Physical and Mental Health in Patients and Spouses After Intensive Care of Severe Sepsis: A Dyadic Perspective on Long-Term Sequelae Testing the Actor-Partner Interdependence Model

Objective: To examine the physical and mental long-term consequences of intensive care treatment for severe sepsis in patients and their spouses under consideration of a dyadic perspective using the Actor Partner Interdependence Model. Design: Prospective study. Setting: Patients and spouses who had requested advice from the German Sepsis Aid's National Helpline were invited to participate. Subjects: We included 55 patients who survived severe sepsis and their spouses an average of 55 months after ICU discharge. Measurements and Main Results: The Hospital Anxiety and Depression Scale, the Short Form-12 Health Survey, the Posttraumatic Stress Scale-10, and the Giessen Subjective Complaints List-24 were used. The Actor Partner Interdependence Model was tested using multilevel modeling with the actor effect representing the impact of a person's posttraumatic stress symptoms on his or her own mental health-related quality of life and the partner effect characterized by the impact of a person's posttraumatic stress symptoms on his or her partner's mental health-related quality of life. A significant proportion of patients and spouses (26%-42%) showed clinically relevant scores of anxiety and depression; approximately two thirds of both, patients and spouses, reported posttraumatic stress symptoms defined as clinically relevant. Compared with normative samples, patients reported greater anxiety, poorer mental and physical health-related quality of life, and greater exhaustion; spouses had an impaired mental health-related quality of life and increased anxiety. Testing the Actor Partner Interdependence Model revealed that posttraunnatic stress symptoms were related to patients' (beta = -0.71, 95% confidence interval -0.88 to -0.54) and spouses' (beta = -0.62, 95% confidence interval -0.79 to -0.46) own mental health-related quality of life. Posttraumatic stress symptoms further influenced the mental health-related quality of life of the respective other (beta = -0.18, 95% confidence interval -0.35 to -0.003 for patients; beta = -0.15, 95% confidence interval -0.32 to 0.02 for spouses). Conclusions: Interventions to treat posttraumatic stress symptoms after critical illness to improve mental health-related quality of life should not only include patients, but also consider spouses. (Crit Care Med 2013; 41:69-75)