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. 2021 Nov 5;21(1):1202.
doi: 10.1186/s12913-021-07218-1.

The impact of patient delirium in the intensive care unit: patterns of anxiety symptoms in family caregivers

Therese G Poulin  1 , Karla D Krewulak  1 , Brianna K Rosgen  2 , Henry T Stelfox  2 , Kirsten M Fiest  3 , Stephana J Moss  2
Affiliations

The impact of patient delirium in the intensive care unit: patterns of anxiety symptoms in family caregivers

Therese G Poulin et al. BMC Health Serv Res. .

Abstract

Background: The purpose of this study was to examine the association of patient delirium in the intensive care unit (ICU) with patterns of anxiety symptoms in family caregivers when delirium was determined by clinical assessment and family-administered delirium detection.

Methods: In this cross-sectional study, consecutive adult patients anticipated to remain in the ICU for longer than 24 h were eligible for participation given at least one present family caregiver (e.g., spouse, friend) provided informed consent (to be enrolled as a dyad) and were eligible for delirium detection (i.e., Richmond Agitation-Sedation Scale score ≥ - 3). Generalized Anxiety Disorder-7 (GAD-7) was used to assess self-reported symptoms of anxiety. Clinical assessment (Confusion Assessment Method for ICU, CAM-ICU) and family-administered delirium detection (Sour Seven) were completed once daily for up to five days.

Results: We included 147 family caregivers; the mean age was 54.3 years (standard deviation [SD] 14.3 years) and 74% (n = 129) were female. Fifty (34% [95% confidence interval [CI] 26.4-42.2]) caregivers experienced clinically significant symptoms of anxiety (median GAD-7 score 16.0 [interquartile range 6]). The most prevalent symptoms of anxiety were "Feeling nervous, anxious or on edge" (96.0% [95%CI 85.2-99.0]); "Not being able to stop or control worrying" (88.0% [95%CI 75.6-94.5]; "Worrying too much about different things" and "Feeling afraid as if something awful might happen" (84.0% [95%CI 71.0-91.8], for both). Family caregivers of critically ill adults with delirium were significantly more likely to report "Worrying too much about different things" more than half of the time (CAM-ICU, Odds Ratio [OR] 2.27 [95%CI 1.04-4.91]; Sour Seven, OR 2.28 [95%CI 1.00-5.23]).

Conclusions: Family caregivers of critically ill adults with delirium frequently experience clinically significant anxiety and are significantly more likely to report frequently worrying too much about different things. Future work is needed to develop mental health interventions for the diversity of anxiety symptoms experienced by family members of critically ill patients.

Trial registration: This study is registered on ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03379129 ).

Keywords: Anxiety; Critical care; Delirium; Engagement; Family; Intensive care unit.

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Conflict of interest statement

The authors have no competing interests relevant to this work.

Figures

Fig. 1
Fig. 1
Study Flow Diagram
Fig. 2
Fig. 2
Ordinal Logistic Regression Analyses for GAD-7 Items by Patient Delirium Detection Tool. GAD-7 = Generalized Anxiety Disorder-7. Each item scored as 0, not at all; 1, several days; 2, more than half the days; 3, nearly every day. Sour Seven is scored out of 18; cutpoint of 4. Ordinal logistic regression (cumulative logit) of ordered GAD-7 items; Odds ratio above 1 indicate trend towards item score 2 or greater among family caregivers of patients with delirium. Models adjusted for family age, family sex, family education, and patient Acute Physiology and Chronic Health Evaluation II score (dichotomized at median value). All values represent odds ratio with 95% CI; * = p < 0.05
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References

    1. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182(4):446–454. doi: 10.1164/rccm.201002-0210CI. - DOI - PMC - PubMed
    1. Finfer S, Vincent JL. Critical care--an all-encompassing specialty. N Engl J Med. 2013;369(7):669–670. doi: 10.1056/NEJMe1304035. - DOI - PubMed
    1. Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38(1):65–71. doi: 10.1097/CCM.0b013e3181b090d0. - DOI - PubMed
    1. Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Palliat Med. 2013;27(6):486–498. doi: 10.1177/0269216312457214. - DOI - PubMed
    1. Diwell RA, Davis DH, Vickerstaff V, Sampson EL. Key components of the delirium syndrome and mortality: greater impact of acute change and disorganised thinking in a prospective cohort study. BMC Geriatr. 2018;18(1):24. doi: 10.1186/s12877-018-0719-1. - DOI - PMC - PubMed

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