Adverse childhood experiences in families with multiple members diagnosed to have psychiatric illnesses.

OBJECTIVE: Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditions (multiplex families), identified as part of an ongoing longitudinal study. METHODS: Our sample consisted of 509 individuals from 215 families. Of these, 268 were affected, i.e., diagnosed with bipolar disorder (n = 61), obsessive-compulsive disorder (n = 58), schizophrenia (n = 52), substance dependence (n = 59) or co-occurring diagnoses (n = 38), while 241 were at-risk first-degree relatives who were either unaffected (n = 210) or had other depressive or anxiety disorders (n = 31). All individuals were evaluated using the Adverse Childhood Experiences - International Questionnaire and total adverse childhood experiences exposure and severity scores were calculated. RESULTS: It was seen that affected males, as a group, had the greatest adverse childhood experiences exposure and severity scores in our sample. A Cox mixed effects model fit by gender revealed that a higher total adverse childhood experiences severity score was associated with significantly increased risk for an earlier age of onset of psychiatric diagnoses in males. A similar model that evaluated the interaction of diagnosis revealed an earlier age of onset in obsessive-compulsive disorder and substance dependence, but not in schizophrenia and bipolar disorder. CONCLUSION: Our study indicates that adverse childhood experiences were associated with an earlier onset of major psychiatric conditions in men and individuals diagnosed with obsessive-compulsive disorder and substance dependence. Ongoing longitudinal assessments in first-degree relatives from these families are expected to identify mechanisms underlying this relationship.

Perspectives of Glioblastoma Patients on Death and Dying: A Qualitative Study.

BACKGROUND: Glioblastoma (GBM) is a terminal illness and associated with poor prognosis. Brain cancer creates significant traumatic effects including death and dying fears not only on patients but also in Asia's tightly knitted families. Very few studies made attempt to elicit the death and dying issues among brain cancer patients. Therefore, the study aimed to explore the patient's perspectives on death and dying among GBM patients during hospitalization. METHODOLOGY: The study used qualitative approach. Purposive sampling was used to enroll 31 consented patients for in depth interviews. The in-depth interviews were guided by pre-designed open ended guidelines and took 45 min to 1 h. All interviews were conducted in the private room in the hospital. Interviews were manually documented soon after the interview. Thematic analysis was used to generate themes. R (QOL) software was used for data analysis. RESULTS: Four themes were emerged from the analysis; (i). Understanding about illness (ii). Personal views and feelings on death and dying (iii). Coping with fear of death and dying (iv). Need for early preparation to face death and dying fears. CONCLUSION: Psychosocial interventions on early death preparation programs are recommended for GBM patients in the in-patient care. Yet, it should be handled carefully and sensitively, otherwise, it creates more psychological and emotional harm than the illness per se.

Prehospital Impact on Family Members of Road Traffic Accident.

Background Prehospital care is nonexistent in most rural and semiurban areas. The implementation of golden hour care is still unachieved. The psychosocial problems of family members who accompany the traumatic brain injury (TBI) survivors after road traffic accidents (RTA) are not given attention during prehospital care. Therefore, the current study was aimed to understand the prehospital psychosocial impact on family members. Methodology A cross-sectional study was conducted at the Emergency and Trauma Care Centre at National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru between July 2017 to April 2018. Forty-five ( n = 45) referred family members providing care for trauma survivors were purposively recruited in the study. Structured checklists were administered to measure the psychological reactions and psychosocial problems experienced by the family members during prehospital care. Data analysis was analyzed using the R software 3.0.1 version. Results TBI survivor's mean age was found to be 33 years (33.09 ± 13.20), of which males were 23 (51.1%) and females were 22 (48.9%), respectively. The result depicted first aid was provided by unskilled people after an average of 41 minutes (41 ± 30). The results further showed that family members had experienced agitation (100%), shock (82.2%), fatigue and headache (75.6%), depression (66.7%), feeling of hopelessness (55.6%) helplessness, and lack of support from family and financial constraints (48.9%) during prehospital care. Conclusion Psychosocial interventions need to be provided during prehospital care by trained medical and psychiatric social work professionals to address the need of family members during the crisis.

Tailor-Made Psychosocial Intervention for the Caregivers in Emergency and Trauma Care Center.

