Lived experiences: Growing up with a seriously mentally ill parent.

INTRODUCTION: Individuals with serious mental illness often have persistent and disruptive symptoms. These can profoundly affect their children's lives, exposing them to adverse social and psychological conditions. Such conditions can result in traumatic lived experiences during childhood, which can carry over into adulthood, influencing their self-perceptions and shaping their attitudes toward themselves and society. To gain insights into this phenomenon, this study explored the lived experiences of adults who grew up with a parent with serious mental illness and their perceptions of their lives in adulthood. DESIGN: This study used an interpretive phenomenological design. METHODS: Participants were invited to voluntarily participate in the study through a call posted on social media. Semi-structured interviews were conducted with 30 adults (age range, 20-55 years) who grew up with a parent with serious mental illness. The interviews were recorded and transcribed, and inductive thematic analysis was used to identify main and overarching themes. RESULTS: The overarching theme of transition from childhood survival to adulthood survival emerged and included four main themes: (1) a traumatic childhood, (2) perceived control, (3) resilience and general self-efficacy, and (4) adult quality of life. A traumatic childhood consisted of experiences of neglect and abuse, while participants used perceived control to achieve personal growth, self-care, and care of others. Resilience and general self-efficacy emerged during the transition to adulthood and helped participants further their social status and strengthen family bonds. Lastly, adult quality of life was described as being disturbed by feelings of loneliness and being burdensome, stemming from an inherent tendency to rely solely on themselves, leading to trust issues and mental health complications. Therefore, these adults found it difficult to reach out and get help or treatment for their concerns, as they initially did not want to appear dysfunctional or in need. CONCLUSION: This study has illuminated the lived experiences of a specific, vulnerable population that has not been intentionally explored until now. To delve into these experiences, we employed a distinctive qualitative approach, merging the interpretive phenomenological perspective with an inductive thematic analysis. This allowed for rich insight with a relatively large group of participants and enabled an in-depth exploration within this methodological framework. Consequently, this study constitutes a notable contribution to the extant body of knowledge, exploring the intricacies of personal growth and its impact on participants' quality of life. It uncovers the essence of resilience and general self-efficacy, revealing how these elements intertwine with the negative results observed. However, the study findings emphasize the need for healthcare professionals, including nurses and other caregivers, to be mindful of the long-lasting effects of the adverse experiences of children of patients with serious mental illness. Prioritizing active clinical assessment and implementing tailored interventions to address such children's specific needs and difficulties across different developmental stages is imperative. Such comprehensive and targeted approaches are crucial in providing appropriate support and promoting the well-being of these individuals. CLINICAL RELEVANCE: Enhanced clinical attention in holistic psychiatric care is crucial for individuals and their relatives, especially children. Comprehensive assessments of children and adults raised by seriously mentally ill parents can enable tailored and preventive interventions, positively impacting overall quality of life.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review.

BACKGROUND: A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. OBJECTIVE: The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. RESULTS: Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. CONCLUSIONS: Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Historic redlining and health outcomes: A systematic review.

OBJECTIVE: The purpose of this systematic review was to synthesize the existing literature on the associations between historic redlining and modern-day health outcomes across the lifespan. METHOD: This review searched PubMed and CINAHL for peer-reviewed, data-based articles examining the relationship between historic redlining and any health outcome. Articles were appraised using the JBI critical appraisal checklist. The results were synthesized using a narrative summary approach. RESULTS: Thirty-six articles were included and focused on various health outcomes, including cardiovascular outcomes, breast cancer incidence and mortality, firearm injury or death, birth-related outcomes, and asthma outcomes. Most of the included articles (n = 31; 86%) found significant associations between historic redlining and adverse health outcomes such as increased cardiovascular disease, higher rates of preterm births, increased cancer incidence, reduced survival time after breast cancer diagnosis, and increased firearm injury incidence. DISCUSSION: This review demonstrates the persistent effect of historic redlining on individuals' health. Public health nurses should recognize redlining as a form of structural racism when caring for affected communities and should advocate for policies and programs that advance health equity. Nurse researchers should develop and test multilevel interventions to address systemic racism and improve health outcomes in communities affected by redlining.

The Mediating Effect of Caregiving Relationship Quality on the Association Between Caregiving Stressors and Mental Health Problems Among Older Spousal Caregivers.

Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect = .14, p = .016). Moreover, role overload was positively associated with caregiver mental health problems, which was mediated by negative relationship quality (indirect effect = .13, p = .002). Findings suggest that caregiving stressors can adversely affect mental health by exacerbating negative relationship quality. Interventions that limit negative exchanges and increase compassionate communications between older spousal caregivers and their care-receiving partners are needed.

