[A "I would like to give him my life": results of a psychological support intervention to caregivers of patients undergoing neuromotor rehabilitation].
A large proportion of patients hospitalised for severe neuromotor disorders are supported during the in-hospital rehabilitation program by family members. To target interventions of psychological support for these caregivers it can be of help to identify the causes of caregiver burden or specific needs. Anxiety and depression are common in caregivers and constitute, together with emotional distress caused by loneliness and reduced social activities, an important part of the caregiving burden. This paper presents results emerging from a clinical intervention of psychological support offered to caregivers of neuromotor patients, mainly post-stroke, who were undergoing a course of in-hospital rehabilitation. A psychometric assessment was carried out on a sample of 50 caregivers, spouses or children, at the beginning and end of the in-hospital rehabilitation period. The following questionnaires were used: the Revised Anxiety and Depression Scale (RADS), measuring anxiety and depression, the Caregiver Need Assessment (CNA), assessing needs related to the assisted patient, and the Family Strain Questionnaire (FSQ) for a broader assessment of the problems faced by caregivers. The Functional Independence Measure (FIM) was completed by the medical doctor. A significant reduction was found, between the beginning and end of the rehabilitation period, in the needs related to patient care on the CNA (p < 0.001). Caregiver females, in contrast to males, showed an improvement in mood compared to the beginning of the rehabilitation period (p < 0.05). About half of the sample had, at the beginning, a marked clinical level of anxiety while 22% of caregivers had a marked clinical level of depression. Caregivers who received intense psychological support, i.e. at least one interview with the psychologist per week, showed, in contrast to those who received 3-4 interviews during the entire rehabilitation period, a decline in thoughts of death (p < 0.05) and, in cases where baseline anxiety was above the clinical cut-off, a reduced level of anxiety (p < 0.05). At the beginning of rehabilitation, there emerged: higher anxiety scores in caregivers who live with their patient (p < 0.05) compared to those living alone or with others; an increase in depression scores in inverse proportion to the patient's age (p = 0.01); higher scores of emotional stress in spouses (p < 0.05) compared to children and in caregivers of patients with left hemisphere deficits (p < 0.05); a greater need for knowledge about the disease (p < 0.001) and more thoughts of death (p < 0.05) in caregivers of female patients. These characteristics may be considered "alarm signals" that should alert hospital medical staff to the need to seek psychological help for the caregiver. At the end of rehabilitation, a greater degree of psychological strain was observed in caregivers of patients with severe disability. High needs related to the assisted patient (p < 0.01), high scores of emotional stress (p < 0.05), problems of social involvement (p < 0.05) and thoughts of death about the patient (p < 0.05) were found in caregivers of patients who had persisting high motor disability or who were admitted for consequences of a left hemisphere lesion. High depression scores were also found in caregivers of patients with high residual cognitive disability (p < 0.05). This psychometric evaluation makes it possible to tailor the psychological support offered to the needs of each individual caregiver both during rehabilitation and in relation to eventual future developments. A multidisciplinary team approach to the caregiver can thus lead to a general reduction of caregiver strain.
Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione IRCCS, Istituto Scientifico di Tradate Servizio di Psicologia, Italy. loretta.moroni@fsm.it
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Colangelo
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Gallì
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Bertolotti
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D017028:Caregivers / Q000523:psychology*; D003376:Counseling / Q000379:methods; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D007297:Inpatients; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000534:rehabilitation*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods; D012934:Social Isolation; D013315:Stress, Psychological / Q000209:etiology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires