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A total of 289 ICs of patients with lung cancer were included in the final analysis, of whom 67 reported insomnia (Figure 1). Their ages ranged from 20 to 85 years, and female ICs outnumbered male ICs (58.8% vs. 41.2%, respectively). Of the ICs, 91.0% were married and 46.7% had an undergraduate degree or above. Most ICs were children or spouses, with proportions of 40.8% and 48.8%, respectively. Regarding employment status, 39.8% were full-time workers and 37.4% were retired. The percentages of ICs who smoked or consumed alcohol were 30.4% and 27.7%, respectively (Table 1).
Variables Both
(n = 289)Male
(n = 119)Female
(n = 170)T / χ2 / Z P value Insomnia
(n = 67)Non-insomnia
(n = 222)T / χ2 / Z P value Age, years, x ± s 49.44 ± 12.52 47.16 ± 12.31 51.04 ± 12.46 2.615 0.009 52.96 ± 12.66 48.38 ± 12.31 −2.649 0.009 BADLs (P25, P75) 0 (0, 2.5) 0 (0, 3) 0.5 (0, 2.25) −2.133 0.033 1 (0, 4) 0 (0, 2) −3.029 0.003 IADLs (P25, P75) 2 (0, 7) 2 (0, 8) 3 (0,7) −0.634 0.526 4 (0, 10) 2 (0, 6) −2.552 0.012 Years diagnosed with Cancer
(P25, P75)2 (2, 2) 2 (1, 2) 2 (2,2.25) −1.694 0.09 2 (2, 3) 2 (2 ,2) −1.065 0.288 ICs characteristics Education, n 6.221 0.013 1.070 0.301 University and above 135 69 66 35 100 High school and below 154 101 53 32 122 Marriage, n 2.396 0.122 0.976 0.323 Married 263 112 151 63 22 Other 26 7 19 4 200 Smoking, n 112.095 0.000 0.180 0.671 Yes 88 77 11 19 69 No 201 42 159 48 153 Alcohol consumption, n 73.343 0.000 0.205 0.651 Yes 80 65 15 20 60 No 209 54 155 47 162 Underlying condition, n 4.951 0.027 37.207 < 0.001 Yes 100 50 50 44 56 No 189 69 120 23 166 Acute events, n 1.664 0.197 2.987 0.084 Yes 38 12 26 13 54 No 251 107 144 54 197 Monthly income, n 24.238 0.000 11.917 0.018 < 3,000 64 17 47 15 49 3,000− 100 37 63 33 67 6,000− 43 20 23 9 34 10,000− 64 29 35 7 57 ≥ 20,000 18 16 2 3 15 Monthly cost, n 7.221 0.125 2.066 0.724 < 3,000 62 25 37 15 47 3,000− 101 43 58 25 76 6,000− 65 19 46 13 52 10,000− 39 21 18 7 32 ≥ 20,000 22 11 11 7 15 Note. x ± s, mean ± standard error; M (P25, P75), Median (interquartile range); ADLS, Activities of Daily Living Scale; BADLS, Basic Activities of Daily Living Scale; IADLS, Instrumental Activities of Daily Living Scale. Table 1. Basic characteristics of lung cancer patients’ ICs
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Most IC households (29.8%) spent > RMB 100,000 on medical expenses over the past year. This group was followed by the RMB 10,000–RMB 50,000 group (59, 20.4%) and the RMB 50,000–RMB 100,000 group (58, 20.1%). Regarding the duration of caregiving, the majority of ICs spent < 6 months on caregiving (176, 60.9%), while 197 (68.2%) spent six months to one year caregiving. A total of 133 (46.0%) ICs spent more than eight hours per day caring for patients. Additionally, 100 ICs (34.6%) had at least one underlying medical condition, 38 (13.1%) experienced acute events during caregiving, 64 (22.1%) had a monthly income of < RMB 3,000, and the monthly expenses of 22 (7.6%) exceeded RMB 20,000.
