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Septic sadness

From the December ACP Hospitalist, copyright © 2012 by the American College of Physicians

By Stacey Butterfield

If your husband or wife survived a bout with severe sepsis, you'd be happy, right? Glad to have that stressful experience over and move on with your lives?

Not necessarily, according to a recent study of the spouses of severe sepsis patients. The cohort study of about 1,000 sepsis hospitalizations measured rates of depression among the patients' spouses. They found a pretty unhappy group, according to results published in Critical Care Medicine in July.

Dimitry Davydow, MD, MPH. Photo courtesy of Dr. Davydow.

Dimitry Davydow, MD, MPH. Photo courtesy of Dr. Davydow.



Among wives of sepsis patients (who made up the majority of the study), prevalence of substantial depressive symptoms grew from 20% before sepsis to 34% after. Husbands weren't affected so significantly, but they did show an 8% increase in depression. Controlling for whether the sepsis patient died or became disabled did not explain the association.

These depression symptoms are a problem for both the spouses and the patients in need of caregiving, according to lead study author Dimitry S. Davydow, MD, MPH, assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. He recently spoke with ACP Hospitalist about the potential consequences of his findings and what hospitalists can do to help these patients and families.

Q: Why did you choose to study sepsis specifically?

A: In part because sepsis is very common in older adults. Several hundred thousand older adults are hospitalized for it annually. A decade or two ago, it was kind of like an automatic death sentence. Now we're starting to understand more about older folks who are cognitively intact and functioning well on their own, end up hospitalized with sepsis, and they survive and now they have new impairments. That puts a certain amount of burden on their caregivers. Often that's the spouse. We were interested in getting an idea about how this affects someone's spouse.

Q: How did the results of your study compare to your expectations?

A: Probably the best comparison is spouses of folks with dementia. There's a pretty big literature that spouses of folks with dementia are at greater risk for depression. A lot of these [sepsis patients] who survive end up with a degree of cognitive impairment, and some mild dementia they didn't have before. What we found was in line with what we were expecting. Certainly rates are pretty high.

Q: What advice would you give hospitalists based on your findings?

A: One thing is really assessing burden [on caregivers]. When we're putting together a follow-up plan for after discharge, how much burden is this going to place on the patient's spouse or other family who are going to be the caregivers for this patient? If there's other family besides the spouse who could provide support, we should try to bring them in. Are there any things that could interfere with the patient's recovery? Does the spouse seem particularly depressed, even while they're in the hospital? We know that's obviously going to impact their ability to help the patient.

Q: Does a spouse's depression cause issues before discharge?

A: Another reason to consider that a patient's spouse may be depressed is things like surrogate decision making in the intensive care unit. Depression can certainly impact the ability to make medical decisions. Often [sepsis patients] are not able to make decisions for themselves. If they have a spouse, that's the one who ends up being asked to make these decisions. There's literature showing that depression or anxiety among family members can impact their ability to make decisions as well as their desire to even want to make these decisions.

Q: How can a physician raise the issue of depression with a patient's spouse?

A: Obviously, it's difficult because the spouse is not the physician's patient. How do you talk to the spouse? What I would compare it to is if I am working with a patient with a mental illness who has a family member who is very involved in their care. I tend to reflexively provide information about resources and support groups and other things like that.

Q: What future research are you planning on this subject?

A: We're interested in understanding to what extent a depressed spouse impacts a patient's recovery following something like sepsis. How can we design [an intervention] that can improve a patient's outcome that incorporates some way to help the burden that's on their spouses?

We have to recognize [a sepsis patient's] recovery isn't going to happen in a vacuum. It's going to be influenced by the amount of support their spouse and other family can provide. We can do a lot to help the patient, but if we're not considering the spouse and family, it could negate a lot of what we're trying to do to help the patient directly.

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