Decreased mental health care utilization following a psychosocial intervention in caregivers of hematopoietic stem cell transplant patients

Rita Ouseph, Calvin Croy, Crystal Natvig, Teresa Simoneau, Mark L Laudenslager, Rita Ouseph, Calvin Croy, Crystal Natvig, Teresa Simoneau, Mark L Laudenslager

Abstract

Caregivers are known to experience increased morbidity when compared to noncaregivers. Does an intervention targeting caregiver distress affect their health care utilization? One hundred forty-eight caregivers of allogeneic hematopoietic stem cell transplant patients were randomized to treatment as usual (TAU) or a psychoeducation, paced respiration, and relaxation (PEPRR) intervention. Assessments of caregivers' service utilization were collected at baseline and 1, 3, and 6 months post-transplant. During the first 30 days after patient transplant, caregiver medical and mental health professional service use decreased while support group attendance peaked. Mixed model regressions showed a significant decrease in mental health service use by the PEPRR group (P=0.001). At six months caregivers in TAU had predicted marginal probabilities of mental health services utilization over 10 times as high as caregivers in PEPRR (18.1% vs 1.5%). Groups failed to differ in medical service (P=0.861) or support group (P=0.067) use. We can conclude that participation in PEPRR compared to TAU was associated with reduced mental health service utilization. Caregiver psychosocial support services are critical to improve caregiver outcomes.

Keywords: caregivers; intervention; mental health; stress.

Conflict of interest statement

Conflict of interests: the authors declare no potential conflict of interests.

Figures

Figure 1.
Figure 1.
Caregiver response rates and flow through the study.
Figure 2.
Figure 2.
A) shows the proportions of caregivers who reported visiting a mental health professional at each time point, through 6 months. C) shows the predicted marginal probabilities of mental health professional utilization at each time point. B) shows the proportions of caregivers who reported attending a support group at each time point, through 6 months. D) shows the predicted marginal probabilities predicting support group utilization at each time point.

References

    1. Copelan EA.Hematopoietic stem-cell transplantation. New Engl J Med. 2006;354: 1813-26.
    1. Neofytos D, Horn D, Anaissie E, et al. Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) alliance registry. Clin Infect Dis. 2009;48:265-73.
    1. Martinelli G, Terragna C, Zamagni E, et al. Molecular remission after allogeneic or autologous transplantation of hematopoietic stem cells for multiple myeloma. J Clin Oncol. 2000;18:2273-81.
    1. Majhail NS, Brazauskas R, Rizzo JD, et al. Secondary solid cancers after allogeneic hematopoietic cell transplantation using busulfan-cyclophosphamide conditioning. Blood. 2011;117:316-22.
    1. Lowe T, Bhatia S, Somlo G.Second malignancies after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplan. 2007;13:1121-34.
    1. Laudenslager M.Anatomy of an Illness: control from a caregiver’s perspective. Brain Behav Immun. 2014;36:1-8.
    1. Moore MJ, Zhu CW, Clipp EC.Informal costs of dementia care: estimates from the national longitudinal caregiver study. J Gerontol B Psychol Sci Soc Sci. 2001;56: S219-28.
    1. Simoneau TL, Mikulich-Gilbertson SK, Natvig C, et al. Elevated peri-transplant distress in caregivers of allogeneic blood or marrow transplant patients. Psychooncology. 2013;22:2064-70.
    1. Mitchell AJ, Ferguson DW, Gill J, et al. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol. 2013;14:721-32.
    1. Vanderwerker LC, Laff RE, Kadan-Lottick NS, et al. Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. J Clin Oncol. 2005;23:6899-907.
    1. Kim Y, Schulz R, Carver CS.Benefit-finding in the cancer caregiving experience. Psychosom Med. 2007;69:283-91.
    1. Bower JE, Segerstrom SC.Stress management, finding benefit, and immune function: positive mechanisms for intervention effects on physiology. J Psychosom Res. 2004;56:9-11.
    1. Rohleder N, Marin TJ, Ma R, Miller GE.Biologic cost of caring for a cancer patient: dysregulation of pro- and anti-inflammatory signaling pathways. J Clin Oncol. 2009; 27:2909-15.
    1. Lutgendorf SK, Laudenslager ML.Care of the caregiver: stress and dysregulation of inflammatory control in cancer caregivers. J Clin Oncol. 2009;27:2894-5.
    1. Christakis NA, Allison PD.Mortality after the hospitalization of a spouse. New Engl J Med. 2006;354:719-30.
    1. Gouin JP, Hantsoo L, Kiecolt-Glaser JK.Immune dysregulation and chronic stress among older adults: a review. Neuroimmunomodulation. 2008;15:251-9.
    1. Scharlach AE, Midanik LT, Runkle MC, Soghikian K.Health practices of adults with elder care responsibilities. Prev Med. 1997;26:155-61.
    1. Fillit HM.The pharmacoeconomics of Alzheimer’s disease. Am J Manag Care. 2000;6:S1139-44.
    1. Vitaliano PP, Zhang J, Scanlan caregiving hazardous to one’s physical health? A meta-analysis. Psychologic Bull. 2003; 129:946-72.
    1. Burns A.The burden of Alzheimer’s disease. Int J Neuropsychopharmacol. 2000; 3:31-8.
    1. Son J, Erno A, Shea DG, et al. The caregiver stress process and health outcomes. J Aging Health. 2007;19:871-87.
    1. Kolanowski AM, Fick D, Waller JL, Shea D.Spouses of persons with dementia: their healthcare problems, utilization, and costs. Res Nurs Health. 2004;27:296-306.
    1. Schubert CC, Boustani M, Callahan CM, et al. Acute care utilization by dementia caregivers within urban primary care practices. J General Intern Med. 2008;23:1736-40.
    1. Knapp M, King D, Romeo R, et al. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. BMJ. 2013;347: 6342.
    1. Laudenslager ML, Natvig C.Challenges to conducting a randomized control behavioral intervention trial for caregivers of hematopoietic stem cell transplant recipients. [In press].
    1. Antoni MH, Wimberly SR, Lechner SC, et al. Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry. 2006;163:1791-7.
    1. Mahtani KR, Nunan D, Heneghan CJ.Device-guided breathing exercises in the control of human blood pressure: systematic review and meta-analysis. J Hypertension. 2012;30:852-60.
    1. Hox J.Multilevel analysis: techniques and applications. 2 New York: Routledge; 2010.
    1. Grasel E.When home care ends – changes in the physical health of informal caregivers caring for dementia patients: a longitudinal study. J Am Geriatr Soc. 2002;50: 843-9.
    1. Ng TP, Nyunt MS, Chiam PC, Kua EH.Religion, health beliefs and the use of mental health services by the elderly. Aging Mental Health. 2011;15:143-9.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다