Informal caregivers of critically ill patients report high levels of depressive symptoms

1. From the caregivers for patients who had spent at least 7 days on a ventilator in an ICU, 67% initially and 43% at 1 year were found to report high levels of depressive symptoms.

2. Over 80% of all caregivers demonstrated a gradual decline in depressive symptoms by the first year.

Evidence Rating Level: 2 (Good)        

Study Rundown: The unpaid labor of informal caregivers has been estimated to have an annual value of $642 billion in the United States. These unpaid caregivers who are typically family or close friends are thought to be susceptible to poor psychological well-being. Additionally, poor caregiver outcomes may compromise patients’ rehabilitation potential and the sustainability of home care. This paper reports the findings of a multicenter, prospective, parallel cohort of patients who received mechanical ventilation for at least 7 days in an ICU and their caregivers. The outcomes analyzed were caregivers’ scores on four questionnaires of depressive symptoms, psychological well-being, and physical and mental health. This study shows strong evidence that most caregivers of critically ill patients report high levels of depressive symptoms, and that some caregivers do not show a decline in these symptoms even by one year.

The study was limited by its uncontrolled design and lack of assessment of the caregivers’ baseline mental health status before the ICU admission. As such, despite a strong correlation, causation of the depressive symptoms cannot be inferred. Furthermore, only 55% of the enrolled caregivers completed all four assessments that were examined in the study.

Click to read the study, published today in NEJM

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In-Depth [prospective cohort]: A total of 280 caregivers were enrolled in this study, while 238 completed at least one of the four assessments. The percentage of caregivers who reported high levels of depressive symptoms at 7 days was 67%, at 3 months was 49%, at 6 months was 43%, and at 12 months was 43%. 70% were women and 61% of them were caring for a spouse. The study revealed the presence of two sub-groups of caregivers: those whose depressive symptoms decreased over time (84%) and those whose depressive symptoms remained at a high level for up to one year (16%). Significant between-group differences were between those caregivers whose depressive symptoms decreased over time and those whose depressive symptoms remained high in physical health (p<0.001), mental health (p=0.003), control over life (p< 0.001), caregiver assistance (p=0.006), perceived social support (p<0.001), and ability to maintain participation in valued activities (p<0.001). A non-significant difference was found between the two cohorts’ psychological well-being (p=0.10).

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