Sleep,anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study

Introduction

Family members of critically ill patients often experience increased incidence of physical and mental health issues. One of the first ways family members suffer is by losing sleep. The purpose of this study is to understand sleep quality, levels of fatigue and anxiety, and factors contributing to poor sleep in adult family members of critically ill patients.

Methods

A questionnaire was designed to evaluate sleep, fatigue and anxiety during the intensive care unit (ICU) admission. We incorporated three validated instruments: General Sleep Disturbance Scale (GSDS), Beck Anxiety Index (BAI) and Lee Fatigue Scale (NRS-F). Adult family members of patients in ICU for more than 24 hours were approached for questionnaire completion. Patient demographics were recorded.

Results

The study population consisted of 94 respondents, (49.1 ± 12.9 years, 52.7% male); 43.6% were children and 21.3% were spouses of ICU patients. Sleep quality was rated as poor/very poor by 43.5% of respondents, and good/very good by 15.2%. The most common factors contributing to poor sleep were anxiety (43.6%), tension (28.7%) and fear (24.5%). Respondents'' most common suggestions to improve sleep were more information regarding the patient''s health (24.5%) and relaxation techniques (21.3%). Mean GSDS score was 38.2 ± 19.3, with 58.1% of respondents experiencing moderate to severe sleep disturbance. Mean BAI was 12.3 ± 10.2, with 20.7% of respondents experiencing moderate to severe anxiety. Mean NRS-F was 3.8 ± 2.5, with 57.6% of respondents experiencing moderate to high fatigue. Family members who spent one or more nights in the hospital had significantly higher GSDS, BAI and NRS-F scores. The patient''s Acute Physiology and Chronic Health Evaluation (APACHE) II score at survey completion correlated significantly with family members'' GSDS, BAI and NRS-F.

Conclusion

The majority of family members of ICU patients experience moderate to severe sleep disturbance and fatigue, and mild anxiety.     

Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity

OBJECTIVE: Anxiety and depression may have a major impact on a person's ability to make decisions. Characterization of symptoms that reflect anxiety and depression in family members visiting intensive care patients should be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues. DESIGN: Prospective multicenter study. SETTING: Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days. PATIENTS: Six hundred thirty-seven patients and 920 family members. INTERVENTIONS: Intensive care unit characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. MEASUREMENTS AND MAIN RESULTS: Of 920 Hospital Anxiety and Depression Scale questionnaires that were completed by family members, all items were completed in 836 questionnaires, which formed the basis for this study. The prevalence of symptoms of anxiety and depression in family members was 69.1% and 35.4%, respectively. Symptoms of anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors associated with symptoms of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by general practitioner), and caregiver-related factors (absence of regular physician and nurse meetings, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors associated with symptoms of depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers). CONCLUSIONS: More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.     

Needs and anxiety levels in relatives of intensive care unit patients

The purpose of this study was to explore the perceived needs and anxiety levels of adult family members of intensive care unit (ICU) patients. The study was conducted over a 3-month period, on a convenience sample of 166 subjects selected from the total adult population of family members visiting an ICU patient in three Sudbury hospitals. Data were gathered using a self-report questionnaire, the Critical Care Family Needs Inventory (CCFNI) and Spielberger's State Trait Anxiety Inventory (STAI). Interviews were conducted in French or English according to the subject's preference. The major variables examined were: family needs; state and trait anxiety; on-site sources of worry; spiritual needs; level of knowledge of ICU from past experience or pre-surgery education; sociodemographic data. The Situational Anxiety Scale yielded a mean score of 45.24 and the Trait Anxiety Scale a mean score of 37.3. Inferential statistics demonstrated that family needs and situational anxiety were significantly related (P less than 0.0002). Furthermore, worries, trait anxiety, age and family needs explained 38% of the variation of situational anxiety. As well, spiritual needs and situational anxiety explained 33% of the variation of family needs.     

Self-reported sleep and health among Norwegian hospital nurses in intensive care units

Aim and background: Shift work, and especially night work, is associated with poor health. Nurses, work a variety of work schedules including night work. So far, few studies have specifically investigated sleep and health among intensive care nurses. Design and methods: We investigated sleep, sleepiness, fatigue, subjective health complaints, anxiety and depression in 150 intensive care nurses (convenience sample representing a response rate of 56·2%). The nurses worked at two major University hospitals in Norway and answered a questionnaire survey. Results: The intensive care nurses reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to normative data. Poor sleep was reported by 70% and excessive sleepiness by 25% of the nurses; however, the design of the study did not allow us to determine the causes underlying these findings. Multiple linear regression analyses showed that age was positively associated with sleep problems, fatigue, subjective health complaints and anxiety and depression. In contrast, shift work experience was negatively associated with sleep problems, suggesting better coping with shift work over time. Conclusions: Nurses working in intensive care units reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to Norwegian norm groups. Age was positively related to these complaints, whereas shift work experience was negatively related to poor sleep. More studies are needed on strategies to improve sleep and health in nurses.     

