Psychological Distress In Family Members Research Articles

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study

BackgroundFamily member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PurposeTo explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. MethodQualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FindingsWe interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme ‘Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a ‘distance’ due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient’s wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. ConclusionVisiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members’ perceptions of distance and exclusion from the intensive care unit.

Risk and resilience of vulnerable families in Hong Kong under the impact of COVID-19: an ecological resilience perspective.

PurposeHong Kong has experienced four waves of COVID-19 since the first case was confirmed in January 2020. Several studies have highlighted the psychological impacts of the outbreak in Hong Kong but have largely ignored the protective factors that contribute to resilience among vulnerable families. This study adopted an ecological resilience framework to explore the impact of this epidemic on members of families with youth with a delinquent tendency/mental health concerns and the ecological protective factors for these vulnerable families.MethodsRandom sampling based on a sampling frame provided by one of the largest local social service organizations in Hong Kong led to the recruitment of 407 respondents who were interviewed using a battery of standardized questionnaires.ResultsThe results showed that 30.6% and 11.5% of respondents reported a moderate and a severe level of psychological distress, respectively, almost double the percentages reported in a previous study conducted in Hong Kong before the COVID-19 outbreak. Around 36.6% of respondents indicated they had encountered financial problems and almost 40% indicated aggravated financial circumstances since the outbreak. Hierarchical regression analysis revealed that financial stress was the strongest predictor of psychological distress. Structural equation modeling indicated that family support, indoor leisure activities and community resources significantly mediated the negative influence of COVID-19-related stressors on psychological distress of family members.ConclusionFamily leisure activities, family support, community spirit and mutual help within the context of social-distancing restrictions may need to be promoted to benefit vulnerable families in Hong Kong under the COVID-19 epidemic.

Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model

BackgroundAdverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients.MethodsWe conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other’s ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures.ResultsA total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress.ConclusionsOur results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.

FAMILY ACCOMMODATION, CAREGIVER BURDEN AND PSYCHOLOGICAL DISTRESS IN FAMILY MEMBERS OF PATIENTS WITH OBSESSIVE COMPULSIVE DISORDER

Psychological disorders affect the life of both patients and their family members. Family members of psychological patients play a vital part in treatment and intervention of patients suffering from psychological problems. Their support may facilitate the patient in treatment as well as on the other hand may contribute to exacerbation. However, such family members also suffer while dealing with their relatives who suffer from psychological disorders. Therefore, this study is intended to find out how family accommodation causes impairment in treatment of obsessive-compulsive disorder (OCD) patients, to measure the burden of care (in terms of six dimensions i.e., financial burden, disruption of family routine, disruption of family leisure, disruption of family interaction, effect on physical health of others and effect on mental health of others) and to determine the level of psychological distress in family members of OCD patients. The present correlational research was consisted of 120 family members (42 men, 78 women), who were the primary caregivers. Result of Pearson Product Moment Correlation showed a highly significant positive relationship between family accommodation, caregiver burden and psychological distress. Mediation analysis was done using PROCESS which showed that caregiver burden mediated the relationship between family accommodation and psychological distress. Family interventions regarding accommodation by family members can be provided in order to improve the patient treatment and research findings can also be implied to teach coping strategies to family members in order to deal the burden they experienced.

Family-clinician communication in the ICU and its relationship to psychological distress of family members: A cross-sectional study

BackgroundEffective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members’ perception of communication quality with clinicians may be associated with their psychological symptoms. ObjectivesTo examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs). DesignA cross-sectional study. Settings and participantsThe participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea. MethodsParticipants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis. ResultsThe mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants’ HADS-depression scores (β = −.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates. ConclusionsThe findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills.

