PURPOSE: This study explored the trajectory of depressive symptoms in caregivers of the CCI (chronically critically ill: on mechanical ventilation ≥ 4 days) from ICU admission to 2 months post-ICU discharge.
METHODS: In this prospective longitudinal descriptive study, patients (n=47) and their family caregivers (n=50) were recruited in a tertiary university hospital medical ICU. Caregivers completed the Center for Epidemiologic Studies-Depression-10 items (CESD-10) during ICU admission, at ICU discharge, and 2 months post- ICU discharge. Caregiver burden (Brief Zarit Burden Interview-12 items) and health risk behaviors (Caregiver Health Behavior) were measured at the same time points. Caregiver socio-demographic characteristics and health history, and patient clinical characteristics and functional dependency were also obtained. Data were analyzed using group based trajectory analysis and Fisher’s exact test.
RESULTS: Caregivers were mostly Caucasian (92%), female (74%) and aged of 52 ± 12 years. Patients were mostly Caucasian (93.6 %), male (66%), aged of 56 ± 17 years and diagnosed with a pulmonary condition (53%, n=26). At ICU admission, 56% (n=28) of caregivers reported CESD-10 scores placing them at risk for clinical depression (≥ 8); scores remained high 2 months post-ICU discharge (high trajectory [HT] group). Caregivers in the HT group tended to report higher burden and more health risk behaviors. They tended to be female, report a history of emotional problems and more economic hardship compared to those in the low trajectory group. These caregivers also tended to provide care for patients with more comorbid conditions, higher acuity at ICU admission, longer ICU stay, and greater functional dependency at all time points.
CONCLUSIONS: Our findings suggest two distinct responses of family caregivers over the course of CCI which continued after ICU admission and was associated with differing caregivers and patient characteristics.
CLINICAL IMPLICATIONS: Exploring trajectories of depressive symptoms in caregivers of the CCI may help clinicians better understand patterns of caregiver stress response and identify vulnerable caregivers who can most benefit from targeted interventions.
DISCLOSURE: The following authors have nothing to disclose: JiYeon Choi, Leslie Hoffman, Dianxu Ren, Michael Donahoe, Paula Sherwood
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