Psychological repercussions in family members of hospitalised critical condition patients

Depression, anxiety, hopelessness, and suicide in first-degree relatives of patients hospitalised in intensive care units in Türkiye

OBJECTIVE

The purpose of this study was to investigate the prevalence of depression, anxiety disorder, hopelessness, and suicide among first-degree relatives of patients hospitalised in medical and anaesthesia intensive care units at an academic medical centre.

METHODS

In this case-control study conducted in Türkiye, 32 first-degree relatives of 32 patients hospitalised for 14 days or more in intensive care units and 32 healthy volunteers were included for assessment. The Beck Depression Scale (BDS), Beck Anxiety Scale (BAS), Beck Hopelessness Scale (BHS), and Suicide Probability Scale (SPS) were administered to participants. Results: The mean age of patients' relatives was 42.1 ± 11.6 years and that of the controls was 43.0 ± 11.3 years. The median scores for the BDS, BHS, and SPS were significantly higher among the relatives of the patients than among controls (P = .008, P = .013, and P = .001, respectively). Based on cutoff scores for the BDS and BAS, depression was observed in 56.3% of the relatives of the patients and anxiety disorder was observed in 46.9%. In the group comprising patients' relatives, the median score for the BDS was significantly higher among female participants than among male participants (P = .038).

CONCLUSIONS

First-degree relatives of patients hospitalised in intensive care units have a higher prevalence of depression, hopelessness, and suicidality. Female relatives are more depressed than male. Ensuring psychiatric evaluation of the relatives of patients hospitalised in intensive care units in Türkiye is important.

The effect of two facets of physicians' environmental stress on patients' compliance with COVID-19 guidelines: moderating roles of two types of ego network

Drawing upon the Conservation of Resources Theory, this study seeks to examine the association between two dimensions of environmental stress experienced by physicians and patients' adherence to COVID-19 guidelines, within the context of a social network framework. A third-wave longitudinal study was employed to gather 439 valid data points in China. Social network analysis and structural equation model were used to test the conceptual model. The results reveal the pivotal role of physicians' environmental stress related to their work and family contexts in influencing patients' adherence to COVID-19 guidelines through the mediation of physicians' information sharing. The ego networks of physicians, encompassing both advice-seeking and friendship ties, were observed to negatively moderate the relationship between stress and resource depletion. Broadly, our study shows the importance of understanding physicians' stress caused by the working and family environments, as these factorsnot only impact the psychological well-being of physicians but also significantly affect patients' compliance with COVID-19 guidelines. In addition, the work offers a framework for understanding the impact of the ego advice-seeking network and the ego friend network.

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as "new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization". A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.

Development of the nursing practice scale for end-of-life family conferences in critical care

OBJECTIVES

This study aimed to develop the Nursing Practice Scale for End-of-life Family conferences in critical care and to clarify the current status of nursing practice regarding family conferences.

RESEARCH METHODOLOGY/DESIGN

We conducted a cross-sectional, self-administered questionnaire survey with 955 critical care unit nurses in 97 hospitals. Content validity, factor validity and criterion-related validity, known-group validity, internal consistency and test-retest reliability were evaluated. Data were then analysed statistically.

SETTING

Adult intensive care units or high dependency units in Japan.

RESULTS

Three factors with 39 items were extracted through item analysis and confirmatory factor analysis as hypothesised (Factor 1: Preparation, Factor 2: Discussion and Factor 3: Follow-up), and the mean score per item for each factor was 3.57, 3.73 and 3.75, respectively. Nurses who had any certification or had worked in critical care unit for >5 years had a significantly greater score than the others. The Cronbach's α were 0.86-0.96 and the intraclass correlation coefficients were 0.79-0.87.

CONCLUSION

The Nursing Practice Scale for End-of-life Family conferences in critical care is a valid and reliable scale. This study could effectively facilitate communication among patients, their families and healthcare providers.

Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters

Background

Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking.

Methods

The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU.

Results

Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients.

Conclusions

Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment.

Trial registration

German Clinical Trials Register No. DRKS00003386. Registered 13 November 2011

Electronic supplementary material

The online version of this article (10.1186/s13054-019-2321-0) contains supplementary material, which is available to authorized users.

Burden and Psychological Distress of Intensive Care Unit Caregivers of Traumatic Brain Injury Patients

Aim

Admission to Intensive Care Unit (ICU) is a stressful event and unforeseen crisis for the caregivers. Burden and psychosocial distress among caregivers in the ICU were unexplored. Therefore, the current study was aimed to assess the caregivers’ burden and psychological distress among caregivers of traumatic brain injury (TBI) patients at emergency ICU during hospitalization.

Materials and Methods

A total of 60 caregivers recruited by using purposive sampling method with descriptive research design. Consent was obtained. Interview schedule of family for depression, anxiety, stress scale (DAS-21) were administered. The data were analyzed by using SPSS. Descriptive statistics and independent burden t-test were used.