Brief multifamily Psychoeducation for family members of patients with chronic major depression: a randomized controlled trial

BackgroundMajor depressive disorder (MDD) is a common and often chronic problem. Patients with chronic MDD often have negative impacts on the health of their families. Family psychoeducation is recognized as part of the optimal treatment for patients with psychotic disorder, and has been shown to reduce the rate of relapse in individuals with schizophrenia and to reduce the burden on their caregivers. Thus, we predict that family psychoeducation has the potential to reduce the burden on the caregivers of patients with chronic MDD. In the present study, we aimed to investigate the effects of brief multifamily psychoeducation (BMP) on the mental health status of family members of patients with chronic MDD.MethodsWe conducted a clinical trial consisting of 49 chronic MDD patients and their families. Each family was randomly assigned to either the BMP intervention group or the control group. The intervention group received four BMP sessions, once every two weeks for eight weeks. The control group received one counseling session administered by a nurse. All patients received standard treatment administered by physicians. The primary outcome measurement was the Kessler Screening Scale for Psychological Distress (K6) score of family members at 16- weeks after the first BMP session. Secondary outcomes were depressive symptoms of both family members and patients at multiple time points, as well as family functioning as evaluated by the patients. Intention-to-treat analyses were conducted.ResultsThere was no statistically significant effect of BMP on K6 scores at 16- weeks (mean difference 1.17, 95% confidence interval: − 0.63 to 2.98, P = 0.19). Exploratory analyses revealed that BMP reduced depressive symptoms in family members at 8- weeks (difference = − 3.37, 95%CI -6.32 to − 0.43, P = 0.02) and improved family functioning at multiple time points (Role; 8 W, difference = − 0.13, 95%CI -0.26 to − 0.00, P = 0.04, Affective Responsiveness; 8 W, difference = − 0.24, 95%CI -0.43 to − 0.05, P = 0.01, 32 W, difference = − 0.22, 95%CI -0.41 to − 0.03, P = 0.02, Behavior Control; 16 W, difference = − 0.17, 95%CI -0.34 to − 0.00, P = 0.04).ConclusionsFour BMP sessions did not significantly reduce the psychological distress of family members of patients with chronic MDD.Trial registrationClinical Trials. gov NCT01734291, retrospectively registered (Registration date: November 21, 2012).

Effectiveness of family interventions on psychological distress and expressed emotion in family members of individuals diagnosed with first-episode psychosis: a systematic review.

A critical period for persons with first-episode psychosis is the first two years after diagnosis, when they are at high risk of suicide attempts, violent behaviors and substance abuse. This period also has a great impact on the psychological distress of family members, particularly caregivers who either provide care or live with ill family members. In addition, the families also report feelings of being overwhelmed when accessing service facilities at this critical point. These consequences impact on the affective tone/atmosphere in the family, also referred to as so-called expressed emotion. In addition, expressed emotion research has indicated that the family atmosphere contributes to recurrent psychosis and lengthy hospital stays for patients in the initial phase. Therefore, family interventions aimed at reducing psychological distress and improving expressed emotion in families during this critical time are very important. Modern research has yielded international evidence addressing these outcomes, but little is known about which interventions are the most effective. Therefore, this review aimed to evaluate the effectiveness of these interventions. The objective of this review was to examine the effectiveness of family interventions on psychological distress and expressed emotion in family members of persons with first-episode psychosis (FEP). Family members of persons with FEP and who had received treatment after being diagnosed within two years. Studies that examined interventions among family members of persons with FEP. Family interventions referred to any education, psychoeducation, communication, coping and problem-solving skills training and cognitive behavioral therapy that was provided to family members of persons with FEP. Psychological distress and expressed emotions of those family members. Randomized controlled trials, quasi-experimental studies, cohort studies and case-control studies. The preliminary search was conducted in MEDLINE and CINAHL with keywords containing the title, abstract and subject description analysis as the first identification of related studies. An extensive search was conducted in other databases including ProQuest Dissertations and Theses, ScienceDirect, Scopus, PsychINFO, ThaiLIS and Thai National research databases. In addition, searches of reference lists and other manual searches were undertaken. Studies were critically appraised by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted using the standardized data extraction tools from the Joanna Briggs Institute. The mean score and standard deviation (SD) were extracted for targets outcomes relating to psychological distress and expressed emotion. Quantitative data could not be pooled due to the heterogeneity of the included studies. Data were synthesized based on the individual results from the three included studies and have been presented in a narrative format accompanied with tabulated data. Data synthesis of the three individual studies indicated that there were no statistically significant interventions that address psychological distress and expressed emotion in family members who live with and care for persons with FEP. There is insufficient evidence available to evaluate the effect sizes for pooled outcomes. Based on the results of this review, there is insufficient evidence to validate the effectiveness of family interventions on psychological distress and expressed emotion in family members who live with and care for persons with FEP. In addition, based on the individual primary studies, the implications for practice should be carefully considered.