Opinions of families,staff, and patients about family participation in care in intensive care units

PurposeThe aims of the study were to assess opinions of caregivers, families, and patients about involvement of families in the care of intensive care unit (ICU) patients; to evaluate the prevalence of symptoms of anxiety and depression in family members; and to measure family satisfaction with care.Materials and MethodsBetween days 3 and 5, perceptions by families and ICU staff of family involvement in care were collected prospectively at a single center. Family members completed the Hospital Anxiety and Depression Scale (HADS) and a satisfaction scale (Critical Care Family Needs Inventory). Nurses recorded care provided spontaneously by families. Characteristics of patient-relative pairs (n = 101) and ICU staff (n = 45) were collected. Patients described their perceptions of family participation in care during a telephone interview, 206 ± 147 days after hospital discharge.ResultsThe numbers of patient-relative pairs for whom ICU staff reported favorable perceptions were 101 (100%) of 101 for physicians, 91 (90%) for nurses, and 95 (94%) for nursing assistants. Only 4 (3.9%) of 101 families refused participation in care. Only 14 (13.8%) of 101 families provided care spontaneously. The HADS score showed symptoms of anxiety in 58 (58.5%) of 99 and of depression in 26 (26.2%) of 99 family members. The satisfaction score was high (11.0 ± 1.25). Among patients, 34 (77.2%) of 44 had a favorable perception of family participation in care.ConclusionsFamilies and ICU staff were very supportive of family participation in care. Most patients were also favorable to care by family members.     

Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study

STUDY OBJECTIVES: More than two thirds of family members visiting intensive care unit (ICU) patients have symptoms of anxiety or depression during the first days of hospitalization. Identifying determinants of these symptoms would help caregivers support families at patient discharge or when death is imminent. DESIGN AND SETTING: Prospective multicenter study including 78 ICUs (1184 beds) in France. PARTICIPANTS: Family members completed the Hospital Anxiety and Depression Scale on the day of patient discharge or death to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. RESULTS: Three hundred fifty-seven patients were included in the study, and 544 family members completed the Hospital Anxiety and Depression Scale. Symptoms of anxiety and depression were found in 73.4% and 35.3% of family members, respectively; 75.5% of family members and 82.7% of spouses had symptoms of anxiety or depression (P = .007). Symptoms of depression were more prevalent in family members of nonsurvivors (48.2%) than of survivors (32.7%) (P = .008). The multivariate model identified 3 groups of factors associated with symptoms: (1) patient-related: severity as assessed by the Simplified Acute Physiology Score II (odds ratio [OR] 1.017 per point) and patient age (OR 0.984 per year) predicted anxiety, and Simplified Acute Physiology Score II (OR, 1.015 per point), patient death (OR 2.092), and patient age (OR 0.981) predicted depression; (2) family-related: the spouse predicted anxiety (OR 2.085); and (3) ICU-related: a room with more than 1 bed (OR 1.539) predicted depression. CONCLUSION: The prevalence of symptoms of anxiety and depression remains high at the end of the ICU stay, whether the patient is well enough to be discharged or is near death.     

神经症病人家属情绪障碍调查与心理干预

[目的]了解神经症病人家属的情绪障碍和心理干预的效果。[方法]采用90项症状自评量表(SCL-90)对120例神经症病人家属进行心理状况调查,并对病人家属进行心理干预。[结果]神经症病人家属普遍存在心理问题,情绪障碍以焦虑、抑郁、躯体化、睡眠障碍为突出,通过心理干预后,SCL-90评分明显下降。[结论]心理干预能有效减轻家属的焦虑、抑郁情绪,改善家属的躯体化障碍、睡眠障碍。     

Fatigue,anxiety and depression levels,activities of daily living of patients with chronic obstructive pulmonary disease

The aim of this cross‐sectional study was to determine the fatigue, anxiety and depression levels, activities of daily living of patients with chronic obstructive pulmonary disease (n = 255). It was found that there was significant difference between Visual Analogue Scale for Fatigue (VAS‐F) point averages and gender, education levels, marital status and economical status of patient with chronic obstructive pulmonary disease. Among the participants in this study, 36.5% had an anxiety disorder whereas 69.0% exhibited depression. In the study, it was determined that 85.5% of those were independent in their Katz's Index of Activities of Daily Living (ADLs) and 49.4% of those were independent in their Lawton and Brody's Index of Instrumental Activities of Daily Living (IADLs). This study has shown that VAS‐F, the Hospital Anxiety and Depression Scale, ADL and IADL instruments that measure the various aspects of health‐related quality of living can contribute considerably to a more diversified understanding of the patients' situation with chronic obstructive pulmonary disease.     

