A multicentre evaluation exploring the impact of an integrated health and social care intervention for the caregivers of ICU survivors

Abstract

Background Caregivers and family members of Intensive Care Unit (ICU) survivors can face emotional problems following patient discharge from hospital. We aimed to evaluate the impact of a multi-centre integrated health and social care intervention, on caregiver and family member outcomes. Methods This study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme across 9 sites in Scotland. InS:PIRE is an integrated health and social care intervention. We compared caregivers who attended this programme with a contemporary control group of ICU caregivers (usual care cohort), who did not attend. Results The primary outcome was anxiety measured via the Hospital Anxiety and Depression Scale at 12 months post-hospital discharge. Secondary outcome measures included depression, carer strain and clinical insomnia. A total of 170 caregivers had data available at 12 months for inclusion in this study; 81 caregivers attended the InS:PIRE intervention and completed outcome measures at 12 months post-hospital discharge. In the usual care cohort of caregivers, 89 completed measures. The two cohorts had similar baseline demographics. After adjustment, those caregivers who attended InS:PIRE demonstrated a significant improvement in symptoms of anxiety (OR: 0.42, 95% CI: 0.20–0.89, p = 0.02), carer strain (OR: 0.39; 95% CI: 0.16–0.98 p = 0.04) and clinical insomnia (OR: 0.40; 95% CI: 0.17–0.77 p < 0.001). There was no significant difference in symptoms of depression at 12 months. Conclusions This multicentre evaluation has shown that caregivers who attended an integrated health and social care intervention reported improved emotional health and less symptoms of insomnia, 12 months after the delivery of the intervention.

Social determinants of recovery

“…Family caregiving, for example, can contribute to financial and relationship strain when family members take time off work or feel overwhelmed by caregiving responsibilities [25,[29][30][31]. Evidence from the United Kingdom suggests patients and caregivers benefit from social support and social welfare interventions and that enhanced support can improve outcomes [32][33][34].…”

Mental Health in Women

“…For caregivers of ICU survivors, more than two-thirds experience symptoms of depression, up to 80% have symptoms of anxiety, 30% have symptoms of posttraumatic stress, and more than half can experience caregiver strain 9,10. Caregivers are more commonly female in 71% of cases and spouses in 76% of cases 11.…”

“…Forty-eight percent of caregivers requested more physiotherapy and rehabilitation for the patient and psychological contact and support for caregivers during hospitalization 9,13. A 58% adjusted odds reduction in symptoms of anxiety and 61% reduction in the odds of caregiver strain and insomnia were seen when interventions of social support were implemented 10…”

“…8 For caregivers of ICU survivors, more than two-thirds experience symptoms of depression, up to 80% have symptoms of anxiety, 30% have symptoms of posttraumatic stress, and more than half can experience caregiver strain. 9,10 Caregivers are more commonly female in 71% of cases and spouses in 76% of cases. 11 This striking disparity is extremely significant, given psychiatric disease is more common in women and spouses, particularly those of younger patients.…”

“…9,13 A 58% adjusted odds reduction in symptoms of anxiety and 61% reduction in the odds of caregiver strain and insomnia were seen when interventions of social support were implemented. 10 In the ICU, excessive workloads, long hours, and emotional stress factors derived from exposure to suffering and dying patients place staff at risk for the development of burnout syndrome. Reduced social support and moral at work, spiritual distress related to ethical issues, uncertainty concerning the treatment path of patients, conflicts with superiors, fear of making a mistake, anxiety in the face of uncertainty, lack of user knowledge of equipment, and lack of staff are also associated with the development of this syndrome among ICU workers.…”