Baseline Resilience and Posttraumatic Symptoms in Dyads of Neurocritical Patients and Their Informal Caregivers: A Prospective Dyadic Analysis
Baseline Resilience and Posttraumatic Symptoms in Dyads of Neurocritical Patients and Their Informal Caregivers: A Prospective Dyadic Analysis
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DOI：
10.1016/j.psym.2019.11.007
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发表时间：
2020-03-01
期刊：
影响因子：
3.4
通讯作者：
Vranceanu, Ana-Maria
中科院分区：
文献类型：
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作者：
Meyers, Emma E.;Shaffer, Kelly M.;Vranceanu, Ana-Maria
背景：进入神经科学重症监护病房（Neuro-ICU）对患者及其非正式护理人员来说是突然的，通常是创伤性的。以前没有研究前瞻性地评估慢性创伤后症状的风险和弹性因素，以及患者和照顾者症状之间的潜在相互依赖性。目的：分析基线弹性因素对神经重症监护病房（Neuro-ICU）患者及其主要家庭照顾者的创伤后应激（PTS）症状的纵向影响。方法：我们招募了神经重症监护室（N = 102）和他们的家庭照顾者（N = 103）的患者（M = 108）。Dyads在神经ICU完成了基线时PTS和弹性因素（正念和应对）的自我报告评估。在3个月和6个月随访时再次测量PTS。结果如下：基线时，患者（20%）和护理人员（16%）的临床显著PTS症状均较高，并在6个月内保持较高水平（患者25%;护理人员14%）。行为者-同伴相互依赖模型显示PTS症状的严重程度可预测后续时间点的PTS症状（P < 0.001）。在所有时间点，高基线正念和应对能力预测患者和照顾者的PTS症状较轻（P < 0.001）。对于患者和照顾者，3个月时自己的PTS症状程度预测6个月时伴侣的PTS症状更严重（P = 0.02）。结论：调查结果强调，需要通过二元方法优先评估和治疗神经重症监护室患者及其非正式护理人员的PTS。
Background: Admission to a neuroscience intensive care unit (Neuro-ICU) is sudden and often traumatic for both patients and their informal caregivers. No prior studies have assessed prospectively risk and resiliency factors for chronic posttraumatic symptoms, as well as the potential interdependence between patients' and caregivers' symptoms over time. Objective: To analyze the impact of baseline resiliency factors on symptoms of posttraumatic stress (PTS) longitudinally in dyads of patients admitted to the Neuro-ICU and their primary family caregivers. Methods: We recruited dyads (M = 108) of patients admitted to the Neuro-ICU (total N = 102) and their family caregivers (total N = 103 ). Dyads completed self-report assessments of PTS and resiliency factors (mindfulness and coping) at baseline in the Neuro-ICU. PTS was measured again at 3- and 6-month follow-up. Results: Clinically significant PTS symptoms were high at baseline in both patients (20%) and caregivers ( 16%) and remained high through 6 months (25% in patients; 14% in caregivers). Actor-partner interdependence modeling demonstrated that severity of PTS symptoms was predictive of PTS symptoms at subsequent time points (P < 0.001). High baseline mindfulness and coping predicted less severe PTS symptoms in patients and caregivers (P < 0.001) at all time points. Own degree of PTS symptoms at 3 months predicted worse PTS symptoms in one's partner at 6 months, for both patients and caregivers (P = 0.02). Conclusions: Findings highlight the need to prioritize assessment and treatment of PTS in Neuro-ICU patients and their informal caregivers through a dyadic approach.