Results

Results revealed that male caregivers (75%) and female caregivers (25%) took part in the study. Caregivers' mean age was found to be 35.22±11.29 years. Most of the TBI survivors admitted in ICU had severe injury (8.30±3.63). Mean scores showed that caregivers had experienced financial burden (6.28±2.36), severe depression (12.15±4.84), and a moderate level of anxiety (12.85±5.20). Independent t-test showed significant difference in caregiving burden between male and female caregivers at ICU (Male = 18.43±4.83; Female = 14.29±4.83; t = 2.16; p <0.035). Overall, caregivers experienced higher family burden and severe psychological distress at ICU.

Conclusion

There is an immediate need to assess psychological distress and family burden of caregivers at ICU and provide timely psychosocial intervention.

How to cite this article

Kanmani TR, Thimmappur RM, Birudu R, Reddy KN, Raj P. Burden and Psychological Distress of Intensive Care Unit Caregivers of Traumatic Brain Injury Patients. Indian J Crit Care Med 2019;23(5):220-223.

Reprint of Recovery programme for ICU survivors has no effect on relatives' quality of life: Secondary analysis of the RAPIT-study

BACKGROUND

Relatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain.

AIM

To determine whether relatives benefit from a recovery programme intended for intensive care survivors.

RESEARCH DESIGN

A randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94).

SETTING

Ten intensive care units in Denmark.

MAIN OUTCOME MEASURES

Primary outcome: health-related quality of life (HRQOL).

SECONDARY OUTCOMES

Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge.

RESULTS

No difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: -3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: -1.88; 5.59], p = 0.33). No differences were found in secondary outcomes.

CONCLUSION

The recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.

Recovery programme for ICU survivors has no effect on relatives' quality of life: Secondary analysis of the RAPIT-study

BACKGROUND

Relatives of intensive care patients are at risk of developing symptoms of anxiety, depression and posttraumatic stress resulting in reduced health-related quality of life. Recovery programmes for patients have been implemented, but their effect on relatives is uncertain.

AIM

To determine whether relatives benefit from a recovery programme intended for intensive care survivors.

RESEARCH DESIGN

A randomised controlled trial of 181 adult relatives: intervention group (n = 87), control group (n = 94).

SETTING

Ten intensive care units in Denmark.

MAIN OUTCOME MEASURES

Primary outcome: health-related quality of life (HRQOL).

SECONDARY OUTCOMES

Sense of coherence (SOC), and symptoms of anxiety, depression and posttraumatic stress, compared to standard care at 12 months after intensive care discharge.

RESULTS

No difference in HRQOL between groups was observed at 12 months (mean difference in mental component summary score, 1.35 [CI 95%: -3.13; 5.82], p = 0.55; and physical component summery score, 1.86 [CI 95%: -1.88; 5.59], p = 0.33). No differences were found in secondary outcomes.

CONCLUSION

The recovery programme intended for intensive care survivors did not have an effect on the relatives. Future recovery programmes should be targeted to help both patient and family, and future research should be conducted on a larger scale to make conclusions with higher probability.

Psychosocial needs of families of intensive care patients: Perceptions of nurses and families

Background:

Admission to an intensive care unit (ICU) is not only stressful to the patients but the patients' family members. Families are believed not to receive their required attention because their needs are incorrectly and inaccurately evaluated by the health care team. Therefore, the present study aimed to examine the perceptions of ICU nurses and families regarding the psychosocial needs of families of intensive care patients.

Materials and Methods:

This descriptive-analytical study was conducted on a randomly selected population of 80 nurses and 80 family members of ICU patients. Data were collected using a two-part questionnaire containing sociodemographic characteristics and the Critical Care Family Need Inventory (CCFNI).

Results:

The rank order of the five most important CCFNI item needs identified by families were as follows: “To feel that the hospital personnel care about the patient”, “to be assured that the best care possible is being given to the patient”, “to have questions answered honestly”, “to know specific facts concerning patient's progress”, and “to be called at home about changes in the patient's condition.” The top five CCFNI item needs identified by nurses were in the following order: “To be assured that the best care possible is being given to the patient”, “to be told about transfer plans while they are being made”, “to feel that the hospital personnel care about the patient”, “to have questions answered honestly”, and “to know specific facts concerning patient's progress.”

Conclusion:

The present study showed there are similarities and dissimilarities between nurses and family members in their perceived importance of some family needs in the ICU. It can thus be inferred from our results that the participating nurses misestimated the needs of family members, attested by their wrong estimation of the most need statements.

Reported burden on informal caregivers of ICU survivors: a literature review

BACKGROUND

Critical illness and the problems faced after ICU discharge do not only affect the patient, it also negatively impacts patients' informal caregivers. There is no review which summarizes all types of burden reported in informal caregivers of ICU survivors. It is important that the burdens these informal caregivers suffer are systematically assessed so the caregivers can receive the professional care they need. We aimed to provide a complete overview of the types of burdens reported in informal caregivers of adult ICU survivors, to make recommendations on which burdens should be assessed in this population, and which tools should be used to assess them.

