Psychological distress in critically ill patients: Risk and protective factors
DOI:
https://doi.org/10.5944/rppc.26224Palabras clave:
Critically ill patients, psychological distress, risk factors, protective factorsResumen
Abstract: Despite the importance of patients’ psychological well-being in their own recovery from illness, few studies examine these issues while the patient is still in ICU. This study analyzes the psychological distress of 71 ICU patients and the potential risk/protective factors for such distress. Patients showed moderate anxiety and depression although in a significant percentage clinical symptomatology was observed. More than halve of the patients revealed an intermediate general stress level and the most important stressor was having pain. Regarding risk factors for psychological distress, being a woman increased the risk for anxiety, depression and stress. Being a septic patient also increased the risk of experiencing stress. Conversely, some protective factors were being married and younger. These data provide a landscape of the distress experienced by patients while they are still in ICU, which is important to optimize the attention provided in a context where time for intervention is rather limited. Keywords: Critically ill patients; psychological distress; risk factors; protective factors. Afectación emocional en pacientes críticos: Factores de riesgo y de protección Resumen: A pesar de la importancia del bienestar psicológico del paciente en su recuperación, pocos estudios analizan estos aspectos mientras el paciente está todavía en UCI. Este estudio analiza la afectación emocional de 71 pacientes críticos y factores de riesgo/protección para dicha afectación. Los pacientes mostraron síntomas de ansiedad/depresión moderados, aunque un porcentaje significativo mostró sintomatología clínica. Más de la mitad de los pacientes reveló un nivel de estrés intermedio y el estresor más importante fue tener dolor. Asimismo, ser mujer aumentó el riesgo de ansiedad, depresión y estrés. Ser paciente séptico incrementó el riesgo de experimentar estrés. Por el contrario, algunos factores protectores fueron estar casado y ser más joven. Estos datos proporcionan un panorama general del malestar experimentado por los pacientes mientras están en UCI, lo cual es importante para optimizar la atención de los pacientes en un contexto en el que el tiempo para intervenir es bastanteescaso. Palabras clave: Pacientes críticamente enfermos; malestar emocional; factores de riesgo; factores protectores.Descargas
Citas
Backes, M.T.S., Erdmann, A.L., & Büscher, A. (2015). The Living, Dynamic and Complex Environment Care in Intensive Care Unit. Revista Latino-Americana de Enfermagem, 23, 411-418. http://dx.doi.org/10.1590/0104-1169.0568.2570.
Ballester, R., Abizanda, R., Edo, M., Ibáñez, M.P., Bernat, A., & Bisbal, E. (2006). Estresores para el paciente que ingresa en una Unidad de Cuidados Intensivos. V Congreso de la Asociación Española de Psicología Clínica y Psicopatología. Valencia, España.
Beck, A.T., Steer, R.A., & Carbin, M.G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100. https://doi.org/10.1016/0272-7358(88)90050-5.
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugm, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
Choi, J., Tate, J.A., Rogers, M.A., Donahoe, M.P., & Hoffman, L.A. (2016). Depressive symptoms and anxiety in intensive care unit (ICU) survivors after ICU discharge. Heart Lung, 45(2), 140-146. https://doi.org/10.1016/j.hrtlng.2015.12.002.
Curtis, J.R. (2003). Measuring health status after critical illness: Where are we and where do we go from here? In D.C. Angus & J. Carlet (Eds.), Surviving Intensive Care. Update in Intensive Care and Emergency Medicine (Volume 39) (pp.181-196). Germany: Springer-Verlag Berlin Heidelberg.
Davydow, D.S., Gifford, J.M., Desai, S.V., Bienvenu, O.J., & Needham, D.M. (2009). Depression in general intensive care unit survivors: a systematic review. Intensive Care Medicine, 35, 796-809. https://doi.org/10.1007/s00134-009-1396-5.
Dias, Dde. S., Resende, M.V., & Diniz, Gdo. C. (2015). Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit. Revista Brasileira de Terapia Intensiva, 27, 18-25. http://dx.doi.org/10.5935/0103-507X.20150005.
Ding, Q., Redeker, N.S., Pisani, M.A., Yaggi, H.K., & Knauert, M.P. (2017). Factors Influencing Patients' Sleep in the Intensive Care Unit: Perceptions of Patients and Clinical Staff. American journal of critical care, 26, 278-286. https://doi.org/10.4037/ajcc2017333.
