title: Psychosocial outcomes in informal caregivers of the critically ill: a systematic review.
abstract: OBJECTIVE
  The objective of the review was to evaluate and synthesize the prevalence, risk factors, and trajectory of psychosocial morbidity in informal caregivers of critical care survivors.
  
  
  METHODS
  A systematic search of MEDLINE, PsychInfo, PubMed, CINAHL, Cochrane Library, Scopus, PILOTS, EMBASE, and Physiotherapy Evidence Database was undertaken between January and February 2014.
  
  
  METHODS
  Citations were screened independently by two reviewers for studies that investigated psychosocial outcomes (depression, anxiety, stress, posttraumatic stress disorder, burden, activity restriction, and health-related quality of life) for informal caregivers of critical care survivors (mechanically ventilated for 48 hr or more).
  
  
  METHODS
  Data on study outcomes were extracted into a standardized form and quality assessed by two independent reviewers using the Newcastle-Ottawa Scale, the Physiotherapy Evidence Database, and the National Health and Medical Research Council Hierarchy of Evidence guide. Preferred Reporting Items for Systematic Reviews guidelines were followed.
  
  
  RESULTS
  Fourteen studies of 1,491 caregivers were included. Depressive symptoms were the most commonly reported outcome with a prevalence of 75.5% during critical care and 22.8-29% at 1-year follow-up. Risk factors for depressive symptoms in caregivers included female gender and younger age. The greatest period of risk for all outcomes was during the patient's critical care admission although psychological symptoms improved over time. The overall quality of the studies was low.
  
  
  CONCLUSIONS
  Depressive symptoms were the most prevalent in informal caregivers of survivors of intensive care who were ventilated for more than 48 hours and persist at 1 year with a prevalence of 22.8-29.0%, which is comparable with caregivers of patients with dementia. Screening for caregiver risks could be performed during the ICU admission where intervention can be implemented and then evaluated. Further high-quality studies are needed to quantify anxiety, stress, caregiver burden, and posttraumatic stress disorder outcomes in informal caregivers of long-stay patients surviving ICU.
authors: 1Department of Physiotherapy, Austin Hospital, Heidelberg, Victoria, Australia. 2Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia. 3Department of Physiotherapy, Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia. 4Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
authors: Kimberley J
authors: KJ
authors: Haines
authors: Linda
authors: L
authors: Denehy
authors: Elizabeth H
authors: EH
authors: Skinner
authors: Stephen
authors: S
authors: Warrillow
authors: Sue
authors: S
authors: Berney
mesh_terms: D000367:Age Factors; D001526:Behavioral Symptoms / Q000453:epidemiology*; D017028:Caregivers / Q000523:psychology*; D016638:Critical Illness; D006304:Health Status; D006801:Humans; D008603:Mental Health / Q000706:statistics & numerical data*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors