The Impact of Resilience Factors and Anxiety During Hospital Admission on Longitudinal Anxiety Among Dyads of Neurocritical Care Patients Without Major Cognitive Impairment and Their Family Caregivers.
Actor–partner interdependence model
Anxiety
Coping
Dyad
Mindfulness
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
31
1
2020
medline:
30
9
2021
entrez:
31
1
2020
Statut:
ppublish
Résumé
Anxiety is common in patients experiencing neurocritical illness and their family caregivers. Resilience factors like mindfulness and coping skills may be protective against symptoms of emotional distress, including anxiety. Less is known about the interplay of anxiety symptoms and resilience factors between patients and caregivers. The purpose of this study is to examine the trajectory of anxiety symptoms among dyads of neurocritical care patients without major cognitive impairment and their family caregivers and to elucidate the relationship between resiliency (e.g., mindfulness and coping) and anxiety in these dyads. Prospective, longitudinal study of adults admitted to the neurological intensive care unit (Neuro-ICU) and their caregivers. Dyads of patients (N = 102) and family caregivers (N = 103) completed self-report measures of mindfulness (Cognitive Affective Mindfulness Scale-Revised) and coping (Measure of Current Status-Part A) during Neuro-ICU hospitalization and anxiety symptoms (anxiety subscale of the Hospital Anxiety and Depression Scale) during hospitalization and at 3- and 6-month follow-up. We used actor-partner interdependence modeling to predict the effect of one's own baseline characteristics on one's own and one's partner's future anxiety symptoms. Rates of clinically significant anxiety symptoms were 40% for patients and 42% for caregivers at baseline. Of these, 20% of patients and 23% of caregivers showed moderate and severe symptoms. Approximately, one-third of patients and caregivers reported clinically significant anxiety symptoms at 3- and 6-month follow-ups, with more than 20% endorsing moderate or severe symptoms. Patients' own baseline mindfulness, coping, and anxiety symptoms were associated with lower anxiety symptoms at all time points (ps < 0.001)-this was also true for caregivers. For both patients and caregivers, one's own baseline mindfulness predicted their partner's anxiety symptoms 3 months later (p = 0.008), but not at 6-month follow-up. Anxiety symptoms in Neuro-ICU patient-caregiver dyads are high through 6 months following admission. Mindfulness is interdependent and protective against anxiety in dyads at 3-month but not 6-month follow-up. Early, dyad-based interventions may prevent the development of chronic anxiety in patients without major cognitive impairment and caregivers.
Sections du résumé
BACKGROUND/OBJECTIVE
Anxiety is common in patients experiencing neurocritical illness and their family caregivers. Resilience factors like mindfulness and coping skills may be protective against symptoms of emotional distress, including anxiety. Less is known about the interplay of anxiety symptoms and resilience factors between patients and caregivers. The purpose of this study is to examine the trajectory of anxiety symptoms among dyads of neurocritical care patients without major cognitive impairment and their family caregivers and to elucidate the relationship between resiliency (e.g., mindfulness and coping) and anxiety in these dyads.
METHODS
Prospective, longitudinal study of adults admitted to the neurological intensive care unit (Neuro-ICU) and their caregivers. Dyads of patients (N = 102) and family caregivers (N = 103) completed self-report measures of mindfulness (Cognitive Affective Mindfulness Scale-Revised) and coping (Measure of Current Status-Part A) during Neuro-ICU hospitalization and anxiety symptoms (anxiety subscale of the Hospital Anxiety and Depression Scale) during hospitalization and at 3- and 6-month follow-up. We used actor-partner interdependence modeling to predict the effect of one's own baseline characteristics on one's own and one's partner's future anxiety symptoms.
RESULTS
Rates of clinically significant anxiety symptoms were 40% for patients and 42% for caregivers at baseline. Of these, 20% of patients and 23% of caregivers showed moderate and severe symptoms. Approximately, one-third of patients and caregivers reported clinically significant anxiety symptoms at 3- and 6-month follow-ups, with more than 20% endorsing moderate or severe symptoms. Patients' own baseline mindfulness, coping, and anxiety symptoms were associated with lower anxiety symptoms at all time points (ps < 0.001)-this was also true for caregivers. For both patients and caregivers, one's own baseline mindfulness predicted their partner's anxiety symptoms 3 months later (p = 0.008), but not at 6-month follow-up.
CONCLUSIONS
Anxiety symptoms in Neuro-ICU patient-caregiver dyads are high through 6 months following admission. Mindfulness is interdependent and protective against anxiety in dyads at 3-month but not 6-month follow-up. Early, dyad-based interventions may prevent the development of chronic anxiety in patients without major cognitive impairment and caregivers.