In the Caregiver Reaction Assessment (CRA) scale for lung cancer, the scores for the subscales self-esteem (SE), lack of family support (FS), financial problems (FP), disturbed schedule (DS), and health problems (HP) were 30.21 ± 3.70, 11.20 ± 3.93, 8.51 ± 3.41, 18.15 ± 3.85, and 9.75 ± 3.80, respectively. The subscales of the Hospital Anxiety and Depression Scale (HADS) scores were 7.26 ± 4.69 and 6.84 ± 4.88, respectively. Among the 289 ICs of patients with lung cancer, 159 had no symptoms of anxiety, 69 had suspected symptoms, and 61 had definite symptoms, 163 had no symptoms of depression, 59 had suspected symptoms, and 67 had definite symptoms. Based on the overall HADS score, 53 (18.34%) ICs had suspected symptoms of depression and anxiety, and 32 (11.07%) had definite symptoms of depression and anxiety. The ISI score was 8.96 ± 6.71; according to the score classification, 139 ICs had no insomnia, 83 had mild insomnia, 53 had moderate insomnia, and 14 had severe insomnia (Table 2).
Basic characteristics Both
(n = 289)Male
(n = 119)Female
(n = 170)T / χ2 P value Insomnia
(n = 150)Non-insomnia
(n = 139)T / χ2 P value CRA, x ± s SE 30.21 ± 3.70 30.36 ± 3.65 30.11 ± 3.75 −0.563 0.574 30.09 ± 3.34 30.35 ± 4.07 0.573 0.567 FS 11.20 ± 3.93 10.77 ± 3.75 11.51 ± 4.04 1.581 0.115 11.51 ± 3.91 10.87 ± 3.94 −1.376 0.170 FP 8.51 ± 3.41 8.27 ± 3.54 8.68 ± 3.31 1.001 0.318 9.45 ± 3.33 7.50 ± 3.20 −5.068 < 0.001 DS 18.15 ± 3.85 17.90 ± 3.76 18.32 ± 3.91 0.922 0.357 19.41 ± 3.28 16.79 ± 3.96 −6.083 < 0.001 HP 9.75 ± 3.80 9.02 ± 3.65 10.27 ± 3.82 2.796 0.006 11.36 ± 3.62 8.02 ± 3.17 −8.305 < 0.001 HADS HAS 7.26 ± 4.69 6.58 ± 4.50 7.74 ± 4.77 2.074 0.039 9.31 ± 4.67 5.04 ± 3.58 −8.766 < 0.001 HDS 6.84 ± 4.88 6.04 ± 4.56 7.40 ± 5.04 2.344 0.020 9.25 ± 4.45 4.24 ± 3.90 −10.151 < 0.001 HAS Group, n 6.576 0.037 39.522 < 0.001 No symptoms 159 76 83 59 100 Suspected symptoms 69 24 45 40 29 Positive symptoms 61 19 42 51 10 HDS Group, n 6.390 0.041 50.182 < 0.001 No symptoms 163 77 86 55 108 Suspected symptoms 59 22 37 42 17 Positive symptoms 67 20 47 53 14 ISI, x ± s 8.96 ± 6.71 7.73 ± 6.00 9.81 ± 7.06 2.620 0.009 14.05 ± 5.19 3.45 ± 2.49 −22.861 < 0.001 ISI Group, n 8.664 0.034 289.00 < 0.001 No insomnia 139 64 75 139 0 Mild insomnia 83 31 52 0 83 Moderate insomnia 53 23 30 0 53 Sever insomnia 14 1 13 0 14 Note. x ± s, mean ± standard error; CRA, Caregiver Reaction Assessment; SE, Self-esteem; FS, Family Support; FP, Financial Problems; DS, Disturbed Schedule; HP, Health Problems; HADS, Hospital Anxiety and Depression Scale; HAS, Hospital Anxiety Scale; HDS, Hospital Depression Scale; ISI, Insomnia Severity Index. Table 2. Burden of lung cancer patients’ ICs
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The ISI risk factors for ICs of patients with lung cancer were female gender, alcohol consumption, underlying medical conditions, years of caregiving, and monthly expenses. The ISI score of female ICs was 2.597 times higher than that of male ICs (95% confidence interval [CI]: –4.711 to 0.483, P = 0.016). The ISI score of ICs who consumed alcohol was 2.247 times higher than that of ICs who did not consume alcohol (95% CI: 0.170–4.325, P = 0.034). The ISI score of ICs with underlying medical conditions was 3.579 times higher than that of ICs without such conditions (95% CI: 1.677–5.480, P < 0.001). The ISI score of ICs increased 1.236 times (95% CI: 0.361–2.112, P = 0.006) for each increase in the number of years of caregiving. The ISI score for ICs decreased 0.975 times (95% CI: 0.263–1.687, P = 0.007) for each increase in monthly expenses. The ISI protective factors were the number of years since cancer diagnosis and the ICs’ monthly income. The ISI score of ICs decreased by 0.838 times (95% CI: –1.489 to 0.188, P = 0.012) for each additional year in which the patient had cancer, and decreased by 0.990 times (95% CI: –1.748 to 0.233, P = 0.011) for each increase in their monthly income. Alcohol consumption, underlying medical conditions, and monthly expenses were risk factors for insomnia in the ICs of patients with lung cancer, whereas monthly income was a protective factor (Table 3).
