SICQ Coping and the Health-Related Quality of Life and Recovery of Critically Ill ICU Patients

Abstract

BackgroundThe coping styles of the Sickness Insight in Coping Questionnaire (SICQ; positivism, redefinition, toughness, fighting spirit, nonacceptance) may affect the health and recovery of hospitalized critically ill patients.Research QuestionDo the SICQ coping styles of hospitalized critically ill patients relate to the patients health-related quality of life (HRQoL) and recovery?Study Design and MethodsA prospective cohort study was conducted in a single university-affiliated Dutch hospital. Participants were critically ill adult patients admitted to a mixed medical-surgical ICU (start: n = 417; pre-ICU: n = 391; hospital discharge: n = 350; 3-month follow-up: n = 318; 6-month follow-up: n = 308; 12-month follow-up: n = 285). Coping was recorded with the SICQ pre-ICU and at discharge. HRQoL was measured with the SF-12 pre-ICU, at discharge, and 3, 6, and 12 months after discharge. Indicators of recovery were ICU and hospital length of stay, discharge disposition, and mortality. Correlation and regression analyses were used for data analysis.ResultsPositivism (r = 0.28-0.51), fighting spirit (r = 0.14-0.35), and redefinition (r = 0.12-0.23) associated significantly (P < .05) with mental HRQoL after discharge. Furthermore, positivism associated positively (P < .01) with physical HRQoL (r = 0.17-0.26) after discharge. Increase in positivism (r = 0.13), redefinition (r = 0.13), and toughness (r = 0.13) across the period of hospitalization associated positively (P ≤ .05) with mental HRQoL at discharge. Pre-ICU positivism associated with hospital length of stay (ρ = −.21, P ≤ .05) and hazard for death (HR = 0.57, P < .01) and had a unidirectional effect on mental HRQoL (β = .30, P < .001).InterpretationSICQ coping is associated with long-term mental HRQoL, hospital length of stay, and hazard for death among hospitalized critically ill patients. The coping styles of the Sickness Insight in Coping Questionnaire (SICQ; positivism, redefinition, toughness, fighting spirit, nonacceptance) may affect the health and recovery of hospitalized critically ill patients. Do the SICQ coping styles of hospitalized critically ill patients relate to the patients health-related quality of life (HRQoL) and recovery? A prospective cohort study was conducted in a single university-affiliated Dutch hospital. Participants were critically ill adult patients admitted to a mixed medical-surgical ICU (start: n = 417; pre-ICU: n = 391; hospital discharge: n = 350; 3-month follow-up: n = 318; 6-month follow-up: n = 308; 12-month follow-up: n = 285). Coping was recorded with the SICQ pre-ICU and at discharge. HRQoL was measured with the SF-12 pre-ICU, at discharge, and 3, 6, and 12 months after discharge. Indicators of recovery were ICU and hospital length of stay, discharge disposition, and mortality. Correlation and regression analyses were used for data analysis. Positivism (r = 0.28-0.51), fighting spirit (r = 0.14-0.35), and redefinition (r = 0.12-0.23) associated significantly (P < .05) with mental HRQoL after discharge. Furthermore, positivism associated positively (P < .01) with physical HRQoL (r = 0.17-0.26) after discharge. Increase in positivism (r = 0.13), redefinition (r = 0.13), and toughness (r = 0.13) across the period of hospitalization associated positively (P ≤ .05) with mental HRQoL at discharge. Pre-ICU positivism associated with hospital length of stay (ρ = −.21, P ≤ .05) and hazard for death (HR = 0.57, P < .01) and had a unidirectional effect on mental HRQoL (β = .30, P < .001). SICQ coping is associated with long-term mental HRQoL, hospital length of stay, and hazard for death among hospitalized critically ill patients. Take-home PointsStudy Question: Do the SICQ coping styles of hospitalized critically ill patients relate to the patients health-related quality of life (HRQoL) and recovery?Results: The SICQ coping styles of the hospitalized critically ill patients correlated with the patients HRQoL and recovery. The SICQ positivism of the hospitalized critically ill patients most consistently associated with the patients’ HRQoL and recovery.Interpretation: In the caretaking of hospitalized critically ill patients, assessing