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

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. 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. 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. 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.