Research Reports - Associated mental illness symptoms in close relatives of patients with severe traumatic brain injury

Acta Neurochir (Wien). 2015 Jun 24

Rueckriegel SM(1), Baron M, Domschke K, Neuderth S, Kunze E, Kessler AF, Nickl R,
Westermaier T, Ernestus RI

BACKGROUND: Close relatives (CR) of patients with severe traumatic brain injury
(TBI) and high-grade subarachnoid hemorrhage (SAH) suffer extraordinary distress
during the treatment: Distress may lead to persisting mental illness symptoms
within the spectrum of post-traumatic stress disorder (PTSD), anxiety disorders,
and depression. The primary goal of this study was to determine the prevalence
and severity of these symptoms in CR. The secondary goal was identification of
associated factors.
METHOD: Standardized interviews were conducted with 53 CR (mean age of
57.7 ± 11.4 years) of patients with TBI °III (n = 27) and high-grade SAH H&H
°III-V (n = 26) between 5 and 15 months after the event. The interviews contained
a battery of surveys to quantify symptoms of PTSD, anxiety disorders, and
depression, i.e., Impact of Event Scale (IES-R), 36-item Short-Form General
Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). Fixed
and modifiable possibly influencing factors were correlated.
RESULTS: Twenty-eight CR (53 %) showed IES-R scores indicating a probable
diagnosis of PTSD. Twenty-five CR (47 %) showed an increased anxiety score and 18
(34 %) an increased depression score using HADS. Mean physical component summary
of SF-36 was not abnormal (49.1 ± 9.1), whereas mean mental component summary was
under average (41.0 ± 13.2), indicating a decreased quality of life caused by
mental effects. Perception of the interaction quality with the medical staff and
involvement into medical decisions correlated negatively with severity of mental
illness symptoms. Evasive coping strategies were highly significantly associated
with symptoms.
CONCLUSIONS: This study quantifies an extraordinarily high prevalence of mental
illness symptoms in CR of patients with critical acquired brain injury due to SAH
and TBI. Modifiable factors were associated with severity of mental illness
symptoms. Prospective studies testing efficiency of early psychotherapeutic
interventions are needed.

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