Psychiatric Disorder in Dying Patients & Their Survivors

临终患者的精神疾病

• 批准号: 6644135
• 负责人: Holly Gwen Prigerson
• 金额: $ 51.57万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-08-07 至 2006-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6644135
• 关键词: adult human (21+); behavioral /social science research tag; bereavement; caregivers; clinical depression; clinical research; death; grief; human mortality; human subject; interview; longitudinal human study; neoplasm /cancer; suicide; terminal patient care

DESCRIPTION (provided by applicant): Little is known about the prevalence and treatment of psychiatric disorders among terminally ill cancer patients and their caregivers, nor about the ways in which mental health may affect the patient's comfort at death, and the impact this may have on the caregiver' s bereavement adjustment. A sample of cancer patients (N=300) with a life-expectancy of < 6 months, and their primary caregivers (eg, spouses, adult children; N=3 00), will be recruited from cancer clinics at Yale, the Veterans Affairs Connecticut Healthcare System, and Memorial Sloan-Kettering. A structured diagnostic interview will be used to evaluate psychiatric status of patients and caregivers. Newly refined and validated instruments will determine "caseness" of Complicated Grief and provide a thorough evaluation of suicidality of patients and caregivers. Interviews will occur at 2 time points: (1) at baseline when patients are terminally ill and caregivers are attending to them; (2) at follow-up for caregivers 6 months after the patients' death. The study aims are to determine: (1) the prevalence of psychiatric disorders and their treatment among terminally ill cancer patients and their primary caregivers, and (2) the influence of the patients' mental health on their degree of comfort at the time of death (eg, lack of pain, physical, emotional, social, existential distress). The study also aims to determine the extent to which the bereaved caregiver's mental health at follow-up is influenced by: a.) the caregiver's baseline mental health and mental health service use, b.) realistic caregiver expectations of the patient's life expectancy, c.) patient comfort, and d.) caregiver satisfaction about the way the death occurred (eg, absence of regrets about the care provided, having an opportunity to say "good-bye"). By determining the prevalence of specific psychiatric disorders and their treatment in terminally ill cancer patients and their caregivers, clinicians will be alerted to likely mental disorders for which to screen, refer, and/or treat. If patient's with better mental health are more likely to die comfortably, then interventions to improve patient mental health would be expected to improve the patient's quality of life at the time of death. If caregiver's better mental health at follow-up is significantly influenced by their baseline mental health, their realistic expectations of the patient's life-expectancy, and their satisfaction with the way the death occurred, each of these factors could be targeted by future interventions designed to improve the mental health of bereaved survivors.

描述（由申请人提供）：关于绝症患者及其护理人员的精神疾病的患病率和治疗知之甚少，也不了解心理健康对患者在死亡时的舒适感以及这对照料者的丧亲者调整的影响。癌症患者（n = 300）的样本<6个月，其主要护理人员（例如，配偶，成年子女； n = 3 00），将从耶鲁大学的癌症诊所，退伍军人事务康涅狄格州医疗保健系统和纪念Sloan-kettering中招募。结构化的诊断访谈将用于评估患者和护理人员的精神病状态。新精致和经过验证的工具将确定复杂的悲伤的“估计性”，并对患者和看护人的自杀性进行彻底评估。访谈将在2个时间点进行：（1）当患者绝症并且护理人员正在照顾他们时，在基线时； （2）在患者死亡6个月后的护理人员随访中。该研究的目的是确定：（1）精神疾病的患病率及其在绝症癌症患者及其主要护理人员中的治疗率，以及（2）患者心理健康对死亡时舒适程度的影响（例如，缺乏疼痛，身体，身体，情感，社交，社交，存在性困扰）。该研究还旨在确定丧亲者在随访中的心理健康的影响：通过确定特定精神疾病的患病率及其在绝症癌症患者及其护理人员中的治疗，临床医生将被告知可能筛查，参考和/或治疗的精神障碍。如果心理健康的患者更有可能舒适地死亡，那么预计改善患者心理健康的干预措施将在死亡时改善患者的生活质量。如果护理人员在随访中的更好的心理健康受到基准心理健康的显着影响，他们对患者预期的现实期望以及他们对死亡方式的满意度，那么这些因素都可以针对未来的干预措施，旨在改善居民的心理健康。