Abstract
BackgroundWitnessing delirium can be distressing for family caregivers (i.e., relatives or friends) of critically ill patients. This study aimed to evaluate associations between caregiver-detected delirium in critically ill patients and depression and anxiety symptoms in their family caregivers.MethodsConsecutive adult patient-caregiver dyads were enrolled from a 28-bed medical-surgical intensive care unit. Patient delirium was screened for daily by family caregivers using the Sour Seven instrument. Family caregivers completed the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) instruments daily to assess their own depression and anxiety symptoms. Response feature analysis was used to handle repeated measures. Descriptive statistics and regression analyses were completed.ResultsOne hundred forty-seven patient-caregiver dyads were enrolled. Clinically significant symptoms of depression and anxiety occurred in 27% and 35% of family caregivers, respectively. Caregiver-detected delirium occurred in 65% of patients, and was not associated with clinically significant caregiver depression (Odds Ratio [OR] 1.4, 95% Confidence Interval [95%CI] 0.6–3.1) or anxiety (OR 1.2, 95%CI 0.6–2.6) symptoms. When stratified by Sour Seven scores, scores 1–3 and 4–9 were associated with increased symptoms of anxiety (OR 3.1, 95%CI 1.3–7.0) and depression (OR 2.6, 95%CI 1.1–6.1) in family caregivers. Caregiver-detected delirium score was associated with severity of family caregiver anxiety symptoms (coefficient 0.2, 95%CI 0.1–0.4), but not depression symptoms (coefficient 0.2, 95%CI -0.0–0.3).ConclusionsCaregiver-detected patient delirium was associated with increased depression and anxiety symptoms in family caregivers of critically ill patients. Further randomized research is required to confirm these associations.
Highlights
Witnessing delirium can be distressing for family caregivers of critically ill patients
Family caregivers may be especially useful for identifying delirium, when delirium presents with subtle symptoms such as lethargy and withdrawal [6]
We found that delirium detected by family caregivers using the Sour Seven was not significantly associated with the presence of clinically significant symptoms of depression or anxiety in family caregivers
Summary
Witnessing delirium can be distressing for family caregivers (i.e., relatives or friends) of critically ill patients. An ICU stay can be distressing for family caregivers due to uncertainty regarding their loved ones’ condition, inability to speak with their loved one, and witnessing their loved one in a critically ill condition [2]. Caregivers are often present at the bedside and familiar with a patient’s baseline mental status and well-positioned to detect delirium. In an ICU sample, the Sour Seven performed similar to provider-administered delirium measurement tools in identifying delirium, highlighting the potential utility for involving family caregivers in delirium detection [7]. Meaningful involvement of family caregivers in patient care has demonstrated improvements in satisfaction with care and reduced distress [8, 9]. It is unknown how family participation in delirium detection impacts distress and adverse psychological outcomes in family caregivers
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