Dziadzko, V., Dziadzko, M.A., Johnson, M.M., Gajic, O., & Karnatovskaia, L.V. (2017). Acute psychological trauma in the critically ill: Patient and family perspectives. General Hospital Psychiatry, 47, 68-74. https://doi.org/10.1016/j.genhosppsych.2017.04.009.
Engström, A., Rogmalm, K., Marklund, L., & Wälivaara, B.M. (2015). Follow-up visit in an ICU: receiving a sense of coherence. Nursing in Critical Care. https://doi.org/10.1111/nicc.12168.
Garrouste-Orgeas, M., Coquet, I., Périer, A., Timsit, J.F., Pochard, F., Lancrin, F, Philippart, F., Vesin, A., Bruel, C., Blel, Y., Angeli, S., Cousin, N., Carlet, J., & Misset, B. (2012). Impact of an intensive care unit diary on psychological distress in patients and relatives. Critical Care Medicine, 40, 2033-2040. https://doi.org/10.1097/CCM.0b013e31824e1b43.
Gil, B., Ballester, R., Gómez, S., Ruiz, E., & Giménez, C. (2010). Síntomas de ansiedad y depresión tras la hospitalización en una Unidad de Cuidados Intensivos. Fórum de Recerca, 15, 293-304.
Gil-Juliá, B., Bernat-Adell, M.D., Collado-Boira, E.J., Molés-Julio, M.P., & Ballester-Arnal, R. (2018). Psychological distress in relatives of critically ill patients: Risk and protective factors. Journal of Health Psychology. https://doi.org/10.1177/1359105318817357.
Gómez-Carretero, P., Monsalve, V., Soriano, J.F., & De Andrés, J. (2007). Alteraciones emocionales y necesidades psicológicas de pacientes en una Unidad de Cuidados Intensivos. Medicina Intensiva, 31, 318-325. https://doi.org/10.1016/S0210-5691(07)74830-1.
Granja, C., Lopes, A., Moreira, S., Dias, C., Costa-Pereira, A., Carneiro, A., & for the JMIP Study Group. (2005). Patients' recollections of experiences in the intensive care unit may affect their quality of life. Critical Care, 9 (2), R96-R109. https://doi.org/10.1186/cc3026.
Gültekin, Y., Özçelik, Z., Akıncı, S.B., & Yorgancı, H.K. (2018). Evaluation of stressors in intensive care units. Turkish Journal of Surgery, 34, 5-8. http://dx.doi.org/10.5152/turkjsurg.2017.3736.
Hashmi, A.M., Han, J.Y., & Demla, V. (2017). Intensive Care and its Discontents. Psychiatric Illness in the Critically Ill. Psychiatric Clinics of North America, 40(3), 487-500. https://doi.org/10.1016/j.psc.2017.05.011.
Hatch, R., Young, D., Barber, V., Griffiths, J., Harrison, D.A., & Watkinson, P. (2018). Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study. Critical Care, 22,310. https://doi.org/10.1186/s13054-018-2223-6.
Herrero, M.J., Blanch, J., Peri, J.M., De Pablo, J., Pintor, L., & Bulbena, A. (2003). A validation study of the hospital anxiety and depression scale (HADS) in a Spanish population. General Hospital Psychiatry, 25, 277-283. https://doi.org/10.1016/S0163-8343(03)00043-4.
Hewitt, J. (2002). Psycho-affective disorder in intensive care units: a review. Journal of Clinical Nursing, 11, 575-584. https://doi.org/10.1046/j.1365-2702.2002.00638.x.
Hupcey, J.E. (2000). Feeling Safe: The Psychosocial Needs of ICU Patients. Journal of Nursing Scholarship, 32, 361-367. https://doi.org/10.1111/j.1547-5069.2000.00361.x.
Hweidi, I.M., & Nizamli, F.M. (2015). Stressors in intensive care units in Syria: Patients' perceptions. Journal of Research in Nursing, 20, 114-126. http://dx.doi.org/10.1177/1744987114524202.
Kalfon, P., Baumstarck, K., Estagnasie, P., Geantot, M.A., Berric, A., Simon, S., Floccard, B., Signouret, T., Boucekine, M., Fromentin, M., Nyunga, M., Sossou, A., Venot, M., Robert, R., Follin, A., Audibert, J., Renault, A., Garrouste‑Orgeas, M., Collange, O., Levrat, Q., Villard, I., Thevenin, D., Pottecher, J., Patrigeon, R.G., Revel, N., Vigne, C., Azoulay, E., Mimoz, O., Auquier, P., & on behalf of the IPREA Study group. (2017). A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial. Intensive Care Medicine, 43, 1829-1840. https://doi.org/10.1007/s00134-017-4991-x.
