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Psychosocial Outcomes in Informal Caregivers of the Critically Ill

A Systematic Review*

Haines, Kimberley J. B Health Science (Physiotherapy)1; Denehy, Linda PhD, B Applied Science (Physiotherapy)2; Skinner, Elizabeth H. PhD, B Physiotherapy (Hons)3; Warrillow, Stephen MBBS, FCICM, FRACP4; Berney, Sue B Physiotherapy, M Physiotherapy, PhD1

doi: 10.1097/CCM.0000000000000865
Review Articles

Objective: The objective of the review was to evaluate and synthesize the prevalence, risk factors, and trajectory of psychosocial morbidity in informal caregivers of critical care survivors.

Data Sources: A systematic search of MEDLINE, PsychInfo, PubMed, CINAHL, Cochrane Library, Scopus, PILOTS, EMBASE, and Physiotherapy Evidence Database was undertaken between January and February 2014.

Study Selection: Citations were screened independently by two reviewers for studies that investigated psychosocial outcomes (depression, anxiety, stress, posttraumatic stress disorder, burden, activity restriction, and health-related quality of life) for informal caregivers of critical care survivors (mechanically ventilated for 48 hr or more).

Data Extraction: Data on study outcomes were extracted into a standardized form and quality assessed by two independent reviewers using the Newcastle-Ottawa Scale, the Physiotherapy Evidence Database, and the National Health and Medical Research Council Hierarchy of Evidence guide. Preferred Reporting Items for Systematic Reviews guidelines were followed.

Data Synthesis: Fourteen studies of 1,491 caregivers were included. Depressive symptoms were the most commonly reported outcome with a prevalence of 75.5% during critical care and 22.8–29% at 1-year follow-up. Risk factors for depressive symptoms in caregivers included female gender and younger age. The greatest period of risk for all outcomes was during the patient’s critical care admission although psychological symptoms improved over time. The overall quality of the studies was low.

Conclusions: Depressive symptoms were the most prevalent in informal caregivers of survivors of intensive care who were ventilated for more than 48 hours and persist at 1 year with a prevalence of 22.8–29.0%, which is comparable with caregivers of patients with dementia. Screening for caregiver risks could be performed during the ICU admission where intervention can be implemented and then evaluated. Further high-quality studies are needed to quantify anxiety, stress, caregiver burden, and posttraumatic stress disorder outcomes in informal caregivers of long-stay patients surviving ICU.

1Department of Physiotherapy, Austin Hospital, Heidelberg, Victoria, Australia.

2Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.

3Department of Physiotherapy, Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia.

4Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.

*See also p. 1149.

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Ms. Haines (primary author) was supported by the National Health and Medical Research Council Dora Lush Scholarship (no. 1055996); is employed by St. Vincent’s Hospital Melbourne, Austin Health; and lectured for Australian Physiotherapy Association. Her institution received grant support from the Austin Health Medical Research Foundation and the University of Melbourne, Melbourne Abroad Traveling Scholarship. Dr. Denehy is employed by the University of Melbourne. Her institution received grant support from the National Health and Medical Council. Dr. Skinner is employed by Western Health and lectured for the Australian Physiotherapy Association. Her institution received grant support from the Australian Institute of Musculoskeletal Science, Western Health, the Department of Health (Victoria), the National Health and Medical Research Council, the Australian Physiotherapy Association, the Physiotherapy Research Foundation, and the Australian and New Zealand College of Anaesthetists. Dr. Berney is employed by Austin Health. Her institution received grant support from the National Health and Medical Research Council Fellowship. Mr. Warrillow has disclosed that he does not have any potential conflicts of interest.

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