Lauren C. Vanderwerker

Psychiatric Disorders and Mental Health Service Use Among Caregivers of Advanced Cancer Patients

PURPOSE Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers. METHODS Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use. RESULTS Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patients cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patients cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patients cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services. CONCLUSION Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.

Psychiatric illness in the next of kin of patients who die in the intensive care unit.

Objectives:To determine the rates of psychiatric illness in next of kin following the death of a relative in a medical intensive care unit. Design:Cross-sectional survey. Setting:A university teaching hospital, New Haven, CT. Patients:Forty-one next of kin who had served as primary surrogate decision makers before the death of their loved one in the intensive care unit 3–12 months previously. Interventions:Structured Clinical Interviews for DSM-IV and the Inventory of Complicated Grief–Revised were used to determine prevalence of psychiatric illness. Formal questionnaires were used to evaluate key features of the intensive care unit experience. Bivariate statistics were used to identify factors associated with the presence of psychiatric illness. Measurements and Main Results:Following 107 patient deaths, 51 next of kin were successfully contacted and 41 (80%) agreed to study participation. Thirty-four percent (95% confidence interval, 20% to 51%) met criteria for at least one psychiatric illness: major depressive disorder (27%), generalized anxiety disorder (10%), panic disorder (10%), or complicated grief disorder (5%). Disorders were more common in spouses than other kinship relations (63% vs. 16%, p = .002), those experiencing additional stressors after the loss (53% vs. 21%, p = .03), those who said the patient was ill <5 yrs (45% vs. 8%, p = .03), and those who said the patient’s physician was not comforting (71% vs. 23%, p = .02). Conclusions:In a cohort of bereaved next of kin of patients who died in the intensive care unit, we identified a high prevalence of psychiatric illness, particularly major depressive disorder. More work is needed to identify those at risk for psychiatric illness so that appropriate interventions may be targeted.

An exploration of associations between separation anxiety in childhood and complicated grief in later life

Recent studies have suggested that the vulnerability to complicated grief (CG) may be rooted in insecure attachment styles developed in childhood. The aim of this study was to examine the etiologic relevance of childhood separation anxiety (CSA) to the onset of CG relative to major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder in bereaved individuals. The Structured Clinical Interview for the DSM-IV, Inventory of Complicated Grief-Revised, and CSA items from the Panic Agoraphobic Spectrum Questionnaire were administered to 283 recently bereaved community-dwelling residents at an average of 10.6 months postloss. CSA was significantly associated with CG (OR = 3.2; 95% CI, 1.2–8.9), adjusting for sex, level of education, kinship relationship to the deceased, prior history of psychiatric disorder, and history of childhood abuse. CSA was not significantly associated with major depressive disorder, posttraumatic stress disorder, or generalized anxiety disorder.

SOCIAL SUPPORT AND TECHNOLOGICAL CONNECTEDNESS AS PROTECTIVE FACTORS IN BEREAVEMENT

Bereavement is associated with heightened risk of mental and physical health impairments as well as social isolation. The purpose of this study was to explore the effects of social support and technological connectedness on major depressive disorder (MDD), complicated grief (CG), posttraumatic stress disorder (PTSD), and quality of life. Participants were 293 community-based bereaved individuals (mean age = 61.5 years) who completed a baseline interview and a follow-up interview at an average of 5.9 and 10.6 months postloss. At baseline, subjects reported using the Internet (58.7%), e-mail (49.5%), and/or cellular phones (49.2%). Overall social support was protective against MDD, PTSD, and CG and associated with better quality of life. Internet and e-mail use at baseline and follow-up were associated with increased energy levels at follow-up, after control for confounding influences (e.g., chronic physical conditions, history of psychiatric disorders). Though not conclusive, our results suggest potential protection against psychiatric illness secondary to bereavement (MDD, PTSD, CG) and enhanced quality of life afforded by Internet and e-mail use.