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Spouses of severe-sepsis patients at high risk of depression, U-M study shows

As severe sepsis becomes a silent epidemic among the elderly, greater mental health screenings may be necessary for spouses

July 25, 2012--Severe sepsis, a body’s dangerous defensive response against an infection, not only diminishes the quality of life for patients – it puts their spouses at a greater risk of depression, a joint University of Michigan Health System and University of Washington School of Medicine study shows.

Wives whose husbands were hospitalized for severe sepsis were nearly four times more likely to experience substantial depressive symptoms, according to the study released July 18 ahead of the August publish date in Critical Care Medicine.

Sepsis happens when an infection such as pneumonia or urinary tract infection throws off the immune system, prompting it to attack the body it’s designed to protect. This exaggerated inflammatory response can trigger damage to vital body organs, bleeding, organ failure and possibly death.

Severe sepsis is responsible for four times more hospitalizations than more obvious illnesses such as heart attacks and is a leading cause of death among older Americans.

“We know that patients who survive sepsis face many new problems, but we know little about the emotional toll it takes on patients’ loved ones,” says senior author Theodore J. Iwashyna, M.D., Ph.D., assistant professor of internal medicine at U-M and who also works with the Institute of Social Research and the VA Center for Clinical Management Research.

“Emotional distress may diminish spouses’ abilities to support patients in ongoing rehabilitation and act as surrogate decision-makers for them.”

With hundreds of thousands of Americans hospitalized for severe sepsis a year, it is the most common non-cardiac cause of critical illness. The rapidly growing number of hospitalizations and disabilities caused by the condition especially impose overwhelming burdens on older spouses, Iwashyna notes.

The study is believed to be the first of its kind in gauging depression among spouses of severe-sepsis survivors. It suggests that patients’ spouses may benefit from greater support and depression screening not just when their loved one dies, but also when their loved one survives.

Physicians may also consider including non-spousal family members and support networks to help facilitate patients’ recovery post ICU-care.

“Depression in family members could affect end-of-life decisions in the ICU and impact a loved ones’ caretaking ability so interventions may improve the outcomes of patients themselves,” says lead author Dimitry S. Davydow, M.D, M.P.H., assistant professor of psychiatry at U-W.

“Providers must learn to assess the burden of follow- up care on patients’ spouses to help improve the health and quality of life for this growing population of older Americans.”

While older women clearly showed greater risks for depression if their spouses were hospitalized for severe sepsis, data was less definitive for husbands in the same situation. Authors noted that these findings may be due to older men possibly being less willing to report depressive symptoms.

Iwashyna and his colleagues conducted the study using participants in the Health and Retirement Study, a nationally-representative sample of older Americans that is conducted by the U-M Institute for Social Research on behalf of the National Institute of Aging

Additional authors: In addition to Iwashyna and Davydow, authors were Catherine L. Hough, M.D., M.Sc., of U-W; and Kenneth M. Langa, M.D., Ph.D., of U-M.

Funding: National Center for Research Resources, National Center for Advancing Translational Sciences, National Heart, Lung, and Blood Institute and National Institute of Aging, all part of the National Institutes of Health.