Sleep problems in elderly women caregivers depend on the level of depressive symptoms: results of the Caregiver--Study of Osteoporotic Fractures

OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women.
DESIGN: Cross-sectional study conducted in four communities in 1999 to 2001.
SETTING: Home-based interviewer-administered questionnaires.
PARTICIPANTS: Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures.
MEASUREMENTS: Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item.
RESULTS: In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES-D≥16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems (adjusted odds ratios ranging from 2.5, 95% confidence interval (CI)=1.2–5.2 for trouble falling asleep to 4.0, 95% CI=2.0–7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations (e.g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems.
CONCLUSION: Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems.     

Prevalence and outcomes of caregiving after prolonged (> or =48 hours) mechanical ventilation in the ICU

OBJECTIVES: (1) To estimate caregiver support required by patients 2 months after prolonged (at least 48 h) mechanical ventilation (MV) in an ICU; (2) to describe caregiver burden, caregiver depressive symptomatology, and caregiver limitations in activities; and (3) to investigate factors related to depressive symptoms at 2 months in caregivers. DESIGN: Prospective cohort study. STUDY PARTICIPANTS: Caregivers of 115 patients who received prolonged MV in an ICU. MEASUREMENTS: Sociodemographics, employment status, hours spent providing care, help from paid caregiving sources, caregiver burden, and caregiver depressive symptoms. RESULTS: The proportion of patients who survived at least 2 months and required caregiver support was 74.8%. The average age of caregivers was 52.9 years (SD, 14.2), 76.5% were women, and more than half were spouses (52.2%). Only 33 of the caregivers (28.7%) were working, and 30.3% had to reduce their time spent at work to provide care to the patient. The prevalence of risk of clinical depression (defined as Center for Epidemiological Studies depression scale [CES-D] score > or =16) among caregivers was 33.9%. The mean caregiver CES-D score was 13.2 (SD, 11; median, 10). Multiple linear regression analysis showed that higher CES-D score was associated with more hours per day helping with patients' activities of daily living and instrumental activities of daily living (p = 0.003). CONCLUSIONS: Two months after being placed on MV for at least 48 h, a high proportion of patients need caregiver support. Approximately 34% of caregivers are at risk of clinical depression. Many caregivers report lifestyle changes and burden when providing care for the patients.     

Can Counseling and Support Reduce Burden and Depressive Symptoms in Caregivers of People with Alzheimer's Disease During the Transition to Institutionalization? Results from the New York University Caregiver Intervention Study

OBJECTIVES: To determine whether counseling and support reduce the burden and depressive symptoms of spouse caregivers of patients with Alzheimer's disease (AD) during the transition to institutionalization.
DESIGN: A randomized, controlled trial of an enhanced counseling and support program for spouse caregivers of persons with AD. Structured interviews were conducted with spouse caregivers at baseline, every 4 months during Year 1, and every 6 months thereafter for up to 16 years.
SETTING: Outpatient research clinic in the New York City metropolitan area.
PARTICIPANTS: Referred volunteer sample of 406 spouse caregivers of community-dwelling patients with AD enrolled over a 9.5-year period.
INTERVENTION: Enhanced counseling and support consisting of six sessions of individual and family counseling, support group participation, and continuous availability of ad hoc telephone counseling.
MEASUREMENTS: Outcome measures included burden (modified Zarit Burden Interview) and depressive symptoms (Geriatric Depression Scale).
RESULTS: Burden and depressive symptoms were significantly lower for caregivers in the treatment group than for controls receiving usual care at the time of and after institutionalization. Nursing home admission itself significantly reduced burden and depressive symptoms in the intervention and control groups.
CONCLUSION: Institutionalization alone can reduce caregiver burden and depressive symptoms, but enhanced counseling provides additional long-term benefits. The results offer some of the first clinical evidence of the benefits of enhanced counseling during the transition to institutionalization for caregivers of people with AD.     

The relationship between mastery and depression among Japanese family caregivers

The present study examined the relationship between caregiver mastery and depressive symptoms among family stroke caregivers in western Japan (N = 100). Family caregivers were identified from a sample of rehabilitation hospitals; participation rate was 100 percent for all eligible caregivers. Caregivers with high mastery were found to have significantly fewer depressive symptoms than low mastery caregivers and were significantly more likely to use a respite caregiver. They also reported significantly less burden, yet paradoxically were significantly more likely to rate their care-recipients as more functionally dependent on them. Caregiver age, health status, and caregiving duration did not relate to mastery. However, men had a significantly higher sense of mastery. In general, findings parallel those for Western family caregivers, although mean mastery scores for Japanese caregivers were lower than those reported for American family caregivers.     

