Browsing by Subject "family caregiver"

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    Perceived Burden and Family Functioning among Informal Caregivers of Individuals Living with Schizophrenia in Tanzania: A Cross-Sectional Study
    (2021) Clari Yaluff, Rosarito

    Background: Deinstitutionalization of persons with schizophrenia has led to families providing the majority of care and carrying the bulk of burden. There is a need to identify factors that influence caregiver burden in order to properly address the needs of caregivers. This is particularly important in low-resource settings, where psychiatric services are scarce and interventions for schizophrenia could be most effective if targeted to the affected individual and their caregiver. This study seeks to examine the association between family functioning and perceived burden in informal caregivers of individuals with schizophrenia in Tanzania and identify socio-demographic and illness-related factors that may be associated with caregiver burden in the study population.Methods: This study analyzed cross-sectional data from 65 dyads of individuals with schizophrenia and their informal caregivers in Dar es Salaam and Mbeya, Tanzania. Caregiver burden was measured using the Burden Assessment Scale (BAS). Univariable and multivariable regression analyses were performed to determine the relationship between perceived caregiver burden and family functioning and explore correlates of burden among caregivers. Results: Sixty-three percent of caregivers in our study reported experiencing high burden as a result of caring for a relative with schizophrenia. Multivariable regression analyses revealed that poor family functioning was a significant correlate of high caregiver burden (OR = 4.79; 95% CI = 1.19, 19.32). Additionally, caregiver having worked in the past 3 months was associated with high caregiver burden (OR = 4.80; 95% CI = 1.14, 20.23), while higher levels of hope in the caregiver were associated with low caregiver burden (OR = 0.82; 95% CI = 0.70, 0.95). Although not included in the multivariable regression model, another factor that was linked to high caregiver burden was caring for a woman with schizophrenia (OR = 3.91; 95% CI = 1.13, 13.50). Conclusions: We found that poor family functioning, caregiver having worked in the past 3 months, lower levels of hope in the caregiver, and caring for a woman with schizophrenia were correlates of high caregiver burden. Future interventions aiming to reduce caregiver burden may benefit from improving family functioning and nurturing hope among caregivers of individuals living with schizophrenia. We must pay special attention to the needs of caregivers that work in addition to providing care for a relative with schizophrenia in order to better support them.

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    Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.
    (Critical care explorations, 2022-03) Wendlandt, Blair; Ceppe, Agathe; Gaynes, Bradley N; Cox, Christopher E; Hanson, Laura C; Nelson, Judith E; Carson, Shannon S
    Symptoms of posttraumatic stress disorder (PTSD) are common among surrogate decision makers of patients with chronic critical illness (CCI). PTSD symptoms can be categorized into clusters including intrusion, avoidance, and hyperarousal, each of which has been associated with distinct outcomes and treatment responses. Our objective was to determine which symptom cluster was predominant among surrogates of patients with CCI.

    Design

    Secondary analysis of data from a clinical trial of a communication intervention.

    Setting

    The original trial was conducted in medical intensive care units at three tertiary-care centers and one community hospital.

    Patients

    Patients with CCI (≥7 d of mechanical ventilation and not expected to die or to be weaned from the ventilator in the subsequent 72 hr) and their surrogates.

    Interventions

    None.

    Measurements and main results

    Surrogate PTSD symptoms were measured 90 days after onset of patient CCI using the Impact of Events Scale-Revised (IES-R). The IES-R includes a total score (range, 0-88, higher scores indicate severe symptoms) as well as three subscales that assess intrusion, avoidance, and hyperarousal (range of intrusion and avoidance scores 0-32 and range of hyperarousal score 0-24). Intrusion symptoms were most severe (mean score, 10.3; 95% CI, 9.3-11.2), followed by avoidance (mean score, 8.0; 95% CI, 7.2-8.8). Hyperarousal symptoms were lowest (mean score, 5.1; 95% CI, 4.5-5.7). In a multivariable linear regression model, we found that surrogates of patients who died had higher odds of intrusion (β, 5.52; p < 0.0001) and avoidance (β, 3.29; p = 0.001) symptoms than surrogates of patients who lived, even after adjusting for baseline symptoms of anxiety and depression. Patient death was not associated with hyperarousal symptoms.

    Conclusions

    Intrusive thoughts are the most severe PTSD symptom in surrogates of patients experiencing CCI, with intensified symptoms among surrogates of patients who died. These results have the potential to inform tailored treatment strategies to reduce PTSD symptoms in this population.