Sobrecarga, estresse e depressão em cuidadores informais de pacientes com cirrose hepática: pré e pós-transplante de fígado

Abstract

Informal caregivers of patients with chronic illness have an increased vulnerability to the development of burden, stress and depression. Aims: To assess the level of burden, stress and depression in informal caregivers of patients with liver cirrhosis before and after liver transplant. Casuistry and Method: Analytical observational cross-sectional study. Informal caregivers of liver cirrhosis patients, transplanted or not, were evaluated during treatment at a referral hospital in São Paulo northwest. Caregivers were assessed using the following questionnaires and inventories: The Patient Identification Form (Adult); the Interview guide for informal caregivers of patients with chronic liver disease; the Brazilian Version of the Caregiver Burden Scale (CBS); the Lipp Inventory of Stress Symptoms for Adults (LISS); and the Beck Depression Inventory - Second Edition (BDI-II). Exploratory data analysis was performed, comparison of numerical variables between groups by the Mann-Whitney test, comparison of ordinal variables by the Wilcoxon Rank-Sum Test, and nominal categorical variables were compared using Pearson's chi-squared Test or Fisher's Exact Test. All tests were two-tailed and P values <0.05 were considered significant. Results: 142 informal caregivers of patients with liver cirrhosis were included in the study, 77 caregivers in the pre-transplant group (Group C1) and 65 caregivers in the post-liver transplant group (Group C2). There was a predominance of females in groups C1 and C2, 66 (85.7%) and 55 (84.6%) caregivers, respectively. Regarding the age group, there was a predominance of caregivers living between the fourth and sixth decade of life. Caregivers were largely the patient's spouses, 59 (76.6%) caregivers in group C1 and 41 (63.1%) in group C2. In both groups, significant levels of burden, stress and depression were found in the caregivers. In the comparative analysis between the groups, lower scores of burden and depression were found in group C2, significantly. In the burden analysis, 35 (45.5%) and 38 (49.4%) caregivers in group C1, as well as 40 (61.5%) and 14 (21.5%) caregivers in group C2 (p = 0.001), presented a need to seek some form of help and presented risk of burden, respectively. In both groups, the following proportion of caregivers with stress was observed: 28 (36.4%) and 22 (33.8%) caregivers in groups C1 and C2, respectively (p = 0.754). As for the symptoms of depression, there were minimal, mild, moderate and severe symptoms, respectively, 50 (64.9%), 11 (14.3%), 9 (11.7%) and 7 (9.1%) caregivers group C1, as well as 55 (84.6%), 6 (9.2%), 1 (1.5%) and 3 (4.6%) caregivers in group C2 (p = 0.005). Conclusions: The present study showed an important proportion of caregivers with burden, stress and depression, both in the pre-transplant period and in the post-liver transplant period. However, the levels of burden and depression were significantly lower in the post-liver transplantation period, significantly, which points to the extended benefit of this procedure also for the patients' relatives, and consequently, for society.