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The Impact of Resilience Factors and Anxiety During Hospital Admission on Longitudinal Anxiety Among Dyads of Neurocritical Care Patients Without Major Cognitive Impairment and Their Family Caregivers

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Abstract

Background/Objective

Anxiety is common in patients experiencing neurocritical illness and their family caregivers. Resilience factors like mindfulness and coping skills may be protective against symptoms of emotional distress, including anxiety. Less is known about the interplay of anxiety symptoms and resilience factors between patients and caregivers. The purpose of this study is to examine the trajectory of anxiety symptoms among dyads of neurocritical care patients without major cognitive impairment and their family caregivers and to elucidate the relationship between resiliency (e.g., mindfulness and coping) and anxiety in these dyads.

Methods

Prospective, longitudinal study of adults admitted to the neurological intensive care unit (Neuro-ICU) and their caregivers. Dyads of patients (N = 102) and family caregivers (N = 103) completed self-report measures of mindfulness (Cognitive Affective Mindfulness Scale-Revised) and coping (Measure of Current Status-Part A) during Neuro-ICU hospitalization and anxiety symptoms (anxiety subscale of the Hospital Anxiety and Depression Scale) during hospitalization and at 3- and 6-month follow-up. We used actor–partner interdependence modeling to predict the effect of one’s own baseline characteristics on one’s own and one’s partner’s future anxiety symptoms.

Results

Rates of clinically significant anxiety symptoms were 40% for patients and 42% for caregivers at baseline. Of these, 20% of patients and 23% of caregivers showed moderate and severe symptoms. Approximately, one-third of patients and caregivers reported clinically significant anxiety symptoms at 3- and 6-month follow-ups, with more than 20% endorsing moderate or severe symptoms. Patients’ own baseline mindfulness, coping, and anxiety symptoms were associated with lower anxiety symptoms at all time points (ps < 0.001)—this was also true for caregivers. For both patients and caregivers, one’s own baseline mindfulness predicted their partner’s anxiety symptoms 3 months later (p = 0.008), but not at 6-month follow-up.

Conclusions

Anxiety symptoms in Neuro-ICU patient–caregiver dyads are high through 6 months following admission. Mindfulness is interdependent and protective against anxiety in dyads at 3-month but not 6-month follow-up. Early, dyad-based interventions may prevent the development of chronic anxiety in patients without major cognitive impairment and caregivers.

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Acknowledgements

We thank Tara Tehan, Mary Guanci, Danielle Salgueiro, and the dedicated team of Neuro-ICU nurses for their help with recruitment.

Funding

This work was supported by the National Institute of Nursing Research [Grant 1R21NR017979] and support from the Henry and Allison McCance Center for Brain Health.

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Authors and Affiliations

  1. Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, 55 Fruit St., Wang Ambulatory Care Center 8th Floor, Suite 815 and 85, Boston, MA, 021140, USA

    Emma E. Meyers, Jonathan Rosand & Ana-Maria Vranceanu

  2. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA

    Emma E. Meyers & Jonathan Rosand

  3. Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA

    Emma E. Meyers, Jonathan Rosand & Ana-Maria Vranceanu

  4. Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA

    Emma E. Meyers, Melissa Gates, Ann Lin & Ana-Maria Vranceanu

  5. Department of Psychology, University of Colorado Denver, Denver, CO, 80217, USA

    Alex Presciutti

  6. Center for Behavioral Health and Technology, University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22902, USA

    Kelly M. Shaffer

  7. Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Melissa Gates, Ann Lin & Ana-Maria Vranceanu

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Contributions

Meyers and Vranceanu were involved in protocol/project development, manuscript writing/editing, data collection/management, and data analysis. Presciutti and Shaffer were involved in manuscript writing/editing and data analysis. Gates was involved in manuscript writing/editing and data collection/management. Lin was involved in protocol/project development, manuscript writing/editing, and data collection/management. Rosand was involved in protocol/project development and manuscript writing/editing. All authors contributed sufficiently to this scientific work and met criteria for authorship.

Corresponding author

Correspondence to Ana-Maria Vranceanu.

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Conflict of interest

Dr. Rosand reports serving as a consultant for Boehringer Ingelheim, Pfizer, and New Beta Innovation. All other authors declare that they have no conflicts of interest.

Ethical Approval

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. The study was approved by the Institutional Review Board at our hospital. All participants completed informed consent prior to study procedures.

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Meyers, E.E., Presciutti, A., Shaffer, K.M. et al. The Impact of Resilience Factors and Anxiety During Hospital Admission on Longitudinal Anxiety Among Dyads of Neurocritical Care Patients Without Major Cognitive Impairment and Their Family Caregivers. Neurocrit Care 33, 468–478 (2020). https://doi.org/10.1007/s12028-020-00913-7

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