METHOD

We performed a systematic search in PubMed and CINAHL from database inception until June 2014. All articles reporting on burdens in informal caregivers of adult ICU survivors were included. Two independent reviewers used a standardized form to extract characteristics of informal caregivers, types of burdens and instruments used to assess these burdens. The quality of the included studies was assessed using the Newcastle-Ottawa and the PEDro scales.

RESULTS

The search yielded 2704 articles, of which we included 28 in our review. The most commonly reported outcomes were psychosocial burden. Six months after ICU discharge, the prevalence of anxiety was between 15% and 24%, depression between 4.7% and 36.4% and post-traumatic stress disorder (PTSD) between 35% and 57.1%. Loss of employment, financial burden, lifestyle interference and low health-related quality of life (HRQoL) were also frequently reported. The most commonly used tools were the Hospital Anxiety and Depression Scale (HADS), Centre for Epidemiological Studies-Depression questionnaire, and Impact of Event Scale (IES). The quality of observational studies was low and of randomized studies moderate to fair.

CONCLUSIONS

Informal caregivers of ICU survivors suffer a substantial variety of burdens. Although the quality of the included studies was poor, there is evidence that burden in the psychosocial field is most prevalent. We suggest screening informal caregivers of ICU survivors for anxiety, depression, PTSD, and HRQoL using respectively the HADS, IES and Short Form 36 and recommend a follow-up period of at least 6 months.

Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients

The goal of this new theory is to prevent adverse psychological outcomes of ICU patients’ family members.

Fixed belief in cognitive dysfunction despite normal neuropsychological scores: neurocognitive hypochondriasis?

A subset of patients who present for neuropsychological testing report dysfunction in daily life activities secondary to cognitive deficits, but are found on formal testing to have no objective abnormalities, raising the possibility of "neurocognitive hypochondriasis." Such a case is presented, and the factors that appear to give rise to this presentation are explored. Cases of hypochondriacal overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue syndrome, fibromyalgia, toxic mold exposure, and post-polio syndrome.

Emotional distress, coping and adjustment in family members of neuroscience intensive care unit patients

OBJECTIVE

We evaluated emotional distress, coping strategy use, caregiver adjustment, and the relationship among these variables in family members (FMs) of patients hospitalized in a neuroscience intensive care unit (NSICU).

METHODS

Fifty-one primary relatives of NSICU patients were administered the Brief Symptom Inventory (BSI) and an abbreviated version of the COPE within 2 days of admission to the NSICU, just prior to patient discharge from the unit, and approximately 30 days after patient discharge (follow-up). FMs' adjustment to the role of caregiver was also evaluated at follow-up with the Caregiver Appraisal Scale (CAS).

RESULTS

BSI emotional distress levels were higher than those of the nonpatient normative sample at patient admission, but, except for anxiety, were within a standard deviation of the mean of the said group; with the exception of anxiety they declined to below nonpatient normative levels at follow-up. Females' distress levels were higher than those of males'. FMs' use of both problem-focused and emotion-focused coping strategies increased from admission through follow-up. Emotional distress was unrelated to problem-focused coping but was associated with emotion-focused coping at admission and discharge, with use of denial as a coping strategy primarily accounting for this relationship. Extent of use of both problem-focused and emotion-focused coping at admission was associated with better caregiver adjustment at follow-up, but over time only increases in problem-focused coping were associated with better subsequent caregiver adjustment.

CONCLUSIONS

Findings suggest that interventions fostering increased use of problem-focused coping and sense of control will be effective in lowering FM distress level and enhancing subsequent adjustment in the role of caregiver.

Short-term psychological impact on family members of intensive care unit patients

OBJECTIVE

This study aimed to evaluate the short-term psychological impact on family members of intensive care unit (ICU) patients during their stay in the unit.

METHODS

Thirty-two first-degree relatives of patients treated in the ICU of two general hospitals were investigated for symptoms of early posttraumatic stress reaction, anxiety, and depression. Patients' and relatives' sociodemographic data and information pertaining to the patients' ICU treatment were collected. Family members were assessed at intake and before discharge through the Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory, and the Impact of Event Scale.

RESULTS

High rates of anxiety, depressive (97%), and posttraumatic stress (81%) symptoms were recorded at the initial assessment. Although symptoms remitted significantly, 87% and 59% of the sample fulfilled the criteria for a depressive and posttraumatic stress reaction, respectively, at the second assessment. Women exhibited higher levels of distress and more persisting symptoms than men did. Trait anxiety was the most significant predictor (P<.001) of the severity of depressive symptoms and the single predictor of the development of posttraumatic stress reaction (P<.000); also, state anxiety was a predictor of the development of posttraumatic stress symptoms, especially of the female gender.

CONCLUSIONS

Family members of ICU patients exhibit high levels of distress that persist throughout their relatives' hospitalization. Women and individuals with high trait anxiety are at increased risk for developing such reactions. Severe early anxiety responses predicted the development of posttraumatic stress symptoms. Early case identification and intervention may prevent the full development of posttraumatic stress disorder.