Variables OR LL UL P value Years diagnosed with cancers 1.312 1.004 1.715 0.047 Marriage 4.548 1.490 13.881 0.008 Education 0.651 0.318 1.329 0.008 Patients’ sex 1.048 0.494 2.223 0.903 Sex 2.071 0.908 4.719 0.083 Smoking 0.509 0.211 1.232 0.134 Alcohol consumption 0.513 0.221 1.190 0.120 Underlying condition 0.688 0.323 1.466 0.333 Acute events 1.757 0.712 4.333 0.211 Years of caregiving 0.668 0.460 0.970 0.034 Monthly income 0.862 0.625 1.189 0.366 Monthly cost 0.936 0.702 1.249 0.653 Age 0.988 0.957 1.020 0.452 Patients Age 0.979 0.949 1.020 0.183 Patients ADL score 0.985 0.947 1.020 0.444 Anxiety & depression 0.517 0.216 1.234 0.137 Anxiety or depression 0.136 0.607 0.303 < 0.001 Note. ICs, Informal Caregivers; ADLS, Activities of Daily Living Scale; OR , Odds Ratio; LL, Lower limits, UL, Upper Limits. Table 3. Risk factors of insomnia among lung cancer patients’ ICs
The ICs of patients with lung cancer were classified into four categories according to their ISI scores: no insomnia, mild insomnia, moderate insomnia, and severe insomnia. Ordinal logistic regression was performed; however, because it did not satisfy the test of parallel lines (P < 0.001), nominal logistic regression was used instead. Given the small sample size of the severe insomnia group, it was combined with the moderate insomnia group to form a moderate-to-severe insomnia group. Using the no-insomnia group as the reference, the ISI score of ICs was set as the dependent variable, while the ICs’ marital status, education level, gender, smoking status, alcohol consumption, underlying medical conditions, experience of acute events, years of caregiving, income, and expenses, as well as the patients’ number of years with cancer, gender, age, and ADL score were set as independent variables for analysis. The results of the model likelihood ratio test were χ2 = 152.995, P < 0.001.
Multinomial logistic regression analysis showed that for lung cancer patients with higher ADL scores, the likelihood of ICs’ ISI scores indicating definite symptoms was OR = 0.940 (95% CI: 0.898–0.983, P = 0.007). Compared to female ICs, the likelihood of a male IC’s ISI score indicating mild insomnia was OR = 0.263 (95% CI: 0.095–0.729, P = 0.010), and moderate to severe insomnia was OR = 0.171 (95% CI: 0.046–0.635, P = 0.008). Compared to ICs who did not consume alcohol, the likelihood of the ISI scores of ICs who consumed alcohol indicating moderate-to-severe insomnia was OR = 3.745 (95% CI: 1.086–12.821, P = 0.037). Compared to ICs without underlying medical conditions, the likelihood of ICs with underlying medical conditions showing ISI scores indicating mild insomnia was OR = 11.765 (95% CI: 4.065–34.483, P < 0.001). Compared to ICs with < 6 months of caregiving experience, ICs with 5–10 years of caregiving experience showed a higher risk of moderate-to-severe insomnia based on their ISI scores (OR = 37.037, 95% CI: 2.141–500.000, P = 0.013). Compared to ICs with monthly expenses of < RMB 3,000, ICs with monthly expenses of RMB 6,000–RMB 10,000 were 5.714 times more likely to have moderate-to-severe insomnia, as shown by their ISI scores (95% CI: 1.074–30.303, P = 0.041). Compared to ICs with monthly expenses of < RMB 3,000, ICs with monthly expenses of RMB 10,000–RMB 20,000 were 11.236 times more likely to have moderate-to-severe insomnia, as shown by their ISI scores (95% CI: 1.883–66.667, P = 0.008). Finally, compared to ICs with monthly expenses of < RMB 3000, ICs with monthly expenses of > RMB 20,000 were 0.183 more likely to suffer from mild insomnia, as shown by their ISI scores (95% CI: 0.034–0.989, P = 0.049; Table 4).
