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Publication
A Ideação suicida no enlutado: identificação da prevalência e evolução da ideação suicida no luto Pré e Pós-morte em cuidadores familiares de doentes acompanhados em cuidados paliativos
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Advisor(s)
Abstract(s)
Introdução: Há evidência de que a experiência de ser um cuidador familiar de um paciente
acompanhado em cuidados paliativos é um grande stressor com consequências físicas,
emocionais e psicológicas. Um dos sintomas relacionados ao luto experienciado antes da
morte do paciente (Luto Antecipatório) e ao luto pós-morte, é a ideação suicida. Não há
registros de estudos realizados sobre a comparação da ideação suicida do cuidador entre os
momentos pré e pós-morte do paciente acompanhado em cuidados paliativos, sendo essencial
mais estudos a explorar esta temática e possibilidades de suporte psicológico de caráter
preventivo. Objetivo: Verificar a prevalência e evolução da ideação suicida nos cuidadores de
pacientes acompanhados em cuidados paliativos entre os momentos pré e pós-morte, além de
identificar em qual medida a Perturbação de Luto Prolongado, depressão, ansiedade,
somatização e a sobrecarga do cuidador impactam na ideação suicida. Método: Foi realizado
um estudo coorte, de desenho longitudinal prospectivo com avaliação na fase pré-morte (T1)
e follow-up 6-12 meses após a morte (T2) numa amostra de 155 cuidadores com a aplicação
dos instrumentos: Zarit Burden Interview, Sub-escalas de Depressão e Ansiedade e
Somatização do BSI (Brief Symptom Inventory-18), PG-13 (Prolonged Grief Disorder
Questionnaire) e PG-12 (Prolonged Grief Disorder Questionnaire-Pre-Death). Resultados:
Participantes em T1 (n=155) foram majoritariamente mulheres portuguesas de etnia
caucasiana, casadas e filhas do paciente em cuidados paliativos, com média de idade de 51,77
anos (DP=12,42). Em T2, a amostra contou com 73 participantes. A prevalência da ideação
manteve-se em T2 da mesma forma que em T1 para os ideadores (66,6%) e não ideadores
(86%). A evolução da ideação suicida manteve-se igual na maior parte dos níveis estudados
(86% “nunca”, 71,4% “algumas vezes” e 50% “muitas vezes”). A depressão teve um impacto
significativo e positivo na ideação suicida em T1 (p<.001;B=.781) e em T2 (p<.001;B=.638).
Os scores dos questionários sobre a PLP obtiveram diferenças significativas entre os grupos
no PG-12 (p<.05) e no PG-13 (p<.001) com scores maiores nos participantes com maior
índice de ideação suicida. Discussão: Estes resultados contribuem para uma melhor
identificação e rastreio da ideação suicida em cuidadores familiares, permitindo um
tratamento precoce a fim de evitar maior sofrimento desta população.
ABSTRACT: Introduction: There is evidence that the experience of being a family caregiver for a patient receiving palliative care is a major stressor with physical, emotional and psychological consequences. One of the symptoms related to grief experienced before the patient's death (Anticipatory Grief) and post-death grief is suicidal ideation. There are no records of studies carried out on the comparison of the caregiver's suicidal ideation between the pre- and post-death moments of the patient followed in palliative care, and more studies are essential to explore this topic and possibilities of psychological support of a preventive nature. Objective: To verify the prevalence and evolution of suicidal ideation in caregivers of patients receiving palliative care between the pre- and post-death moments, in addition to identifying the extent to which prolonged grief disturbance, depression, anxiety, somatization and caregiver overload impact in suicidal ideation. Method: A cohort study, with a prospective longitudinal design, was carried out with assessment in the pre-death phase (T1) and follow-up 6-12 months after death (T2) in a sample of 155 caregivers applying the following instruments: Zarit Burden Interview, Depression and Anxiety and Somatization subscales of the BSI (Brief Symptom Inventory-18), PG-13 (Prolonged Grief Disorder Questionnaire) and PG-12 (Prolonged Grief Disorder Questionnaire-Pre-Death). Results: Participants in T1 (n=155) were mostly Portuguese women of Caucasian ethnicity, married and daughters of a palliative care patient, with a mean age of 51.77 years (SD=12.42). In T2, a sample had 73 participants. The prevalence of ideation remained at T2 in the same way as at T1 for ideators (66.6%) and non-ideators (86%). The evolution of suicidal ideation remained the same across most trained levels (86% “never”, 71.4% “sometimes” and 50% “very often”). Depression had a significant and positive impact on suicidal ideation at T1 (p<0.001;B=0.781) and at T2 (p<0.001;B=0.638). The scores on the PLP questionnaires showed significant differences between the groups in PG-12 (p<0.05) and PG-13 (p<0.001) with higher scores in participants with a higher rate of suicidal ideation. Discussion: These negative results support better identification and screening of suicidal ideation in family caregivers, allowing early treatment to avoid greater suffering in this population.
ABSTRACT: Introduction: There is evidence that the experience of being a family caregiver for a patient receiving palliative care is a major stressor with physical, emotional and psychological consequences. One of the symptoms related to grief experienced before the patient's death (Anticipatory Grief) and post-death grief is suicidal ideation. There are no records of studies carried out on the comparison of the caregiver's suicidal ideation between the pre- and post-death moments of the patient followed in palliative care, and more studies are essential to explore this topic and possibilities of psychological support of a preventive nature. Objective: To verify the prevalence and evolution of suicidal ideation in caregivers of patients receiving palliative care between the pre- and post-death moments, in addition to identifying the extent to which prolonged grief disturbance, depression, anxiety, somatization and caregiver overload impact in suicidal ideation. Method: A cohort study, with a prospective longitudinal design, was carried out with assessment in the pre-death phase (T1) and follow-up 6-12 months after death (T2) in a sample of 155 caregivers applying the following instruments: Zarit Burden Interview, Depression and Anxiety and Somatization subscales of the BSI (Brief Symptom Inventory-18), PG-13 (Prolonged Grief Disorder Questionnaire) and PG-12 (Prolonged Grief Disorder Questionnaire-Pre-Death). Results: Participants in T1 (n=155) were mostly Portuguese women of Caucasian ethnicity, married and daughters of a palliative care patient, with a mean age of 51.77 years (SD=12.42). In T2, a sample had 73 participants. The prevalence of ideation remained at T2 in the same way as at T1 for ideators (66.6%) and non-ideators (86%). The evolution of suicidal ideation remained the same across most trained levels (86% “never”, 71.4% “sometimes” and 50% “very often”). Depression had a significant and positive impact on suicidal ideation at T1 (p<0.001;B=0.781) and at T2 (p<0.001;B=0.638). The scores on the PLP questionnaires showed significant differences between the groups in PG-12 (p<0.05) and PG-13 (p<0.001) with higher scores in participants with a higher rate of suicidal ideation. Discussion: These negative results support better identification and screening of suicidal ideation in family caregivers, allowing early treatment to avoid greater suffering in this population.
Description
Dissertação de Mestrado realizada sob
a orientação de Professora Doutora Alexandra
Manuela de Moura Coelho,
apresentada no Ispa – Instituto
Universitário para obtenção de grau de
Mestre na especialidade de Psicologia
Clínica.
Keywords
Cuidadores familiares Cuidados paliativos Ideação suicida Luto antecipatório Family caregivers Palliative care Suicidal ideation Anticipatory grief