Prevalence, Risk Factors, and Outcomes of Financial Stress in Survivors of Critical Illness

Abstract

Objectives: Little is known about the experience of financial stress for patients who survive critical illness or their families. Our objective was to describe the prevalence of financial stress among critically ill patients and their families, identify clinical and demographic characteristics associated with this stress, and explore associations between financial stress and psychologic distress.

Design: Secondary analysis of a randomized trial comparing a coping skills training program and an education program for patients surviving acute respiratory failure and their families.

Setting: Five geographically diverse hospitals.

Participants: Patients (n = 175) and their family members (n = 85) completed surveys within 2 weeks of arrival home and 3 and 6 months after randomization.

Measurements and main results: We used regression analyses to assess associations between patient and family characteristics at baseline and financial stress at 3 and 6 months. We used path models and mediation analyses to explore relationships between financial stress, symptoms of anxiety and depression, and global mental health. Serious financial stress was high at both time points and was highest at 6 months (42.5%) among patients and at 3 months (48.5%) among family members. Factors associated with financial stress included female sex, young children at home, and baseline financial discomfort. Experiencing financial stress had direct effects on symptoms of anxiety (β = 0.260; p < 0.001) and depression (β = 0.048; p = 0.048).

Conclusions: Financial stress after critical illness is common and associated with symptoms of anxiety and depression. Our findings provide direction for potential interventions to reduce this stress and improve psychologic outcomes for patients and their families.

Figure 1. Path Models of Hypothesized Effects of Patients’ Financial Stress and Its Precursors on Quality of Life, Anxiety and Depression Symptoms, and Global Mental Health

(A) Based on R² estimates, the model accounts for 22.1% of the variance in patients’ perceptions of their quality of life, 37.0% of the variance in the existence of financial stress as one of the top three stressors, 30.7% of the variance in the latent anxiety construct, and 54.1% of the variance in patients’ self-assessed mental health status. All of these values have associated p <0.001. The p-value for the χ² test of fit of this model to the observed data = 0.0854. (B) Based on R² estimates, the model accounts for 21.2% of the variance in patients’ perceptions of their quality of life, 31.2% of the variance in the existence of financial stress as one of the top three stressors, 55.5% of the variance in the latent depression construct, and 52.5% of the variance in patients’ self-assessed mental health status – all having p <0.001. This model provided substantially better fit to the observed data than did the analogous model with anxiety symptoms as the mediator, having p-value for the χ² test of fit = 0.2529.