The relationships between disability level, health-promoting lifestyle, and quality of life in outpatients with systemic lupus erythematosus

The purpose of this study was to explore the relationships between disability, health-promoting lifestyle and quality of life in SLE outpatients. Cross-sectional research design and purposive sampling were used in this study. One hundred and twenty-nine SLE outpatients from a medical center were sampled. Questionnaires, including the Visual Analogue Scale, Pittsburgh Sleep Quality Index, and The Hospital Anxiety and Depression Scale, were adopted in order to survey subject disabilities in terms of pain, fatigue, quality of sleep, anxiety, and depression. Health-promoting lifestyle was measured using the Health-Promoting Lifestyle Profile, while quality of life data were collected using Short-Form 36. Hierarchical regressions and a Sobel test were the major statistical procedures employed. Study results indicated that SLE patient self-reported pain and fatigue related to the SLE disease to be 27.7 +/- 26.2 and 37.4 +/- 26.6, respectively. Seventy-two percent of SLE patients were reported to be troubled by poor sleep quality, while 20%-32% suffered from severe anxiety and depression. The Health-Promoting Lifestyle Profile total score for SLE patients was 61.5 +/- 17.2. In terms of SLE patient quality of life (QOL), physical component summary (PCS) and mental component summary (MCS) scores were 45.3 +/- 9.1 and 43.8 +/- 9.7, respectively. Based on the hierarchical regressions and Sobel test, it was revealed that the health-promoting lifestyle has no significant effect on the physical component summary (p > .05). Fatigue was the mediator factor of health-promoting lifestyle to physical component summary of quality of life. Nevertheless, health-promoting lifestyle has a significant effect on the mental component summary (p <.05). Interestingly, the results showed facilitating health- promoting lifestyle in SLE patient could not enhance physical component summary of quality of life directly without an improvement in fatigue disability; however, facilitating health-promoting lifestyle had a direct and positive effect on the mental component summary of quality of life.     

肝移植受者疲乏状况与焦虑抑郁情绪的相关性研究

目的了解肝移植受者疲乏状况与焦虑抑郁情绪的关系。方法使用一般资料调查表、中文版多维度疲乏症状量表-简表、医院焦虑抑郁量表对北京市某三级甲等医院肝移植随访中心进行随访的270例肝移植受者进行问卷调查。结果肝移植术后移植受者存在一定程度的疲乏、焦虑和抑郁情绪,且疲乏焦虑、抑郁密切相关;其中焦虑、抑郁总分均与疲乏总分、一般疲乏、身体疲乏、情绪疲乏、心理疲乏得分呈正相关(P0.01),与活力维度得分呈负相关(P0.01)。回归分析显示焦虑、抑郁能影响肝移植受者的疲乏状况。结论肝移植受者的疲乏与焦虑、抑郁密切相关,医护人员应注重肝移植受者的心理问题,并教授受者一些调节情绪的方法,从而改善疲乏。     

Psychometric assessment of four fatigue scales with a sample of rural cancer patients

There are differences between rural and urban persons experiencing cancer that may make the experience of fatigue more difficult for rural cancer patients. There were no scale to measure fatigue that had been validated with rural cancer patients. The purpose of the present research was to study the psychometric properties of four fatigue scales for use with rural cancer patients. The four scales were the Multidimensional Assessment of Fatigue Scale, the Fatigue Severity Scale, the Visual Analogue Scale for Fatigue, and the Rhoten Fatigue Scale. The four scales were mailed to 270 rural cancer patients, with 131 usable scales returned (48% return rate). Interitem correlations, Cronbach's alpha reliability, and factor analyses were performed on the four scales. Based on these analyses, the Multidimensional Assessment of Fatigue Scale, the Fatigue Severity Scale, and the Visual Analogue Scale for Fatigue were judged to be adequate for use with rural cancer patients.     

