1
|
Hu C, Weng Y, Wang Q, Yu W, Shan S, Niu N, Chen Y. Fear of progression among colorectal cancer patients: a latent profile analysis. Support Care Cancer 2024; 32:469. [PMID: 38940963 DOI: 10.1007/s00520-024-08660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Fear of progression (FoP) leads to poor clinical outcomes in colorectal cancer patients. The study aimed to clarify the profiles and influencing factors of FoP among colorectal cancer patients. METHODS A cross-sectional study was conducted with 409 colorectal cancer patients. Convenience sampling method was used to select colorectal cancer patients hospitalized in a tertiary-level hospital in Nanjing as the survey subjects. General information questionnaire, Fear of Progression Questionnaire-Short Form, Distress Disclosure Index, and Social Support Rating Scale were used to collect the data. Latent profile analysis was used to explore the latent profiles of FoP in colorectal cancer patients. Additionally, the influencing factors of profiles were explored by Univariate Analysis and Binomial Logistic Regression Analysis. RESULTS Latent profile analysis identified two subgroups of fear of disease progression: the "fear low-risk profile (83%)", and the "severe fear profile (17%)." Patients with low age, low social support utilization, first hospital admission, severe healthcare burden, and preoperative bowel symptoms were prone to severe fear of disease progression. CONCLUSIONS There is some heterogeneity in the level of postoperative fear of disease progression in colorectal cancer patients. Doctors and nurses should focus on patients with severe fear and take targeted preventive and psychological care for patients' fear of disease progression as early as possible according to the distribution characteristics of different categories.
Collapse
Affiliation(s)
- Chen Hu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yajuan Weng
- Nursing Department, Nanjing Drum Tower Hospital, Nanjing, China
| | - Qian Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenhui Yu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shihan Shan
- Department of Colorectal Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Niu Niu
- Department of Colorectal Surgery, Nanjing Drum Tower Hospital, Nanjing, China.
| | - Yan Chen
- Nursing Department, Nanjing Drum Tower Hospital, Nanjing, China.
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
| |
Collapse
|
2
|
LaBuzetta JN, Bongbong DN, Mlodzinski E, Sheth R, Trando A, Ibrahim N, Yip B, Malhotra A, Dinglas VD, Needham DM, Kamdar BB. Survivorship After Neurocritical Care: A Scoping Review of Outcomes Beyond Physical Status. Neurocrit Care 2024:10.1007/s12028-024-01965-9. [PMID: 38622487 DOI: 10.1007/s12028-024-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Following intensive care unit hospitalization, survivors of acute neurological injury often experience debilitating short-term and long-term impairments. Although the physical/motor impairments experienced by survivors of acute neurological injury have been described extensively, fewer studies have examined cognitive, mental health, health-related quality of life (HRQoL), and employment outcomes. This scoping review describes the publication landscape beyond physical and/or motor sequelae in neurocritical care survivors. Databases were searched for terms related to critical illness, intensive care, and outcomes from January 1970 to March 2022. English-language studies of critically ill adults with a primary neurological diagnosis were included if they reported on at least one outcome of interest: cognition, mental health, HRQoL or employment. Data extraction was performed in duplicate for prespecified variables related to study outcomes. Of 16,036 abstracts screened, 74 citations were identified for inclusion. The studies encompassed seven worldwide regions and eight neurocritical diagnosis categories. Publications reporting outcomes of interest increased from 3 before the year 2000 to 71 after. Follow-up time points included ≤ 1 (n = 15 [20%] citations), 3 (n = 28 [38%]), 6 (n = 28 [38%]), and 12 (n = 21 [28%]) months and 1 to 5 (n = 19 [26%]) and > 5 years (n = 8 [11%]), with 28 (38%) citations evaluating outcomes at multiple time points. Sixty-six assessment tools were used to evaluate the four outcomes of interest: 22 evaluating HRQoL (56 [76%] citations), 21 evaluating cognition (20 [27%] citations), 21 evaluating mental health (18 [24%] citations), and 2 evaluating employment (9 [12%] citations). This scoping review aimed to better understand the literature landscape regarding nonphysical outcomes in survivors of neurocritical care. Although a rising number of publications highlight growing awareness, future efforts are needed to improve study consistency and comparability and characterize outcomes in a disease-specific manner, including outlining of a minimum core outcomes set and associated assessment tools.
Collapse
Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA.
| | - Dale N Bongbong
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Eric Mlodzinski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Richa Sheth
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Aaron Trando
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Nicholas Ibrahim
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Brandon Yip
- Division of Neurocritical Care, Department of Neurosciences, University of California, San Diego Health, 9444 Medical Center Dr., East Campus Office Building 3-028, La Jolla, CA, 92037-7740, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA
| |
Collapse
|
3
|
Lin D, Liang D, Huang M, Xu X, Bai Y, Meng D. The dyadic effects of family resilience and social support on quality of life among older adults with chronic illness and their primary caregivers in multigenerational families in China: A cross-sectional study. Heliyon 2024; 10:e27351. [PMID: 38463805 PMCID: PMC10923707 DOI: 10.1016/j.heliyon.2024.e27351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 02/18/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Older adults with chronic illness, as well as their primary caregivers in multigenerational families, may experience a complex interplay of factors that affect their quality of life (QOL). However, this interplay is not yet well-characterized for Chinese multigenerational families in particular. In this study, we analyzed how family resilience and social support affect the QOL of both older adults and caregivers in multigenerational Chinese families specifically. We enrolled 258 pairs of older adults with chronic illness and their primary caregivers in a multicenter cross-sectional study conducted in southern China in December 2021. Using the Actor-Partner Interdependence Model (APIM), we then examined the correlation between family resilience, social support, and QOL in dyadic analysis and found that QOL, family resilience, and social support for primary caregivers were better than those of older adults with chronic illness (t = 3.66-16.3, p<0.01). These factors were found to be positively correlated (r = 0.22-0.60, p<0.05), except for the family resilience of primary caregivers and the QOL of older adults with chronic illness (r = -0.14, p = 0.04). Additionally, actor effect results showed that when a dyadic member has high family resilience and objective social support, they tend to have a better QOL (β = 0.5-1.48, P < 0.01). However, partner effect results showed that when the primary caregiver has high family resilience, this is associated with a worse QOL for the older adult (β = -1.06, P < 0.01). Furthermore, we found that objective social support of dyads does not significantly influence their partner's QOL (β = 0.88/0.31, P>0.05) for any pair. This suggests that medical staff should pay attention to the impact of family resilience on the QOL of older adult and caregiver dyads and explore health management plans that focus on binary coping in multigenerational families.
