Relationship between decision regret, anxiety, and depression in surrogate decision-makers for neurocritical patients with prolonged disorders of consciousness: a cross-lagged analysis.

backgroundDecision regret is common among surrogate decision-makers for neurocritical patients with prolonged disorders of consciousness (pDoC). This regret, which stems from uncertain patient preferences and complex critical care decisions, predisposes surrogates to adverse psychological outcomes, including anxiety and depression. However, as most evidence on this association comes from cross-sectional studies, the directional relationships and underlying mechanisms between decision regret and psychological distress remain unclear. This prospective longitudinal study employed a cross-lagged panel analysis to delineate the longitudinal trajectory of these symptoms and to explore their bidirectional relationships.

methodsWe conducted a prospective longitudinal study from January to November 2024, recruiting 227 surrogate decision-makers for neurocritical patients with pDoC from two tertiary hospitals in Shanghai, China. We assessed decision regret, anxiety, and depression using the Decision Regret Scale and the Hospital Anxiety and Depression Scale at one (T1), three (T2), and six (T3) months after the patient's diagnosis. Cross-lagged panel models examined the bidirectional relationships between heightened decision regret and symptoms of anxiety and depression.

resultsThe average level of decision regret among surrogate decision-makers initially peaked and subsequently declined over time. In contrast, symptoms of anxiety and depression demonstrated a gradual decrease. The incidence rates of heightened decision regret at T1, T2, and T3 were 23.18% (n = 54), 34.33% (n = 80), and 18.03% (n = 42), respectively. Cross-lagged analyses revealed a bidirectional relationship between heightened decision regret and anxiety from T1 to T2 (β = 0.327, p < 0.05; β = 0.113, p < 0.001). From T2 to T3, however, only anxiety predicted subsequent heightened decision regret (β = 0.052, p < 0.05). A bidirectional relationship was also observed between heightened decision regret and depression from T1 to T2 (β = 0.321, p < 0.05; β = 0.094, p < 0.05).

conclusionsThis study found a reciprocal relationship and time‑dynamic relationship between heightened decision regret and symptoms of anxiety and depression of in surrogate decision-makers for neurocritical patients with pDoC. Specifically, from T1 to T2, heightened decision regret had bidirectional relationships with anxiety and with depression, respectively; from T2 to T3, only anxiety predicted subsequent heightened decision regret. Therefore, clinical staff should dynamically assess the psychological status of surrogate decision-makers in a stage-specific manner and implement differentiated intervention strategies accordingly. TRIAL REGISTRATION NUMBER: Not applicable.