Associations Between Gender, Resiliency Factors, and Anxiety in Neuro-ICU Caregivers: a Prospective Study

Factors Associated with and Predictive Model for Resilience in Family Caregivers of Care-Dependent Adults

Background: Caring for dependent people is an intense task that leads family caregivers to suffer physical or mental pathologies. Resilience is a protective factor that makes an individual more resistant to adverse events. Some characteristics of the caregiver or the care provided predispose the caregiver to be less resilient. Knowing these characteristics will allow us to detect vulnerable caregivers. Aim: The aim of this study was to explore the factors associated with caregiver resilience and establish a predictive model, including the relationship between preparedness, burden, resilience, and anxiety. Materials and Methods: The study design was descriptive, observational, and cross-sectional, with purposive sampling. The sample included 172 family caregivers of care-dependent patients in Spain. Questionnaires were administered to assess caregiver resilience, anxiety, burden, and the preparedness of care-dependent patients. Correlation, univariate, and multiple linear regression analyses were performed to identify the factors associated with resilience. Results: We found that there is a correlation between resilience, preparation, and burden. Factors related to resilience include age, the caregiver's health status, kinship, childcare, and state aid granted. Caregiver preparedness is the factor that most predicts caregiver resilience in our model. Caregivers with high levels of resilience also demonstrated high levels of preparedness and experienced less burden than those with low levels of resilience. Conclusions: These findings emphasize the relevance of improving the preparation of family caregivers to increase their resilience and, at the same time, the quality of care provided.

Caregiver Burden and Readiness in Patients with Moderate and Severe Traumatic Brain Injury: The Chain Mediation Effect of Disease Uncertainty and Mental Resilience

OBJECTIVE

To analyze the mediating effects of caregiver illness uncertainty and psychological resilience in caregiver burden and readiness in patients with moderate-to-severe traumatic brain injuries (TBIs). This can help improve caregiver readiness in patients with moderate-to-severe TBIs.

METHODS

A purposive sampling method was used to recruit patients with moderate-to-severe TBIs, and their caregivers, who were hospitalized in the Department of Neurosurgery of the Affiliated Hospital of Yangzhou University between October 2022 and August 2023. The Zarit Caregiver Burden Interview, Mishel Uncertainty In Scale for Family Member, Connor-Davidson Resilience Scale, and Caregivers Preparedness Scale, as well as general information questionnaire, were used to conduct the survey.

RESULTS

Caregiver readiness correlated with caregiver burden, illness uncertainty, and psychological resilience in patients with moderate-to-severe TBI (P < 0.01). Caregiver readiness was not only directly affected by caregiver burden (95% confidence interval: -0.510, -0.196) but was also affected through the chain mediation of illness uncertainty and psychological resilience (95% confidence interval: -0.146, -0.011).

CONCLUSIONS

Caregiver burden in patients with moderate-to-severe TBI influences caregiver readiness levels and is mediated by illness uncertainty and psychological resilience. By improving caregivers' illness uncertainty and increasing their psychological resilience, the impact of low caregiver readiness caused by high caregiver burden could be reduced.

Does gender moderate resiliency variables and posttraumatic stress symptoms in informal caregivers of neurocritical care patients? An exploratory study

We examined gender differences between resiliency factors (i.e. mindfulness, self-efficacy, coping, intimate care, and caregiver preparedness) and posttraumatic stress symptoms (PTSS) in informal caregivers of patients in the neuroscience intensive care unit (Neuro-ICU). Ninety-two informal caregivers were enrolled during patients' hospitalization and completed resiliency measures at baseline, and a PTSS measure at baseline, 3 and 6 months. We conducted five ANCOVAs to explore gender and resiliency on PTSS. No significant main effects of gender on PTSS were observed across time points. However, main effects were seen for resiliency on PTSS at baseline for informal caregivers with high (vs. low) mindfulness, coping, and self-efficacy. Gender moderated the association between mindfulness and PTSS (i.e. high mindfulness at baseline was associated with lower PTSS in males compared to females at 3 months) and intimate care and PTSS (high intimate care at baseline was associated with lower PTSS in males than females at 6 months; high intimate care at baseline for females was associated with lower PTSS at 6 months than females with low intimate care). Overall, we observed associations among informal caregivers' gender, resiliency, and PTSS, with males particularly benefitting from mindfulness and intimate care. These findings hold value for future inquiry into gender differences in this population with possible clinical implications.

