Psychological Distress Common for Family Surrogates of Stroke Patients

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Psychological distress commonly seen among family surrogates who made decisions about life-sustaining treatments

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Dec. 27, 2023 (HealthDay News) — For family surrogates who make decisions about life-sustaining treatments for stroke patients, psychological distress is common and is worse among Mexican Americans (MAs), according to a study published online Dec. 20 in Neurology.

Lewis B. Morgenstern, M.D., from Michigan Medicine in Ann Arbor, and colleagues conducted a population-based, prospective cohort study involving stroke patients and their surrogate decision-makers, enrolled soon after any stroke if surrogates made decisions about life-sustaining treatments. Surrogates completed validated measures of posttraumatic stress, anxiety, and depression at three, six, and 12 months. Data were included for 301 family surrogates of 241 severe stroke patients who were followed for a mean of 315 days.

The researchers found that 17 to 28 percent of surrogates had high scores on measures of psychological distress. Overall, 17 to 43 percent of surrogates had one or more high levels of the psychological outcomes; 12 to 27 percent had two or more; and 5 to 16 percent had all three. In unadjusted analyses, all psychological outcomes were worse among MAs; posttraumatic stress remained worse in MAs in fully adjusted models (0.36), but ethnic differences were attenuated and no longer significant for anxiety and depression. The trajectory for depression differed by ethnicity; over time, depression scores improved more rapidly among non-Hispanic White people than MAs. Ethnic differences were not confounded by advance care plans.

“Additional research and care should be directed at surrogate decision makers that have long-term negative consequences after their loved ones suffer a severe stroke,” the authors write.

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