Use of the Hospital Anxiety and Depression Scale in Spanish caregivers

Fulfilling last wishes: improving the compassionate discharge process

BACKGROUND

Compassionate discharges (ComD), commonly known as rapid discharges, are urgent one-way discharges for critically ill hospitalised patients with death expected within hours or less than 7 days, to die at their place of choice-usually in their own home. Challenges abound in this time-sensitive setting when multiple parties must work together to prepare medically unstable patients for discharge, yet healthcare staff are largely unaware of the process, resulting in delays.

METHODS

Process mapping, an Ishikawa diagram and a Pareto chart were used to identify barriers, which included timely acquisition of home equipment and medication and poor communication among stakeholders. In May 2020, the Quality Improvement (QI) team embarked on a pilot project to reduce family caregiver anxiety and delays in the ComD process while maintaining a success rate above 90% over a 12-month period.

INTERVENTIONS

Three Plan-Do-Study-Act (PDSA) cycles were used to refine a ComD resource package that was developed; this consisted of a checklist, a kit and caregiver resources. This was to support nurses, doctors and families during this difficult and emotional transition. Items in the ComD resource package were revised iteratively based on user feedback, with further data collected to measure its usefulness.

RESULTS

The 12-month ComD success rate over 3 PDSA cycles were 88.9%, 94.2% and 96.7%, respectively, after each cycle. There was a consistent reduction in the level of family anxiety before and after caregiver training and resources. Reasons for failed ComD included acute clinical deterioration or delays in obtaining home oxygen support.

CONCLUSION

The ComD resource package allowed collaborative work across different disciplines, strengthening the safety and utility of ComD and allowing patients to die in their place of choice. These are ubiquitous across settings; this QI problem is thus relevant beyond our local institution.

A systematic review and meta-analysis of the association between anxiety symptoms and coping in family carers of dependent people aged 18 and over

Anxiety symptoms are prevalent in family carers of dependent people. Despite accumulating evidence in the area, there are still inconsistent findings on the association between carer anxiety symptoms and coping strategies. The aim of our study was to systematically analyse the relationship between anxiety symptoms and coping strategies in carers of dependent adults aged 18 years and older, and examine possible sources of heterogeneity in the results. The study design was a systematic review and meta-analysis. We searched several international databases (Pubmed, CINAHL, PsycINFO and LILACS) from June 2022 up to February 2023. We followed the preferred reporting items for systematic reviews and meta-analyses statement and performed several subgroup analyses to examine whether study design, cause of dependency and whether or not controlling for various biases influenced results. Forty-one studies were included in the review. We found significant associations between greater use of dysfunctional coping and higher anxiety symptoms. Greater use of problem-focused coping was associated with lower anxiety symptoms in carers of frail older people, but higher anxiety in carers of people surviving cancer. Emotion-focused coping and some of its individual strategies, such as acceptance and positive reappraisal, in probabilistic samples, were associated with lower anxiety symptoms across all groups. Most of the studies included in this review were cross-sectional. Evidence overall indicates that only specific dimensions and strategies of coping are significantly associated with anxiety symptoms in family carers. These findings should be considered when developing future interventions supporting carers.

Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study

Background

The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future.

Methods

The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score.

Results

Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members.

Conclusions

The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.

Factors associated with anxiety and depression among caregivers of patients receiving medical home visits

