Mental Health Interventions to Improve Psychological Outcomes in Informal Caregivers of Critically Ill Patients: A Systematic Review and Meta-Analysis

Abstract

Objectives: Determine effect of mental health interventions on psychologic outcomes in informal caregivers of critically ill patients.

Data sources: Searches conducted in MEDLINE, Embase, and other databases from inception to October 31, 2019.

Study selection: Interventions for informal caregivers of critically ill patients in adult ICU, PICU, or neonatal ICU.

Data extraction: Two independent, blinded reviewers screened citations and extracted data. Random-effects models with inverse variance weighting pooled outcome data when suitable. Psychologic outcomes categorized: 1) negative (anxiety, depression, post-traumatic stress disorder, distress, and burden) or 2) positive (courage, humanity, justice, transcendence, temperance, and wisdom and knowledge). Stratification according to intervention type and patient population was performed.

Data synthesis: Of 11,201 studies, 102 interventional trials were included (n = 12,676 informal caregivers). Interventions targeted caregiver experience (n = 58), role (n = 6), or support (n = 38). Meta-analysis (56 randomized controlled trials; n = 22 [39%] in adult ICUs; n = 34 [61%] in neonatal ICU or PICU) demonstrated reduced anxiety (ratio of means = 0.92; 95% CI, 0.87-0.97) and depression (ratio of means = 0.83; 95% CI, 0.69-0.99), but not post-traumatic stress disorder (ratio of means = 0.91; 95% CI, 0.80-1.04) or distress (ratio of means = 1.01; 95% CI, 0.95-1.07) among informal caregivers randomized to mental health interventions compared with controls within 3 months post-ICU discharge. Increased humanity (ratio of means = 1.11; 95% CI, 1.07-1.15), transcendence (ratio of means = 1.11; 95% CI, 1.07-1.15), and caregiver burden (ratio of means = 1.08; 95% CI, 1.05-1.12) were observed. No significant effects of mental health interventions observed after 3 months postdischarge.

Conclusions: Mental health interventions for caregivers of critically ill patients improved short-term anxiety, depression, humanity, and transcendence while increasing burden. Clinicians should consider short-term prescriptions of mental health interventions to informal caregivers of critically ill patients with capacity to manage interventions.

Figure 1.

Study flow diagram. PTSD = post-traumatic stress disorder.

Figure 2.

Ratio of means in psychological outcomes in the randomized trials amenable to meta-analysis. Ratio of means is the difference between the experimental group to the control group. Horizontal lines denote 95% confidence intervals. Diamonds represent point estimates for informal caregiver (A) negative and (B) positive psychological outcomes grouped by follow-up. PTSD = post-traumatic stress disorder.

Figure 3.

Ratio of means in psychological outcomes in the randomized trials amenable to meta-analysis. Ratio of means is the difference between the experimental group to the control group. Horizontal lines denote 95% confidence intervals. Diamonds represent point estimates for informal caregiver (A) anxiety and (B) depression grouped by follow-up. Parentheses following study reference denote intervention type: caregiver experience (E); caregiver role (R); caregiver support (S). Asterisk indicates adult patient population. PTSD = post-traumatic stress disorder.

Figure 4.

Ratio of means in psychological outcomes in the randomized trials amenable to meta-analysis. Ratio of means is the difference between the experimental group to the control group. Horizontal lines denote 95% confidence intervals. Diamonds represent point estimates for informal caregiver burden (A) humanity (B), and transcendence (C) grouped by follow-up. Parentheses following study reference denote intervention type: caregiver experience (E); caregiver role (R); caregiver support (S). Asterisk indicates adult patient population. PTSD = post-traumatic stress disorder.