and addressing the adaptive coping of these patients is relevant. Study Question: Do the SICQ coping styles of hospitalized critically ill patients relate to the patients health-related quality of life (HRQoL) and recovery? Results: The SICQ coping styles of the hospitalized critically ill patients correlated with the patients HRQoL and recovery. The SICQ positivism of the hospitalized critically ill patients most consistently associated with the patients’ HRQoL and recovery. Interpretation: In the caretaking of hospitalized critically ill patients, assessing and addressing the adaptive coping of these patients is relevant. Patients treated in an ICU commonly experience psychological distress for a number of reasons, including discomfort due to invasive medical treatments, the unfamiliar environment, and intrusive thoughts about mortality.1Charalambous A. Kaite C.P. Charalbous M. Titsi T. Kouta C. The effects of anxiety and quality of life of breast cancer patients following completion of the first cycle of chemotherapy.Sage Open Med. 2017; 5: 1-10Crossref Google Scholar, 2Mogos M. Roffey P. Thangathurai D. Demoralization syndrome: a condition often undiagnosed in terminally ill patients.J Palliat Med. 2013; 16: 601Crossref PubMed Scopus (3) Google Scholar, 3Sottile P.D. Moss M. The importance of coping in critically ill patients.Crit Care Med. 2016; 44: 1797-1798Crossref PubMed Scopus (3) Google Scholar, 4Wade D.M. Hankins M. Smyth D.A. et al.Detecting acute distress and risk of future psychological morbidity in critically ill patients: validation of the intensive care psychological assessment tool.Crit Care. 2014; 18: 519Crossref PubMed Scopus (39) Google Scholar, 5Pattison N. Psychological implications of admission to critical care.Br J Nurs. 2005; 14: 708-714Crossref PubMed Scopus (42) Google Scholar, 6Hofhuis J.G.M. Spronk P.E. Van Stel H.F. Schrijvers A.J.P. Rommes J.H. Bakker J. Experiences of critically ill patients in the ICU.Intensive Crit Care Nurs. 2008; 24: 300-313Crossref PubMed Scopus (126) Google Scholar As a result of this distress, patients may report decreased health-related quality of life (HRQoL) and impaired recovery during the ICU stay and after discharge.7Peris A. Bonizzoli M. Iozzelli D. et al.Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients.Crit Care. 2011; 15: R41Crossref PubMed Scopus (148) Google Scholar, 8Hatch R. McKechnie S. Griffiths J. Psychological intervention to prevent ICU-related PTSD: who, when and for how long?.Crit Care. 2011; 15: 141Crossref PubMed Scopus (21) Google Scholar, 9Elliot R. McKinley S. Fien M. Elliott D. Posttraumatic stress symptoms in intensive care patients: an exploration of associated factors.Rehabil Psychol. 2016; 61: 141-150Crossref PubMed Scopus (25) Google Scholar Adaptive coping helps in decreasing psychological distress, and in general and patient populations adaptive coping positively affects mental health and HRQoL.10Holton K.H. Barry A.E. Chaney J.D. Employee stress management: an examination of adaptive and maladaptive coping strategies on employee health.Work. 2016; 53: 299-305Crossref Scopus (53) Google Scholar, 11DeBerard M.S. Masters K.S. Psychosocial correlates of the Short Form-36 multidimensional health survey in university students.Psychology. 2014; 5: 46961Crossref Google Scholar, 12Lo Buono V. Corallo F. Bramanti P. Marino S. Coping strategies and health-related quality of life after stroke.J Health Psychol. 2017; 22: 16-28Crossref PubMed Scopus (63) Google Scholar, 13Kershaw T. Northouse L. Kritpracha C. Schafenacker A. Mood D. Coping strategies and quality of life in women with advanced breast cancer and their family caregivers.Psychol Health. 2004; 19: 139-155Crossref Scopus (162) Google Scholar Accordingly, researchers have begun to address the coping styles of ICU survivors,14Dettling-Ihnenfeldt D.S. De Graaff A.E. Beelen A. Nollet F. Van der Schaaf M. Coping style and quality of life in Dutch intensive care unit survivors.Rehabil Psychol. 