Sintomas psicológicos em familiares de pacientes críticos

Abstract

Objetivo: Investigar a existência de associação entre resiliência, sobrecarga de cuidado e níveis de cortisol capilar em familiares de pacientes internados em unidade de terapia intensiva (UTI). Método: Esta tese é composta de três partes: (1) Revisão de literatura sobre os sintomas psicológicos vivenciados pelos familiares com pacientes internados em UTI; (2) Elaboração de um estudo com o objetivo de investigar a associação entre resiliência e sobrecarga de cuidado após a alta da UTI em familiares de pacientes críticos crônicos, além da associação com sintomas de ansiedade e depressão; (3) Elaboração de um segundo estudo com o objetivo de investigar a existência de associação entre a concentração de cortisol no cabelo (CCC) antes da internação na UTI, e a ocorrência de sintomas de estresse agudo em familiares de pacientes com doença crítica persistente. Resultados: O primeiro estudo incluiu 131 pacientes e familiares que permaneceram na UTI por pelo menos 10 dias. Houve associação entre idade e religiosidade intrínseca e resiliência. As médias dos escores HADS-ansiedade e HADS-depressão foram 9,7 ± 4,5 e 7,3 ± 4,1, respectivamente. Houve correlação negativa entre a idade do familiar e o escore HADS-ansiedade (r = -0,26; p = 0,002). A média do escore de Zarit foi de 30,3 ± 13,8. Houve associação entre o escore de Zarit e o escore HADS-ansiedade (r = 0,51; p <0,001) e o escore HADS-depressão (r = 0,47; p <0,001). O segundo estudo incluiu 110 pacientes e seus familiares. Oitenta e oito familiares (80,0%) apresentaram sintomas de estresse agudo. Não houve associação entre religiosidade intrínseca e estresse (p = 0,721) e nem entre resiliência e estresse (p = 0,791). A mediana de CCC foi 2,37 pg/mg (1,16 - 5,06 pg/mg). Não houve diferença de CCC entre familiares com e sem sintomas de estresse agudo (p = 0,419). Na análise multivariada, apenas o fato de o paciente estar alerta no momento da entrevista com o familiar apresentou associação significativa com a prevalência de sintomas de estresse agudo do familiar. Conclusão: Familiares resilientes de pacientes gravemente enfermos têm uma carga de cuidado menor e menos sintomas de ansiedade e depressão. Não houve evidência de associação entre a CCC dos familiares em segmentos do cabelo referentes aos meses anteriores à admissão do paciente na UTI e a ocorrência de sintomas de estresse.

Objective: To investigate the existence of an association between resilience, care overload and capillary cortisol levels in relatives of patients hospitalized in an intensive care environment (ICU). Methods: This thesis is composed of three parts: (1) Literature review on the psychological symptoms experienced by family members of patients admitted to the ICU; (2) Elaboration of a study with the objective of investigating the association between resilience and care burden after ICU discharge in relatives of chronic critical patients, in addition to the association with symptoms of anxiety and depression; (3) Elaboration of a second study with the objective of investigating the existence of an association between the concentration of cortisol in the hair (CCC) before ICU admission and the occurrence of symptoms of acute stress in family members of patients with persistent critical illness. Results: The first study included 131 patients and family members who stayed in the ICU for at least 10 days. There was an association between age and intrinsic religiosity and resilience. The mean HADS-anxiety and HADS-depression scores were 9.7 ± 4.5 and 7.3 ± 4.1, respectively. There was a negative correlation between the relative's age and the HADS-anxiety score (r = -0.26; p = 0.002). The mean Zarit score was 30.3 ± 13.8. Clinically significant levels of burden (Zarit≥21) were observed in 55 (72.4%) family members. There was an association between the Zarit score and the HADS-anxiety score (r = 0.51; p <0.001) and the HADS-depression score (r = 0.47; p <0.001). The second study included 110 patients and their families. Eighty-eight family members (80.0%) showed symptoms of acute stress. There was no association between intrinsic religiosity and stress (p = 0.721) or between resilience and stress (p = 0.791). The median CCC was 2.37 pg/mg (1.16 - 5.06 pg/mg). There was no difference in CCC between family members with and without symptoms of acute stress (p = 0.419). In the multivariate analysis, only the fact that the patient was alert at the time of the interview with the family member was significantly associated with the prevalence of acute stress symptoms in the family member. Conclusion: Resilient family members of critically ill patients have a lower care burden and fewer symptoms of anxiety and depression. There was no evidence of an association between the CCC of family members in hair segments referring to the months prior to the patient's admission to the ICU and the occurrence of stress symptoms.