Mental health and quality of life outcomes in family members of patients with chronic critical illness admitted to the intensive care units of two Brazilian hospitals serving the extremes of the socioeconomic spectrum


Autoři: Renata Rego Lins Fumis aff001;  Antonio Bento Ferraz aff002;  Isac de Castro aff003;  Henrique Souza Barros de Oliveira aff001;  Marcelo Moock aff002;  José Mauro Vieira Junior aff001
Působiště autorů: Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, Brazil aff001;  Intensive Care Unit, Hospital Geral do Grajaú, São Paulo, Brazil aff002;  Division of Nephrology and Molecular Medicine, Department of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0221218

Souhrn

Chronic critical illness (CCI) is a relevant clinical, social and financial health issue. The aim of this study was to compare the mental outcomes (symptoms of anxiety and depression) and quality of life outcomes of the family members of patients with CCI from different socioeconomic backgrounds who were admitted to one of the intensive care units (ICUs) in two Brazilian hospitals, one private and one public. It is a prospective study involving a public hospital that serves a low-income population and a tertiary private hospital that serves a high-income population. Family members of patients with CCI answered the Hospital Anxiety and Depression Scale (HADS) and The World Health Organization Quality of Life–WHOQOL-bref questionnaires. They responded to the European Quality of life Five Dimension three Level (EuroQol-5D-3L) and the Activities of Daily Living (ADL) questionnaires on behalf of the patients at three time points: during the ICU stay, 30 and 90 days after the patient was discharged. We used logistic regression models to evaluate the main predictors of a binary outcome regarding symptoms of anxiety and depression. We enrolled 186 patients with CCI. Many patients from public hospitals who were independent became dependent for their ADLs at 90 days (41.7% versus 14.3%, p = 0.03). At 30 days, family members from public hospital had worse impact on all domains of WHOQOL-bref compared with families from private hospital. At 90-days, the difference persists in the physical domain, worse for families from public hospital (p = 0.006). The symptoms of depression at 30-days (p = 0.008) and at 90-days (p = 0.013) were worse in the public hospital. CCIs affected quality of life and the emotional condition of family members, especially in families with fewer resources when the patients became more dependent. Family members with higher education were more likely to experience depression, while depression was associated with cohabiting with the patient in low-income families.

Klíčová slova:

Medicine and health sciences – Health care – Health care facilities – Hospitals – Intensive care units – Quality of life – Activities of daily living – Mental health and psychiatry – Mood disorders – Depression – Public and occupational health – Socioeconomic aspects of health – Biology and life sciences – Psychology – Emotions – Anxiety – Social sciences


Zdroje

1. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182:446–54. doi: 10.1164/rccm.201002-0210CI 20448093

2. Kahn JM, Le T, Angus DC, Cox CE, Hough CL, White DB, et al. The epidemiology of chronic critical illness in the United States*. Crit Care Med. 2015;43:282–7. doi: 10.1097/CCM.0000000000000710 25377018

3. Hickman RL Jr., Douglas SL. Impact of chronic critical illness on the psychological outcomes of family members. AACN Adv Crit Care. 2010;21:80–91. doi: 10.1097/NCI.0b013e3181c930a3 20118707

4. Sakusic A, Gajic O. Chronic critical illness: unintended consequence of intensive care medicine. Lancet Respir Med. 2016;4:531–2. doi: 10.1016/S2213-2600(16)30066-2 27155771

5. Im K, Belle SH, Schulz R, Mendelsohn AB, Chelluri L. Prevalence and outcomes of caregiving after prolonged (> or = 48 hours) mechanical ventilation in the ICU. Chest. 2004;125:597–606. doi: 10.1378/chest.125.2.597 14769744

6. Van Pelt DC, Milbrandt EB, Qin L, Weissfeld LA, Rotondi AJ, Schulz R, et al. Informal caregiver burden among survivors of prolonged mechanical ventilation. Am J Respir Crit Care Med. 2007;175:167–73. doi: 10.1164/rccm.200604-493OC 17068327

7. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370:1929–38. doi: 10.1016/S0140-6736(07)61696-1 18063029

8. Maguire JM, Carson SS. Strategies to combat chronic critical illness. Curr Opin Crit Care. 2013;19:480–7. doi: 10.1097/MCC.0b013e328364d65e 23995126

9. Rzewuska M, de Azevedo-Marques JM, Coxon D, Zanetti ML, Zanetti AC, Franco LJ, et al. Epidemiology of multimorbidity within the Brazilian adult general population: evidence from the 2013 national health survey (PNS 2013). PLoS One. 2017;12:e0171813. doi: 10.1371/journal.pone.0171813 28182778

10. Lewis M, Penteado E, Malik AM. Brazil’s mixed public and private hospital system. World Hosp Health Serv. 2015;51:22–6.