Caregiving During the COVID-19 Pandemic: Factors Associated With Feelings of Caregiver Preparedness

Examination of caregiver preparedness for the COVID-19 pandemic can inform efforts to support caregivers in future times of global crisis. Informal caregivers of adults with dementia or severe disabilities (n = 72, Mage = 62.82 years, 90.28% female) were recruited through Adult Day Centers across the United States. Caregivers responding to an online survey regarding their experiences and preparedness reported an increase in burden, stress, and time spent caregiving since the onset of the pandemic. Caregivers reported feeling prepared for typical caregiving responsibilities but felt less prepared for someone else to assume the role of primary caregiver. Multiple regression modeling indicated that resilience accounted for significant variance in primary caregiver preparedness, over and above burden, but only caregiver age accounted for significant variability in a component representing feeling prepared to delegate caregiving to another person. These findings have implications for research and applied efforts to promote caregiver well-being and preparedness.

Predictive model for the preparedness level of the family caregiver

Background

Many caregivers are insufficiently prepared, and little is known about measures that can be employed to enhance their preparedness.

Aim

The aim of this study was to explore the factors associated with caregiver preparedness and establish a predictive model including the relationship between preparedness, burden, resilience and anxiety.

Design

A cross‐sectional design was used.

Methods

The sample included 172 family caregivers who were selected from one private hospital and daytime nursing centres. Caregivers were recruited from 2018 to 2019; they completed assessments for caregiver preparedness, anxiety, resilience and burden. A multiple linear regression analysis was performed to identify the factors associated with preparedness.

Results

Preparedness was significantly associated with high levels of resilience and a low level of burden, while it was not associated with anxiety. Caregivers' gender, experience and cohabitation status were the main predictors. Resilience is an explanatory factor for caregiver preparedness in the predictive model.

Conclusion

The demographic variables related to preparedness can be used to guide efforts to meet the needs of vulnerable caregivers. A caregiver's preparedness depends on their level of burden and resilience. Nursing interventions focused on these aspects could make the caregiver's role easier and improve the quality of care provided.

What is already known about this topic?

Many caregivers are inadequately prepared for this role, and ensuring adequate preparedness is important for family caregivers.

Preparedness and factors predictive of this in Spanish family caregivers have not been well‐documented.

Resilience, burden and anxiety affect caregivers, but the degree to which they influence caregivers' preparation levels is unknown.

What is the contribution of this paper?

Specific factors influence the preparedness of family caregivers. Men and caregivers who do not cohabit in the same household with the care‐dependent person may present greater deficits in preparedness. Moreover, poor health and lack of experience in caring can result in inadequate caregiving performance.

Readiness, resilience and burden are significantly related, and the best predictor of family caregivers' preparedness is resilience.

Resilience leads to greater preparedness in caregivers, and better‐prepared caregivers experience a lighter burden.

What are the implications of this paper?

Knowing the factors associated with preparedness in advance will allow health‐care professionals to prevent deficits in vulnerable family caregivers.

Resilience is a decisive factor which prevents negative consequences such as low preparedness. A resilient coping style can diminish the burden and promote successful adaptation in caregivers.

Predictors of posttraumatic growth of the family members of neurosurgical intensive care unit patients: A cross-sectional study

OBJECTIVES

Confronted with the potentially traumatic experience of a patients intensive care unit hospitalisation, family members may show positive changes associated with growth in addition to negative impact. This study aimed to identify the level of posttraumatic growth of the family members of neurosurgical intensive care unit patients and to explore its relation to positive personality characteristics, such as gratitude, resilience and hope.

DESIGN AND SETTING

A cross-sectional study involving 340 family members of patients admitted to the neurosurgical intensive care unit at a general tertiary hospital in Shanghai, China.

METHODS

Before the patients' hospital discharge, the participants completed questionnaires, assessing posttraumatic growth (PTG Inventory), social support (Social Support Rating Scale), resilience (Chinese version of the Connor-Davidson Resilience Scale), hope (Herth Hope Index) and gratitude (Gratitude Questionnaire Six-Item Form).