2016; 61: 165-172Crossref PubMed Scopus (6) Google Scholar, 15Cox C.E. Hough C.L. Carson S.S. et al.Effects of a telephone- and web-based coping skills training program compared with an education program for survivors of critical illness and their family members.Am J Respir Crit Care Med. 2018; 197: 66-78Crossref PubMed Scopus (56) Google Scholar, 16Orwelius L. Kristenson M. Fredrikson M. Wlather S. Sjöberg F. Hopelessness: independent associations with health-related quality of life and short-term mortality after critical illness: a prospective multicenter trial.J Crit Care. 2017; 41: 58-63Crossref PubMed Scopus (6) Google Scholar family members of ICU patients,17Nadig N. Huff N.G. Cox C.E. Ford D.W. Coping as a multifaceted construct: ssociations with psychological outcomes among family members of mechanical entilation survivors.Crit Care Med. 2016; 44: 1710-1717Crossref PubMed Scopus (19) Google Scholar ICU staff members,18Rodriguez-Rey R. Palacios A. Alonso-Tapia J. et al.Burnout and posttraumatic stress in paediatric critical care personnel: prediction from resilience and coping styles.Aust Crit Care. 2019; 32: 46-53Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar and hospitalized ICU patients.19Shaffer K.M. Riklin E. Jacobs J.M. Rosand J. Vranceanu A.M. Mindfulness and coping are inversely related to psychiatric symptoms in patients and informal caregivers in the neuroscience ICU: implications for clinical care.Crit Care Med. 2016; 44: 2028-2036Crossref PubMed Scopus (29) Google Scholar,20Boezeman E.J. Hofhuis J.G.M. Hovingh A. Cox C.E. De Vries R.E. Spronk P.E. Measuring adaptive coping of hospitalized patients with a severe medical condition: the Sickness Insight in Coping Questionnaire.Crit Care Med. 2016; 44: e818-e826Crossref PubMed Scopus (8) Google Scholar However, research in this area is still underdeveloped. The Sickness Insight in Coping Questionnaire (SICQ) is an instrument that measures coping styles of particular relevance to the experience of serious illness during and after hospitalization, including positivism (ie, having a positive attitude), redefinition (ie, seeing advantages of the medical situation such as personal growth), toughness, fighting spirit, and nonacceptance (of the current medical condition and its possible outcome).20Boezeman E.J. Hofhuis J.G.M. Hovingh A. Cox C.E. De Vries R.E. Spronk P.E. Measuring adaptive coping of hospitalized patients with a severe medical condition: the Sickness Insight in Coping Questionnaire.Crit Care Med. 2016; 44: e818-e826Crossref PubMed Scopus (8) Google Scholar A previous SICQ study has focused on its measurement properties and found good structural validity, good patient-proxy agreement, and high reliability of its subscales.20Boezeman E.J. Hofhuis J.G.M. Hovingh A. Cox C.E. De Vries R.E. Spronk P.E. Measuring adaptive coping of hospitalized patients with a severe medical condition: the Sickness Insight in Coping Questionnaire.Crit Care Med. 2016; 44: e818-e826Crossref PubMed Scopus (8) Google Scholar However, whether SICQ-measured coping styles are associated with ICU patients’ HRQoL and recovery remains unclear. Therefore, the aim of the current research was to whether the (ie, assessment pre-ICU and after coping of ill patients relate to HRQoL and recovery As a whether the pre-ICU coping of critically ill patients had a in the HRQoL and recovery was the about the research and for the research a for this study was from the number that that this study was to the A prospective cohort study with was The data of the current research were in the of a cohort study on the HRQoL of ICU Van Stel H.F. Schrijvers Rommes J.H. Spronk P.E. ICU survivors in health-related quality of life after Care Med. 41: PubMed Scopus Google Scholar The study was conducted in the a Dutch university-affiliated hospital in with a medical-surgical The research of measurement patient data were pre-ICU, at the of hospital discharge, and 3, 6, and 12 months after hospital discharge. The were adult patients admitted to the Patients with were from J.G.M. A. De L. Hovingh A. Spronk P.E. and general health critical illness is of Crit Care. 2019; PubMed Scopus (3) Google Scholar was recorded in in the the patients to a on mechanical and family members of the patients were to the first about the patients’ and family members of patients were in the research as ICU patients were to a at the of had to in with the patient on a and were to on of the patient and the that the of health and coping style in the the to a for assessment as in previous E.J. Hofhuis J.G.M. Hovingh