Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Depression in Caregivers of Critically Ill Patients

N Engl J Med; 2016 May 12; Cameron, Chu, et al

Most caregivers of critically ill patients were at risk for poor mental health outcomes, including high levels of depressive symptoms which commonly persisted up to 1 year and did not decrease in some caregivers, whereas physical health was similar to population norms. This according to a study of 280 caregivers (mean age 53 years; 70% women) of patients who had received 7 or more days of mechanical ventilation in an ICU. Assessments occurred 7 days and 3, 6, and 12 months after ICU discharge. Researchers found:

• 67% of caregivers initially reported high levels of depressive symptoms; 43% at 1 year.

• Depressive symptoms decreased at least partially in time in 84% of the caregivers.

• Variables associated with worse mental health outcomes in caregivers were younger age, greater effect of patient care on other activities, less social support, less control over life, and less personal growth.

• No patient variables were consistently associated with caregiver outcomes over time.

Citation: Cameron JL, Chu LM, Matte A, et al. One-year outcomes in caregivers of critically ill patients. N Engl J Med. 2016;374:1831-1841. doi:10.1056/NEJMoa1511160.

Commentary: Typically when someone is ill, all the focus is on the patient. Any caregiver will tell you however, that illness has a strong ripple effect on family members, who day in and day out often receive little recognition or appreciation. Being a caregiver is socially isolating as well as physically exhausting. This wonderful study refocuses on the important needs of caregivers and reminds us to ask caregivers how they are doing, to create strategies that include social support, and to think about depression in caregivers as a part of our clinical care of patients. —Neil Skolnik, MD