RESULTS

The mean total posttraumatic growth score was 73.38 (14.02). Hope, gratitude, resilience and social support showed a positive correlation with the posttraumatic growth Inventory scores. There were significant differences in the posttraumatic growth scores of the family members of neurosurgical intensive care patients with respect to their different religious beliefs, payment methods, family relationship quality and presence of chronic diseases among family members. Multiple linear regression analysis showed that gratitude, resilience and social support were independent predictors of the posttraumatic growth Inventory score.

CONCLUSION

Family members may experience some degree of posttraumatic growth during hospitalisation of patients in the neurosurgical intensive care units. Gratitude, social support and resilience are predictive factors for posttraumatic growth.

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: A Randomized Clinical Trial

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.

DESIGN, SETTING, AND PARTICIPANTS

This single-blind, pilot randomized clinical trial of RT vs an educational control was conducted among 58 dyads in which either the survivor or caregiver endorsed clinically significant symptoms of depression, anxiety, or PTS. The study was conducted in the neuroscience intensive care unit at Massachusetts General Hospital. Data were collected from September 2019 to March 2020.

INTERVENTIONS

Both RT and control programs had 6 sessions (2 at bedside and 4 via live video after discharge), and both survivor and caregiver participated together.

MAIN OUTCOMES AND MEASURES

The primary outcomes were feasibility of recruitment and intervention delivery, credibility, and satisfaction. The secondary outcomes included depression and anxiety (measured by the Hospital Depression and Anxiety Scale), PTS (measured by the PTSD Checklist-Civilian Version), and intervention targets (ie, mindfulness, measured by the Cognitive and Affective Mindfulness Scale-Revised; coping, measured by the Measure of Current Status-Part A; and dyadic interpersonal interactions, measured by the Dyadic Relationship Scale). Main outcomes and targets were assessed at baseline, 6 weeks, and 12 weeks.

RESULTS

The 58 dyads were randomized to RT (29 dyads [50.0%]; survivors: mean [SD] age, 49.3 [16.7] years; 9 [31.0%] women; caregivers: mean [SD] age, 52.4 [14.3] years; 22 [75.9%] women) or control (29 dyads [50.0%]; survivors: mean [SD] age, 50.3 [16.4] years; 12 [41.3%] women; caregivers, mean [SD] age, 52.1 [14.9], 17 [58.6%] women). Feasibility (recruitment [76%], randomization [100%], and data collection [83%-100%]), adherence (86%), fidelity (100%; κ = 0.98), satisfaction (RT: 57 of 58 [98%] with scores >6; control: 58 of 58 [100%] with scores >6), credibility (RT: 47 of 58 [81%] with scores >6; control: 46 of 58 [80%] with scores >6), and expectancy (RT: 49 of 58 [85%] with scores >13.5; 51 of 58 [87%] with scores >13.5) exceeded benchmarks set a priori. Participation in RT was associated with statistically and clinically significant improvement between baseline and postintervention in symptoms of depression (among survivors: -4.0 vs -0.6; difference, -3.4; 95% CI, -5.6 to -1.3; P = .002; among caregivers: -3.8 vs 0.6; difference, -4.5; 95% CI, -6.7 to -2.3; P < .001), anxiety (among survivors: -6.0 vs 0.3; difference, -6.3; 95% CI, -8.8 to -3.8; P < .001; among caregivers: -5.0 vs -0.9; difference, -4.1; 95% CI, -6.7 to -1.5, P = .002), and PTS (among survivors: -11.3 vs 1.0; difference, -12.3; 95% CI, -18.1 to -6.5, P < .001; among caregivers, -11.4 vs 5.0; difference, -16.4, 95% CI, -21.8 to -10.9; P < .001). Improvements sustained through the 12-week follow-up visit. We also observed RT-dependent improvement in dyadic interpersonal interactions for survivors (0.2 vs -0.2; difference, 0.4; 95% CI, 0.0 to 0.8; P = .04).

CONCLUSIONS AND RELEVANCE

In this pilot randomized clinical trial, RT was feasible and potentially efficacious in preventing chronic emotional distress in dyads of survivors of the neuroscience intensive care unit and their informal caregivers.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03694678.