Identifiants
pubmed: 31997141
doi: 10.1007/s12028-020-00913-7
pii: 10.1007/s12028-020-00913-7
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
468-478Subventions
Organisme : NINR NIH HHS
ID : R21 NR017979
Pays : United States
Références
Campbell Burton CA, Murray J, Holmes J, Astin F, Greenwood D, Knapp P. Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies. Int J Stroke Off J Int Stroke Soc. 2013;8(7):545–59.
doi: 10.1111/j.1747-4949.2012.00906.x
Cumming TB, Blomstrand C, Skoog I, Linden T. The high prevalence of anxiety disorders after stroke. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. 2016;24(2):154–60.
doi: 10.1016/j.jagp.2015.06.003
Shaffer KM, Riklin E, Jacobs JM, Rosand J, Vranceanu A-M. Mindfulness and coping are inversely related to psychiatric symptoms in patients and informal caregivers in the neuroscience ICU: implications for clinical care. Crit Care Med. 2016;44(11):2028–36.
doi: 10.1097/CCM.0000000000001855
Denno MS, Gillard PJ, Graham GD, DiBonaventura MD, Goren A, Varon SF, et al. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil. 2013;94(9):1731–6.
doi: 10.1016/j.apmr.2013.03.014
Hwang DY, Yagoda D, Perrey HM, Currier PF, Tehan TM, Guanci M, et al. Anxiety and depression symptoms among families of adult intensive care unit survivors immediately following brief length of stay. J Crit Care. 2014;29(2):278–82.
doi: 10.1016/j.jcrc.2013.11.022
Hatch R, Young D, Barber V, Griffiths J, Harrison DA, Watkinson P. Anxiety, depression and post traumatic stress disorder after critical illness: a UK-wide prospective cohort study. Crit Care Lond Engl. 2018;22(1):310.
doi: 10.1186/s13054-018-2223-6
Nikayin S, Rabiee A, Hashem MD, Huang M, Bienvenu OJ, Turnbull AE, et al. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2016;43:23–9.
doi: 10.1016/j.genhosppsych.2016.08.005
Roest AM, Martens EJ, Denollet J, de Jonge P. Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med. 2010;72(6):563–9.
doi: 10.1097/PSY.0b013e3181dbff97
Cserép Z, Balog P, Székely J, Treszl A, Kopp MS, Thayer JF, et al. Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery. Interact CardioVasc Thorac Surg. 2010;11(5):567–72.
doi: 10.1510/icvts.2010.244582
American Psychological Association. The road to resilience. [Internet]. 2014; Washington, D.C. Available from: http://www.apa.org/helpcenter/road-resilience.aspx . Accessed Nov 2019.
Tugade MM, Fredrickson BL, Barrett LF. Psychological resilience and positive emotional granularity: examining the benefits of positive emotions on coping and health. J Pers. 2004;72(6):1161–90.
doi: 10.1111/j.1467-6494.2004.00294.x
Bonanno GA, Galea S, Bucciarelli A, Vlahov D. What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. J Consult Clin Psychol. 2007;75(5):671–82.
doi: 10.1037/0022-006X.75.5.671
Shaffer KM, Riklin E, Jacobs JM, Rosand J, Vranceanu A-M. Psychosocial resiliency is associated with lower emotional distress among dyads of patients and their informal caregivers in the neuroscience intensive care unit. J Crit Care. 2016;36:154–9.
doi: 10.1016/j.jcrc.2016.07.010
Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–48.
doi: 10.1037/0022-3514.84.4.822
Whitebird RR, Kreitzer M, Crain AL, Lewis BA, Hanson LR, Enstad CJ. Mindfulness-based stress reduction for family caregivers: a randomized controlled trial. The Gerontol. 2013;53(4):676–86.
doi: 10.1093/geront/gns126
Brown KW, Coogle CL, Wegelin J. A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia. Aging Ment Health. 2016;20(11):1157–66.
doi: 10.1080/13607863.2015.1065790
Penley JA, Tomaka J, Wiebe JS. The association of coping to physical and psychological health outcomes: a meta-analytic review. J Behav Med. 2002;25(6):551–603.
doi: 10.1023/A:1020641400589
Austenfeld JL, Stanton AL. Coping through emotional approach: a new look at emotion, coping, and health-related outcomes. J Pers. 2004;72(6):1335–63.
doi: 10.1111/j.1467-6494.2004.00299.x
Lim J-W, Shon E-J, Paek M, Daly B. The dyadic effects of coping and resilience on psychological distress for cancer survivor couples. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2014;22(12):3209–17.
Ben-Zur H, Gilbar O, Lev S. Coping with breast cancer: patient, spouse, and dyad models. Psychosom Med. 2001;63(1):32–9.
doi: 10.1097/00006842-200101000-00004
Jacobs JM, Shaffer KM, Nipp RD, Fishbein JN, MacDonald J, El-Jawahri A, et al. Distress is interdependent in patients and caregivers with newly diagnosed incurable cancers. Ann Behav Med Publ Soc Behav Med. 2017;51(4):519–31.
doi: 10.1007/s12160-017-9875-3
Bakas T, Clark PC, Kelly-Hayes M, King RB, Lutz BJ, Miller EL, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke. 2014;45(9):2836–52.
doi: 10.1161/STR.0000000000000033
Savini S, Buck HG, Dickson VV, Simeone S, Pucciarelli G, Fida R, et al. Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol. J Adv Nurs. 2015;71(3):676–87.
doi: 10.1111/jan.12524
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
doi: 10.1016/j.jbi.2008.08.010
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.