Resilience as a moderator of role overload and sleep disturbance among caregivers of persons with dementia.

The purpose of this study was to examine if resilience moderates the association between role overload and sleep disturbance among caregivers of persons with dementia. This was a secondary analysis of data on 437 informal caregivers (mean age=61.77 years, SD=13.69) of persons with dementia in the United States. Data from the 2017 wave of the National Study of Caregiving were analyzed using multiple regression with interaction terms to evaluate the moderation effect of resilience, while controlling for caregivers' age, race, gender, education, self-rated health, caregiving hours, and primary caregiving status. Higher role overload was associated with greater sleep disturbance and this association was attenuated among caregivers with higher levels of resilience. Our findings highlight the stress-buffering effects of resilience in the context of sleep disturbance in dementia caregivers. Interventions to improve caregivers' ability to recover, resist, and rebound during challenging situations may mitigate role overload and optimize sleep health.

Understanding and Optimizing Family Caregiver Participation in Dyadic Research.

BACKGROUND: Research to understand self-care behaviors increasingly engages patient-caregiver dyads. However, collecting data on dyads requires both members to complete the research protocol, potentially resulting in biased information if caregivers who do not participate differ from caregivers who do. OBJECTIVES: The aim of the study was to examine how recruitment conditions and patients' appraisal of dyadic engagement in heart failure management are related to caregiver participation across two research studies. METHODS: We used logistic regression to examine whether recruitment strategy and patients' responses on the dyadic symptom management-type instrument were associated with caregivers' participation. RESULTS: Caregivers not present at the initial recruitment were less likely to participate in the study. Regardless of recruitment strategy, caregivers were less likely to participate if the patient indicated primary responsibility for heart failure management. In the restricted recruitment study (recruiting both dyad members simultaneously), caregiver participation was significantly higher when patients selected a collaborative-oriented care type relative to patient- or caregiver-oriented type. DISCUSSION: Instruments assessing dyad-level information could aid researchers in deploying resources at recruitment, as well as in adjusting results for data that could bias results and conclusions. Our findings support the importance of considering the recruitment strategy as well as dyadic care type as part of the recruitment process.

Negative marital interaction, purpose in life, and depressive symptoms among middle-aged and older couples: evidence from the Health and Retirement Study.

OBJECTIVE: Negative marital interaction and purpose in life have been associated with depressive symptoms. Yet, these associations have not been fully explored in a dyadic context. This study examines the actor (intra-individual) and partner (cross-spousal) effects of negative marital interaction on depressive symptoms in couples and the potential mediating role of purpose in life. METHODS: Data came from 1186 heterosexual married couples who participated in the 2016 (T1) and 2018 (T2) waves of the Health and Retirement Study and completed the psychosocial questionnaire in 2016. Structural equation modeling was used to estimate the direct and indirect associations among T1 negative marital interaction, T1 purpose in life, and T2 depressive symptoms at the actor and partner levels. Models controlled for age, race, educational level, self-rated health, and length of marriage. RESULTS: At the actor level, a greater negative marital interaction was associated with significantly lower levels of purpose in life for husbands and wives. Negative marital interaction was also associated with depressive symptoms for wives. Purpose in life mediated the relationship between negative marital interaction and depressive symptoms. At the partner level, wives' negative marital interaction was negatively associated with husbands' purpose in life, independent of husbands' own effects. CONCLUSION: The findings support the dominant marital discord model of depression and highlight gender differences in the cross-spousal effects of negative marital interaction on purpose in life. Positive psychology interventions can be beneficial to promote purpose in life and subsequently improve mental health outcomes among couples.

Caregiving Stress and Self-Rated Health during the COVID-19 Pandemic: The Mediating Role of Resourcefulness.

Family caregivers faced unprecedented circumstances and experienced increased levels of stress during the COVID-19 pandemic. Resourcefulness can minimize the effect of stress on health outcomes. The purpose of this study was to examine the associations between caregiving stress during the pandemic, resourcefulness, and self-rated health and assess the mediating effect of resourcefulness. A convenience sample of 70 family caregivers of adults with chronic and/or disabling conditions was recruited using social media groups and professional networking platforms. Data were collected using an online survey and analyzed using linear regression. Mediation analysis was conducted using the PROCESS macro. Higher levels of caregiving stress during the pandemic and lower levels of resourcefulness were associated with worse self-rated health, while controlling for age, employment status, and weekly caregiving hours. Resourcefulness mediated the relationship between caregiving stress and self-rated health. Our findings highlight the importance of assessing the psychological impact of the pandemic on family caregivers' outcomes. Resourcefulness skills can be targeted to improve the health and well-being of family caregivers during and beyond the pandemic.

