics, disease characteristics, activities of daily living, Mini Mental State Examination, sleep quality, depressive symptoms, and health-related quality of life was collected via questionnaires. The grey relational analysis approach was applied to evaluate the relationship between the results and health outcomes. Results: A total of 13.6% of participants had cognitive disturbances, of whom 1.4% had severe cognitive dysfunction. However, with regard to sleep disorders, 56.4% had sleep disturbances of varying degrees from light to severe. Further investigation is needed to address this problem. A higher prevalence of sleep disturbances among diabetic patients translates to a higher degree of depressive symptoms and a worse physical and mental health-related quality of life. Furthermore, based on the grey relational analysis, the grey relation coefficient varies from 0.6217~0.7540. Among the subjects, Participant 101 had the highest value, suggesting a need for immediate medical care. In this study, we observed that 20% of the total participants, for whom the grey relation coefficient was 0.6730, needed further and immediate medical care.

Family Experience during Patient Assistance Process in General Intensive Care Unit: A Phenomenology Study

BACKGROUND: Intensive care unit (ICU) treatment can lead to fear, anxiety, depression, panic, and tension in the family. Place of the family as active presence, guardian, facilitator, historian, and coaching of the family cannot be separated from the recovery process. During the assistance of ICU patients, the family is faced with a strange environment, strict rules, emotional stress, and everyday life changes that have caused them to encounter psychological and physiological concerns. AIM: This study aims to describe and interpret of the family’s experience during assistance patient in the ICU. METHODS: A phenomenological methodology is used to explore experience of family. In-depth interviews were conducted on nine participants who were selected using purposive sampling. Data were analyzed by Colaizzi techniques, began with read transcripts, look for phenomenon, formulated data, organized, and verified to the participants. RESULTS: The result is presented in three themes; physically and psychologically tired; good language is a medicine, strengthens each other’s companion. CONCLUSION: The support of the patient in the ICU helps the family face a number of stressful circumstances. Adaptive coping and psychosocial help from health care workers and friends build a supportive family to cope with the difficulties when supporting patients in the ICU.

Factors That Influence Women's Symptoms of Postpartum Depression After Discharge of Their Preterm Infants From the NICU

OBJECTIVE

To examine resourcefulness, perception of child vulnerability, and stress in relation to symptoms of postpartum depression (PPD) in women after discharge of their preterm infants from the NICU.

DESIGN

Cross-sectional, descriptive, correlational study.

SETTING

An urban NICU follow-up clinic, a pediatric office in the northeastern United States, and an online NICU parent support group.

PARTICIPANTS

Seventy-four women who gave birth to preterm infants who were discharged home from the NICU.

METHODS

The participants completed a demographic data questionnaire, the Resourcefulness Scale, Child Vulnerability Scale, Perceived Stress Scale, and Edinburgh Postnatal Depression Scale. I examined the relationships among these data using correlational analysis and hierarchical multiple linear regression analysis.

RESULTS

Perception of child vulnerability and stress were predictors of symptoms of PPD; these variables accounted for 9% (p = .001) and 18% (p < .001) of the variation in symptoms of PPD, respectively. Although resourcefulness initially predicted PPD, it was no longer significant when controlling for demographic variables in the final regression analysis.

CONCLUSIONS

These results supported previously reported findings on the effects of women's perceptions of their child's vulnerability and stress on symptoms of PPD. However, the findings are not consistent with those of previous research regarding the inverse relationship between resourcefulness and symptoms of PPD. Nurses can implement interventions for women regarding perceptions of child vulnerability and stress to decrease symptoms of PPD after their preterm infant's discharge from the NICU.

Nurses' knowledge, attitude, and competence regarding palliative and end-of-life care: a path analysis

Background

Nurses’ knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care.

Purpose

We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses’ demographic characteristics, previous experiences, knowledge, competence, and attitude.

Method

A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling.

Results

Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses’ palliative attitudes were divided into “positive perception” and “negative perception”. “Positive perception” was highly correlated with competence (r = 0.48, p < 0.001), but “negative perception” was not significantly correlated with competence (r = −0.07, p = 0.25). “Positive perception” (β =  −0.01, p = 0.84) and competence (β =  0.02, p = 0.80) were not related to palliative knowledge. “Negative perception”, however, was negatively associated with palliative knowledge (β =  −0.20, p < 0.01).

Conclusions

This study suggests continuing education to decrease nurses’ “negative perception” attitude regarding the provision of information to patients and families to provide better palliative and EOL care.

Implications for Practice

Nurses’ attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions.

Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review

AIMS AND OBJECTIVES

To map research-based psychological distress among the family members with patients in the intensive care unit (ICU).

BACKGROUND

Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery.

DESIGN

The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist.

METHODS

A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL^® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed.

RESULTS

From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress.

CONCLUSIONS

Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members.

RELEVANCE TO CLINICAL PRACTICE

The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.

Coping strategies of family members of intensive care unit patients

OBJECTIVE

To analyse the coping strategies of family members of patients admitted to intensive care units.

DESIGN

A cross-sectional study developed with 70 relatives of patients admitted to the intensive care unit.

SETTING

An adult intensive care unit at a university hospital in Brazil.

MAIN OUTCOME MEASURES

Coping strategies were identified by the Folkman and Lazarus Inventory of Coping Strategies and statistically compared to the sociodemographic data of family members and patients' clinical data.

RESULTS

Coping strategies focused on emotion were the most used, especially those attributed to the escape-avoidance factor. There was a significant association (p < 0.05) between women and the use of adaptive strategies focused on the problem; less education and lower income with maladaptive strategies focused on emotion; second-degree relatives and the positive reassessment factor; participants involved in religious activities and the social support factor. Regarding the clinical variables, patients admitted to the intensive care unit for more than seven days showed an association (p < 0.05) with the social support factor.

