Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
Crit Care Med. 2018 May;46(5):713-719. doi: 10.1097/CCM.0000000000002988.
Informal caregivers-that is, close family and friends providing unpaid emotional or instrumental care-of patients admitted to ICUs are at risk for posttraumatic stress disorder. As a first step toward developing interventions to prevent posttraumatic stress disorder in ICU caregivers, we examined the predictive validity of psychosocial risk screening during admission for caregiver posttraumatic stress disorder at 3 and 6 months post hospitalization.
An observational, prospective study.
Ninety-nine caregivers were recruited as part of a longitudinal research program of patient-caregiver dyads in a neuroscience ICU.
None.
Caregiver posttraumatic stress disorder symptoms were assessed during admission (baseline), 3 months, and 6 months post hospitalization. We 1) characterized prevalence of clinically significant symptoms at each time point 2); calculated sensitivity and specificity of baseline posttraumatic stress disorder screening in predicting posttraumatic stress disorder at 3 and 6 months; and 3) used recursive partitioning to select potential baseline factors and examine the extent to which they helped predict clinically significant posttraumatic stress disorder symptoms at each time point. Rates of caregiver posttraumatic stress disorder remained relatively stable over time (16-22%). Screening for posttraumatic stress disorder at baseline predicted posttraumatic stress disorder at 3 and 6 months with moderate sensitivity (75-80%) and high specificity (92-95%). Screening for posttraumatic stress disorder at baseline was associated with caregiver anxiety, mindfulness (i.e., ability to be aware of one's thoughts and feelings in the moment), and bond with patient. Furthermore, baseline posttraumatic stress disorder screening was the single most relevant predictor of posttraumatic stress disorder at 3 and 6 months, such that other baseline factors did not significantly improve predictive ability.
Screening neuroscience ICU caregivers for clinically significant posttraumatic stress disorder symptoms during admission is the single most important way to identify the majority of those likely to suffer from chronic posttraumatic stress disorder following discharge. Addressing early posttraumatic stress disorder symptoms and their psychosocial correlates during admission may help prevent chronic posttraumatic stress disorder in these at-risk caregivers.
为 ICU 患者提供无偿情感或工具性护理的非专业护理人员（即亲密的家人和朋友）有患创伤后应激障碍的风险。作为开发针对 ICU 护理人员创伤后应激障碍预防干预措施的第一步，我们在 ICU 护理人员入院时进行了心理社会风险筛查，以检验其在住院后 3 个月和 6 个月时预测创伤后应激障碍的预测效度。
一项观察性、前瞻性研究。
99 名护理人员作为神经科学 ICU 患者-护理人员对的纵向研究计划的一部分被招募。
无。
在入院时（基线）、住院后 3 个月和 6 个月评估护理人员的创伤后应激障碍症状。我们 1）描述每个时间点上临床显著症状的患病率；2）计算基线创伤后应激障碍筛查在预测 3 个月和 6 个月时创伤后应激障碍的敏感性和特异性；3）使用递归分区选择潜在的基线因素，并检查它们在多大程度上有助于预测每个时间点的临床显著创伤后应激障碍症状。随着时间的推移，护理人员创伤后应激障碍的发生率相对稳定（16-22%）。基线创伤后应激障碍筛查对 3 个月和 6 个月时的创伤后应激障碍具有中等敏感性（75-80%）和高特异性（92-95%）。基线创伤后应激障碍筛查与护理人员焦虑、正念（即，在当下意识到自己的想法和感受的能力）和与患者的联系有关。此外，基线创伤后应激障碍筛查是预测 3 个月和 6 个月时创伤后应激障碍的唯一最重要的预测因素，因此其他基线因素并没有显著提高预测能力。
在入院时对神经科学 ICU 护理人员进行临床显著创伤后应激障碍症状筛查是识别大多数在出院后患有慢性创伤后应激障碍风险的人员的最重要方法。在入院时处理早期创伤后应激障碍症状及其心理社会相关性可能有助于预防这些高危护理人员的慢性创伤后应激障碍。