Collapse
Affiliation(s)
- Dan Lin
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu province, 210023, China
| | - Dong Liang
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian province, 350122, China
| | - Minqing Huang
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian province, 350122, China
| | - Xinxin Xu
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian province, 350122, China
| | - Yamei Bai
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu province, 210023, China
| | - Dijuan Meng
- Nursing College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu province, 210023, China
| |
Collapse
|
4
|
Quinn PA, Mace RA, Presciutti A, Vranceanu AM. Depression Negatively Impacts Dyadic Quality of Life Following Neuro-ICU Admission: A Prospective Study of Cognitively Intact Patients and Caregivers. Int J Behav Med 2024; 31:97-108. [PMID: 36754950 DOI: 10.1007/s12529-022-10149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Admission to a neurological intensive care unit (Neuro-ICU) can increase risk for depressive and anxiety symptoms for both patients and caregivers. To better understand the long-term mental health impact of a Neuro-ICU admission, we examined the dyadic interdependence between depression and anxiety at Neuro-ICU admission with 3-month quality of life (QoL) for patients and caregivers in a longitudinal, observational cohort study. METHOD We assessed depressive and anxiety symptoms (Hospital Anxiety and Depression Scale; HADS) reported by neurologically intact patients (n = 72) and their caregivers (n = 72) within 2 weeks of Neuro-ICU admission (baseline) and 3-months post-discharge (follow-up). We examined the longitudinal association between dyadic depression and anxiety at Neuro-ICU admission and 3-month QoL (World Health Organization; QOL-BREF) across four domains (Physical, Psychological, Social relationships, and Environmental QoL) in separate actor-partner interdependence models (APIM) for patients and caregivers. RESULTS In the overall models, patients' own baseline depression levels were negatively associated with their own 3-month QoL in all domains (β = - 0.53 to - 0.64, p < 0.001), and for caregivers, only in the psychological (β = - 0.73, p < .001) and social relationships (β = - 0.56, p < .001) domains. No actor effects were found for one's own baseline anxiety impacting one's own 3-month QoL. Partner effects for one's own depression were significant for caregivers on patients' 3-month psychological (β = - 0.26, p < .02) and environmental (β = - 0.29, p < .03) QoL, as well as for patients on caregiver's 3-month psychological QoL (β = 0.25, p < .02). No partner effects were significant in association with baseline anxiety and 3-month QoL in both patients and caregivers. CONCLUSION Neuro-ICU patients' and caregivers' baseline depression has significant negative impacts on their own long-term QoL. Caregivers demonstrate significant negative impacts on patient long-term QoL in domains related to emotional distress and caregiver burden. Early identification of mental health symptoms, especially depression, during Neuro-ICU admission may provide an intervention opportunity to improve QoL post-discharge for both dyad members.
Collapse
Affiliation(s)
- Patricia A Quinn
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard University, Cambridge, MA, USA
| | - Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alex Presciutti
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
5
|
Sun H, Qian Q, Qin Y, Guo L, Hengudomsub P. Dynamic changes in resilience among family caregivers in the face of healthcare challenges: A scoping review. Arch Psychiatr Nurs 2023; 45:113-123. [PMID: 37544685 DOI: 10.1016/j.apnu.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Resilience as a dynamic concept has already been described through various longitudinal studies. To better understand the changes in the resilience of caregivers over the course of care-providing, however, a scoping review can provide a clearer picture of their resilience process which, in turn, can be used to improve caregivers' well-being. OBJECTIVES To provide a comprehensive overview of dynamic change in the resilience of caregivers while caring for the family to enhance understanding and potential for future research. METHODS Following the methodological framework of Arksey and O'Malley, this scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and the Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Five electronic databases were searched for research published in English between January 2012 and May 2022, after which a manual search was performed. Key terms related to resilience and caregivers in longitudinal studies were included and screened for. Identified trajectories of patterns in resilience and factors associated with resilience process were categorized using content analysis. RESULTS In total, 24 longitudinal studies met the eligibility criteria. Conceptually, our findings demonstrate three modes of change following healthcare challenges, each of which varies substantially. Methodologically, the results reveal three subcategories of assessment tools that can be used to impact caregivers' resilience when confronted with significant healthcare challenges. Consequentially, personal traits and environmental resources interacting with the resilience process will then lead to various outcomes in their resilience, including stability, growth, or decline. CONCLUSION This review describes the change patterns of the resilience process, assessment instruments, and associated factors to offer a dynamic perspective for the investigation and intervention of psychological resilience. Major gaps nonetheless remain for future research regarding an operationalizing dynamic change in resilience.
