Psychother Psychosom Med Psychol 2012; 62(09/10): 352-358
DOI: 10.1055/s-0032-1312679
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Partner von Patienten mit akuter Hirnschädigung: Angst und Depressivität in der akuten und sub-akuten Krankheitsphase

Partners of Patients with Acute Brain Injury: Anxiety and Depression in the Acute and Sub-Acute Phase
Friedrich Balck
1   Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitäts Klinikum Carl Gustav Carus an der TU Dresden
,
Andreas Dinkel
2   Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Technische Universität München
› Author Affiliations
Further Information

Publication History

eingereicht 07 February 2012

akzeptiert 02 May 2012

Publication Date:
14 June 2012 (online)

Zusammenfassung

Nur wenige Arbeiten beschäftigen sich mit der kurzfristigen psychischen Beeinträchtigung der Angehörigen von Patienten mit akuter Hirnschädigung. Wir untersuchten die Prävalenz von Angst und Depressivität der Partner (N=70) von Patienten mit Schädelhirntrauma (SHT) oder Subarachnoidalblutung (SAB) sowie den Einfluss verletzungsbezogener, personaler und kontextueller Merkmale. Die Partner wurden im Mittel 40,3 Tage (SD=15,7; Range 12–85) nach der Hirnverletzung des Patienten mittels Beck Angst-Inventar (BAI) und Beck Depressions-Inventar (BDI) befragt. 30,0% zeigten eine mittlere bis schwere Angstsymptomatik und 14,3% klinisch bedeutsame depressive Beschwerden. Eine stärkere funktionelle Beeinträchtigung des Patienten hing mit einer höheren Depressivität zusammen. Frauen waren emotional stärker beeinträchtigt. Zusätzliche psychosoziale Belastungen, eine akutmedizinische Versorgung sowie tägliche Besuche des Patienten gingen mit einer stärkeren psychischen Beeinträchtigung einher.

Abstract

There are only few studies that deal with psychological distress in short-term carers of patients with acute brain injuries. We investigated the prevalence of anxiety and depression in partners (N=70) of patients with traumatic brain injury (TBI) or subarachnoid haemorrhage (SAB). Furthermore, we analysed the influence of injury-related, personal, and contextual factors on psychological distress. Partners were interviewed, on average, 40,3 days (SD=15,7, Range 12–85) after the patient’s brain injury. They filled out the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Moderate to severe anxiety was prevalent in 30,0% of the partners, and 14,3% experienced significant depression. Partners of patients low in functional capacity exhibited a higher level of depression. Women were more distressed than men. Additional burden due to psychosocial background stress, acute care of the patient, and daily visits were associated with higher psychological distress.

