Stress and Coping Strategies among Informal Caregivers of the Critically Ill at the Greater Accra Regional Hospital

Abstract

Background Stress among caregivers of the critically ill over the last decade has become an issue of great concern to health professionals and policy makers, both locally and internationally. According to Hickman & Douglas, (2010), the proportion of family members exposed to the psychological consequences of critical illness will continue to increase due to the consistently increasing number of patients admitted to the intensive care unit (ICU). In developed countries, policymakers are recognizing the importance of supporting the caregiver (Schulz and Sherwood, 2008). In Ghanaian society, there is little information on the issue focusing importance on providing care to the ill at the expense of the psychological and physical health of caregivers. Inadequacy of evidence based data makes efforts towards the formulation of policy to deal with the situation difficult, if not impossible. For these reasons, the conduct of additional research on the subject would be the right step towards the solution of the problem. Objective This study aimed at assessing the stress among caregivers of the critically ill and its associated factors as well as the coping strategies employed by caregivers of the critically ill to minimize the level of stress they undergo. Methods The study involved an analytical cross-sectional design utilizing quantitative methods for data collection and analysis. A consecutive sampling method was used to survey participants and collect data which were analyzed with STATA 15.0 with chi square and simple logistic regression. Bivariate regression analysis was used to determine the association between the dependent and independent variables at a 5% significant level (P-value<0.05), and multivariate regression analysis was used to determine the strength of association. Results The proportion of caregivers of critically ill patients who are stressed at the Greater Accra Regional Hospital (GARH) were 73.4%. 39.3% of caregivers reported that they were under extremely severe stress. The coping strategies associated with stress include; reliance on financial support from family members and friends (p = 0.002), reliance on emotional support from family members and friends (p = 0.003) and decision to see situation as another test case (p = 0.020). Among the socio demographic factors, caregivers between the ages of 26 to 35 years (aOR = 2.16; 95% CI = 1.00 – 4.65; p = 0.050), 36 to 45 (aOR = 2.76; 95% CI = 1.09 – 7.00; p = 0.032), 46 to 55 years (aOR = 4.71; 95% CI = 1.15 – 19.34; p = 0.032) and 55 to 70 years (aOR = 5.71; 95% CI = 1.28 – 25.39; p = 0.022), cohabiting (aOR = 4.39; 95% CI = 1.29 – 14.91; p = 0.018), and grandparents of the critically ill (aOR = 0.18; 95% CI = 0.05 – 0.64; p = 0.007), were the factors that significantly influence stress among the caregivers. Lastly, relative to situational factors, spending three hours at the hospital daily (aOR = 16.76; 95% CI = 3.12 – 90.13; p = 0.001), spending 4 hours or more at the hospital daily (aOR = 4.62; 95% CI = 1.09 – 19.69; p = 0.038), long distance from home to hospital (aOR = 2.31; 95% CI = 1.13 – 4.74; p = 0.022) and very long distance from home to hospital (aOR = 3.04; 95% CI = 1.47 – 6.29; p = 0.003) were factors found to be significantly associated with stress among caregivers of critically ill patients. Conclusion The act of caregiving by informal caregivers though unappreciated in GARH put caregivers under unprecedented levels of stress. It is an issue of major concern and needs attention.