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Original Article


One-Year Outcomes in Caregivers of Critically Ill Patients


Jill I. Cameron, Ph.D.1,2,3, Leslie M. Chu, B.Sc.4, Andrea Matte, B.Sc.4, George Tomlinson, Ph.D.4, Linda Chan, B.A.Sc.1, Claire Thomas, R.N.4, Jan O. Friedrich, M.D., D.Phil.5,6 Sangeeta Mehta, M.D.5,7, Francois Lamontagne, M.D.9, Melanie Levasseur, M.D.9,, Niall D. Ferguson, M.D., M.Sc.4,5, Neill K.J. Adhikari, M.D., M.Sc.5,11, Jill C. Rudkowski, M.D.8, Hilary Meggison, M.D.11, Yoanna Skrobik, M.D.12, John Flannery, M.D.3,4,13, Mark Bayley, M.D.3,4,13, Jane Batt, M.D.5,6, Claudia dos Santos, M.D.5,6, Susan E. Abbey, M.D.14, Adrienne Tan, M.D.14, Vincent Lo, P.T., B.Sc.4, Sunita Mathur, P.T., Ph.D.15, Matteo Parotto, M.D.4,5, Denise Morris, R.N.4, Linda Flockhart, R.N.4, Eddy Fan, M.D., Ph.D.4, Christie M. Lee, M.D.5,6, M. Elizabeth Wilcox, M.D.4, Najib Ayas, M.D.16, Karen Choong, M.D.17, Robert Fowler, M.D.5,10, Damon C. Scales, M.D.5,10, Tasnim Sinuff, M.D.5,10, Brian H. Cuthbertson, M.D.5,10, Louise Rose, R.N., Ph.D.7, Priscila Robles, P.T., M.Sc.3,4, Stacey Burns, R.N.4, Marcelo Cypel, M.D.4, Lianne Singer, M.D.4,6, Cecilia Chaparro, M.D.4,5, Chung-Wai Chow, M.D.4,5, Shaf Keshavjee, M.D., M.Sc.4, Laurent Brochard, M.D.5,7, Paul Hebert, M.D.9, Arthur S. Slutsky, M.D.5,18 John C. Marshall, M.D.6,18, Deborah Cook, M.D. M.Sc.8, Margaret S. Herridge, M.D., M.P.H.4,5, for the RECOVER Program Investigators (Phase 1: towards RECOVER) and the Canadian Critical Care Trials Group.



N Engl J Med | May 11, 2016 |DOI: 10.1056/NEJMoa1511160


BACKGROUND
Few resources are available to support caregivers to survivors of critical illness; consequently their own health may suffer. We studied caregiver and patient characteristics that were associated with caregivers’ health outcomes during the first year after intensive care unit (ICU) discharge.


METHODS
We prospectively enrolled 280 caregivers of patients who received 7 or more days of mechanical ventilation in an intensive care unit. Using hospital data and self-administered questionnaires, we collected information on caregiver and patient characteristics, caregiver depression symptoms, psychological wellbeing, health-related quality of life, sense of control over life, and impact of providing care on other activities. Assessments occurred 7 days and 3, 6, and 12-months after ICU discharge. 


RESULTS
Caregivers’ mean age was 53 years, 70% were women, and 61% were caring for a spouse. A large percentage of caregivers (from 67% initially to 43% at one year) reported high levels of depression symptoms. Depression symptoms improved at least partially with time in 84% of caregivers but did not in 16%. Variables significantly associated with worse caregiver mental health outcomes were younger age, greater impact of patient care on other activities, less social support and sense of control over life, and less sense of personal growth. No patient variables were consistently associated with caregiver outcomes over time.


CONCLUSIONS
Most caregivers reported high levels of depression symptoms, which commonly persisted up to one year and did not improve in some. Our findings highlight the need to consider the mental health of caregivers in post-ICU care. (ClinicalTrials.gov number, NCT00896220)


 Originally Appeared in The New England Journal of Medicine on May 11, 2016.


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