 
  • Literatur

  • 1 Riggio S. Traumatic brain injury and its neurobehavioral sequelae. Neurol Clin 2011; 29: 35-47
  • 2 Teasdale TW, Engberg AW. Subjective well-being and quality of life following traumatic brain injury in adults: A long-term population-based follow-up. Brain Inj 2005; 19: 1041-1048
  • 3 Rinkel GJE, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10: 349-356
  • 4 Morrison V, Pollard B, Johnston M et al. Anxiety and depression 3 years following stroke: demographic, clinical, and psychological predictors. J Psychosom Res 2005; 59: 209-213
  • 5 Röding J, Glader EL, Malm J et al. Perceived impaired physical and cognitive functions after stroke in men and women between 18 and 55 years of age – a national survey. Disabil Rehabil 2009; 31: 1092-1099
  • 6 Blais MC, Boisvert JM. Psychological and marital adjustment in couples following a traumatic brain injury (TBI): a critical review. Brain Inj 2005; 19: 1223-1235
  • 7 Katzlberger F, Oder W. Psychosoziale Folgen schwerer Hirnverletzungen. Interviews mit Patienten und Angehörigen im Vergleich. Psychother Psych Med 2000; 50: 209-214
  • 8 Kreutzer JS, Rapport LJ, Marwitz JH et al. Caregivers’ well-being after traumatic brain injury: a multicenter prospective investigation. Arch Phys Med Rehabil 2009; 90: 939-946
  • 9 Han B, Haley WE. Family caregiving for patients with stroke. Review and analysis. Stroke 1999; 30: 1478-1485
  • 10 Hämmerling E, Ludwig C, Wendel C. Lebenszufriedenheit von PartnerInnen chronisch hirngeschädigter Menschen unter besonderer Berücksichtigung von Persönlichkeitsversänderungen. Z Neuropsychol 2008; 19: 223-233
  • 11 Norup A, Kristensen KS, Siert L et al. Neuropsychological support to relatives of patients with severe traumatic brain injury in the sub-acute phase. Neuropsychol Rehabil 2011; 21: 306-321
  • 12 Livingston MG, Brooks DN, Bond MR. Three months after severe head injury: psychiatric and social impact on relatives. J Neurol Neurosurg Psychiatry 1985; 48: 870-875
  • 13 Norup A, Siert L, Mortensen EL. Emotional distress and quality of life in relatives of patients with severe brain injury: the first month after injury. Brain Inj 2010; 24: 81-88
  • 14 Greenwood N, Mackenzie A. An exploratory study of anxiety in carers of stroke survivors. J Clin Nurs 2010; 19: 2032-2038
  • 15 Kitze K, von Cramon DY, Wilz G. Psychische Belastung bei Angehörigen von Schlaganfallpatienten. Rehabilitation 2002; 41: 401-406
  • 16 Visser-Meily A, Post M, van de Port I et al. Psychosocial functioning of spouses of patients with stroke from initial inpatient rehabilitation to 3 years poststroke. Course and relations with coping strategies. Stroke 2009; 40: 1399-1404
  • 17 Wilz G, Kalytta T. Anxiety symptoms in spouses of stroke patients. Cerebrovasc Dis 2008; 25: 311-315
  • 18 Gervasio AH, Kreutzer JS. Kinship and family members’ psychological distress after traumatic brain injury: A large sample study. J Head Trauma Rehabil 1997; 12: 14-26
  • 19 Perlesz A, Kinsella G, Crowe S. Psychological distress and family satisfaction following traumatic brain injury: Injured individuals and their primary, secondary, and tertiary carers. J Head Trauma Rehabil 2000; 15: 909-929
  • 20 Grant JS, Bartolucci AA, Elliot TR et al. Sociodemographic, physical, and psychosocial characteristics of depressed and non-depressed family caregivers of stroke survivors. Brain Inj 2000; 14: 1089-1100
  • 21 Kotila M, Numminnen H, Waltimo O et al. Depression after stroke. Results of the FINNSTROKE Study. Stroke 1998; 29: 368-372
  • 22 Schulz R, Tompkins CA, Rau MT. A longitudinal study of the psychosocial impact of stroke on primary support persons. Psychol Aging 1988; 3: 131-141
  • 23 Forsberg-Wärleby G, Möller A, Blomstrand C. Spouses of first-ever stroke patients. Psychological well-being in the first phase after stroke. Stroke 2001; 32: 1646-1651
  • 24 Novack TA, Bergquist TF, Bennett G et al. Primary caregiver distress following severe head injury. J Head Trauma Rehabil 1991; 6: 69-77
  • 25 King RB, Carlson CE, Shade-Zeldow Y et al. Transition to home care after stroke: Depression, physical health, and adaptive processes in support persons. Res Nurs Health 2001; 24: 307-323
  • 26 Turner BJ, Fleming JM, Ownsworth TL et al. The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations. Disabil Rehabil 2008; 30: 1153-1176
  • 27 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; ii: 81-84
  • 28 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28: 14-20
  • 29 Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 61-68
  • 30 Sulter G, Stehen C, De Keyser J. Use of the Barthel Index and Modified Rankin Scale in acute stroke trials. Stroke 1999; 30: 1538-1541
  • 31 Margraf J, Ehlers A. Das Beck Angst-Inventar (BAI). Manual. Frankfurt am Main: Harcourt Test Services; 2007
  • 32 Hautzinger M, Bailer M, Worall H et al. Beck-Depressions-Inventar (BDI). 2. Aufl. Bern: Huber; 1995
  • 33 Pinquart M, Sörensen S. Gender differences in caregivers stressors, social resources, and health: an updated meta-analysis. J Gerontol B Psychol Sci Soc Sci 2006; 61B: P33-P45
  • 34 Yee JL, Schulz R. Gender differences in psychiatric morbidity among family caregivers: a review and analysis. Gerontologist 2000; 40: 147-164
  • 35 Lehto US, Ojanen M, Väkevä A et al. Noncancer life stresses in newly diagnosed cancer. Support Care Cancer 2008; 16: 1231-1241
  • 36 Low CA, Stanton AL, Thompson N et al. Contextual life stress and coping strategies as predictors of adjustment to breast cancer survivorship. Ann Behav Med 2006; 32: 235-244
  • 37 Cope DN, Wolfson B. Crisis intervention with the family in the trauma setting. J Head Trauma Rehabil 1994; 9: 67-81
  • 38 Dinkel A, Balck F. Krankheit, Rehabilitation und Familie. Prax Klin Verhaltensmed Rehabil 2003; 16: 116-121
  • 39 Wilz G, Böhm B. Interventionskonzepte für Angehörige von Schlaganfallpatienten: Bedarf und Effektivität. Psychother Psych Med 2007; 57: e1-e19
  • 40 Himaj J, Müller E, Fey B et al. Elzacher Konzept und Leistungskatalog der therapeutischen Pflege in der neurologischen Frührehabilitation (Phase B). Rehabilitation 2011; 50: 94-102
  • 41 Stier-Jarmer M, Koenig E, Stucki G. Strukturen der neurologischen Frührehabilitation (Phase B) in Deutschland. Phys Med Rehab Kuror 2002; 12: 260-271
  • 42 Hoffmann B, Karbe H, Krusch C et al. Patientencharakteristika in der neurologisch/neurochirurgischen Frührehabilitation (Phase B): eine multizentrische Erfassung im Jahr 2002 in Deutschland. Akt Neurol 2006; 33: 287-296
  • 43 Turner B, Fleming J, Ownsworth T et al. Perceptions of recovery during the early transition phase from hospital to home following acquired brain injury: a journey of discovery. Neuropsychol Rehabil 2011; 21: 64-91
  • 44 Dombovy ML, Drew-Cates J, Serdans R. Recovery and rehabilitation following subarachnoid haemorrhage. Part I: Outcome after inpatient rehabilitation. Brain Inj 1998; 12: 443-454
  • 45 Hellawell D, Pentland B. Relatives’ reports of long term problems following traumatic brain injury or subarachnoid haemorrhage. Disabil Rehabil 2001; 23: 300-330