In recent years, Japan has promoted home visits to support older adults, with caregivers playing an important role. However, caregivers generally experience a high frequency of anxiety and depression, and the factors associated with these conditions among home visit caregivers remain unknown. To identify the associated factors, we conducted a questionnaire-based cross-sectional study of home visit caregivers in Tokushima Prefecture, Japan. The survey included caregivers' Hospital Anxiety and Depression Scale;sociodemographic items of patients and caregivers;and caregivers' perceptions of the home care environment, patients, and themselves. The questionnaires were sent to 379 caregivers;203 responded (53.6% response rate), of which 173 were valid (85.2% valid response rate). The prevalence of anxiety and depression was 43.9% and 69.4%, respectively. Multiple logistic regression analysis of factors associated with anxiety and depression showed that stable family finances (OR:0.69, 95% CI:0.48-1.00, p=0.049) and stable caregiver health (OR:0.45, 95% CI:0.30-0.68, p<0.001) were associated with anxiety. Further, stable family finances (OR:0.60, 95% CI:0.38-0.93, p=0.022), stable caregiver health (OR:0.49, 95% CI:0.30-0.81, p=0.005), and stable patient condition (OR:0.51, 95% CI:0.29-0.92, p=0.025) were associated with depression. These findings demonstrate that caregiver wellbeing is essential in home care settings. J. Med. Invest. 70 : 443-449, August, 2023.

The ATENción Plena en Enfermedad de Alzheimer (ATENEA—Mindfulness in Alzheimer’s Disease) Program for Caregivers: Study Protocol for a Randomized Controlled Trial

A person affected by Alzheimer’s disease (AD) gradually loses the ability to perform activities of daily living and becomes dependent on caregivers, thereby having a negative impact on the caregivers’ quality of life. There is evidence that suggests that interventions aimed at caregivers, such as mindfulness, may be effective at reducing this burden and emotional issues, such as depression and anxiety, and improving their quality of life. However, there is a lack of consistency in the findings and conclusions remain tentative. In addition, as neuropsychiatric symptoms (NPSs) of AD are major determinants of the caregiver’s burden, these interventions should examine the relationship between these symptoms and caregiver outcomes. Importantly, to improve the design of therapeutic interventions for caregivers and complement the treatment of AD, aspects related to occupational performance and the participation of people with AD and their caregivers should also be considered. Therefore, this study will aim to examine first, the effects of a mindfulness-based program designed for caregivers on NPSs of AD and caregivers’ anxiety and depression; second, the effects of this program on patients’ functional capacity, cognitive performance, executive functions, and quality of life, and on caregivers’ burden, quality of life, occupational balance, executive functions, psychological wellbeing, and self-compassion. We believe that the findings of this study will have significant implications for future healthcare strategies focused on improving the quality of life and wellbeing of caregivers.

Internal consistency and validity of the Hospital Anxiety and Depression Scale (HADS) in women with abnormal Pap smear in Serbia

Receiving a report of an abnormal finding of Pap screening test in women often leads to anxiety and depression. The purpose of this study was to investigate the construct validity and internal consistency reliability of the Serbian version of the Hospital Anxiety and Depression Scale (HADS) in women with abnormal Pap smear results. In 2017, a cross-sectional study was done involving 142 consecutive women attending cervical cancer screening who had received abnormal Pap smear results at one University clinical center in Serbia. We used exploratory factor analysis to establish the structure of the HADS and Cronbach's alpha coefficient was used for assessing the internal consistency. In our study, the HADS demonstrated high internal consistency, for both subscales (Cronbach's alpha coefficient for subscale Anxiety was 0.862, and for subscale Depression was 0.851). The intra-class correlation coefficients for the two components were significant (0.860 and 0.843, p < .001). Principal component analysis with Oblimin rotation indicated a two-factor structure that explained 56.4% of variance. In conclusion, the Serbian version of the HADS showed satisfactory internal consistency reliability and construct validity and could be useful as a screening questionnaire for the assessment of anxiety and depression among women with abnormal Pap smear results.

