Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit : A Randomized Clinical Trial

Key Points

Question

Is participation in a dyadic resiliency intervention associated with a measurable reduction in symptoms of depression, anxiety, and posttraumatic stress (PTS) compared with participation in an educational control?

Findings

In this pilot, single-blind, randomized clinical trial of 58 dyads of survivors of the neuroscience intensive care unit and their informal caregivers, survivors and caregivers who received the active intervention experienced a significant reduction in symptoms of depression, anxiety, and PTS.

Meaning

In this pilot randomized clinical trial, the dyadic resiliency intervention was feasible, and the findings suggest that it may prevent chronic emotional distress in survivors of acute brain injury and their caregivers.

Abstract

This pilot randomized clinical trial evaluates the feasibility and preliminary effect of the novel dyadic resiliency intervention Recovering Together in reducing symptoms of depression, anxiety, and posttraumatic stress among patients hospitalized in the neuroscience intensive care unit and their informal caregivers.

Abstract

Importance

To our knowledge, there are no evidence-based interventions to prevent chronic emotional distress (ie, depression, anxiety, and posttraumatic stress [PTS]) in critical care survivors and their informal caregivers.

Objective

To determine the feasibility and preliminary effect of the novel dyadic resiliency intervention Recovering Together (RT) on reducing symptoms of depression, anxiety, and PTS among hospitalized patients and their informal caregivers.

Design, Setting, and Participants

This single-blind, pilot randomized clinical trial of RT vs an educational control was conducted among 58 dyads in which either the survivor or caregiver endorsed clinically significant symptoms of depression, anxiety, or PTS. The study was conducted in the neuroscience intensive care unit at Massachusetts General Hospital. Data were collected from September 2019 to March 2020.

Interventions

Both RT and control programs had 6 sessions (2 at bedside and 4 via live video after discharge), and both survivor and caregiver participated together.

Main Outcomes and Measures

The primary outcomes were feasibility of recruitment and intervention delivery, credibility, and satisfaction. The secondary outcomes included depression and anxiety (measured by the Hospital Depression and Anxiety Scale), PTS (measured by the PTSD Checklist–Civilian Version), and intervention targets (ie, mindfulness, measured by the Cognitive and Affective Mindfulness Scale–Revised; coping, measured by the Measure of Current Status–Part A; and dyadic interpersonal interactions, measured by the Dyadic Relationship Scale). Main outcomes and targets were assessed at baseline, 6 weeks, and 12 weeks.

Results

The 58 dyads were randomized to RT (29 dyads [50.0%]; survivors: mean [SD] age, 49.3 [16.7] years; 9 [31.0%] women; caregivers: mean [SD] age, 52.4 [14.3] years; 22 [75.9%] women) or control (29 dyads [50.0%]; survivors: mean [SD] age, 50.3 [16.4] years; 12 [41.3%] women; caregivers, mean [SD] age, 52.1 [14.9], 17 [58.6%] women). Feasibility (recruitment [76%], randomization [100%], and data collection [83%-100%]), adherence (86%), fidelity (100%; κ = 0.98), satisfaction (RT: 57 of 58 [98%] with scores >6; control: 58 of 58 [100%] with scores >6), credibility (RT: 47 of 58 [81%] with scores >6; control: 46 of 58 [80%] with scores >6), and expectancy (RT: 49 of 58 [85%] with scores >13.5; 51 of 58 [87%] with scores >13.5) exceeded benchmarks set a priori. Participation in RT was associated with statistically and clinically significant improvement between baseline and postintervention in symptoms of depression (among survivors: −4.0 vs −0.6; difference, −3.4; 95% CI, −5.6 to −1.3; P = .002; among caregivers: −3.8 vs 0.6; difference, −4.5; 95% CI, −6.7 to −2.3; P < .001), anxiety (among survivors: −6.0 vs 0.3; difference, −6.3; 95% CI, −8.8 to −3.8; P < .001; among caregivers: −5.0 vs −0.9; difference, −4.1; 95% CI, −6.7 to −1.5, P = .002), and PTS (among survivors: −11.3 vs 1.0; difference, −12.3; 95% CI, −18.1 to −6.5, P < .001; among caregivers, −11.4 vs 5.0; difference, −16.4, 95% CI, −21.8 to −10.9; P < .001). Improvements sustained through the 12-week follow-up visit. We also observed RT-dependent improvement in dyadic interpersonal interactions for survivors (0.2 vs −0.2; difference, 0.4; 95% CI, 0.0 to 0.8; P = .04).

Conclusions and Relevance

In this pilot randomized clinical trial, RT was feasible and potentially efficacious in preventing chronic emotional distress in dyads of survivors of the neuroscience intensive care unit and their informal caregivers.

Trial Registration

ClinicalTrials.gov Identifier: NCT03694678