Collapse
Affiliation(s)
- Haiyan Sun
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China; Faculty of Nursing, Burapha University, 20131, Chon Buri, Thailand
| | - Qian Qian
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China
| | - Yang Qin
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China; Faculty of Nursing, Burapha University, 20131, Chon Buri, Thailand
| | - Lingling Guo
- School of Nursing, Jiangsu Vocational College of Medicine, 224005, Jiangsu, P.R. China
| | | |
Collapse
|
6
|
Hines EA, Farr EM, Rhudy LM, Chesak SS, Kinzelman Vesely EA, Esterov D. Efficacy of resilience interventions for dyads of individuals with brain injury and their caregivers: A systematic review of prospective studies. NeuroRehabilitation 2023; 52:29-46. [PMID: 36617756 DOI: 10.3233/nre-220125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acquired brain injury (BI) is associated with negative mental health outcomes for both people with BI, their caregivers (CG), and patient-CG dyads, which may be mitigated through increased resilience. However, little is known regarding the efficacy of resilience interventions focused on CGs of individuals with BI, as well as dyads, which may be instrumental for positive outcomes. OBJECTIVE To systematically review the evidence of the efficacy of resilience interventions focused on CGs and/or dyads of individuals with BI. METHODS A search of MEDLINE, Embase, APA PsycINFO, CINAHL with Full Text, Scopus, SCIE, and ESCI was conducted. Each title and abstract were screened by two authors independently. Each full text review, study data extraction, and study quality assessment was performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. RESULTS Out of 11,959 articles retrieved, 347 full text articles were assessed for review and 18 met inclusion criteria for data extraction and quality assessment. Resilience interventions were stratified into 5 different categories based on the type of intervention. CONCLUSION This systematic review suggests that dyadic/CG resilience interventions may improve mental health related outcomes, but conclusions were limited secondary to heterogenous outcomes and lack of a standardized resiliency construct. Future efforts are compulsory to create a standardized resiliency construct and associated outcomes focused on persons with BI, their CGs, and dyads.
Collapse
Affiliation(s)
- Emily A Hines
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ellen M Farr
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Lori M Rhudy
- Department of Graduate Nursing, Winona State University, Rochester, MN, USA
| | - Sherry S Chesak
- Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, MN, USA
| | | | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
7
|
Putowski Z, Rachfalska N, Majewska K, Megger K, Krzych Ł. Identification of risk factors for post-intensive care syndrome in family members (PICS-F) among adult patients: a systematic review. Anaesthesiol Intensive Ther 2023; 55:168-178. [PMID: 37728444 PMCID: PMC10496103 DOI: 10.5114/ait.2023.130831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/25/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Relatives of critically ill patients who either die or survive the intensive care unit (ICU) may develop substantial mental health problems that are collectively defined as post-intensive care syndrome in family (PICS-F). MATERIAL AND METHODS By using a systematised search strategy we included studies that focused on PICS-F in relatives of adult ICU patients and reported the risk factors associated with its development. The search was conducted within PubMed, Embase, SCOPUS, clinicaltrials.gov, and Cochrane Library on the 23 August 2022. PRISMA 2020 guidelines were implemented for appropriate reporting. The objective was to document all possible risk factors associated with the development of PICS-F. RESULTS We included 51 papers covering 9302 relatives. The frequency of PICS-F varied between 2.5 and 69%. We identified 51 different risk factors of PICS-F, among which we distinguished patient-related ( n = 16), relative-related ( n = 27), and medical staff-related ( n = 8) risk factors. Among 21 studies of the highest quality, we identified the 33 variables associated with the development of PICS-F, of which younger age of a patient, death of a patient, depression in relatives during the ICU stay, history of mental disorders in relatives, being a female relative, being a spouse, and having low satisfaction with communication and care in the ICU were the most commonly reported risk factors. CONCLUSIONS PICS-F is a highly frequent phenomenon that can be exacerbated by several risk factors. Special attention should be paid to relatives of younger patients with worse prognosis and with the following relative-related risk factors: female sex, being a spouse, and history of mental health disorders. Finally, the medical staff play a role in preventing the PICS-F development, not only by maintenance of proper communication, but also by early identification of relatives prone to PICS-F.
Collapse
Affiliation(s)
- Zbigniew Putowski
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University, Kraków, Poland
| | - Natalia Rachfalska
- Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
| | - Karolina Majewska
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
| | | | - Łukasz Krzych
- Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
- Department of Cardiac Anaesthesia and Intensive Therapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
| |
Collapse
|
8
|
The Recovering Together study protocol: A single-blind RCT to prevent chronic emotional distress in patient-cargiver dyads in the Neuro-ICU. Contemp Clin Trials 2022; 123:106998. [PMID: 36368480 PMCID: PMC10161144 DOI: 10.1016/j.cct.2022.106998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/20/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Patients admitted to the Neuroscience Intensive Care Unit (Neuro-ICU) with acute neurological illnesses (ANI; e.g., stroke, tumor, TBI) and their informal caregivers experience high rates of anxiety, depression, and posttraumatic stress. To address this need, we previously developed the Recovering Together (RT) dyadic intervention to help prevent chronic emotional distress in both patients and caregivers. Currently, we are conducting a fully-powered, single-blind randomized clinical trial (RCT) to evaluate the efficacy of RT versus an attention matched health education control. Here, we describe the protocol and current status of this RCT. METHODS We aim to recruit 194 at risk patient-caregiver dyads from the Neuro-ICU at MGH. Eligible dyads include patients diagnosed with ANI, cognitively intact, at least one partner endorses emotional distress (on Hospital Anxiety and Depression Scale), English speaking, age 18 or older. Dyads are randomized to the intervention (RT-1) or control condition (RT-2) (both six sessions). RT-1 teaches resiliency (e.g., coping, mindfulness) and interpersonal skills. RT-2 provides education on health-related topics (e.g., stress, self-care, adhering to medical recommendations). Blinded research assistants collect measures at baseline, post-intervention, and three months follow-up. We will conduct mixed linear, mediation, and actor-partner interdependence models to examine changes in dyads' outcomes across time. RESULTS We have recruited 41 dyads and aim to recruit 194 total. DISCUSSION If successful, we plan to test RT in a large-scale, multisite hybrid effectiveness-implementation study in Neuro-ICUs across the country. Enhancing psychosocial supports for patients and families could improve health outcomes, healthcare efficiency, and the culture of these units.