doi: 10.1111/j.1600-0447.1983.tb09716.x
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.
doi: 10.1016/S0022-3999(01)00296-3
Feldman G, Hayes A, Kumar S, Greeson J, Laurenceau J-P. Mindfulness and emotion regulation: the development and initial validation of the cognitive and affective mindfulness scale-revised (CAMS-R). J Psychopathol Behav Assess. 2006;29(3):177.
doi: 10.1007/s10862-006-9035-8
Shaffer KM, Jacobs JM, Coleman JN, Temel JS, Rosand J, Greer JA, et al. Anxiety and depressive symptoms among two seriously medically ill populations and their family caregivers: a comparison and clinical implications. Neurocrit Care. 2017;27(2):180–6.
doi: 10.1007/s12028-016-0358-3
Marshall A, Guillien U, Mackley A, Sturtz W. Mindfulness training among parents with preterm neonates in the neonatal intensive care unit: a pilot study. PubMed—NCBI. Am J Perinatol [Internet]. 2019 [cited 2019 Sep 12]; Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Mindfulness+training+among+parents+with+preterm+neonates+in+the+neonatal+intensive+care+unit%3A+a+pilot+study . Accessed Nov 2019.
Carver CS. Measure of current status. [Internet]. 2006. Available from: http://www.psy.miami.edu/faculty/ccarver/sclMOCS.html . Accessed Nov 2019.
Antoni M, Kazi A, Wimberly S, Sifre T, Urcuyo K, Phillips K, et al. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006;74(6):1143–52.
doi: 10.1037/0022-006X.74.6.1143
Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.
doi: 10.1037/0033-2909.112.1.155
Kenny D, Cook W. Partner effects in relationship research: conceptual issues, analytic difficulties, and illustrations. Personal Relationsh. 1999;6(4):433–48.
doi: 10.1111/j.1475-6811.1999.tb00202.x
Kenny DA, Kashy DA, Cook WL. Dyadic data analysis. New York: Guilford Press; 2006. xix, 458. (Dyadic data analysis).
Li T, Hutfless S, Dickersin K, Scharfstein D, Neaton J, Hogan J, et al. Minimal standards in the prevention and handling of missing data in observational and experimental patient centered outcomes research [Internet]. Baltimore, MD: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; 2012 Mar p. 1–17. Available from: https://www.pcori.org/assets/Minimal-Standards-in-the-Prevention-and-Handling-of-Missing-Data-in-Observational-and-Experimental-Patient-Centered-Outcomes-Research1.pdf . Accessed Nov 2019.
van Buuren S. Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res. 2007;16(3):219–42.
doi: 10.1177/0962280206074463
Statistical Package for the Social Sciences. Armonk, NY: IBM Corporation; 2011. Accessed Nov 2019.
Zwann M, Enderle J, Wagner S, Mühlhans B, Ditzen B, Mitchell J, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. PubMed—NCBI J Affect Disord. 2011;133(1–2):61–8.
doi: 10.1016/j.jad.2011.03.025
Hanssen T, Nordrehaug J, Eide G, Bjelland I, Rokne B. Anxiety and depression after acute myocardial infarction: an 18-month follow-up study with repeated measures and comparison with a reference popula. PubMed—NCBI Eur J Cardiovasc Prev Rehabil. 2009;16(6):651–9.
doi: 10.1097/HJR.0b013e32832e4206
Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999;282(23):2215–9.
doi: 10.1001/jama.282.23.2215
Beach SR, Schulz R, Williamson GM, Miller LS, Weiner MF, Lance CE. Risk factors for potentially harmful informal caregiver behavior. J Am Geriatr Soc. 2005;53(2):255–61.
doi: 10.1111/j.1532-5415.2005.53111.x
Zale EL, Heinhuis TJ, Tehan T, Salgueiro D, Rosand J, Vranceanu A-M. Resiliency is independently associated with greater quality of life among informal caregivers to neuroscience intensive care unit patients. Gen Hosp Psychiatry. 2018;52:27–33.
doi: 10.1016/j.genhosppsych.2018.02.012
Mayer SA, Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, et al. Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology. 2002;59(11):1750–8.
doi: 10.1212/01.WNL.0000035748.91128.C2
Hackett ML, Anderson CS. Health outcomes 1 year after subarachnoid hemorrhage an international population-based study. Neurology. 2000;55(5):658–62.
doi: 10.1212/WNL.55.5.658
mccurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, et al. Preventing chronic emotional distress in stroke survivors and their informal caregivers. Neurocrit Care. 2019;30(3):581–9.
doi: 10.1007/s12028-018-0641-6
Hwang D. Is post-neurointensive care syndrome actually a thing? PubMed—NCBI. Neurocrit Care [Internet]. 2019 [cited 2019 Sep 12]; Available from: https://www.ncbi.nlm.nih.gov/pubmed/31420783 . Accessed Nov 2019.
LaBuzetta J, Rosand J, Vranceanu A. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. PubMed—NCBI. Neurocrit Care [Internet]. 2019 [cited 2019 Sep 12]; Available from: https://www.ncbi.nlm.nih.gov/pubmed/31486026 . Accessed Nov 2019.