Douglas Sara L, Daly Barbara J, Kelley Carol Genet, O'Toole Elizabeth, Montenegro Hugo
School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4904, USA.
Chest. 2005 Dec;128(6):3925-36. doi: 10.1378/chest.128.6.3925.
Few studies have examined the effects of caregiving on the caregivers of chronically critically ill (CCI) patients, and no one has examined the impact of a disease management program (DMP) on physical and psychological outcomes for the caregivers of CCI patients. The purposes of this study of caregivers of CCI patients were as follows: (1) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression, subjective burden, and physical health; (2) to examine factors related to depression after hospital discharge; and (3) to examine the effects of a DMP on the physical health, depression, and burden of caregivers 2 months post-hospital discharge.
Prospective experimental design.
Caregivers of 290 patients who had received > 3 days of mechanical ventilation while in the ICU of a university medical center.
Sociodemographics, caregiver burden, physical health status, and depression were measured using established tools.
Interviews of caregivers were conducted at hospital discharge and 2 months later. Seventy-three percent of patients survived, completed the study period, and required caregiving 2 months later. Caregivers of patients residing in an institution reported higher depression (p = 0.0001), higher burden (ie, disrupted schedule, p = 0.0001; lack of family support, p = 0.036), and greater health problem scores (p = 0.0001) than did caregivers of patients residing at home. The DMP did not have a statistically significant impact on any of the outcome variables. However, by 2 months, 54% of caregivers in the experimental group had no depression or mild depression compared with 34.5% of the control group.
Two months after hospital discharge, approximately 25% of caregivers were classified as depressed with 16.7% of the depressed group classified as moderately or severely depressed. The caregivers of CCI patients are at risk for post-hospital discharge depression, and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving.
很少有研究探讨照护慢性危重症（CCI）患者对照护者的影响，且无人研究疾病管理项目（DMP）对CCI患者照护者身体和心理结局的影响。本研究针对CCI患者照护者的目的如下：（1）描述CCI患者及照护者的特征，并调查抑郁、主观负担及身体健康状况的发生频率；（2）调查出院后与抑郁相关的因素；（3）调查DMP对出院后2个月照护者身体健康、抑郁及负担的影响。
前瞻性实验设计。
一所大学医学中心重症监护病房（ICU）中接受过3天以上机械通气的290例患者的照护者。
使用既定工具测量社会人口统计学特征、照护者负担、身体健康状况及抑郁情况。
在出院时及出院2个月后对照护者进行访谈。73%的患者存活，完成研究期，且在2个月后仍需照护。与居家患者的照护者相比，入住机构的患者照护者报告有更高的抑郁水平（p = 0.0001）、更高的负担（即日程安排受干扰，p = 0.0001；缺乏家庭支持，p = 0.036）以及更高的健康问题评分（p = 0.0001）。DMP对任何结局变量均无统计学上的显著影响。然而，到2个月时，实验组54%的照护者无抑郁或有轻度抑郁，而对照组为34.5%。
出院2个月后，约25%的照护者被归类为抑郁，其中16.7%的抑郁组被归类为中度或重度抑郁。CCI患者的照护者在出院后有发生抑郁的风险，而入住机构接受照护的CCI患者的照护者面临照护带来长期负面影响的风险最高。