A. Cox C.E. De Vries R.E. Spronk P.E. Measuring adaptive coping of hospitalized patients with a severe medical condition: the Sickness Insight in Coping Questionnaire.Crit Care Med. 2016; 44: e818-e826Crossref PubMed Scopus (8) Google Scholar, Van Stel H.F. Schrijvers Rommes J.H. Spronk P.E. ICU survivors in health-related quality of life after Care Med. 41: PubMed Scopus Google Scholar, J.G.M. A. De L. Hovingh A. Spronk P.E. and general health critical illness is of Crit Care. 2019; PubMed Scopus (3) Google Scholar the of hospital discharge, the patients the of the research that recorded patient coping and HRQoL at the of hospital discharge. (ie, (ie, and 12 (ie, months after hospital discharge, the patients the that recorded their HRQoL at the of the The were the The data was and study J. The pre-ICU recorded the of the study Study staff used the hospital patient to of illness (ie, and Health at the of ICU hospital and ICU length of stay, patient after from the hospital (ie, and 12-month mortality. The E.J. Hofhuis J.G.M. Hovingh A. Cox C.E. De Vries R.E. Spronk P.E. Measuring adaptive coping of hospitalized patients with a severe medical condition: the Sickness Insight in Coping Questionnaire.Crit Care Med. 2016; 44: e818-e826Crossref PubMed Scopus (8) Google Scholar was used to the patients’ coping styles pre-ICU and at the of hospital discharge. The SICQ has to a coping and positivism, redefinition, toughness, fighting spirit, and SICQ has and to the are recorded on a A SICQ adaptive The Short J. M. A Health of and of reliability and Care. PubMed Scopus Google Scholar a of the R. of the Health a multidimensional of general health J Med. PubMed Scopus Google Scholar was used to the mental and physical HRQoL of the patients. The SF-12 was to the patients pre-ICU, at the of hospital discharge, and 3, 6, and 12 months after hospital discharge. The SF-12 a mental HRQoL and a physical HRQoL with a quality of M. the SF-12 physical and mental health 5: Scholar The Cox regression and regression analyses were conducted with the for Scholar The was used for for Scholar of the SICQ was (r < on used to the associations patients’ SICQ coping admission to the ICU as as after hospital and HRQoL hospital discharge and 3, 6, and 12 months after hospital Furthermore, was used to the the patients’ pre-ICU SICQ and length of In analyses were conducted to in these when for the of and = = was used to whether an in patients’ SICQ coping from the pre-ICU to hospital discharge period was associated with the HRQoL at the of hospital discharge and in the months after discharge from the hospital. to and effect in psychological and 2019; Scopus Google Scholar are of in of a of in of a and .30, and of in of a of effect in psychological and 2019; Scopus Google Scholar Cox regression was used to whether the pre-ICU coping hazard for death during study regression analyses were conducted to whether the patients’ pre-ICU SICQ were associated with patient discharge (ie, Furthermore, after the measurement of was used to whether the outcomes of and A. et are of strategies related to and 2014; PubMed Scopus Google Scholar was used to whether the SICQ the patients’ HRQoL in a unidirectional (ie, the HRQoL HRQoL for in the recorded at discharge were correlated to their to A. et are of strategies related to and 2014; PubMed Scopus Google Scholar were used to the of the (ie, the and < R.E. A to Google Scholar The the on the associations pre-ICU SICQ coping and including patients’ HRQoL, length of stay, of stay after discharge, and mortality. ICU a of patients were and patients women and and were The patients’ was and were the number of patients at study In family members about the coping of the of length of stay in length of stay in and of admission when admitted to the when admitted to the in first after admission to the hospital discharge, patient was during hospital stay, Open in a The patients’ positivism (r = to and fighting spirit (r = to recorded pre-ICU and at discharge from the associated significantly (P < .05) with the patients’ mental SF-12 in the months after discharge Furthermore, the pre-ICU redefinition associated significantly (r = with the mental in the months after discharge Furthermore, positivism correlated positively and significantly (r = P < .05) with the physical (P < .05) positive were toughness and nonacceptance was found to associated with SF-12 mental physical and in patients’ positivism, redefinition, and toughness from the pre-ICU to period correlated significantly (P < .05) with the patients’ SF-12 mental at hospital discharge and patient HRQoL are in that the pre-ICU positivism was associated with mental HRQoL, the pre-ICU redefinition was significantly associated with the physical and ICU Coping of = after discharge = after discharge = after discharge = recorded pre-ICU < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < recorded at discharge < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < are for the of and = = P < P < P < Open in a and Coping of = = = = recorded pre-ICU < < < < < < < < < < < < < < < < < < < < < < < < < < recorded at discharge < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < are for the of and = = P < P < P < Open in a in to and of of in in to quality of life hospital < < < after after < 12 after < < quality of life hospital < < < after after < 12 after < positive that an in the of in the to hospital discharge (ie, with an in HRQoL, a that a in the of in the period with a in P < P < Open in a are for the of and = = are for the of and = = A positive that an in the of in the to hospital discharge (ie, with an in HRQoL, a that a in the of in the period with a in The patients’ positivism recorded pre-ICU correlated significantly and with the hospital (ρ = −.21, P < and ICU (ρ = P < length of stay that the patients’ pre-ICU positivism (ρ = P < and redefinition (ρ = P < as associated with the patients’ hospital length of The Cox regression that pre-ICU positivism = P < = = decreased the hazard for death in the 12 months after admission to the hospital Furthermore, regression that the pre-ICU positivism the patients’ after hospital discharge this effect of positivism when when admitted to the ICU mechanical when admitted to the ICU and of admission the ICU were as in the regression analysis. the associations of SICQ with discharge Furthermore, pre-ICU and the pre-ICU positivism have a in hazard for death for critically ill patients The a good = = P = = = = that patients’ positivism coping style was the associated with the mental HRQoL Pre-ICU recorded positivism the positivism (β = P < and mental HRQoL (β = .30, P < recorded at the of hospital discharge. pre-ICU recorded mental HRQoL was associated (β = P < .05) with the positivism recorded at hospital discharge. that positivism is an unidirectional of mental prospective cohort study found the SICQ adaptive coping styles to to the patients’ health-related quality of life HRQoL and long-term positivism was associated with a length of hospital stay and risk of death during found that pre-ICU of patients’ adaptive coping were associated with patient HRQoL, the of completion of the researchers the Coping A instrument to ICU patients, that coping strategies such as and maladaptive thoughts were associated with symptoms of and posttraumatic stress K.M. Riklin E. Jacobs J.M. Rosand J. Vranceanu A.M. Mindfulness and coping are inversely related to psychiatric symptoms in patients and informal caregivers in the neuroscience ICU: implications for clinical care.Crit Care Med. 2016; 44: 2028-2036Crossref PubMed Scopus (29) Google Scholar that a psychological intervention that critically ill patients with the severe medical condition and medical to the patients’ quality of A. Bonizzoli M. Iozzelli D. et al.Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients.Crit Care. 2011; 15: R41Crossref PubMed Scopus (148) Google Scholar Furthermore, a coping skills training intervention was found to symptoms of depression among ICU survivors with of C.E. Hough C.L. Carson S.S. et al.Effects of a telephone- and web-based coping skills training program compared with an education program for survivors of critical illness and their family members.Am J Respir Crit Care Med. 2018; 197: 66-78Crossref PubMed Scopus (56) Google Scholar However, have critically ill patients’ coping styles how these may the HRQoL, and recovery of such patients. The current study a to the the of adaptive coping among hospitalized critically ill patients and associations of adaptive coping styles with HRQoL and recovery. research that coping the mental HRQoL of ICU survivors,14Dettling-Ihnenfeldt D.S. De Graaff A.E. Beelen A. Nollet F. Van der Schaaf M. Coping style and quality of life in Dutch intensive care unit survivors.Rehabil Psychol. 