Lasa, L., Ayuso-Mateos, J.L., Vázquez-Barquero, J.L., Díez-Manrique, F.J., & Dowrick, C.F. (2000). The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis. Journal of Affective Disorders, 57, 261-265. https://doi.org/10.1016/S0165-0327(99)00088-9.
Li, D.T., & Puntillo, K. (2006). A pilot study on coexisting symptoms in intensive care patients. Applied Nursing Research, 19, 216-219. https://doi.org/10.1016/j.apnr.2006.01.003.
López, S., Pastor, M.A., Rodríguez, J., Sánchez, S., & Belmonte, J. (1990). Evaluación del estrés del paciente quirúrgico. Revista de Psicología de la Salud, 2, 113-126.
Llubià, C., & Canet, J. (2000). Unidades de cuidados críticos: la difícil tarea de la información. Medicina Clinica (Barc), 114, 141-143. https://doi.org/10.1016/S0025-7753(00)71221-8.
Martin, J.B., & Badeaux, J.E. (2018). Beyond the Intensive Care Unit: Posttraumatic Stress Disorder in Critically Ill Patients. Critical care nursing clinics of North America, 30, 333-342. https://doi.org/10.1016/j.cnc.2018.05.001.
Milton, A., Bruck, E., Schandl, A., Bottai, M., & Sackey, P. (2017). Early psychological screening of intensive care unit survivors: a prospective cohort study. Critical care, 21, 273. https://doi.org/10.1186/s13054-017-1813-z.
Needham, D.M., Feldman, D.R., & Kho, M.E. (2011). The functional costs of ICU survivorship: collaborating to improve post-ICU disability. American Journal of Respiratory and Critical Care Medicine, 183, 962-964. https://doi.org/10.1164/rccm.201012-2042ED.
Pesce, L., van Veen, T., Carlier, I., van Noorden, M.S., van der Wee, N.J.A., van Hemert, A.M., & Giltay, E.J. (2016). Gender differences in outpatients with anxiety disorders: The Leiden Routine Outcome Monitoring Study. Epidemiology and Psychiatric Sciences, 25, 278-287. http://dx.doi.org/10.1017/S2045796015000414.
Quintana, J.M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish Version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107, 216-221. https://doi.org/10.1034/j.1600-0447.2003.00062.x.
Rattray, J.E., Johnston, M., & Wildsmith, J.A.W. (2005). Predictors of emotional outcomes of intensive care. Anaesthesia, 60, 1085-1092. https://doi.org/10.1111/j.1365-2044.2005.04336.x.
Richart, M., Cabrero, J., & Reig, A. (1993). Hospitalización y estrés en el paciente: percepción diferencial de estresores entre paciente y personal de enfermería. Análisis y Modificación de Conducta, 19, 75-89.
Rincon, H.G., Granados, M., Unutzer, J., Gómez, M., Duran, R., Badiel, M., Salas, C., Martínez, J., Mejía, J., Ordóñez, C., Florez, N., Rosso, F., & Echeverri, P. (2001). Prevalence, detection and treatment of anxiety, depression, and delirium in the Adult Critical Care Unit. Psychosomatics, 42, 391-396. https://doi.org/10.1176/appi.psy.42.5.391.
Spielberger, C.D., Gorsuch, R.L., & Lushene, R. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
Volicer, B.J., & Bohanon, M.A. (1975). Hospital stress rating scale. Nursing Research, 24, 352-359.
Wikström, A.C. (2003). Technology – a supporter and challenger in everyday practice. A study of interaction in the intensive care unit. Diss. Licentiate’s degree, Sahlgrenska Academy, Gothenburg.
Wörfel, F., Gusy, B., Lohmann, K., Töpritz, K., & Kleiber, D. (2016). Mental health problems among university students and the impact of structural conditions. Journal of Public Health, 24, 125-133. http://dx.doi.org/10.1007/s10389-015-0703-6.
Zigmond, A.S., & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
©Asociación Española de Psicología Clínica y Piscopatología.
Todos los derechos relacionados con la reproducción o distribución por cualquier foma y medio, corresponden a la Asociación Española de Psicología Clínica y Piscopatología.