A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill.

OBJECTIVES: The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE). METHODS: A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients. RESULTS: The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates. SIGNIFICANCE OF RESULTS: This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.

The Use of Closing Questions in Qualitative Research: Results of a Web-Based Survey.

BACKGROUND: Scarce and differing reasons for including closing questions in qualitative research exist, but how data generated from these questions are used remains uncertain. OBJECTIVES: The purpose of the study was to understand if and how researchers use closing questions in qualitative research, specifically the research questions were: (a) "Why do qualitative researchers include or exclude closing questions during interviews?" and (b) "How do qualitative researchers use data from closing questions?" METHODS: A qualitative descriptive design using a single, asynchronous, web-based, investigator-designed survey containing 14 items was used to collect data. Convenience and snowball sampling were used to recruit participants. Data were analyzed using descriptive statistics and qualitative content analysis. Codes were developed from the qualitative data. Subcategories were derived from similar codes, and these subcategories were further scrutinized and were used to create broad categories. RESULTS: The number of respondents per question ranged from 76 to 99; most identified nursing and sociology as their academic disciplines, lived in the United States, and were involved in qualitative research for 1-10 years. Data, the interview, the interviewee, and the interviewer were broad categories to emerge as reasons for including closing questions. Only one respondent reported a reason for excluding closing questions. The uses of closing question data were described in four broad categories: analysis, data, the interview guide, and inquiry. DISCUSSION: Researchers frequently included closing questions in qualitative studies. The reasons for including these questions and how data are used vary, and support limited previously published literature. One unique reason, adding "new breath" to the interview, emerged. Study findings can aid qualitative researchers in deciding whether to include closing questions.

The Contribution of Living Arrangements, Social Support, and Self-efficacy to Self-management Behaviors Among Individuals With Heart Failure: A Path Analysis.

BACKGROUND: Living arrangements, social support, and self-efficacy have significant implications for self-management science. Despite the theoretical linkages among the 3 concepts, there is limited empirical evidence about their interplay and the subsequent influence on heart failure (HF) self-management. OBJECTIVE: The aim of this study was to validate components of the Individual and Family Self-management Theory among individuals with HF. METHODS: This is a secondary analysis of cross-sectional data generated from a sample of 370 individuals with HF. A path analysis was conducted to examine the indirect and direct associations among social environment (living arrangements), social facilitation (social support) and belief (self-efficacy) processes, and self-management behaviors (HF self-care maintenance) while accounting for individual and condition-specific factors (age, sex, race, and HF disease severity). RESULTS: Three contextual factors (living arrangements, age, and HF disease severity) had direct associations with perceived social support and self-efficacy, which in turn were positively associated with HF self-management behaviors. Living alone (ß = -.164, P = .001) was associated with lower perceived social support, whereas being an older person (ß = .145, P = .004) was associated with better support. Moderate to severe HF status (ß = -.145, P = .004) or higher levels of perceived social support (ß = .153, P = .003) were associated with self-efficacy. CONCLUSIONS: Our results support the Individual and Family Self-management Theory, highlighting the importance of social support and self-efficacy to foster self-management behaviors for individuals with HF. Future research is needed to further explore relationships among living arrangements, perceived and received social support, self-efficacy, and HF self-management.

How home health nurses plan their work schedules: A qualitative descriptive study.

AIMS AND OBJECTIVES: To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process. BACKGROUND: Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting. DESIGN: Qualitative descriptive design. METHODS: Semi-structured interviews were conducted with 20 registered nurses who had >2 years of experience in home health and were employed by one of the three participating home health agencies in the mid-Atlantic region of the United States. Data were analysed using conventional content analysis. RESULTS: Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritise visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients. CONCLUSION: Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments. RELEVANCE TO CLINICAL PRACTICE: Home health nurses plan their work schedules to provide high quality care that is patient-centered and timely. The findings also highlight organisational priorities to facilitate continuity of care and support nurses while alleviating the burnout associated with high productivity requirements.

Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study.

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

Reasons for and reservations about research participation in acutely injured adults.

PURPOSE: The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study. DESIGN AND METHODS: This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis. FINDINGS: The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements. CONCLUSIONS: Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences. CLINICAL RELEVANCE: Understanding perceptions of participants' experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants' experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals.

Discrimination and sleep disturbance among older Black Americans: A longitudinal analysis of the Health and Retirement Study.

