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危重症患者家庭成员入住重症监护病房后心理困扰的影响因素:线性混合效应模型

Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model.

作者信息

Naef Rahel, von Felten Stefanie, Ernst Jutta

机构信息

Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.

出版信息

Biopsychosoc Med. 2021 Feb 15;15(1):4. doi: 10.1186/s13030-021-00206-1.

Abstract

BACKGROUND

Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients.

METHODS

We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other's ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures.

RESULTS

A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress.

CONCLUSIONS

Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.

摘要

背景

重症疾病的不良反应,如抑郁、焦虑或创伤后应激症状,在家庭成员中相对常见。然而,风险因素的作用仍未得到充分理解,但针对那些最需要支持的家庭成员可能很重要。因此,我们在重症患者的一般人群中研究了患者、家庭成员和护理相关因素与家庭成员ICU后心理困扰之间的关联。

方法

我们在瑞士一家拥有900张床位的大学医院的一个有12张床位的外科重症监护病房进行了一项前瞻性、单中心观察性研究。参与者是在重症监护病房接受治疗的患者的家庭成员,他们在其亲人的重症监护病房住院后的前3个月内完成了《重症监护病房-24小时家庭满意度调查》、《医院焦虑抑郁量表》、《事件影响量表修订版-6》和一份人口统计学表格。使用线性混合效应模型分析数据,以抑郁、焦虑和创伤后应激作为结局指标。

结果

共有214名家庭成员(回复率53%)返回了完整的问卷。我们发现,较高的满意度与较低的抑郁、焦虑和创伤后应激水平显著相关。家庭成员特征与任何心理困扰指标之间均无统计学显著关联。在所纳入的患者特征中,患者年龄较小与较高的抑郁水平相关,患者死亡与较高的抑郁和创伤后应激水平相关。

结论

我们的结果表明,对重症监护病房护理的满意度与重症监护病房后的家庭幸福感密切相关。年轻患者和死亡患者的家庭成员似乎最易出现心理困扰,需要特殊支持,而家庭成员特征可能不太相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c9/7885222/a32ebaf31205/13030_2021_206_Fig1_HTML.jpg

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