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Anxiety and Depressive Symptoms Among Two Seriously Medically Ill Populations and Their Family Caregivers: A Comparison and Clinical Implications

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Abstract

Background

Anxiety and depression are common among patients with acute illness and their families. In oncology, psychosocial services addressing these symptoms are increasingly part of regular practice. Less is known about psychiatric distress among patients with acute neurological injury (ANI) and their family caregivers. To highlight this inequity in psychosocial intervention across medical services, we compared anxiety and depressive symptomatology shortly following diagnosis among patients facing incurable cancer or ANI and their family caregivers.

Methods

Recruited from the same hospital, participants were patients within 8 weeks of receiving a diagnosis of incurable cancer (N = 350) and their family caregivers (N = 275; total patient/caregiver dyads = 275) and patients hospitalized in the Neuroscience ICU in the past 2 weeks (N = 81) and their family caregivers (N = 95; total dyads = 75). Participants reported anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale. Symptomatology was compared across illnesses using independent samples t-tests and multiple regressions controlling for differences in sample demographics.

Results

Patients with ANI (M = 6.90) reported greater anxiety symptoms than those with cancer (M = 5.31, p < .001), while caregivers for patients with ANI (M = 5.45) reported greater depressive symptoms than caregivers for patients with cancer (M = 3.81, p < .001). Results remained when controlling for demographic differences between samples.

Conclusion

This is the first cross-comparison of psychiatric distress in patients and family caregivers affected by two distinct, life-threatening illnesses early in the illness trajectory. Findings support the priority of addressing psychiatric distress among patients with ANI and their family caregivers, as has been emphasized in the psychosocial oncology field.

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Acknowledgements

This work was performed at the Massachusetts General Hospital, Boston, MA. We thank Tara Tehan, Mary Guanci, Eric Riklin, and the nursing staff within the Neuroscience ICU for their help with recruitment for patients with Acute Neurological Injury. We thank the Cancer Outcomes Research team for their contributions to the Early Palliative Care study.

Funding

Dr. Vranceanu received support from the National Institute of Neurological Disorders and Stroke Clinical Trials Methodology Course (5R25NS088248-02). Dr. Temel received support from the National Institute of Nursing Research (R01 NR012735) and National Cancer Institute (K24 CA181253).

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    Authors and Affiliations

    1. Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, One Bowdoin Square, 7th Floor, Suite 758, Boston, MA, 02114, USA

      Kelly M. Shaffer, Jamie M. Jacobs, Jessica N. Coleman, Joseph A. Greer & Ana-Maria Vranceanu

    2. Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA

      Jamie M. Jacobs & Joseph A. Greer

    3. Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

      Jennifer S. Temel

    4. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

      Jonathan Rosand

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    1. Kelly M. Shaffer
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    Correspondence to Ana-Maria Vranceanu.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    Shaffer, K.M., Jacobs, J.M., Coleman, J.N. et al. Anxiety and Depressive Symptoms Among Two Seriously Medically Ill Populations and Their Family Caregivers: A Comparison and Clinical Implications. Neurocrit Care 27, 180–186 (2017). https://doi.org/10.1007/s12028-016-0358-3

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