OBJECTIVES: Black and older adults have higher risk for sleep problems than their White and younger counterparts. Yet, our understanding of the determinants of sleep problems specifically among older Black adults is severely limited. The aim of this study was to determine whether everyday and major discrimination are longitudinally associated with sleep disturbance in a nationally representative sample of older Black adults. METHODS: Non-Latinx Black respondents aged 51+ were selected from waves 8 (2006) through 15 (2020) of the Health and Retirement Study (baseline N = 1397). Sleep disturbance was measured with the 4-item Jenkins Sleep Questionnaire. The 6-item Everyday Discrimination Scale was used to measure everyday discrimination, and the Major Experiences of Discrimination Scale was used to measure major discrimination. Analyses controlled for sociodemographics, health behaviors, and health conditions. Lagged mixed-effects linear regression models were performed to test the longitudinal associations between baseline discrimination and sleep disturbance over 12years. RESULTS: Higher baseline everyday discrimination was longitudinally associated with more severe sleep disturbance. Compared to respondents who reported no major discrimination at baseline, those who reported two or more major discrimination experiences had more severe sleep disturbance over time. CONCLUSIONS: This study provides critical information on the possible longitudinal drivers of sleep disparities at the population level. This information has implications for better understanding the mechanisms of health disparities and for attaining health equity.

Medication Adherence of Older Adults with Hypertension: A Systematic Review.

Objective: Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN. Methods: We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis. Results: Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review's aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified. Conclusion: The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.

African American Family Caregivers' Experiences and Mental Health: A Convergent Mixed-Methods Study.

BACKGROUND: Caregiving in the African American community is informed by strong cultural expectations but may be associated with negative experiences and poor mental health outcomes. OBJECTIVE: The purpose of this convergent mixed-methods study is to understand the relationship between caregiving experiences and mental health and explore stress management strategies in African American family caregivers of adults with chronic or disabling conditions. METHODS: African American family caregivers (N = 100) were recruited using community-engaged methods and completed a sociodemographic questionnaire, the Caregiver Reaction Assessment scale, and the Center for Epidemiologic Studies Depression (CES-D-10) Scale. A subsample (n = 24) participated in semi-structured interviews. Data were analyzed using linear regression and content analysis. A matrix was developed to integrate quantitative and qualitative results. RESULTS: Participants were on average 59 years old. Most were women and provided care to a parent. Lack of family support (B = 1.37, P = .03) and impact of caregiving on caregivers' finances (B = 1.74, P = .004), schedule (B = 2.92, P < .001), and health (B = 3.26, P < .001) were associated with depressive symptoms and were reported as stressful experiences. Negative interactions with the care recipient and caring for multiple people emerged as other sources of stress. Participants used independent and interpersonal coping strategies, as well as strategies to facilitate their caregiving role to reduce their stress. Values of reciprocity, limited use of community-based resources, and mental health stigma emerged as important cultural considerations. CONCLUSIONS: Our findings suggest the need for culturally-sensitive interventions to improve communication and care coordination within African American family caregiving networks and educational programs about mental health and caregiving resources endorsed by trusted community sources.

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia.

OBJECTIVES: We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups. METHODS: Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers' age, gender, race, education, relationship to care recipient, and self-rated health. RESULTS: Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia. DISCUSSION: Findings highlight the need for tailored interventions based on caregivers' perceptions of meaningful social activities and dementia-friendly communities to promote social participation.

Longitudinal Associations Among Symptoms of Family Intensive Care Unit Syndrome.

BACKGROUND: Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue. OBJECTIVES: This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU. METHODS: The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline. RESULTS: The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7. CONCLUSIONS: Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care.

Socioeconomic deprivation and cardiometabolic risk factors in individuals with type 1 diabetes: T1D exchange clinic registry.

AIMS: Social determinants of health (SDOH) influence cardiovascular health in the general population; however, the degree to which this occurs in individuals with type 1 diabetes (T1D) is not well understood. We evaluated associations among socioeconomic deprivation and cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index, physical activity) in individuals with T1D from the T1D Clinic Exchange Registry. METHODS: We evaluated the association between the social deprivation index (SDI) and cardiometabolic risk factors using multivariable and logistic regression among 18,754 participants ages 13 - 90 years (mean 29.2 ± 17) in the T1D Exchange clinic registry from 6,320 zip code tabulation areas (2007-2017). RESULTS: SDI was associated with multiple cardiometabolic risk factors even after adjusting for covariates (age, biological sex, T1D duration, and race/ethnicity) in the multivariable linear regression models. Those in the highest socially deprived areas had 1.69 (unadjusted) and 1.78 (adjusted) times odds of a triple concomitant risk burden of poor glycemia, dyslipidemia, and hypertension. CONCLUSIONS: Persistent SDOH differences could account for a substantial degree of poor achievement of cardiometabolic targets in individuals with T1D. Our results suggest the need for a broader framework to understand the association between T1D and adverse cardiometabolic outcomes.