The effectiveness of therapeutic touch on pain, depression and sleep in patients with chronic pain: clinical trial

This research aimed to check the effectiveness of Therapeutic Touch on decreased pain intensity, depression self-assessment scores and improved sleep quality. A clinical before-after trial is presented. The study was carried out at a Basic Health Unit in Fernandópolis, SP-Brazil, involving 30 elderly patients with chronic non-oncologic pain who received 8 sessions of Therapeutic Touch in accordance with the Krieger-Kunz method. The Visual Analogue Scale for pain was applied before and after each session, and Beck Depression Inventory and the Pittsburgh Sleep Quality Index before the first and after the last session. Data analysis showed a significant decrease (p < 0.05) in pain intensity, depression self-assessment scores and the sleep quality index. It is concluded that the Therapeutic Touch was effective to decrease pain intensity and depressive attitudes and symptoms, as well as to improve sleep quality.     

癌痛患者照料者生活质量和心理状态的调查分析

目的探讨癌痛患者照料者的生活质量和心理状态,为临床治疗和护理提供相应的依据,提出有利于照料者健康的对策。方法采用家庭负担量表（（family burden scale,FBS）、焦虑自评量表（self-rating anxiety scale,SAS）及抑郁自评量表（self—rating depression scale,SDS）对慈溪市第二人民医院60名癌痛患者照料者进行心理测评和分析研究。结果癌痛患者给家庭及成员带来严重的负担,其中对家庭成员心理健康和家庭关系影响最为明显,女性照料者受影响程度明显高于男性照料者（P〈0．05）。SAS和SDS结果显示60．24％的照料者存在焦虑及抑郁症状,与患者关系和患者病情明显影响照料者心理状况,其中焦虑和抑郁程度均以配偶关系高于子女关系和其他关系,癌症晚期照料者高于癌症中期照料者（均P〈0．05）。结论癌痛易给患者及照料者造成严重的家庭负担,癌痛患者照料者的焦虑和抑郁情绪明显高于正常人群,须采取有效的干预措施以缓解其心理压力。     

乳腺癌根治术患者疼痛、焦虑及抑郁现况研究

目的:通过对120例25～65岁择期行乳腺癌根治术的女性乳腺癌患者进行现况调查,了解其疼痛、焦虑及抑郁发生的现状。方法:采用现况研究的方法,以状态-特质焦虑问卷和抑郁自评量表在术前一天对研究对象焦虑、抑郁状况进行调查;以简式麦氏疼痛问卷在术后第一天对其疼痛状况进行调查。结果:疼痛指标评分中,疼痛分级指数总分为(8.12±2.83)分,视觉模拟量表评分为(4.49±1.08)分,现有疼痛强度评分为(2.65±0.55)分。状态焦虑评分为(51.99±8.60)分,中、重度焦虑分别为77.5%和15.0%;特质焦虑评分为(48.30±6.18)分,中、重度焦虑分别为90.0%和3.3%。抑郁评分为(37.19±6.30)分,中、重度抑郁分别为25.0%和2.8%。结论:乳腺癌患者术前存在不同程度的焦虑、抑郁心理反应,术后也有不同程度的疼痛以及对疼痛不同级别的敏感性。     

Development and testing of a Faces Scale for the assessment of anxiety in critically ill patients

BACKGROUND: Many patients experience anxiety during treatment in an intensive care unit, but intensive care patients are often not able to respond to existing validated measures of anxiety such as the Brief Symptom Inventory. We have developed a new single item Faces Anxiety Scale made up of drawings of five faces. AIMS: The aims of this study were to: (i) assess the ability of intensive care patients to respond to the Faces Anxiety Scale; and (ii) investigate whether the scale yields ordinal and interval data. ETHICS: The project was approved by two Human Research Ethics Committees. Patients were included in the study if they gave informed consent. INSTRUMENTS AND METHODS: (i) Intensive care patients (n = 40) were asked to respond to the Faces Anxiety Scale, the anxiety subscale of the Brief Symptom Inventory, and a numerical analogue anxiety scale; and (ii) Hospital and University staff and students (n = 75) were asked to place the five faces in rank order. A further 100 staff members and students were asked to place each face at a point on a 60-cm triangular wedge according to the level of anxiety they thought the face showed. RESULTS: The Faces Anxiety Scale elicited more responses from intensive care patients than the numerical analogue anxiety scale the or anxiety subscale of the Brief Symptom Inventory (36 vs. 25 vs. 17, respectively, P < 0.0001). In the testing of the order of the scale items, 93% of respondents independently placed the scale items in the order of least to most anxiety as intended in the design of the scale. In the testing for equality of intervals respondents placed the faces relatively equidistant, with no overlap of 95% confidence intervals around the mean distances. CONCLUSION: The Faces Anxiety Scale has minimal subject burden, elicits self report from intensive care patients more often than other simple scales, and has evidence of the interval scale properties of rank order and equality between the points on the scale.     