From caregiving to bereavement: trajectories of depressive symptoms among wife and daughter caregivers

This study examined the trajectory of depressive symptoms for wife and daughter caregivers during the transition from caregiving to bereavement, and it investigated whether the trajectory varies by caregivers' caregiving stress, social support, and background characteristics. Hierarchical linear modeling was used to analyze four-wave longitudinal data collected from 157 wife and daughter caregivers who lost elderly relatives to death. Results show that, on average, caregivers experience increasing depressive symptoms as their care recipients approach death, and they experience decreasing symptoms after. Care recipients' problematic behavior and caregivers' kinship, income, and feelings of overload moderate the change in depressive symptoms during the transition. Services to support caregivers should target specific groups of caregivers, based on caregiving experience and background characteristics, at times when they are most in need.     

Cultural Equivalence in Depressive Symptoms in Older White, Black, and Mexican-American Adults

OBJECTIVES: To examine cultural equivalence in responses to depressive symptom items of three racial or ethnic elderly groups.
DESIGN: Cross-sectional analyses of two national data sets.
SETTING: The New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the five-state Hispanic EPESE (H-EPESE).
PARTICIPANTS: Whites (n=1,876) and blacks (n=464) were drawn from the New Haven EPESE and Mexican Americans (n=2,623) were drawn from the H-EPESE.
MEASUREMENT: The original 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D).
RESULTS: From differential item functioning analyses, a lack of measurement equivalence was found for 16 depressive symptom items. Mexican Americans were predisposed to endorse 12 depressive symptoms. Blacks were more likely than whites to endorse two interpersonal items (unfriendly and disliked). Mexican Americans were more likely than whites to respond to four positive affect items (good, hopeful, happy, and enjoyed) and more likely than blacks to endorse three positive items (good, happy, and enjoyed).
CONCLUSION: Results suggested response bias to depressive symptom items in racially and ethnically diverse older adults. Mexican Americans were more likely than whites to endorse the large number of depressive symptom items. Blacks were much more likely to respond in patterns similar to those of the whites. Findings from this study provide a foundation for developing culturally appropriate depression measures in health disparities research.     

Depressive symptoms in the frail elderly: physical and psycho-social correlates

The elderly who suffer from chronic illness are at unusually high risk of depression and depressive symptoms. This study was conducted to describe the prevalence of depressive symptoms in a sample of chronically-ill elders and to examine the relationship between physical illness and depression, both as it is illuminated in a regression model and as it is understood by the respondents themselves. Interviews were conducted with a random sample of 100 clients in a community-based care program for low-income elderly at risk of nursing home placement. Over one-third of the sample (36%) reported significant depressive symptoms, as measured by the CES-D. Multiple regression analysis identified functional limitations, cognitive impairment and self-perception as significant correlates of depression in a model that explained 30 percent of the variance in CES-D scores.     

Positive Affect and Incidence of Frailty in Elderly Women Caregivers and Noncaregivers: Results of Caregiver–Study of Osteoporotic Fractures

OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stress-buffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers.
DESIGN: Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004.
SETTING: Home-based interviews.
PARTICIPANTS: Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview.
MEASUREMENTS: High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview.
RESULTS: Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, P <.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35–0.70), caregivers (adjusted HR=0.44, 95% CI=0.24–0.80) and noncaregivers (adjusted HR=0.50, 95% CI=0.32–0.77).
CONCLUSION: These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers.     

Depression among caregivers of impaired elders

Studies have reported that rates of depression among caregivers are higher than in the general population. However, these studies have been limited primarily to caregivers of cognitively impaired elders. Using the Center for Epidemiological Studies Depression (CES-D) Scale, this study investigated depression among caregivers for physically impaired elders. The authors found that one third of these caregivers reported depressive symptoms, a lower rate than for caregivers of cognitively impaired elders but still twice the rate for the general population. The data show that depressive symptoms are related primarily to health status but also to aspects of the caregiving situation, including both the negative impact of that care as well as the relationship of the caregiver to the frail elder. Depressive symptoms are not mediated by formal or informal support.     

