Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, 02114, USA.
Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Neurocrit Care. 2020 Apr;32(2):512-521. doi: 10.1007/s12028-019-00772-x.
BACKGROUND/OBJECTIVE: Informal caregivers (e.g., family and friends) are at risk for developing depression, which can be detrimental to both caregiver and patient functioning. Initial evidence suggests that resiliency may reduce the risk of depression. However, gender differences in associations between multiple psychosocial resiliency factors and depression have not been examined among neuroscience intensive care unit (neuro-ICU) caregivers. We explored interactions between caregiver gender and baseline resiliency factors on depression symptom severity at baseline through 3 and 6 months post-discharge.
Caregivers (N = 96) of neuro-ICU patients able to provide informed consent to participate in research were enrolled as part of a prospective, longitudinal study in the neuro-ICU of a major academic medical center. Caregiver sociodemographics and resiliency factors (coping, mindfulness, self-efficacy, intimate care, and preparedness for caregiving) were assessed during the patient's hospitalization (i.e., baseline). Levels of depressive symptoms were measured using the Hospital Anxiety and Depression Scale at baseline, 3 months, and 6 months post-discharge.
Baseline depressive symptoms predicted depressive symptoms at both 3- and 6-month follow-ups, with no difference at any time point in rates of depression by gender. At baseline, greater levels of coping, mindfulness, and preparedness for caregiving were individually associated with lower levels of concurrent depression regardless of gender (ps < 0.006). The main effect of baseline coping remained significant at 3-month follow-up (p = 0.045). We observed a trend-level interaction between gender and baseline intimate care, such that among male caregivers only, high baseline intimate care was associated with lower depression at 3-month follow-up (p = 0.055). At 6-month follow-up, we observed a significant interaction between caregiver gender and baseline intimate care, such that male caregivers reporting high intimate care reported lower symptoms of depression than females reporting high intimate care (p = 0.037).
Results support implementation of psychosocial resiliency interventions for caregivers of patients admitted to the neuro-ICU early in the recovery process. Male caregivers may particularly benefit from strategies focused on increasing intimate care (e.g., physical and emotional affection with their loved one) and quality of the patient-caregiver dyadic relationship.
背景/目的：非正式照顾者（例如，家人和朋友）有患抑郁症的风险，这可能对照顾者和患者的功能都有不利影响。初步证据表明，适应力可以降低患抑郁症的风险。然而，在神经重症监护病房（神经 ICU）的照顾者中，尚未研究多种心理社会适应力因素与抑郁症之间的关联是否存在性别差异。我们通过出院后 3 个月和 6 个月的时间点，探讨了照顾者性别与基线适应力因素之间的相互作用对出院时基线期抑郁症状严重程度的影响。
在一家主要学术医疗中心的神经 ICU 中，我们对能够提供知情同意参与研究的神经 ICU 患者的照顾者进行了招募，作为一项前瞻性纵向研究的一部分。在患者住院期间（即基线期）评估了照顾者的社会人口统计学特征和适应力因素（应对、正念、自我效能、亲密关怀和照顾准备）。使用医院焦虑和抑郁量表在基线期、3 个月和 6 个月后测量抑郁症状水平。
基线期抑郁症状预测了 3 个月和 6 个月后的抑郁症状，在任何时间点，性别与抑郁发生率均无差异。在基线期，应对、正念和照顾准备水平较高与抑郁症状水平较低相关，无论性别如何（p 值均<0.006）。基线期应对的主要效应在 3 个月随访时仍然显著（p=0.045）。我们观察到性别与基线期亲密关怀之间存在趋势性交互作用，即仅在男性照顾者中，高基线期亲密关怀与 3 个月随访时的低抑郁水平相关（p=0.055）。在 6 个月随访时，我们观察到照顾者性别与基线期亲密关怀之间存在显著交互作用，即报告高亲密关怀的男性照顾者的抑郁症状低于报告高亲密关怀的女性照顾者（p=0.037）。
研究结果支持在神经 ICU 患者康复过程的早期为照顾者实施心理社会适应力干预。男性照顾者可能特别受益于专注于增加亲密关怀（例如，与亲人进行身体和情感上的关爱）和改善患者-照顾者二元关系的策略。
