Mental Health Interventions to Improve Psychological Outcomes in Informal Caregivers of Critically Ill Patients: A Systematic Review and Meta-Analysis*

Abstract

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OBJECTIVES:

Determine effect of mental health interventions on psychologic outcomes in informal caregivers of critically ill patients.

DATA SOURCES:

Searches conducted in MEDLINE, Embase, and other databases from inception to October 31, 2019.

STUDY SELECTION:

Interventions for informal caregivers of critically ill patients in adult ICU, PICU, or neonatal ICU.

DATA EXTRACTION:

Two independent, blinded reviewers screened citations and extracted data. Random-effects models with inverse variance weighting pooled outcome data when suitable. Psychologic outcomes categorized: 1) negative (anxiety, depression, post-traumatic stress disorder, distress, and burden) or 2) positive (courage, humanity, justice, transcendence, temperance, and wisdom and knowledge). Stratification according to intervention type and patient population was performed.

DATA SYNTHESIS:

Of 11,201 studies, 102 interventional trials were included ( n = 12,676 informal caregivers). Interventions targeted caregiver experience ( n = 58), role ( n = 6), or support ( n = 38). Meta-analysis (56 randomized controlled trials; n = 22 [39%] in adult ICUs; n = 34 [61%] in neonatal ICU or PICU) demonstrated reduced anxiety (ratio of means = 0.92; 95% CI, 0.87–0.97) and depression (ratio of means = 0.83; 95% CI, 0.69–0.99), but not post-traumatic stress disorder (ratio of means = 0.91; 95% CI, 0.80–1.04) or distress (ratio of means = 1.01; 95% CI, 0.95–1.07) among informal caregivers randomized to mental health interventions compared with controls within 3 months post-ICU discharge. Increased humanity (ratio of means = 1.11; 95% CI, 1.07–1.15), transcendence (ratio of means = 1.11; 95% CI, 1.07–1.15), and caregiver burden (ratio of means = 1.08; 95% CI, 1.05–1.12) were observed. No significant effects of mental health interventions observed after 3 months postdischarge.

CONCLUSIONS:

Mental health interventions for caregivers of critically ill patients improved short-term anxiety, depression, humanity, and transcendence while increasing burden. Clinicians should consider short-term prescriptions of mental health interventions to informal caregivers of critically ill patients with capacity to manage interventions.