2016; 61: 165-172Crossref PubMed Scopus (6) Google Scholar coping to the HRQoL of ICU L. Kristenson M. Fredrikson M. Wlather S. Sjöberg F. Hopelessness: independent associations with health-related quality of life and short-term mortality after critical illness: a prospective multicenter trial.J Crit Care. 2017; 41: 58-63Crossref PubMed Scopus (6) Google Scholar that SICQ coping styles affect the patients’ HRQoL may in recovery from critical Accordingly, this research the that the critically ill patients with their severe medical condition during their stay at the hospital and ICU has a in HRQoL and recovery after discharge, and this may researchers and ICU staff members in the HRQoL and recovery of ICU for intervention and for pre-ICU adaptive coping of patients may ICU staff members to that the health condition of patients may intervention and this in J. A. R. The of in psychological recovery from intensive care.Crit Care. 2013; PubMed Scopus Google Scholar that education about and to prevent in may in coping in ICU patients are and to A. Bonizzoli M. Iozzelli D. et al.Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients.Crit Care. 2011; 15: R41Crossref PubMed Scopus (148) Google Scholar In with previous T. Northouse L. Kritpracha C. Schafenacker A. Mood D. Coping strategies and quality of life in women with advanced breast cancer and their family caregivers.Psychol Health. 2004; 19: 139-155Crossref Scopus (162) Google Scholar a coping skills training program about SICQ coping may to ICU survivors in the first after hospital discharge a to SICQ the are was a study conducted among a of Dutch patients, and the may to patients in Furthermore, the current for was a and a first in the of the SICQ coping styles in the HRQoL, and recovery of critically ill patients. In the current study whether adaptive coping as recorded with the for the distress and anxiety of hospitalized critically ill patients. Accordingly, research is to whether SICQ coping styles affect of outcomes among patients, to the of that may SICQ coping in patients and to address and in SICQ coping of patients. the SICQ is a survey instrument for and the of that aim to the psychological coping of critically ill patients during In the current associations were SICQ coping styles recorded during hospitalization and HRQoL patient as recorded during and after research is to how the SICQ to and patients’ adaptive the SICQ at in the patient of critically ill patients, about psychological coping and its effects may may that the of the SICQ coping styles may during recovery. critically ill patients may to fighting spirit and toughness intensive in the ICU and to redefinition during after intensive at the Furthermore, whether patients to and SICQ coping styles and how these may long-term health and is The SICQ coping that have found to critically ill patients positivism, coping fighting spirit, toughness, nonacceptance) that may to patients and their health and recovery may at first after discharge and in the of patients may to decreased to in such as that may adaptive coping in of fighting spirit, toughness, and addressing the relevance of coping styles the SICQ the to recovery of critically ill patients, the of the psychological coping of critically ill patients may Adaptive coping styles measured with the SICQ were associated with long-term mental HRQoL, hospital length of stay, and 12-month mortality among critically ill patients. research is to the clinical of and on coping styles as with the to this E. J. for the the of the including the data and analysis. P. E. J. M. and R. E. V. to the and of the J. M. and P. E. S. the patient E. J. and R. E. V. the for of the E. J. the P. E. R. E. J. M. and E. J. outcomes of the data analysis. C. E. C. the of the outcomes of the data and for E. J. P. E. J. M. R. E. and C. E. C. the about the to the about the and the about the have the of the about the have to for the and to that related to the of of the in the was are and the in the The found in the of the with

Topics & Concepts