Quantitative–Qualitative Discordance in Measuring Distress Among Intensive Care Unit Family Caregivers: A Mixed-Methods Study

Background: The Impact of Events Scale-Revised (IES-R) is widely used in outcomes research involving family caregivers in the intensive care unit (ICU), but whether IES-R scores align with caregivers' perceptions of their own distress is not known. Methods: We performed a secondary mixed-methods analysis, comparing 6-month IES-R scores and self-described wellness or distress outcomes in a semi-structured interview to categorize caregivers as experiencing quantitative-qualitative concordance or discordance and describing caregivers' specific symptoms. Results: The frequency of quantitative-qualitative discordance was 4/18 (22%), and all cases involved a low IES-R score (suggesting quantitative wellness) and qualitative distress. These caregivers described physical and financial stress rather than psychological symptoms. Conclusion: One in four ICU family caregivers identified qualitative distress that was not captured by the IES-R. While the IES-R performed well in identifying caregivers with intense psychological symptoms, additional outcome measures are needed to identify caregivers experiencing physical or financial distress.