Stress, depression and suicidal ideation amongst family members caring for a patient with brain injury.

Abstract

Background This study investigated the relationship between stress, depression, ill health and suicidal ideation in family members caring for a patient with acquired brain injury. The sample consisted of 80 family caregivers who are members of Headway Gauteng (the brain injury association) located in Johannesburg and Soweto, South Africa. Most were primary caregivers (72.5%) with secondary caregivers making up a smaller percentage (27.5%), their role being to assist and support the primary caregiver. Method and materials The study involved a mixed methodology that incorporated a cross-sectional descriptive and phenomenological approach. This included self-report procedures (structured questionnaires and interviews), post-interview content analyses and three individually administered standardized measures (The Stress Symptom Checklist, The Beck Depression Inventory and Beck’s Hopelessness Scale). Scores were non-normally distributed. Therefore, nonparametric statistical tests were used, including the Kruskal-Wallis, Mann Whitney and Chi-Square Tests with a significance level of p = 0.05. Results The results revealed significant levels of stress, depression, ill health and suicidal ideation in the research participants. Suicidal ideation increased with elevating stress levels and 62.5% (50) of the sample had received a medical and/or psychological diagnosis after they became a caregiver. Five themes were identified as causing the caregivers’ profound stress that highlighted a lack of caregiver support, preparation, referral and education regarding their relative’s acquired brain injury and the stress they experience due to caregiver burden. Most participants (78.7%) did not feel adequately prepared by healthcare professionals (during the acute and sub-acute hospital treatment) for the neuropsychological deficits caused by the acquired brain injury, resulting in reduced coping and family conflict once the patient started receiving home-based care. Predominantly the family caregivers identified the patients’ neuropsychological deficits, such as affect, cognitive ability, behaviour, personality, executive function, and social factors as causing them profound stress. Conclusions This study underscored a significant prevalence of depression, ill health and stress-related suicidal ideation in family members caring for patients with acquired brain injury. Early identification of these problems and referral for appropriate treatment are recommended, along with the need to alert professional healthcare workers to the value of psychological screening for elevated stress and poor coping in family caregivers. Additionally, a collaborative effort between medical and psychological healthcare practitioners is recommended.