CONCLUSION

Family members used adaptive coping strategies more focused on emotion. Additionally, the lower the educational and economic levels, the greater the use of maladaptive strategies focused on emotion.

Psychological Sequelae in Family Caregivers of Critically III Intensive Care Unit Patients. A Systematic Review

Rationale: Family members of critically ill patients hospitalized in the intensive care unit (ICU) often become caregivers, and they are at risk to develop adverse psychological outcomes. There is a need to understand the psychological impact of critical illness on family caregivers. Objectives: The aim of this systematic review is to document the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) in family caregivers of critically ill patients and identify potential risk factors for psychological outcomes to inform clinical and future research recommendations. Methods: A literature search for psychological outcomes for family caregivers of critically ill patients was conducted. A total of 1,148 studies from PsycINFO, CINAHL, Web of Science, SCOPUS, and Medline were identified. Results: Forty studies met inclusion criteria and were included in the review. The prevalence of psychological outcomes in family caregivers ranged from 4% to 94% for depression, 2% to 80% for anxiety, and 3% to 62% for PTSD. Caregiver depression, anxiety, and PTSD decreased in most studies that assessed longitudinal outcomes. Common risk factors identified for adverse psychological outcomes included younger caregiver age, caregiver relationship to the patient, lower socioeconomic status, and female sex. Conclusions: The prevalence of depression, anxiety, and PTSD varies greatly across studies of family caregivers of critically ill patients. This finding highlights the need for more systematic investigations of psychological outcomes and the implementation of clinical interventions to prevent or reduce depression, anxiety, and PTSD in family caregivers of critically ill patients.

Resilience and coping styles as predictors of health outcomes in breast cancer patients: A structural equation modelling analysis

INTRODUCTION

Resilience has been associated with psychological adaptation to many threatening life events, but previous studies have rarely analysed the integrated relationships among demographic and disease characteristics and various health outcomes in Taiwan. This study examined the associations among demographic factors, disease characteristics, resilience, coping styles and adverse health outcomes, including anxiety and depressive symptoms and sleep disorders.

METHODS

A descriptive, cross-sectional study design was used. Data from a convenience sample of 175 patients with breast cancer aged 20 years or older were collected using a self-reported questionnaire. A structural equation modelling approach was applied to examine the relationships among the variables.

RESULTS

The results showed that greater resilience was related to fewer depressive symptoms, lower anxiety levels and better sleep quality. All three coping styles, including active coping, minimising the situation and avoidance coping, were negatively correlated with depressive symptoms, but only active coping was significantly correlated with sleep quality. Resilience had a direct effect on depressive symptoms, anxiety and sleep disorders. Furthermore, a mediating effect of resilience was observed on the relationship between marital satisfaction and depressive symptoms.

CONCLUSION

Resilience can strengthen breast cancer-related adaptation. Additionally, breast cancer survivors who used mainly the active and minimising coping styles tended to experience fewer depressive symptoms.

Social support as a mediator between sleep disturbances, depressive symptoms, and health-related quality of life in patients undergoing hemodialysis

Background

The hemodialysis regimen is an inevitable and mandatory treatment for patients with end-stage renal disease (ESRD). During the dialysis journey, patients may experience maladaptation in terms of sleep disturbances, depressive symptoms, and reduced health-related quality of life (HRQOL). Psychosocial resources such as social support may have beneficial influences on health outcomes, but studies have rarely analyzed the integrated relationships among risk factors which include pain, sleep disturbances, duration since diagnosis and various health outcomes in Taiwan. This study aimed to bridge this gap by investigating the relationships among related risk factors, social support, sleep disturbances, depressive symptoms, and HRQOL, which is composed of physical quality of life (PQOL) and mental quality of life (MQOL), in ESRD patients.

Method

A correlational design was used, and 178 patients aged 20 years or older were recruited via convenience sample. The relationships among the risk factors, the mediators, depressive symptoms, PQOL, and MQOL were analyzed using structural equation modeling.

Results

The findings showed that more than 70% of the participants reported poor sleep quality, and 32% reported depressive symptoms. When participants had greater pain and more sleep disorders, they were more likely to be depressed. When participants had more appraisal support; they had better PQOL and fewer depressive symptoms. Overall, the structural equation model explained 31.8% of the variance in self-reported depressive symptoms, 29.4% of the variance in PQOL, and 5.7% of the variance in MQOL. Moreover, appraisal support enhanced PQOL and reduced depressive symptoms by exerting its two mediating effects on sleep disturbances.

Conclusion

Our findings indicate that patients with ESRD who have more social support have better PQOL and MQOL and fewer depressive symptoms than those with less social support.

Psychological distress in relatives of critically ill patients: Risk and protective factors

The admission to an intensive care unit can result in a significant burden of emotional distress in the family. This study analyzes the psychological distress of 89 relatives of intensive care unit patients and the potential risk/protective factors for such distress. Families show high levels of anxiety, depression, and stress. Regarding risk factors, having steady partner, being a woman, and being a mother are associated with increased risk of anxiety, depression, and stress. Contrarily, being younger and having higher educational level are associated with reduced anxiety and stress. Influencing these trends could change positively the suffering course experienced by relatives and intensive care unit patients indirectly.

Grandchildren's Depressive Symptoms and Perceptions of Family Functioning: Protective and Influencing Factors

A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children's living situation, parental monitoring, child's resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insight into factors influencing children's depressive symptoms and perceived family functioning, and provides direction for the development of future interventions.