The Impact of Resilience Factors and Anxiety During Hospital Admission on Longitudinal Anxiety Among Dyads of Neurocritical Care Patients Without Major Cognitive Impairment and Their Family Caregivers

Meyers, Emma; Presciutti, Alex; Shaffer, Kelly M.; Gates, Melissa; Lin, Ann; Rosand, Jonathan; Vranceanu, Ana‐Maria

doi:10.1007/s12028-020-00913-7

Cited by 25 publications

(49 citation statements)

References 39 publications

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“…Within each dyad, either the patient or caregiver had to screen in for clinically significant symptoms of depression, anxiety, or PTS. This criterion ensures risk for chronic emotional distress within a dyad, based on prior research [35][36][37]. Dyads were excluded if they were unable or unwilling to participate in in-person and video sessions, or complete follow up measures electronically or over the phone.…”

Section: Recruitment Screening and Consentmentioning

confidence: 99%

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Bannon

Lester

Gates

et al. 2020

Pilot Feasibility Stud

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138

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Background: A stroke is a sudden, life-altering event with potentially devastating consequences for survivors and their loved ones. Despite advances in endovascular and neurocritical care approaches to stroke treatment and recovery, there remains a considerable unmet need for interventions targeting the emotional impact of stroke for both patients and their informal caregivers. This is important because untreated emotional distress becomes chronic and negatively impacts quality of life in both patients and caregivers. Our team previously used mixed methods to iteratively develop a six-session modular dyadic intervention to prevent chronic emotional distress in patients with stroke and their informal caregivers called "Recovering Together" (RT) using feedback from dyads and the medical team. The aim of the current study is to test the feasibility of recruitment, acceptability of screening and randomization methods, acceptability of RT, satisfaction with RT, feasibility of the assessment process at all time points, and acceptability of outcome measures. Secondarily, we aimed to explore within-treatment effect sizes and change in clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTS). The larger goal was to strengthen methodological rigor before a subsequent efficacy trial. Methods: We conducted a feasibility randomized controlled trial to evaluate the RT intervention relative to minimally enhanced usual care (MEUC) in stroke patients admitted to a Neurosciences Intensive Care Unit (Neuro-ICU). Dyads were enrolled within 1 week of hospitalization if they met specific eligibility criteria. Assessments were done via paper and pencil at baseline, and electronically via REDCap or over the phone at post-intervention (approximately 6 weeks after baseline), and 3 months later. Assessments included demographics, resiliency intervention targets (mindfulness, coping, self-efficacy, and interpersonal bond), and emotional distress (depression, anxiety, and PTS). Primary outcomes were feasibility and acceptability markers. Secondary outcomes were depression, anxiety, PTS, mindfulness, coping, self-efficacy, and interpersonal bond.

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Section: Recruitment Screening and Consentmentioning

confidence: 99%

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Bannon

Lester

Gates

et al. 2020

Pilot Feasibility Stud

Self Cite

138

View full text Add to dashboard Cite

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“…Second, as symptoms of depression, anxiety, and PTS are interrelated and prevalent during hospitalization, 4 we used a transdiagnostic approach focused on addressing the construct of emotional distress by providing in vivo coping skills, rather than specifically targeting 1 particular psychiatric condition. Third, because psychiatric distress and resiliency factors are interdependent between survivors and caregivers, [5][6][7]19 to fully account for the nuanced presentation of distress, we targeted dyads rather than survivors or caregivers independently. This approach is supported by research from psycho-oncology and recommendations from the American Heart Association.…”

Section: Jama Network Open | Psychiatrymentioning

confidence: 99%

“…Third, we instructed participants to practice skills through the web-based application, but this was not formally collected. Downloaded From: https://jamanetwork.com/ on 10/31/2020 score 4,6,7,18,35,[49][50][51] and others a higher cut-off score. 3,52 Given the acute nature of neurological illness and the detrimental consequences of depression and anxiety symptoms that go unaddressed, we chose to use a lower score that allows for higher sensitivity so that we would not miss any dyads that might benefit from our program.…”

Section: Limitationsmentioning

confidence: 99%

“…These psychiatric sequelae affect not only the survivors but also the informal caregivers 2 who support and attend to them through their hospitalizations and beyond. [3][4][5][6][7] Rates of clinically significant anxiety, depression, and posttraumatic stress (PTS) are high for both patients (43%, 24%, and 21%, respectively) and caregivers (46%, 8%-24%, and 17%, respectively) during hospitalization and remain high 3 and 6 months later. [3][4][5][6][7] This trajectory of emotional distress is concerning given the deleterious effect that long-term distress has on patients' physical recovery as well as patients' and caregivers' morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit

et al. 2020

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IMPORTANCE To our knowledge, there are no evidence-based interventions to prevent chronic emotional distress (ie, depression, anxiety, and posttraumatic stress [PTS]) in critical care survivors and their informal caregivers. OBJECTIVE To determine the feasibility and preliminary effect of the novel dyadic resiliency intervention Recovering Together (RT) on reducing symptoms of depression, anxiety, and PTS among hospitalized patients and their informal caregivers.

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“…Irrespective of cause, the impact of longer duration of intubation can be extrapolated from other critical care studies prior to the COVID-19 pandemic, which show that increased ventilation times are associated with a greater need for sedation and analgesics and higher rates of ventilator-associated pneumonia, line infections, urinary tract infections, delirium, ileus, and decubitus ulcers (34)(35)(36). Further, additional days on ventilators are likely to lead to greater rehabilitation needs, reduced cognitive function, and could be uniquely detrimental for patients with prior neurological deficits and their family members (37,38).…”

Section: Discussionmentioning

confidence: 98%

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19

et al. 2021

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Objectives: Patients with comorbidities are at increased risk for poor outcomes in COVID-19, yet data on patients with prior neurological disease remains limited. Our objective was to determine the odds of critical illness and duration of mechanical ventilation in patients with prior cerebrovascular disease and COVID-19.Methods: A observational study of 1,128 consecutive adult patients admitted to an academic center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. We tested the association between prior cerebrovascular disease and critical illness, defined as mechanical ventilation (MV) or death by day 28, using logistic regression with inverse probability weighting of the propensity score. Among intubated patients, we estimated the cumulative incidence of successful extubation without death over 45 days using competing risk analysis.Results: Of the 1,128 adults with COVID-19, 350 (36%) were critically ill by day 28. The median age of patients was 59 years (SD: 18 years) and 640 (57%) were men. As of June 2nd, 2020, 127 (11%) patients had died. A total of 177 patients (16%) had a prior cerebrovascular disease. Prior cerebrovascular disease was significantly associated with critical illness (OR = 1.54, 95% CI = 1.14–2.07), lower rate of successful extubation (cause-specific HR = 0.57, 95% CI = 0.33–0.98), and increased duration of intubation (restricted mean time difference = 4.02 days, 95% CI = 0.34–10.92) compared to patients without cerebrovascular disease.Interpretation: Prior cerebrovascular disease adversely affects COVID-19 outcomes in hospitalized patients. Further study is required to determine if this subpopulation requires closer monitoring for disease progression during COVID-19.

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The Impact of Resilience Factors and Anxiety During Hospital Admission on Longitudinal Anxiety Among Dyads of Neurocritical Care Patients Without Major Cognitive Impairment and Their Family Caregivers

Cited by 25 publications

References 39 publications

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19

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