Association between family caregivers and depressive symptoms among community-dwelling older adults in Japan: A cross-sectional study during the COVID-19 pandemic

ObjectivesNovel coronavirus disease (COVID-19) pandemic could increase the mental health burden of family caregivers of older adults, but related reports are limited. We examined the association between family caregiving and changes in the depressive symptom status during the pandemic.MethodsThis cross-sectional study included 957 (mean age [standard deviation] = 80.8 [4.8] years; 53.5% females) community-dwelling older adults aged ≥ 65 years from a semi-urban area of Japan, who completed a mailed questionnaire. Based on the depressive symptom status assessed with the Two-Question Screen between March and October 2020, participants were classified into four groups: “non-depressive symptoms,” “incidence of depressive symptoms,” “remission from depressive symptoms,” or “persistence of depressive symptoms.” Participants were assessed in October 2020 for the family caregiving status, caregiving role, the severity of care recipients’ needs, and increased caregiver burden during the pandemic, each with the simple question. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs) for changes in depressive symptom status.ResultsCompared to non-caregivers, family caregivers were associated with the incidence (OR [95% CI] = 3.17 [1.55–6.51], p < 0.01) and persistence of depressive symptoms (OR [95% CI] = 2.39 [1.30–4.38], p < 0.01). Primary caregivers, caregivers for individuals with severe care needs, and caregivers with increased burden during the pandemic had a high risk of depressive symptoms.ConclusionsFamily caregivers had a high risk of depressive symptoms during the pandemic. Our findings highlight the need for a support system for family caregivers.     

Association of changes in self-reported vision and hearing impairments with depressive symptoms in middle-aged and older adults: Evidence from a nationwide longitudinal study in China

ObjectiveThis study assessed the longitudinal relationship between changes in self-reported vision impairment (VI) and hearing impairment (HI), and depressive symptoms in adults aged ≥45 years.MethodsData from the China Health and Retirement Longitudinal Study for 2015 and 2018 were used, with a sample size of 10,050. VI and HI were self-reported. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D10) was used to assess depressive symptoms. Total scores and clinically significant depressive symptoms (CES-D10 scores ≥ 10) were used as outcomes and analyzed using generalized estimating equations with identity link and logit link functions.ResultsOf all changes in HI with good vision, only persistent HI was associated with higher CES-D10 scores (OR 95% CI: 1.09–3.30). Both new-onset and persistent VI with good hearing were associated with CES-D10 scores (OR 95% CI, new-onset: 1.70–3.52; persistent: 1.58–2.78) and clinically significant depressive symptoms (OR 95% CI, new-onset: 1.41–2.56; persistent: 1.36–2.27). Persistent dual sensory impairment (DSI) was associated with the highest CES-D10 scores (OR 95% CI: 3.63–5.97) and the highest risk of clinically significant depressive symptoms (OR 95% CI: 1.78–2.85). Those who self-reported improvements in vision and hearing still had higher CES-D10 scores (OR 95% CI: 1.35–2.83) and a higher risk of clinically significant depressive symptoms (OR 95% CI: 1.03–2.02) than those maintaining good vision and hearing.ConclusionSelf-reported VI and DSI are closely associated with depressive symptoms. Because VI and DSI are modifiable, interventions for them could also prevent depressive symptoms.     

Influence of diabetes mellitus on caregiver burden in home care: A report based on the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE)

Background:   Because little attention has so far been paid to the impact of diabetes mellitus (DM) on caregiver burden in community settings, we sought to confirm the influence of DM on perceived caregiver burden among caregivers providing care to a home elderly person using data from the Nagoya Longitudinal Study of the Frail Elderly (NLS-FE).
Methods:   The NLS-FE is a large prospective study of 1875 community-dwelling elderly. A total of 1592 pairs of dependents and caregivers were included in the analysis. The data we used in this study included the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI), characteristics of caregivers and dependents, and caregiving situation. The pairs were sorted into one control and three DM groups: (i) no DM; (ii) DM taking no medications; (iii) DM taking oral medication only; and (iv) DM taking insulin. The differences in dependent and caregiver characteristics among the groups were assessed.
Results:   Two hundred and twenty-eight dependents from the NLS-FE study had DM. Of these, 25% took no medication to treat it, 55% took oral medications only, and 20% used insulin. No statistical differences were found in age, gender or kinship among caregivers. No differences were found among the DM categories in levels of caregiver burden according to the J-ZBI, before and after adjusting for these baseline variables.
Conclusions:   Among the community-dwelling frail elderly, DM is not an independent predictor of caregiver burden.     

