Decision-makers’ mental health linked to patient outcomes after severe acute brain injury

Key takeaways:

• Study examined patient neurological outcomes and mental health outcomes of decision-makers 18 to 24 months after severe brain injury.
• Mental health symptoms highest when patients survived in dependent state.

BOSTON — Mental health symptoms in surrogate decision-makers were highest when patients survived in a dependent state after severe acute brain injury, according to a poster at the American Academy of Neurology annual meeting.

“Long-term outcomes of people with severe acute brain injury is not well-researched, especially by different subtypes of injury,” Natalie L. Smith, BSc, a fourth-year student at the University of Washington, told Healio. “But the real question is how are the surrogate decision-makers doing after that injury.”

Smith and colleagues sought to describe challenges for patients and surrogate decision-makers (SDMs) during recovery from severe acute brain injury (SABI), assess patients’ neurological outcomes and caretakers’ mental health at 18 to 24 months after SABI, and examine associations between outcomes for SDMs and those under their care.

Researchers included 103 adults with SABI (median age, 58 years; 28% women) who were admitted to the Neuro ICU or Trauma ICU at Harborview Medical Center in Seattle between September and November 2021 with one of four subtypes of traumatic brain injury. They also included 84 SDMs (median age, 53 years; 67% women), who were contacted for phone interviews 18 to 24 months after their patients’ injury.

Primary outcomes were neurological status of SABI patients 18 to 24 months after injury using the Glasgow Outcome Scale-Extended (GOS-E), and assessments of depression, anxiety, PTSD and caregiver strain for SDMs.

According to results, approximately 56% of patients died, 32% were independent and 12% were dependent. About half of SDMs reported their patients’ quality of life was unacceptable, although 66% of patients had GOS-E scores of 5 to 8.

Researchers also reported elevated rates of depression, anxiety and PTSD in SDMs, with mental health symptoms highest when patients were in a dependent state. Major challenges among patients and SDMs were adjusting to new normal, mental health symptoms and barriers to care.

“We found that surrogate decision-makers are doing best if their patient is either dead or made a full functional recovery,” Smith said. “The patients that made either a dependent functional recovery or less-than-full recovery were doing the most in terms of mental health symptoms. That is an area physicians can target when they are doing care conversations with families as well as prognosticating on what their outcomes could be.”