Collapse
|
9
|
Presciutti A, Siry‐Bove B, Newman MM, Elmer J, Grigsby J, Masters KS, Shaffer JA, Vranceanu A, Perman SM. Qualitative Study of Long‐Term Cardiac Arrest Survivors’ Challenges and Recommendations for Improving Survivorship. J Am Heart Assoc 2022; 11:e025713. [PMID: 35861822 PMCID: PMC9707841 DOI: 10.1161/jaha.121.025713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Cardiac arrest survivorship refers to the lived experience of long‐term survivors of cardiac arrest and the many postdischarge challenges they experience. We aimed to gather a nuanced understanding of these challenges and of survivors' perceptions of ways to improve the recovery process.
Methods and Results
We conducted 15 semistructured, one‐on‐one interviews with cardiac arrest survivor members of the Sudden Cardiac Arrest Foundation; the interviews were conducted by telephone and recorded and transcribed verbatim. We used thematic analysis, informed by the Framework Method, to identify underlying themes regarding cardiac arrest survivorship challenges and recommendations to improve cardiac arrest survivorship. Regarding challenges, the overarching theme was a feeling of unpreparedness to confront postarrest challenges because of lack of resources, education, and appropriate expectations for recovery. Regarding recommendations, we uncovered 3 overarching themes including systemic recommendations (eg, providing appropriate resources and expectations, educating providers about survivorship, following up with survivors, including caregivers in treatment planning), social recommendations (eg, attending peer support groups, spending time with loved ones, providing support resources for family members), and individual coping recommendations (eg, acceptance, resilience, regaining control, seeking treatment, focusing on meaning and purpose).
Conclusions
We described common challenges that survivors of cardiac arrest face, such as lacking resources, education, and appropriate expectations for recovery. Additionally, we identified promising pathways that may improve cardiac arrest survivorship at systemic, social, and individual coping levels. Future studies could use our findings as targets for interventions to support and improve survivorship.
Collapse
Affiliation(s)
- Alex Presciutti
- Department of Psychology University of Colorado Denver Denver CO
- Department of Psychiatry Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital Boston MA
- Department of Psychiatry Harvard Medical School Boston MA
| | - Bonnie Siry‐Bove
- Department of Emergency Medicine University of Colorado School of Medicine Denver CO
| | | | - Jonathan Elmer
- University of Pittsburgh School of Medicine, Departments of Emergency Medicine, Critical Care Medicine and Neurology Pittsburgh PA
| | - Jim Grigsby
- Department of Psychology University of Colorado Denver Denver CO
| | - Kevin S. Masters
- Department of Psychology University of Colorado Denver Denver CO
| | | | - Ana‐Maria Vranceanu
- Department of Psychiatry Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital Boston MA
- Department of Psychiatry Harvard Medical School Boston MA
| | - Sarah M. Perman
- Department of Emergency Medicine University of Colorado School of Medicine Denver CO
| |
Collapse
|
10
|
Bannon SM, Cornelius T, Gates MV, Lester E, Mace RA, Popok P, Macklin EA, Rosand J, Vranceanu AM. Emotional distress in neuro-ICU survivor-caregiver dyads: The recovering together randomized clinical trial. Health Psychol 2022; 41:268-277. [PMID: 34498896 PMCID: PMC8904645 DOI: 10.1037/hea0001102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Emotional distress is common in both survivors and their informal caregivers following admission to a neuroscience intensive care unit (Neuro-ICU) and can negatively affect their individual recovery and quality of life. Neuro-ICU survivor-caregiver dyads can influence each other's emotional distress over time, but whether such influence emerges during dyadic treatment remains unknown. The present study involved secondary data analysis of Neuro-ICU dyads enrolled in a randomized clinical trial of a dyadic resiliency intervention, Recovering Together (RT), versus a health education attention placebo control to test dyadic similarities in emotional distress before and after treatment. METHOD Data were collected from 58 dyads following Neuro-ICU admission. Emotional distress (depression, anxiety, and posttraumatic stress) was assessed at baseline, 6 weeks (postintervention), and 12 weeks later. Nonindependence within survivor-caregiver dyads was examined (i.e., correlations between cross-sectional symptoms and changes in symptoms over time); mutual influence of emotional functioning over time (i.e., "partner effects") was examined using cross-lagged path analyses. RESULTS There were strong, positive cross-sectional correlations between survivor and caregiver distress at postintervention and follow-up and between changes in survivor and caregiver distress from baseline to postintervention and postintervention to follow-up. There were no partner effects. CONCLUSIONS Neuro-ICU survivors and their informal caregivers show similar changes in emotional distress after treatment. These findings highlight the potential benefits of intervening on both survivor and caregiver distress following Neuro-ICU admission. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Sarah M. Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
| | - Talea Cornelius
- Department of Medicine, Columbia University Irving Medical Center
| | - Melissa V. Gates
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
| | - Ethan Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
| | - Ryan A. Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
| | - Paula Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
| | | | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital
- Neuroscience Intensive Care Unit, Massachusetts General Hospital
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
| |
Collapse
|
11
|
Mindfulness is inversely associated with psychological symptoms in long-term cardiac arrest survivors. J Behav Med 2022; 45:643-648. [PMID: 35157171 PMCID: PMC8853140 DOI: 10.1007/s10865-022-00295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022]
Abstract
Identifying correlates of psychological symptoms in cardiac arrest (CA) survivors is a major research priority. In this longitudinal survey study, we evaluated associations between mindfulness, baseline psychological symptoms, and 1-year psychological symptoms in long-term CA survivors. We collected demographic and CA characteristics at baseline. At both timepoints, we assessed posttraumatic stress symptoms (PTS) through the PTSD Checklist-5 (PCL-5) and depression and anxiety symptoms through the Patient Health Questionnaire-4 (PHQ-4). At follow-up, we assessed mindfulness through the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). We used adjusted linear regression to predict 1-year PCL-5 and PHQ-4 scores, with particular consideration of the CAMS-R as a cross-sectional correlate of outcome. We included 129 CA survivors (mean age: 52 years, 52% male, 98% white). At 1-year follow-up, in adjusted models, CAMS-R (β: −0.35, p < 0.001) and baseline PCL-5 scores (β: 0.56, p < 0.001) were associated with 1-year PCL-5 scores. CAMS-R (β: −0.34, p < 0.001) and baseline PHQ-4 scores were associated with 1-year PHQ-4 scores (β: 0.37, p < 0.001). In conclusion, mindfulness was inversely associated with psychological symptoms in long-term CA survivors. Future studies should examine the longitudinal relationship of mindfulness and psychological symptoms after CA.
