title: Coping as a Multifaceted Construct: Associations With Psychological Outcomes Among Family Members of Mechanical Ventilation Survivors.
abstract: OBJECTIVE
  To develop and evaluate a preliminary multifaceted model for coping among family members of patients who survive mechanical ventilation.
  
  
  METHODS
  In this multicenter cross-sectional survey, we interviewed family members of mechanically ventilated patients at the time of transfer from the ICU to the hospital ward. We constructed a theoretic model of coping that included characteristics attributable to family members, family-clinician rapport, and patients. We then explored relationships between coping factors and symptoms of psychological distress (anxiety, depression, and posttraumatic stress).
  
  
  METHODS
  Fifty-six family members of survivors of mechanical ventilation.
  
  
  RESULTS
  Psychological distress measured by the Hospital Anxiety and Depression Scale and Posttraumatic Stress Scale. Optimism measured using the Life Orientation Test scale, resiliency by Conner-Davidson Resilience Scale, and social support using the Patient Reported Outcomes Measurement Information System inventory. Family members had moderate levels of psychological distress with median total Hospital Anxiety and Depression Scale equal to 14 (interquartile range, 5-20) and Posttraumatic Stress Scale equal to 22 (interquartile range, 15-31). Among family member characteristics, greater optimism (p = 0.001, Hospital Anxiety and Depression Scale; p = 0.010, Posttraumatic Stress Scale), resilience (p = 0.012, Hospital Anxiety and Depression Scale), and social support (p = 0.013, Hospital Anxiety and Depression Scale) were protective against psychological distress. On the contrary, characteristics of family-clinician rapport such as communication quality and presence of conflict did not have any associations with psychological distress.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to explore coping as a multifaceted construct and its relationship with family psychological outcomes among survivors of mechanical ventilation. We found certain family characteristics of coping such as optimism, resilience, and social support to be associated with less psychological distress. Further research is warranted to identify potentially modifiable aspects of coping that might guide future interventions.
authors.affiliation: 1Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.2Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC.3Duke Program to Support People and Enhance Recovery, Duke University, Durham, NC.
authors.forename: Nandita
authors.initials: N
authors.lastname: Nadig
authors.forename: Nidhi G
authors.initials: NG
authors.lastname: Huff
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Cox
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003422:Critical Care; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*