Symptoms of Cardiac Anxiety in Family Members of Intensive Care Unit Patients.

Studies have shown an association between intensive care unit environments and symptoms of psychological distress in family members of critically ill patients. To investigate levels of cardiac anxiety in family members of intensive care unit patients. From March 2012 to July 2013, on the third day after the patient's admission, 223 family members of 147 patients completed the Cardiac Anxiety Questionnaire. A total score was calculated from 3 subscales: fear and worry about heart sensations, avoidance of activities reproducing cardiac symptoms, and heart-focused attention and monitoring of cardiac activity. Among the family members, 142 were women (63.7%) and 81 (36.3%) were men, 150 (67.3%) were married, and 37 (16.6%) were unemployed. Their mean score for overall cardiac anxiety was 1.11 (SD, 0.64), significantly higher (P < .001) than for the general Greek population. Although all 3 subscales scores were significantly higher than for the general population, the highest score was recorded for the avoidance subscale (mean, 1.77; SD, 0.68). The relationship to the patient had a significant effect on heart-focused attention (F5 = 3.51; P = .03). The mean score for patients' siblings (2.0; SD, 0.01) differed significantly (P = .02) from the mean for other family member groups. Older adults (P = .02) and married participants (P = .05) reported higher levels of fear and worry related to cardiac stimuli, and women further reported higher levels of cardioprotective avoidance behavior (P = .02). A noticeable number of family members of critical care patients had moderate to severe cardiac anxiety during the hospitalization of their relatives.

ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms.

Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

Clinical Pearls

Guidelines for appropriate patient assessments after procedures are often not evidence based. The standard after removal of temporary pacer wires is to monitor “routine” vital signs (VS) at set intervals. To determine if current procedures for obtaining VS after temporary pacemaker wire removal (TPWR) effectively identify risks for cardiac tamponade (CT), Mahon and colleagues reviewed 23 717 cardiothoracic surgery cases with 23 reoperations for CT following TPWR. Blood pressure changes were the most common single symptom after TPWR and before reoperation for CT. Other findings were bleeding in 6 cases (26%), dyspnea in 26% of reviewed patients, and infrequent heart rate changes. Based on these findings, the authors suggest the following:—Elisabeth George,rn, phdSee Article, pp 432–440In a retrospective study, Nye and colleagues compared scores of the Glasgow Coma Scale (GCS) and 3 published “slim” versions of the National Institutes of Health Stroke Scale (NIHSS) with the full NIHSS to evaluate the value of these measures in detecting neurologic disability. Study findings revealed the following:These findings uphold the American Stroke Association and Brain Attack Coalition Guidelines for use of the NIHSS to quantify neurologic disability in acute stroke patients.— Karen A. McQuillan,rn, ms, cns-bc, ccrn, cnrnSee Article, pp 442–448McAdam and colleagues studied the levels of psychological distress in family members of high-risk intensive care unit (ICU) patients and found that psychological symptoms decreased 3 months after the ICU stay but remained high enough to warrant concern. Nurses may be able to recognize symptoms of stress in family members by observing the following:Preventive measures to respond to family needs may include these techniques:—Janet Mulroy,rn, msn, acnp, ccns, ccrnSee Article, pp 386–394

Psychotherapy for Depression Among Patients with Advanced Cancer

Cancer causes profound suffering for patients, and previous reports have demonstrated that psychological distress, particularly depression, is frequently observed in advanced and/or terminally ill cancer patients. Such depression can lead to serious and far-reaching negative consequences in patients with advanced cancer: reducing their quality of life and causing severe suffering, a desire for early death, and suicide, as well as psychological distress in family members. For the management of their distress, cancer patients are more likely to prefer psychotherapeutic interventions to pharmacotherapy, and psychotherapy is known to be effective for the management of depression among advanced cancer patients. Hence, psychotherapy is an important treatment strategy for alleviating their depression. Furthermore, patients with advanced and/or terminal cancer suffer from various physical symptoms and are forced to face a continuous decline in physical function. In addition, psychological defense mechanisms such as denial are frequently observed in these patients. Hence, an individually tailored and careful psychotherapeutic approach should be followed, which considers the specific nature of the advanced and/or terminal cancer. This review focuses on psychological interventions that can be utilized in the clinical oncology practice to ameliorate depression among advanced and/or terminally ill cancer patients, rather than focusing on the level of evidence for each intervention. In addition, the current review introduces some novel therapeutic strategies that have not yet been proved to be effective but show promise for future studies.

Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents

Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at-risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post-traumatic stress symptoms (PTSS). Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self-report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State-trait anxiety, depression, and PTSS were assessed to all of the participants. The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict ('Supportive-type', n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict ('Conflictive-type', n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict ('Intermediate-type', n=113). Among the three types, an analysis of variance revealed that 'Conflictive-type' members had the highest levels of PTSS, depression, and state-trait anxiety. These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family-focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a 'Conflictive-type' family member.

Psychological distress of family members with cancer patients in Japan

BACKGROUND: There were no previous studies in Japan on the psychological distress of members of families with cancer patients which focussed on the disclosure of the diagnosis of cancer. This study was designed to investigate factors that may have an effect on the psychological distress of family members. METHODS: The subjects were 95 members of families of cancer patients in the surgical ward; one member was recruited from each patient's family. The psychiatrist investigated the demographic factors of both the patient and the family member: for the patient - gender, age, occupation, cancer site, disclosure (or not) of cancer diagnosis, cancer stage and performance status (PS); for the family member - gender, age, occupation, relationship to the patient, physical illness, frequency of visiting the ward, the period from when the family member was informed of the diagnosis, and any past experience of the loss of close relatives due to cancer. Furthermore, we conducted a survey on the family member's anxiety and depression by using the Spielberger State - Trait Anxiety Inventory (STAI) and the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: A multiple regression analysis indicated that the factors which were associated with the STAI scores independently were the lack of disclosure of the diagnosis to the patient (P=0.01), and advanced or recurrent cancer (P=0.01). The factors which were associated with the CES-D scores independently were the lack of disclosure of the diagnosis to the patient (P=0.03), advanced or recurrent cancer (P=0.01), and the family member's past history of psychiatric disorders (P=0.01). CONCLUSIONS: The results suggested that the psychological distress of a family member increases when the patient is not informed of the cancer diagnosis, when the cancer is advanced or recurrent, and when the family member has a past history of psychiatric disorders. (Int J Psych Clin Pract 2002; 6: 205-210 )

Psychological distress in family members living with human immunodeficiency virus/acquired immune deficiency syndrome

This article describes the psychological distress experienced by family members living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Survey data were collected from 133 individuals, (47 parents, 53 siblings, 33 adult family members who have HIV/AIDS) representing 80 families. In-depth interview and observational data were collected from a subset of the sample. The physical and psychological health of individual family members was assessed by the 53-item Brief Symptom Inventory. Parents, siblings, and people living with AIDS (PWAs) reported higher levels of overall distress and scored higher on symptom dimensions and clinically discrete symptoms than normative comparison groups. Implications of these findings for research, clinical practice, and health and social service policy are identified and discussed.