Asset Details

  • Description:
  • ImportanceTo our knowledge, there are no evidence-based interventions to prevent chronic emotional distress (ie, depression, anxiety, and posttraumatic stress [PTS]) in critical care survivors and their informal caregivers. ObjectiveTo determine the feasibility and preliminary effect of the novel dyadic resiliency intervention Recovering Together (RT) on reducing symptoms of depression, anxiety, and PTS among hospitalized patients and their informal caregivers. Design, Setting, and ParticipantsThis single-blind, pilot randomized clinical trial of RT vs an educational control was conducted among 58 dyads in which either the survivor or caregiver endorsed clinically significant symptoms of depression, anxiety, or PTS. The study was conducted in the neuroscience intensive care unit at Massachusetts General Hospital. Data were collected from September 2019 to March 2020. InterventionsBoth RT and control programs had 6 sessions (2 at bedside and 4 via live video after discharge), and both survivor and caregiver participated together. Main Outcomes and MeasuresThe primary outcomes were feasibility of recruitment and intervention delivery, credibility, and satisfaction. The secondary outcomes included depression and anxiety (measured by the Hospital Depression and Anxiety Scale), PTS (measured by the PTSD Checklist–Civilian Version), and intervention targets (ie, mindfulness, measured by the Cognitive and Affective Mindfulness Scale–Revised; coping, measured by the Measure of Current Status–Part A; and dyadic interpersonal interactions, measured by the Dyadic Relationship Scale). Main outcomes and targets were assessed at baseline, 6 weeks, and 12 weeks. ResultsThe 58 dyads were randomized to RT (29 dyads [50.0%]; survivors: mean [SD] age, 49.3 [16.7] years; 9 [31.0%] women; caregivers: mean [SD] age, 52.4 [14.3] years; 22 [75.9%] women) or control (29 dyads [50.0%]; survivors: mean [SD] age, 50.3 [16.4] years; 12 [41.3%] women; caregivers, mean [SD] age, 52.1 [14.9], 17 [58.6%] women). Feasibility (recruitment [76%], randomization [100%], and data collection [83%-100%]), adherence (86%), fidelity (100%; κ = 0.98), satisfaction (RT: 57 of 58 [98%] with scores >6; control: 58 of 58 [100%] with scores >6), credibility (RT: 47 of 58 [81%] with scores >6; control: 46 of 58 [80%] with scores >6), and expectancy (RT: 49 of 58 [85%] with scores >13.5; 51 of 58 [87%] with scores >13.5) exceeded benchmarks set a priori. Participation in RT was associated with statistically and clinically significant improvement between baseline and postintervention in symptoms of depression (among survivors: −4.0 vs −0.6; difference, −3.4; 95% CI, −5.6 to −1.3; P = .002; among caregivers: −3.8 vs 0.6; difference, −4.5; 95% CI, −6.7 to −2.3; P < .001), anxiety (among survivors: −6.0 vs 0.3; difference, −6.3; 95% CI, −8.8 to −3.8; P < .001; among caregivers: −5.0 vs −0.9; difference, −4.1; 95% CI, −6.7 to −1.5, P = .002), and PTS (among survivors: −11.3 vs 1.0; difference, −12.3; 95% CI, −18.1 to −6.5, P < .001; among caregivers, −11.4 vs 5.0; difference, −16.4, 95% CI, −21.8 to −10.9; P < .001). Improvements sustained through the 12-week follow-up visit. We also observed RT-dependent improvement in dyadic interpersonal interactions for survivors (0.2 vs −0.2; difference, 0.4; 95% CI, 0.0 to 0.8; P = .04). Conclusions and RelevanceIn this pilot randomized clinical trial, RT was feasible and potentially efficacious in preventing chronic emotional distress in dyads of survivors of the neuroscience intensive care unit and their informal caregivers. Trial RegistrationClinicalTrials.gov Identifier: NCT03694678
  • License:
  • Rights Managed
  • Rights Holder:
  • JAMA
  • License Rights Holder:
  • Copyright 2020 Vranceanu A-M et al. JAMA Network Open.
  • Asset Type:
  • Text
  • Asset Subtype:
  • Article
  • Image Orientation:
  • Portrait
  • Image Dimensions:
  • 1275 x 1650
  • Image File Size:
  • 310 KB
  • Creator:
  • Ana-Maria Vranceanu, Sarah Bannon, Ryan Mace, Ethan Lester, Emma Meyers, Melissa Gates, Paula Popok, Ann Lin, Danielle Salgueiro, Tara Tehan, Eric Macklin, Jonathan Rosand
  • Credit:
  • Vranceanu, A.-M., Bannon, S., Mace, R., Lester, E., Meyers, E., Gates, M., Popok, P., Lin, A., Salgueiro, D., Tehan, T., Macklin, E., & Rosand, J. (2020). Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit. JAMA Network Open, 3(10), e2020807. https://doi.org/10.1001/jamanetworkopen.2020.20807.
  • Collection:
  • Keywords:
  • Restrictions:
  • Property Release:
  • No
  • Model Release:
  • No
  • Purchasable:
  • Yes
  • Sensitive Materials:
  • No
  • Article Authors:
  • Ana-Maria Vranceanu, Sarah Bannon, Ryan Mace, Ethan Lester, Emma Meyers, Melissa Gates, Paula Popok, Ann Lin, Danielle Salgueiro, Tara Tehan, Eric Macklin, Jonathan Rosand
  • Article Copyright Year:
  • Publication Volume:
  • 3
  • Publication Issue:
  • 10
  • Publication Date:
  • 10/14/2020
  • DOI:
  • https://doi.org/10.1001/jamanetworkopen.2020.20807

Would you like to download this asset? Tell us more and we can generate a quote, license and downloadable file.

Add to Cart

Article Preview