Collapse
|
12
|
Lester EG, Fishbein NS, Higgins O, Rosand J, Vranceanu AM. Understanding the interplay between lifestyle factors and emotional distress for hemorrhagic stroke survivors and their informal caregivers: Protocol for a mixed methods dyadic natural history study. PLoS One 2022; 17:e0261635. [PMID: 35061739 PMCID: PMC8782334 DOI: 10.1371/journal.pone.0261635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022] Open
Abstract
Emotional distress (depression, anxiety, and PTS) and unhealthy lifestyle factors (e.g., smoking, alcohol consumption, poor diet, limited physical activity, medication adherence) are common in hemorrhagic stroke (HS) survivors and may increase risk for recurrence, morbidity, and mortality. Emotional distress and unhealthy lifestyle factors tend to be interdependent between survivors and their informal caregivers (e.g., family and friends who provide unpaid care; together called dyads), such that one partner's lifestyle and coping behaviors influence the other's behaviors, yet no research has closely examined this relationship in HS dyads over time. We will conduct a mixed methods study to quantitatively and qualitatively understand the longitudinal relationship between emotional distress and lifestyle factors across time in this population (HS dyads) to identify treatment targets to prevent emotional distress chronicity and stroke recurrence. In aim 1, we will assess emotional distress (i.e., depression, anxiety, and PTS) and lifestyle factors (smoking, alcohol consumption, poor diet, limited physical activity medication adherence/blood pressure control) in dyads of survivors of HS and their caregivers (N = 80), at three separate time points (hospitalization in the Neuro-ICU, 1, and 3 months later). We hypothesize that 1) lifestyle factors and emotional distress will be interrelated within and across time for both survivors and caregivers, and 2) lifestyle factors and emotional distress will be interdependent between survivors and caregivers. We also aim to explore the nuanced interplay between lifestyle factors and emotional distress and gain in depth information on barriers and facilitators for a dyadic intervention to optimize lifestyle behaviors and emotional functioning in HS dyads. Eligible patients will be adults who have a caregiver also willing to participate. Patients will be referred for study participation by the nursing team who will ensure that they are cognitively able to meaningfully participate. Multilevel dyadic modeling (i.e., actor-partner interdependence model; APIM) with distinguishable dyads will be used to determine influences of these factors onto each other over time. In Aim 2, we will conduct live video qualitative dyadic interviews (N = 20 or until theme saturation) at all time points from the same participants with and without emotional distress and at least one lifestyle risk factor, to understand the nuanced relationships between emotional distress and lifestyle behaviors, and barriers and facilitators to engagement in a skills-based psychosocial intervention. Interviews will be analyzed using inductive and deductive approaches. The present study is currently ongoing. So far, we enrolled 2 participants. Recruitment will end October 2022 with plans to analyze data by December 2022. The findings from this study will be used to further develop psychosocial interventions and inform novel treatments for survivors of HS and their informal caregivers.
Collapse
Affiliation(s)
- Ethan G. Lester
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nathan S. Fishbein
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Olivia Higgins
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jonathan Rosand
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
13
|
Lester EG, Mace RA, Bannon SM, Popok PJ, Gates MV, Meyers E, Tehan T, Sagueiro D, Rosand J, Macklin EA, Vranceanu AM. Can a Dyadic Resiliency Program Improve Quality of Life in Cognitively Intact Dyads of Neuro-ICU Survivors and Informal Caregivers? Results from a Pilot RCT. Neurocrit Care 2021; 35:756-766. [PMID: 33880701 PMCID: PMC10947170 DOI: 10.1007/s12028-021-01222-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neuro-ICU hospitalization for an acute neurological illness is often traumatic and associated with heightened emotional distress and reduced quality of life (QoL) for both survivors and their informal caregivers (i.e., family and friends providing unpaid care). In a pilot study, we previously showed that a dyadic (survivor and caregiver together) resiliency intervention (Recovering Together [RT]) was feasible and associated with sustained improvement in emotional distress when compared with an attention placebo educational control. Here we report on changes in secondary outcomes assessing QoL. METHODS Survivors (n = 58) and informal caregivers (n = 58) completed assessments at bedside and were randomly assigned to participate together as a dyad in the RT or control intervention (both 6 weeks, two in-person sessions at bedside and four sessions via live video post discharge). We measured QoL domain scores (physical health, psychological, social relations, and environmental), general QoL, and QoL satisfaction using the World Health Organization Quality of Life Abbreviated Instrument at baseline, post treatment, and 3 months' follow-up. We conducted mixed model analyses of variance with linear contrasts to estimate (1) within-group changes in QoL from baseline to post treatment and from post treatment to 3 months' follow-up and (2) between-group differences in changes in QoL from baseline to post treatment and from post treatment to 3 months' follow-up. RESULTS We found significant within-group improvements from baseline to post treatment among RT survivors for physical health QoL (mean difference 1.73; 95% confidence interval [CI] 0.39-3.06; p = 0.012), environmental QoL (mean difference 1.29; 95% CI 0.21-2.36; p = 0.020), general QoL (mean difference 0.55; 95% CI 0.13-0.973; p = 0.011), and QoL satisfaction (mean difference 0.87; 95% CI 0.36-1.37; p = 0.001), and those improvements sustained through the 3-month follow-up. We found no significant between-group improvements for survivors or caregivers from baseline to post treatment or from post treatment to 3 months' follow-up for any QoL variables (i.e., domains, general QoL, and QoL satisfaction together). CONCLUSIONS In this pilot study, we found improved QoL among survivors, but not in caregivers, who received RT and improvements sustained over time. These RT-related improvements were not significantly greater than those observed in the control. Results support a fully powered randomized controlled trial to allow for a definitive evaluation of RT-related effects among dyads of survivors of acute brain injury and their caregivers.