造血干细胞移植病人的睡眠质量与社会支持和情绪状态的相关性研究

[目的]探讨造血干细胞移植病人的睡眠质量与社会支持、情绪状态的相关性。[方法]选择82例造血干细胞移植病人作为研究对象,填写一般资料调查表、匹兹堡睡眠质量指数量表(PSQI)、社会支持量表(SSRS)、焦虑自评量表(SAS)和抑郁自评量表(SDS),采用Pearson分析睡眠质量与社会支持、焦虑抑郁的相关性。[结果]病人的睡眠质量得分为12.1分±1.5分,社会支持为40.9分±8.4分,焦虑得分为54.2分±8.9分,抑郁得分为53.1分±7.1分。睡眠质量指数量表总分与病人的社会支持呈负相关(P0.05),与焦虑、抑郁呈正相关(P0.05)。[结论]社会支持、不良情绪可影响造血干细胞移植病人的睡眠质量,应采取适当的干预提高其社会支持,减轻不良情绪,从而提高睡眠质量。     

Quality of sleep, fatigue and daytime sleepiness in migraine— a controlled study

The objective of this study was to evaluate whether the quality of sleep and the degree of fatigue and daytime sleepiness are related to migraine. We investigated 489 subjects comprising 97 patients with eight or more, 77 patients with five to seven and 196 patients with one to four migraine days per month, and 119 migraine-free controls with fewer than six headache days per year. The patients were recruited via articles in newspapers not stressing the subject of the study. All participants underwent a semistructured interview and completed the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and the Self-rating Depression Scale and the Self-rating Anxiety Scale. For statistical analysis we used two way manova s, post hoc univariate two-way anova s and Hochberg's GT2 tests as well as three-way mixed design anova s. The PSQI total score was highest in patients with frequent migraine (5.9 ± 4.3) and lowest in controls (4.3 ± 2.5, P  = 0.04). Four subscores of the PSQI showed similar statistically significant differences. The FSS and ESS scores did not differ in the four study groups. Analysing depression and anxiety revealed a significant impact on PSQI, FSS and ESS, but did not demonstrate interactions with migraine, thus suggesting that the impact of migraine is similar in patients without and with psychiatric comorbidity. In conclusion, the quality of sleep is decreased in patients with migraine, whereas fatigue and daytime sleepiness do not differ from healthy controls. The decreased quality of sleep in migraineurs is also a consequence of migraine itself and cannot be explained exclusively by comorbidity with depression or anxiety.     

The impact of pain in patients with polyneuropathy

Peripheral neuropathy (PN) is a common impairment which may impact upon quality of life (QoL). Neuropathic pain (NeP) occurs in up to 50% of patients with PN. We hypothesized that disability and impaired quality of life resulting from PN is primarily associated with presence of NeP. Our aim was to determine using prospectively identified PN patients presenting to a tertiary care neuromuscular clinic if presence of NeP (PN + NeP) had greater impact upon QoL than with absence of NeP (PN − NeP). A second aim was to identify if QoL varied based upon etiology of PN. We analyzed neuropathy severity (Toronto Clinical Neuropathy Score (TCSS)), pain quantity and quality (Visual Analogue Scale (VAS) pain score, Brief Pain Inventory (BPI)), QoL and health status measures (EuroQol Instrument 5 Domains (EQ-5D), Medical Outcomes Sleep Study Scale (MOSSS), Hospital Anxiety and Depression Scale (HADS), Short Form 36 Health Survey (SF-36)) and Health Assessment Questionnaire (HAQ) to determine impact of NeP. Although both cohorts were epidemiologically similar and had similar severity of PN, PN + NeP patients had considerably greater impairment for QoL, sleep efficacy, and features of anxiety and depression, leading to substantially greater health care resources utilization when compared to PN − NeP patients. The magnitude of NeP severity was the only explaining variable for increased impact upon QoL measures and diminishing overall wellbeing. Our results confirm that NeP is a primary indicator for worsening QoL and diminished overall wellbeing in PN patients. The etiology of PN did not influence levels of NeP-related compromise of QoL. Further studies are needed to determine optimal methods for management of PN + NeP patients subjected to a significant physiological, psychological and functional burden.