Salant Jennifer A, Gangopadhyay Maalobeeka, Jia Haomiao, Wocial Lucia D, Edwards Jeffrey D
Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Morgan Stanley Children's Hospital, New York, New York, United States.
Department of Medicine, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
J Pediatr Intensive Care. 2021 Jun 24;12(3):188-195. doi: 10.1055/s-0041-1731429. eCollection 2023 Sep.
Prolonged critical illness in children has emotional consequences for both parents and providers. In this observational cohort study, we longitudinally surveyed anxiety and depression in parents and moral distress in pediatric intensive care unit (PICU) providers (attendings, fellows, and bedside registered nurses) and explored their trajectories and relationships. Anxiety/depression and provider moral distress were measured using the Hospital Anxiety and Depression Scale and the Moral Distress Thermometer, respectively. The relationships of parental and provider distress were evaluated using Spearman's correlations, and their trajectories and potentially associated variables were explored using quadratic random slope and intercept models. Predetermined associated factors included demographic and clinical factors, including parent psychosocial risk and intubation status. We found parental anxiety and depression decreased over their child's admission, and parental psychosocial risk was significantly associated with anxiety (coefficient = 4.43, < 0.001). Clinicians in different roles had different mean levels and trajectories of moral distress, with fellows reporting greater distress early in admissions and nurses later in admissions. Parental anxiety/depression and provider distress were significantly, though moderately, correlated. We conclude that anxiety and depression in parents of children with prolonged PICU admissions and the moral distress of their clinicians correlate and vary over time and by provider role.
儿童长期危重病对父母和医护人员都会产生情感影响。在这项观察性队列研究中，我们纵向调查了父母的焦虑和抑郁情况以及儿科重症监护病房（PICU）医护人员（主治医师、住院医师和床边注册护士）的道德困扰，并探讨了它们的发展轨迹及相互关系。焦虑/抑郁和医护人员的道德困扰分别使用医院焦虑抑郁量表和道德困扰温度计进行测量。使用Spearman相关性评估父母和医护人员困扰之间的关系，并使用二次随机斜率和截距模型探讨它们的发展轨迹以及潜在的相关变量。预先确定的相关因素包括人口统计学和临床因素，包括父母的心理社会风险和插管状态。我们发现，在孩子住院期间，父母的焦虑和抑郁有所减轻，并且父母的心理社会风险与焦虑显著相关（系数 = 4.43，<0.001）。不同角色的临床医生道德困扰的平均水平和发展轨迹不同，住院医师在入院早期报告的困扰更大，而护士在入院后期报告的困扰更大。父母的焦虑/抑郁与医护人员的困扰显著相关，尽管相关性为中等程度。我们得出结论，PICU住院时间延长的患儿父母的焦虑和抑郁与临床医生的道德困扰相关，且会随时间和医护人员角色的不同而变化。