Collapse
Affiliation(s)
- Ethan G Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA
| | - Melissa V Gates
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA
| | - Emma Meyers
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Danielle Sagueiro
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Harvard Medical School, Harvard University, Boston, MA, USA
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Eric A Macklin
- Harvard Medical School, Harvard University, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, USA.
- Harvard Medical School, Harvard University, Boston, MA, USA.
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
14
|
Lin Q, Dong F, Xue Y, Yu Q, Ren J, Zeng L. Predictors of posttraumatic growth of the family members of neurosurgical intensive care unit patients: A cross-sectional study. Intensive Crit Care Nurs 2021; 68:103134. [PMID: 34750040 DOI: 10.1016/j.iccn.2021.103134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Confronted with the potentially traumatic experience of a patients intensive care unit hospitalisation, family members may show positive changes associated with growth in addition to negative impact. This study aimed to identify the level of posttraumatic growth of the family members of neurosurgical intensive care unit patients and to explore its relation to positive personality characteristics, such as gratitude, resilience and hope. DESIGN AND SETTING A cross-sectional study involving 340 family members of patients admitted to the neurosurgical intensive care unit at a general tertiary hospital in Shanghai, China. METHODS Before the patients' hospital discharge, the participants completed questionnaires, assessing posttraumatic growth (PTG Inventory), social support (Social Support Rating Scale), resilience (Chinese version of the Connor-Davidson Resilience Scale), hope (Herth Hope Index) and gratitude (Gratitude Questionnaire Six-Item Form). RESULTS The mean total posttraumatic growth score was 73.38 (14.02). Hope, gratitude, resilience and social support showed a positive correlation with the posttraumatic growth Inventory scores. There were significant differences in the posttraumatic growth scores of the family members of neurosurgical intensive care patients with respect to their different religious beliefs, payment methods, family relationship quality and presence of chronic diseases among family members. Multiple linear regression analysis showed that gratitude, resilience and social support were independent predictors of the posttraumatic growth Inventory score. CONCLUSION Family members may experience some degree of posttraumatic growth during hospitalisation of patients in the neurosurgical intensive care units. Gratitude, social support and resilience are predictive factors for posttraumatic growth.
Collapse
Affiliation(s)
- Qi Lin
- Department of Nursing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Shanghai, China
| | - Fanghui Dong
- Department of Nursing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Shanghai, China
| | - Yiwei Xue
- Intensive Care Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Shanghai, China
| | - Qunya Yu
- General Surgery Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Shanghai, China
| | - Junhong Ren
- Ophthalmology Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University. Shanghai, China
| | - Li Zeng
- Neurosurgical Intensive Care Unit, Shanghai Tenth People's Hospital, School of Medicine, Tongji University. Shanghai, China; Department of Nursing, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
| |
Collapse
|
15
|
Pauley E, Walsh TS. Resilience in survivors of critical illness: A scoping review of the published literature in relation to definitions, prevalence, and relationship to clinical outcomes. J Intensive Care Soc 2021; 23:345-358. [DOI: 10.1177/17511437211034701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Survivors of critical illness face substantial challenges in their recovery, including physical and cognitive dysfunction. Resilience is the ability to adapt and maintain one’s mental health after facing such challenges. Higher resilience levels have been found to be beneficial throughout the illness trajectory in cancer patients, but resilience has not been widely researched in critical care patients. We undertook a scoping review to identify published studies on resilience following critical illness and describe: how resilience has been measured; the prevalence of low resilience in critical care patients; and what associations (if any) exist between resilience and clinical outcomes. We searched: PubMed, Medline, PsychINFO, CINAHL, Web of Science, Cochrane Library, to identify relevant studies. We found 882 unique titles: 17 were selected for full text review, 10 were considered relevant. These included ICU inpatients and survivors, and trauma and sepsis survivors. A broad critical appraisal of each study was undertaken. The overall quality of published studies was low: there was wide variation in resilience-assessment tools across the studies, including the timing of measurement; only one used a validated tool. Estimates of low resilience ranged from 28%-67%, but with varying populations, high risk of inclusion bias, and small samples. Higher resilience levels were significantly associated with lower depression, anxiety, post-traumatic stress, pain, anger, executive dysfunction, and difficulty with self-care in critical care patients and survivors. Future studies should use validated resilience assessment, determine the optimum timing, and explore prevalence, associations with outcomes, and resilience-promoting interventions in non-selected or clearly defined populations.
Collapse
Affiliation(s)
- Ellen Pauley
- Royal Infirmary Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Timothy S Walsh
- Royal Infirmary Edinburgh, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
16
|
Grunberg VA, Bannon SM, Reichman M, Popok PJ, Vranceanu AM. Psychosocial treatment preferences of persons living with young-onset dementia and their partners. DEMENTIA 2021; 21:41-60. [PMID: 34151598 DOI: 10.1177/14713012211027007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persons living with young-onset dementia and their partners often experience elevated emotional distress as they cope with an unexpected progressive illness during an active life stage (typically ages 45-64 years). Despite their heightened emotional distress, psychosocial resources are both limited and lack the specificity to meet the unique needs of both partners. Our aim was to gain an in-depth understanding of the psychosocial treatment preferences of persons with young-onset dementia and their partners-an important first step in developing a tailored intervention. We conducted semi-structured dyadic interviews with persons with young-onset dementia and their partners (N = 23) and used a hybrid deductive-inductive approach to thematic analysis. We identified 12 themes across four domains: (1) perceptions of available and lacking resources, (2) preferences for program content, (3) preferences for program format, and (4) barriers and facilitators to participation. Couples indicated there is a lack of specific and family-oriented resources, which can create more stress and relationship strain. Couples endorsed support for a virtual, dyadic intervention delivered shortly after diagnosis focused on providing tools to cope with difficult emotions and symptom progression and enhance communication and meaningful daily living. They also identified potential barriers to program participation and offered suggestions to promote engagement. By using a qualitative approach, we were able to gather nuanced information that can be used to directly inform a feasible, accepted, and person-centered psychosocial intervention for persons with young-onset dementia and their partners.