Dementia caregivers' burdens and use of public services

Background:   The objectives of the present study are to examine risk factors for the heavy burden of caring for demented patients as well as factors that may affect on the level of utilization by carers of public services under current long-term care insurance in Japan.
Methods:   A cross-sectional study was conducted in the outpatient clinic for dementia, Department of Geriatric and Complementary Medicine, Tohoku University Hospital, Japan.
Results:   Behavioral and psychological symptoms of dementia were significantly associated with heavy caregiver's burden as measured by Zarit's caregiver burden interview ( P  = 0.002 r = 0.45). A heavy caregiver's burden led to depressive symptoms ( P  = 0.01 r = 0.30), especially in spouse caregivers. Despite the presence of depressive symptoms, spouse caregivers less frequently used public services than non-spouse caregivers ( P  < 0.001). On the other hand, the level of service provision was decided primarily by the severity of dementia and physical disability of patients, but not the caregiver's burden.
Conclusion:   Early detection and management of dementia-associated behavioral and psychiatric symptoms could be important to reduce caregivers' burdens and to prevent them from developing depression. Spouse caregivers should be encouraged not to hesitate to use public services.     

Caregiver burden and depressive symptoms: analysis of common outcomes in caregivers of elderly patients

Despite widespread use of caregiver burden and depressive symptoms in caregiving research, the relationship between these two concepts and the way in which burden and depressive symptoms are affected are not clear. METHODS: The authors used structural equation modeling with an inception cohort of 488 family caregivers to examine the relationship between care recipients' mental and functional status and recency of care demands and caregivers' burden and depressive symptoms. RESULTS: Care recipients' mental and functional status and recency of care demands predicted caregiver burden; burden, in turn, was nearly significant in predicting depressive symptoms. Care recipients' mental status and recency of care demands had a near significant indirect effect on caregiver depressive symptoms. There were no significant direct paths between care recipients' mental status, functional status, recency of care demands, and caregivers' depressive symptoms. DISCUSSION: Health care practitioners should assist caregivers with new care demands stemming from care recipients' mental and functional status to decrease burdens and should monitor caregivers with higher levels of burden for the development of depressive symptoms.     

Treatment of Late-Life Depression Alleviates Caregiver Burden

OBJECTIVES: To describe the burden experienced by family caregivers of older adults with depression and to examine the positive effects on caregivers of treating late-life depression.
DESIGN: Two-phase treatment study for major depressive disorder (MDD) that included 6 weeks of open treatment with antidepressant medication for all older patients followed by 16 weeks of randomized treatment for patients who were partial responders, comparing a combination of medication and interpersonal psychotherapy with medication alone.
SETTING: Primary care and university late-life mental health research clinic.
PARTICIPANTS: Adults aged 60 and older participating in a randomized trial for treatment of MDD who enrolled in a family caregiver study and their caregiver (N=244 dyads).
MEASUREMENTS: Improvement in patient symptoms during open treatment (lower scores on the Hamilton Rating Scale for Depression (HRSD)) and remission of depression during randomized treatment (3 consecutive weekly HRSD scores of ≤7) were examined as predictors of lower general caregiver burden and burden specific to patient depression.
RESULTS: Caregivers reported a moderate to high level of general caregiver burden on average. Change in patient depression during open treatment was associated with significantly decreased depression-specific burden (β=−0.22, P =.001) and a trend toward lower general burden (β=−0.08, P =.08). Caregivers of patients who remitted showed significantly decreased depression-specific burden ( F (1,76)=4.27, P =.04).
CONCLUSION: Treatment of late-life depression has benefits that extend to the family members on whom patients depend. Caregiver education and support may strengthen these effects.     

Project CARE: a randomized controlled trial of a behavioral intervention group for Alzheimer's disease caregivers

PURPOSE: The neuropsychiatric symptoms associated with Alzheimer's disease are a major contributor to caregiver distress and burden. Despite recent efforts to teach caregivers skills to manage neuropsychiatric symptoms and reduce burden, there continues to be limited evidence that these strategies have helped caregivers of individuals with Alzheimer's disease to effectively manage neuropsychiatric symptoms. We report here on Project CARE, a randomized controlled trial designed to test the effectiveness of a caregiver-based multicomponent behavioral intervention aimed to reduce caregiver distress related to neuropsychiatric symptoms, as well as general caregiver burden, and to decrease neuropsychiatric symptom severity among individuals with Alzheimer's disease. DESIGN AND METHODS: The behavioral intervention involved five weekly sessions designed to teach caregivers specific techniques for managing patient neuropsychiatric symptoms in the home environment. Through the use of a randomized control trial, 80 caregivers were assigned to either the behavioral intervention group or a psychoeducational control group and were assessed both before and after the intervention. RESULTS: Compared with caregivers in the control group, caregivers in the behavioral intervention group displayed significantly greater reductions in caregiver distress related to neuropsychiatric symptoms (p=.005). Global caregiver burden, however, did not decrease significantly for caregivers in either group (p>.05). Although it was not statistically significant, there was a trend toward greater reductions in care recipients' neuropsychiatric symptom severity in the intervention group (p=.10). IMPLICATIONS: The current findings suggest that targeted, group-based behavioral interventions are effective for reducing distress related to neuropsychiatric symptoms among caregivers of individuals with Alzheimer's disease and for reducing care recipients' neuropsychiatric symptoms.     