Effects of Meditation on Mental Health and Cardiovascular Balance in Caregivers

Background: Caring for a loved one can be rewarding but is also associated with substantial caregiver burden, developing mental outcomes and affecting happiness. The aim of this study was to determine the effects of a four-week, 16-h presential meditation program on physiological and psychological parameters and vagal nerve activity in high-burden caregivers, as compared to a control group. Methods: A non-randomized repeated-measures controlled clinical trial was conducted. Results: According to the ANCOVA results, the global happiness score (F = 297.42, p < 0.001) and the scores for all subscales were significantly higher in the experimental group than in the control group at 5 weeks. Anxiety levels were also significantly reduced in the experimental group (F = 24.92, p < 0.001), systolic (F = 16.23, p < 0.001) and diastolic blood (F = 34.39, p < 0.001) pressures, and the resting heart rate (F = 17.90, p < 0.05). HRV results revealed significant between-group differences in the HRV Index (F = 8.40, p < 0.05), SDNN (F = 13.59, p < 0.05), and RMSSD (F = 10.72, p < 0.05) in the time domain, and HF (F = 4.82 p < 0.05)) in the frequency domain, which were all improved in the experimental group after the meditation program. Conclusions: Meditation can be a useful therapy to enhance the mental health and autonomic nervous system balance of informal caregivers, improving symptoms of physical and mental overload.

Mood Disorders in Levothyroxine-Treated Hypothyroid Women

Background: Hypothyroidism has several symptoms (weight gain, arrhythmias, mood changes, etc.). The aims of this study were (1) to assess the prevalence of anxiety and depression in levothyroxine-treated hypothyroid women and in women without hypothyroidism; (2) to identify variables associated with anxiety and depression. Methods: A case-control study was performed with 393 women. Case-group: 153 levothyroxine-treated hypothyroid women. Control-group: 240 women without hypothyroidism. Convenience sampling. Instrument: The Hamilton Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire. Results: The prevalence of anxiety in levothyroxine-treated hypothyroid women was higher than in women without hypothyroidism (29.4% vs. 16.7%, χ² p < 0.001). The prevalence of depression in the case group was higher than in the control group (13.1% vs. 4.6%, χ² p < 0.001). Levothyroxine-treated hypothyroid women were more likely to have anxiety (OR = 2.08, CI: 1.28-3.38) and depression (OR = 3.13, IC = 1.45-6.45). Conclusion: In spite of receiving treatment with levothyroxine, women with hypothyroidism are more likely to have depression and anxiety. Health professionals need to assess the mood of women with hypothyroidism. Although levothyroxine is a good treatment for the symptoms of hypothyroidism, it may not be enough to prevent development or persistence of depression and anxiety by itself.

Longitudinal Outcomes Among Family Caregivers of Power Mobility Users

OBJECTIVE

To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users.

DESIGN

Longitudinal study.

SETTING

Community.

PARTICIPANTS

Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes.

RESULTS

The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study.

CONCLUSION

Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.

Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study

AIM

To longitudinally describe stroke caregivers' quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers' quality of life, anxiety, depression and burden.

BACKGROUND

Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depression and burden during the first year.

DESIGN

A 12-month longitudinal study. Data were collected between June 2013-May 2016.

METHODS

Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models.

RESULTS

The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depression decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was predicted by caregiver younger age, higher education, living with a stroke survivor, survivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was predicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning.

CONCLUSION

The first 9 months of caregiving are particularly problematic for caregivers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors.

Understanding the Burden Experienced by Caregivers of Older Adults Who Use a Powered Wheelchair: A Cross-Sectional Study

Objective: In this study, we aimed to describe the burden of family caregivers providing powered wheelchair-related and overall assistance and test the hypotheses that caregiver burden correlates with participation, wheelchair skills capacity, anxiety, depression, and social support. Methods: Cross-sectional study. Participants included 35 family caregivers of powered wheelchair users. Caregivers were assessed using the Power Mobility Caregiver Assistive Technology Outcome Measure, Late Life Disability Instrument, Wheelchair Skills Test Questionnaire for caregivers, Hospital Anxiety and Depression Scale, and Interpersonal Support Evaluation List-12. Results: The most burdensome powered wheelchair assistance items were providing verbal hints/directions, needing to be nearby, anxiety, and fear that user may be harmed. The most burdensome overall assistance item was feeling limited in recreational/leisure activities. Caregiver burden was significantly correlated with participation limitations, anxiety, depression, and social support. Discussion: Caregivers experience burden for wheelchair-related and overall help, especially psychological burden. Such results have implications for the type of resources required to support family caregivers.