Introduction The caregiver's psychosocial problems are unnoticed in the emergency and trauma care center. Therefore, the study objective was to understand the impact of psychoeducation and psychosocial intervention on traumatic brain injury (TBI) caregivers during hospitalization. Methodology The study adopted a descriptive research design. Sixty-three ( n = 63) consented caregivers were recruited by using a cross-sectional survey method. Two separate checklists were used to collect the psychosocial problems in emergency and trauma care as well as to know the satisfaction levels of caregivers after the intervention. R free 3.0.1 software was used to calculate the frequency and percentage. Results The caregiver's mean age was 39 years (39.46 ± 16.22). The majority of the caregivers were males (45; 71.4%) working as daily wagers (42; 66.7%). Caregivers experienced psychosocial problems, that is, depression, anxiety, stress, unable to handle crisis, grief, lack of coping skills (57; 90.5%), emotional distress (57; 90.5%), financial constraints (45; 71.1%), and need for referral services (45; 71.1%). Tailor-made psychosocial interventions were provided to the caregivers. Conclusion To conclude, there is a greater need to provide psychosocial intervention and train the caregivers to provide care for TBI survivors during hospitalization. There is a need to develop the uniform standard operating procedure for medical and psychiatric social workers in providing psychosocial care in emergency and trauma care setting.

Caregiver's Psychosocial Concerns and Psychological Distress in Emergency and Trauma Care Setting.

BACKGROUND: Traumatic brain injury (TBI) will be the third largest killer by the year 2020 in the world. It creates the great amount of morbidity, disability, mortality, and reduces the psychosocial well-being of the patients and their caregivers. Hence, the current paper aimed to explore the psychosocial distress and caregivers' concerns in emergency and trauma care (ETC) setting. METHODOLOGY: This study adopted qualitative research design. All caregivers of TBI survivors were considered as a universe of the study. A total of 50 caregivers were recruited, and the predesigned questionnaire was administered. Depression, anxiety, stress scale was used to identify the caregivers' depression, stress, and anxiety. The simple thematic analysis was used to derive the themes from the verbatim data. Data were analyzed using SPSS version 21.0 (SPSS South Asia Pvt. Ltd, Bengaluru, Karnataka, India). RESULTS: In the quantitative analysis, caregivers' mean age was found to be 45 (mean = 45.00 ± 13.83) years. Caregivers had experienced mild depression (13.36 ± 3.07), moderate anxiety (13.70 ± 3.03), and minimum stress (13.66 ± 2.98) levels. Qualitative results identified the following themes: difficulty in accessing timely care, uncertainty about the prognosis and future, family concerns and financial constraints, personal feelings and personal needs, and supportive care. Chi-square test revealed that there was no significant association between gender and depression (χ2 = 2.381 P < 0.12), anxiety (χ2 = 0.01 P < 0.92), and stress (χ2 = 0.235 P < 0.61) levels of caregivers. CONCLUSION: To accomplish, providing psychosocial care in ETC setting, the role of psychiatric social workers is pivotal.

Caregivers satisfaction with intensive care unit services in tertiary care hospital.

BACKGROUND: Caregivers play a vital role in intensive care unit (ICU) because critically ill patients cannot make their own decisions due to their illness. Measuring family satisfaction on quality of ICU care is essential. Hence, the current paper aimed to measure the family caregiver satisfaction in ICU care in tertiary care hospital. METHODS: The study adopted descriptive research design conducted from July 2016 to January 2017 at ICU in Emergency and Trauma Care center. A total number of 60 consented caregivers were recruited. An Internationally validated Family satisfaction survey questionnaire (FS) was used. Continuous variables of the data were described by mean standard deviation and categorical variables by frequency (%). Normality of the continuous variables was checked by Shapiro-Wilk test. Kruskal-Wallis test was used to compare the average FS score between the groups. RESULTS: Results showed that caregiver age was ranged between 25 and 66 years with mean age 40 (±19). Among the caregivers, 75% were male and 25% were female of which 75% were married and remaining were unmarried. Around half of the caregivers (48.3) were educated up to primary or secondary and 26.7% had higher secondary education level. About 46.7% involved in manual laborers and 36.7% were working in the private sector. Family members had taken primary caregiving role without prior experience (81.7%) at ICU. Almost 95% of the caregivers were highly satisfied with ICU care and only 5% were not satisfied. CONCLUSION: Majority of caregivers are satisfied with ICU care. However, adequate measures need to be taken to ensure the complete satisfaction among caregivers at ICU.

Clinically providing psycho-social care for caregivers in emergency and trauma care setting: Scope for medical and psychiatric social workers.

Traumatic brain injury is the leading cause of death and disability in young people. TBI is associated with increased mortality, morbidity, and socioeconomic loss, especially in developing countries such as India. It is creating damage to the psychosocial well-being of caregiver and their family members significantly. Caregivers' informational, educational, psychosocial problems are still overlooked and unaddressed. Providing psychosocial interventions such as educating caregivers about TBI-related consequences, increasing social support, mobilization of resources for the needy, and dealing with psychological stress will be beneficial to reduce the caregiver burden. Medical and psychiatric social workers (MPSWs) have important role in providing psychosocial care and decreasing caregiver burden of TBI survivors. This case report highlights the role of MPSWs in the emergency and trauma care setting.