Variables Mild insomnia Moderate and severe insomnia OR 95% CI P value OR 95% CI P value LL UL LL UL Patients’ age 0.973 0.940 1.006 0.105 1.014 0.969 1.060 0.549 ICs’ age 1.021 0.982 1.062 0.287 0.987 0.948 1.029 0.549 ADL 0.989 0.943 1.037 0.646 0.940 0.898 0.983 0.007 Years with cancers 1.359 0.890 2.075 0.155 1.131 0.801 1.597 0.484 Marriage 0.523 0.166 1.645 0.267 0.649 0.120 3.521 0.617 Education 0.898 0.382 2.110 0.805 2.857 0.985 8.333 0.053 Patients’ sex 0.648 0.280 1.499 0.311 1.464 0.513 4.167 0.476 ICs sex 0.263 0.095 0.729 0.010 0.171 0.046 0.635 0.008 Smoking 1.757 0.662 4.651 0.258 1.656 0.489 5.587 0.418 Drinking 2.451 0.973 6.173 0.057 3.745 1.086 12.821 0.037 Underlying diseases 0.908 0.374 2.203 0.831 11.765 4.065 34.483 < 0.001 Acute events 1.855 0.622 5.525 0.268 1.055 0.352 3.155 0.924 Years of caregiving, y < 0.5 Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. 0.5− − − − 0.998 22.727 0.920 500.000 0.056 1− − − − 0.998 7.463 0.308 166.667 0.217 3− − − − 0.998 4.405 0.185 100.000 0.359 5− − − − 0.998 37.037 2.141 500.000 0.013 ≥ 10 − − − 0.997 0.912 0.912 0.912 − Monthly income < 3,000 Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. 3,000− 0.469 0.079 2.801 0.407 0.242 0.023 2.532 0.237 6,000− 0.948 0.181 4.975 0.950 0.108 0.012 1.007 0.051 10,000− 0.310 0.058 1.650 0.170 0.187 0.020 1.773 0.144 ≥ 20,000 0.797 0.171 3.704 0.772 2.242 0.269 18.868 0.455 Monthly expenses < 3,000 Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. 3,000− 2.066 0.448 9.524 0.352 4.630 0.903 23.810 0.066 6,000− 0.670 0.160 2.801 0.583 5.714 1.074 30.303 0.041 10,000− 1.205 0.274 5.291 0.805 11.236 1.883 66.667 0.008 ≥ 20,000 0.183 0.034 0.989 0.049 0.853 0.123 5.917 0.872 Note. ICs, Informal Caregivers; ADLS, Activities of Daily Living Scale. Ref, Reference group; −: means sample size in the group was too small to estimate; OR, Odds Ratio; LL, Lower Limits, UL, Upper Limits. Table 4. Multinomial logistic regression of insomnia among ICs of lung cancer patients
Insomnia Burden among Informal Caregivers of Hospitalized Lung Cancer Patients and Its Influencing Factors
doi: 10.3967/bes2023.099
- Received Date: 2023-03-22
- Accepted Date: 2023-07-10
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Key words:
- Informal caregivers /
- Insomnia /
- Risk factors /
- Cross-sectional study /
- Lung cancer
Abstract:
The authors declare no conflict of interest.
&These authors contributed equally to this work.
Citation: | LI Chun Yan, SONG Yu Jian, ZHAO Lan, DENG Mu Hong, LI Rui Xin, ZHANG Xiao Ling, LI Qiong Xuan, SHI Ying, LUAN Heng Yu, SUN Yuan Yuan, HU Yi, SAI Xiao Yong. Insomnia Burden among Informal Caregivers of Hospitalized Lung Cancer Patients and Its Influencing Factors[J]. Biomedical and Environmental Sciences, 2023, 36(8): 715-724. doi: 10.3967/bes2023.099 |