11. Mapa da desigualdade. https://www.nossasaopaulo.org.br/arqs/mapa-da-desigualdade-apresentacao-2016.pdf.

12. Fumis RR, Ranzani OT, Martins PS, Schettino G. Emotional disorders in pairs of patients and their family members during and after ICU stay. PLoS One. 2015; 23;10:e0115332. doi: 10.1371/journal.pone.0115332 25616059

13. Botega NJ, Bio MR, Zomignani MA, Garcia C Jr., Pereira WA. Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Rev Saude Publica. 1995;29:355–63. doi: 10.1590/s0034-89101995000500004 8731275

14. Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica. 2000;34:178–83. doi: 10.1590/s0034-89102000000200012 10881154

15. EuroQol Research Foundation: EQ-5D-5L https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/. Accessed 1 July 2017.

16. Lino VT, Pereira SR, Camacho LA, Ribeiro Filho ST, Buksman S. Cross-cultural adaptation of the independence in activities of daily living index (Katz Index). Cad Saude Publica. 2008;24:103–12. 18209838

17. Using Proxies to assess Quality of Life: A Review of the Issues and Challenges. https://core.ac.uk/download/pdf/42411586.pdf

18. https://euroqol.org/eq-5d-instruments/eq-5d-5l-available-modes-of-administration/proxy/

19. Carson SS, Bach PB. The epidemiology and costs of chronic critical illness. Critical Care Clinics. 2002;18:461–76. 12140908

20. Leske JS, Jiricka MK. Impact of family demands and family strengths and capabilities on family well-being and adaptation after critical injury. Am J Crit Care. 1998;7:383–92. 9740889

21. van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Reported burden on informal caregivers of ICU survivors: a literature review. Crit Care. 2016; 21;20:16. doi: 10.1186/s13054-016-1185-9 26792081

22. Cameron JI, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, et al. RECOVER Program Investigators (Phase 1: towards RECOVER); Canadian Critical Care Trials Group. One-Year Outcomes in Caregivers of Critically Ill Patients. N Engl J Med. 2016;374:1831–41. doi: 10.1056/NEJMoa1511160 27168433

23. Matt B, Schwarzkopf D, Reinhart K, Konig C, Hartog CS. Relatives’ perception of stressors and psychological outcomes—results from a survey study. J Crit Care. 2017;39:172–7. doi: 10.1016/j.jcrc.2017.02.036 28273613

24. Moralez GM, Rabello LSCF, Lisboa TC, Lima MdFA, Hatum RM, De Marco FVC, et al. External validation of SAPS 3 and MPM(0)-III scores in 48,816 patients from 72 Brazilian ICUs. Ann Intensive Care. 2017;7:53. doi: 10.1186/s13613-017-0276-3 28523584

25. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31:611–20. doi: 10.1007/s00134-005-2592-6 15803303

26. Wintermann GB, Weidner K, Strauss B, Rosendahl J, Petrowski K. Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care. Ann Intensive Care. 2016;6:69. doi: 10.1186/s13613-016-0174-0 27439709

27. Van den Broucke S. Health literacy: a critical concept for public health. Arch Public Health. 2014;72:10. doi: 10.1186/2049-3258-72-10 24685171

28. Van Pelt DC, Schulz R, Chelluri L, Pinsky MR. Patient-specific, time-varying predictors of post-ICU informal caregiver burden: the caregiver outcomes after ICU discharge project. Chest. 2010;137:88–94. doi: 10.1378/chest.09-0795 19762552

29. Erdem Ö, Van Lenthe FJ, Prins RG, Voorham TA, Burdorf A. Socioeconomic Inequalities in Psychological Distress among Urban Adults: The Moderating Role of Neighborhood Social Cohesion. PLoS One. 2016;11:e0157119. doi: 10.1371/journal.pone.0157119 27280601


Článek vyšel v časopise

PLOS One


2019 Číslo 9
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