High rates of depressive symptoms among patients with systemic sclerosis are not explained by differential reporting of somatic symptoms

OBJECTIVE: Between 36% and 65% of patients with systemic sclerosis (SSc) report symptoms of depression above cutoff thresholds on self-report questionnaires. The objective of this study was to assess whether these high rates result from differential reporting of somatic symptoms related to the high physical burden of SSc. METHODS: Symptom profiles reported on the Center for Epidemiologic Studies Depression Scale (CES-D) were compared between a multicenter sample of 403 patients with SSc and a sample of respondents to an Internet depression survey, matched on total CES-D score, age, race/ethnicity, and sex. An exact nonparametric generalized Mantel-Haenszel procedure was used to identify differential item functioning between groups. RESULTS: Patients with SSc reported significantly higher frequencies (moderate to large effect size; P < 0.01) on 4 CES-D somatic symptom items: bothered, appetite, effort, and sleep. Internet respondents had higher item scores on 2 items that assessed interpersonal difficulties (unfriendly, large effect size; P < 0.01; disliked, large effect size; P < 0.01) and on 2 items that assessed lack of positive effect (happy, moderate effect size; P = 0.01; enjoy, large effect size; P < 0.01). Adjustment of standard CES-D cutoff criteria for potential bias due to somatic symptom reporting resulted in a reduction of only 3.6% in the number of SSc patients with significant symptoms of depression. CONCLUSION: High rates of depressive symptoms in SSc are not due to bias related to the report of somatic symptoms. The pattern of differential item functioning between the SSc and Internet groups, however, suggests some qualitative differences in depressive symptom presentation.     

A longitudinal study of the relationship between levels of depression among persons with Alzheimer's disease and levels of depression among their family caregivers

The purpose of this study was to examine the effects, over time, of depressive symptoms in persons with Alzheimer's disease on depression in their family caregivers. In a sample of 353 patients and caregivers, multilevel longitudinal analysis was used to accommodate an observational design in which the number of observation points and the intervals between points varied across caregivers. The rate of change (increase) in caregiver depression was predicted by the rate of change (increase) in patient depressive symptoms and by increase in patient dependency in instrumental activities of daily living (ADLs). Acceleration of the increase in caregiver depression was predicted by acceleration in patient dependency in instrumental and basic ADLs but not by acceleration in patient depressive symptoms. These findings indicate the importance of measuring the rate and acceleration of change in patient characteristics in order to understand caregiver depression. They also support early interventions for caregivers.     

Clinical importance of HIV and depressive symptoms among veterans with HIV infection

OBJECTIVE: To compare the clinical importance (association with illness severity and survival) of depressive and HIV symptoms among veterans with HIV infection. DESIGN: Cross-sectional study; survival analysis. SETTING: Infectious Disease Clinics at 3 VA Medical Centers. PARTICIPANTS: HIV-infected patients (N = 881) and their health care providers from June 1999 through July 2000. MEASUREMENTS AND MAIN RESULTS: Depressive symptoms were assessed using the 10-item Centers for Epidemiologic Studies Depression Scale (CES-D). Patient baseline survey included an HIV Symptom Index measuring the frequency and bother of 20 common symptoms. Providers were surveyed on patients' illness severity, and survival data were obtained from VA death records. Of 881 patients, 46% had significant depressive symptoms (CES-D >/=10). Increasing depression symptom severity was associated with increasing HIV symptom frequency (P <.001) and bother (P <.001). Multiple regression results revealed that having moderate or severe depressive symptoms was not associated with provider-reported illness severity or survival. However, HIV symptoms were significantly associated with provider-reported illness severity (P <.01) and survival (P =.05), after adjusting for moderate and severe depressive symptoms, CD4 cell count/mm3, viral load, age, race, and antiretroviral use. CONCLUSIONS: Depression, while common in this sample, was not associated with illness severity or mortality after adjusting for HIV symptoms. HIV symptoms are associated with severity of illness and survival regardless of patients' severity of depressive symptoms. This suggests that equal medical consideration should be given to HIV symptoms presented by HIV-infected patients regardless of their depression status, rather than automatically attributing medical complaints to depression.