Collapse
Affiliation(s)
- Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, 2348Department of Psychiatry, Massachusetts General Hospital; 1811Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Verdolini N, Amoretti S, Montejo L, García-Rizo C, Hogg B, Mezquida G, Rabelo-da-Ponte FD, Vallespir C, Radua J, Martinez-Aran A, Pacchiarotti I, Rosa AR, Bernardo M, Vieta E, Torrent C, Solé B. Resilience and mental health during the COVID-19 pandemic. J Affect Disord 2021; 283:156-164. [PMID: 33556749 PMCID: PMC7845537 DOI: 10.1016/j.jad.2021.01.055] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/31/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Resilience is a process that allows recovery from or adaptation to adversities. The aim of this study was to evaluate state resilience during the COVID-19 pandemic in psychiatric patients (PP), unaffected relatives (UR) and community controls (CC). METHODS This study is part of the Barcelona ResIlience Survey for Mental Health COVID-19 (BRIS-MHC) project. Logistic regression models were performed to identify mental health outcomes associated with bad state resilience and predictors of good state resilience. The association between state resilience and specific affective temperaments as well as their influence on the association between depressive symptoms and state resilience were verified. RESULTS The study recruited 898 participants that took part in the survey. The presence of depressive symptoms was a predictor of bad state resilience in PP (β=0.110, OR=1.117, p=0.028). No specific mental health outcome was associated with bad state resilience in UR and CC. Predictors of good state resilience in PP were having pursued hobbies/conducted home tasks (β=1.261, OR=3.528, p=0.044) and level of organization in the family (β=0.986, OR=2.682, p=0.008). Having a controlling family was inversely associated with good state resilience in CC (β=-1.004, OR=0.367, p=0.012). The association between bad state resilience and depressive symptoms was partially mediated by affective temperaments. LIMITATIONS Participants self-reported their psychiatric diagnoses, their relatives' diagnoses or the absence of a psychiatric disorder, as well as their psychiatric symptoms. CONCLUSIONS Enhancing resilience and coping strategies in the face of the COVID-19 pandemic might have important implications in terms of mental health outcomes.
Collapse
Affiliation(s)
- Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Spain
| | - Bridget Hogg
- Centre Fórum Research Unit, Parc de Salut Mar, 410, Llull St., 08019, Barcelona, Catalonia, Spain; Hospital del Mar Medical Research Institute (IMIM), 88, Dr. Aiguader St., 08003, Barcelona, Catalonia, Spain; Predoctoral program, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), UAB Campus, Plaça Cívica, 08193, Bellaterra, Barcelona Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Spain
| | - Francisco Diego Rabelo-da-Ponte
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), 2350, Ramiro Barcelos St., 211, Protásio Alves Av., Santa Cecilia, Porto Alegre, RS, 90035-903, Brazil; Department of Pharmacology, Health science basic Institute, Postgraduate Program in Psychiatry and Behavioral Sciences and Postgraduate Program of Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), 110, Paulo Gama Av., Farroupilha, Porto Alegre - RS, 90040-060, Brazil
| | - Catalina Vallespir
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain
| | - Adriane R Rosa
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), 2350, Ramiro Barcelos St., 211, Protásio Alves Av., Santa Cecilia, Porto Alegre, RS, 90035-903, Brazil; Department of Pharmacology, Health science basic Institute, Postgraduate Program in Psychiatry and Behavioral Sciences and Postgraduate Program of Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul (UFRGS), 110, Paulo Gama Av., Farroupilha, Porto Alegre - RS, 90040-060, Brazil
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain.
| | - Carla Torrent
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain.
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170, Villarroel St., 08037, Barcelona, Catalonia, Spain
| |
Collapse
|
18
|
Associations between depression and anxiety symptoms with quality of life in cardiac arrest survivors with good neurologic recovery and informal caregivers of cardiac arrest survivors. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
19
|
Vranceanu AM, Bannon S, Mace R, Lester E, Meyers E, Gates M, Popok P, Lin A, Salgueiro D, Tehan T, Macklin E, Rosand J. Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2020807. [PMID: 33052404 PMCID: PMC7557506 DOI: 10.1001/jamanetworkopen.2020.20807] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE To our knowledge, there are no evidence-based interventions to prevent chronic emotional distress (ie, depression, anxiety, and posttraumatic stress [PTS]) in critical care survivors and their informal caregivers. OBJECTIVE To determine the feasibility and preliminary effect of the novel dyadic resiliency intervention Recovering Together (RT) on reducing symptoms of depression, anxiety, and PTS among hospitalized patients and their informal caregivers. DESIGN, SETTING, AND PARTICIPANTS This single-blind, pilot randomized clinical trial of RT vs an educational control was conducted among 58 dyads in which either the survivor or caregiver endorsed clinically significant symptoms of depression, anxiety, or PTS. The study was conducted in the neuroscience intensive care unit at Massachusetts General Hospital. Data were collected from September 2019 to March 2020. INTERVENTIONS Both RT and control programs had 6 sessions (2 at bedside and 4 via live video after discharge), and both survivor and caregiver participated together. MAIN OUTCOMES AND MEASURES The primary outcomes were feasibility of recruitment and intervention delivery, credibility, and satisfaction. The secondary outcomes included depression and anxiety (measured by the Hospital Depression and Anxiety Scale), PTS (measured by the PTSD Checklist-Civilian Version), and intervention targets (ie, mindfulness, measured by the Cognitive and Affective Mindfulness Scale-Revised; coping, measured by the Measure of Current Status-Part A; and dyadic interpersonal interactions, measured by the Dyadic Relationship Scale). Main outcomes and targets were assessed at baseline, 6 weeks, and 12 weeks. RESULTS The 58 dyads were randomized to RT (29 dyads [50.0%]; survivors: mean [SD] age, 49.3 [16.7] years; 9 [31.0%] women; caregivers: mean [SD] age, 52.4 [14.3] years; 22 [75.9%] women) or control (29 dyads [50.0%]; survivors: mean [SD] age, 50.3 [16.4] years; 12 [41.3%] women; caregivers, mean [SD] age, 52.1 [14.9], 17 [58.6%] women). Feasibility (recruitment [76%], randomization [100%], and data collection [83%-100%]), adherence (86%), fidelity (100%; κ = 0.98), satisfaction (RT: 57 of 58 [98%] with scores >6; control: 58 of 58 [100%] with scores >6), credibility (RT: 47 of 58 [81%] with scores >6; control: 46 of 58 [80%] with scores >6), and expectancy (RT: 49 of 58 [85%] with scores >13.5; 51 of 58 [87%] with scores >13.5) exceeded benchmarks set a priori. Participation in RT was associated with statistically and clinically significant improvement between baseline and postintervention in symptoms of depression (among survivors: -4.0 vs -0.6; difference, -3.4; 95% CI, -5.6 to -1.3; P = .002; among caregivers: -3.8 vs 0.6; difference, -4.5; 95% CI, -6.7 to -2.3; P < .001), anxiety (among survivors: -6.0 vs 0.3; difference, -6.3; 95% CI, -8.8 to -3.8; P < .001; among caregivers: -5.0 vs -0.9; difference, -4.1; 95% CI, -6.7 to -1.5, P = .002), and PTS (among survivors: -11.3 vs 1.0; difference, -12.3; 95% CI, -18.1 to -6.5, P < .001; among caregivers, -11.4 vs 5.0; difference, -16.4, 95% CI, -21.8 to -10.9; P < .001). Improvements sustained through the 12-week follow-up visit. We also observed RT-dependent improvement in dyadic interpersonal interactions for survivors (0.2 vs -0.2; difference, 0.4; 95% CI, 0.0 to 0.8; P = .04). CONCLUSIONS AND RELEVANCE In this pilot randomized clinical trial, RT was feasible and potentially efficacious in preventing chronic emotional distress in dyads of survivors of the neuroscience intensive care unit and their informal caregivers. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03694678.
Collapse
Affiliation(s)
- Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ryan Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ethan Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Emma Meyers
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Melissa Gates
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Paula Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Danielle Salgueiro
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston
| | - Eric Macklin
- Harvard Medical School, Boston, Massachusetts
- Biostatistics Center, Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston
| |
Collapse
|
20
|
Bannon S, Lester EG, Gates MV, McCurley J, Lin A, Rosand J, Vranceanu AM. Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study. Pilot Feasibility Stud 2020; 6:75. [PMID: 32509320 PMCID: PMC7249683 DOI: 10.1186/s40814-020-00615-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/14/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A stroke is a sudden, life-altering event with potentially devastating consequences for survivors and their loved ones. Despite advances in endovascular and neurocritical care approaches to stroke treatment and recovery, there remains a considerable unmet need for interventions targeting the emotional impact of stroke for both patients and their informal caregivers. This is important because untreated emotional distress becomes chronic and negatively impacts quality of life in both patients and caregivers. Our team previously used mixed methods to iteratively develop a six-session modular dyadic intervention to prevent chronic emotional distress in patients with stroke and their informal caregivers called "Recovering Together" (RT) using feedback from dyads and the medical team. The aim of the current study is to test the feasibility of recruitment, acceptability of screening and randomization methods, acceptability of RT, satisfaction with RT, feasibility of the assessment process at all time points, and acceptability of outcome measures. Secondarily, we aimed to explore within-treatment effect sizes and change in clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTS). The larger goal was to strengthen methodological rigor before a subsequent efficacy trial. METHODS We conducted a feasibility randomized controlled trial to evaluate the RT intervention relative to minimally enhanced usual care (MEUC) in stroke patients admitted to a Neurosciences Intensive Care Unit (Neuro-ICU). Dyads were enrolled within 1 week of hospitalization if they met specific eligibility criteria. Assessments were done via paper and pencil at baseline, and electronically via REDCap or over the phone at post-intervention (approximately 6 weeks after baseline), and 3 months later. Assessments included demographics, resiliency intervention targets (mindfulness, coping, self-efficacy, and interpersonal bond), and emotional distress (depression, anxiety, and PTS). Primary outcomes were feasibility and acceptability markers. Secondary outcomes were depression, anxiety, PTS, mindfulness, coping, self-efficacy, and interpersonal bond. RESULTS We consented 20 dyads, enrolled 17, and retained 16. Although many patients were missed before we could approach them, very few declined to participate or dropped out once study staff made initial contact. Feasibility of enrollment (87% of eligible dyads enrolled), acceptability of screening, and randomization (all RT dyads retained after randomization) were excellent. Program satisfaction (RT post-test M = 11.33/12 for patients M = 12/12 for caregivers), and adherence to treatment sessions (six of seven RT dyads attending 4/6 sessions) were high. There were no technical difficulties that affected the delivery of the intervention. There was minimal missing data. For both patients and caregivers, participation in RT was generally associated with clinically significant improvement in emotional distress symptoms from baseline to post-test. Participation in MEUC was associated with clinically significant worsening in emotional distress. Although some of the improvement in emotional distress symptoms decreased in the RT group between post-test to 3 months, these changes were not clinically significant. RT was also associated with substantial decrease in frequency of individuals who met criteria for clinically significant symptoms, while the opposite was true for MEUC. There were many lessons that informed current and future research. CONCLUSIONS This study provided evidence of feasibility and signal of improvement in RT, as well as necessary methodological changes to increase recruitment efficiency before the future hybrid efficacy-effectiveness trial. TRIAL REGISTRATION NCT02797509.
Collapse
Affiliation(s)
- Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Ethan G. Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Melissa V. Gates
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA 02114 USA
| | - Jessica McCurley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge St, Suite 1600, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA 02114 USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| |
Collapse
|