Associations between characteristics of stroke survivors and caregiver depressive symptoms: a critical review

Background: Poststroke depression is common in stroke survivors. Evidence suggests that caregivers of stroke survivors also experience depression, at rates similar to survivors (30–40%). While much research has focused on developing better understanding of poststroke depression in stroke survivors, stroke caregiver depression has received less attention. Available research suggests that characteristics of the survivor such as age, gender, relation to caregiver, mental health, and physical or cognitive deficits correlate with and may be contributing factors for caregiver depression. Knowledge of risk factors for stroke caregiver depression could translate to better screening, management, and prevention, but further investigation is needed.

Objectives: To examine the existing literature and synthesize evidence surrounding survivor characteristics and their association with poststroke depressive symptoms in caregivers.

Methods: Medline, PsychInfo, and CINAHL databases were searched with variations of keywords: “stroke,” “caregiver” and “depression.” Studies analyzing associations between at least one stroke survivor characteristic and caregiver depressive symptoms were included.

Results: Seventeen studies met eligibility criteria. They analyzed a wide range of survivor characteristics. Many survivor characteristics lacked convincing evidence of an association with caregiver depressive symptoms. However, a trend emerged supporting an association between survivor depressive symptoms and caregiver depressive symptoms.

Conclusions: Health-care providers should be aware that depressive symptoms in one member of a stroke survivor-caregiver dyad may indicate risk for depressive symptoms in the other. Screening both individuals may lead to earlier detection and provide information to guide interventions. Knowing risk factors for stroke caregiver depression may improve prevention/management, but further investigation is needed.     

Diurnal variation of subjective mood in depressive states

Summary Diurnal variation of subjective mood was found to occur in approximately half of 70 depressed patients studied. Morning exacerbation of depression correlates to a statistically significant degree with the presence of agitation, retardation, guilt and early waking. A linear relationship is suggested between subjective retardation and the time of maximum depression, while there is a tendency for physical disturbance preceding the depressive symptoms to relate to morning exacerbation of depression, especially among women. Diurnal variation of mood may be related to the emergence of abnormal biological clocks in certain individuals during depressive states.     

Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy

OBJECTIVE: To improve interventions for depressed older adults, data are needed on the comparative effects of pharmacotherapy versus psychotherapy. Given that most older adults with clinically significant depressive symptoms do not have major depression, data on treatments for minor depression and dysthymia are especially needed. METHOD: Meta-analysis was used to integrate the results of 89 controlled studies of treatments focused on acute major depression (37 studies) and other depressive disorders (52 studies conducted with mixed diagnostic groups, including patients with major depression, minor depression, and dysthymia). A total of 5,328 older adults received pharmacotherapy or psychotherapy in these studies. RESULTS: Clinician-rated depression scores improved, on average, by 0.80 standard deviation (SD) units; self-rated depression scores improved by 0.76 SD units. Clinician-rated depression improved by 0.69 SD units in pharmacotherapeutic studies and by 1.09 SD units in psychotherapeutic studies. Self-rated depression improved by 0.62 SD units and 0.83 SD units, respectively. An interesting finding was the stronger improvements in clinician-rated depression among control subjects participating in medication studies, compared to those in psychotherapeutic studies. CONCLUSIONS: Available treatments for depression work, with effect sizes that are moderate to large. Comparisons of psychotherapy and pharmacotherapy must be interpreted with caution, in part because medication studies are more likely to use a credible active placebo, which may lead to smaller adjusted effect sizes in medication studies. Given that psychotherapy and pharmacotherapy did not show strong differences in effect sizes, treatment choice should be based on other criteria, such as contraindications, treatment access, or patient preferences.     

Assessing the causal associations of insomnia with depressive symptoms and subjective well-being: a bidirectional Mendelian randomization study

BackgroundThe interactions and associations between insomnia, depressive symptoms, and subjective well-being are complex, thus it is hard to explore the effect and direction of causalities. This bidirectional Mendelian randomization (MR) study was to assess the causal associations of insomnia with depressive symptoms and subjective well-being.MethodsSummary statistics for insomnia, depressive symptoms, and subjective well-being were obtained from three large-scale genome-wide association studies (GWAS) of European ancestry. MR analyses were mainly conducted with the inverse-variance-weighted (IVW) method. The weighted-median method, MR-Egger method, and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) test were adopted to test whether the estimates were robust. The adjusted MR analysis was performed to avoid the effect of potential pleiotropy.ResultsThere was evidence to support a causal association between genetically predicted insomnia and depressive symptoms (beta (β) = 0.086, 95% confidence interval (CI) = 0.068 to 0.104, P = 8.6E-21). Meanwhile, genetically predicted depressive symptoms was associated with a higher risk of insomnia (β = 0.543, 95% CI = 0.331 to 0.754, P = 4.8E-07). Genetically predicted insomnia was negatively associated with subjective well-being (β = −0.043, 95% CI = −0.063 to −0.024, P = 1.2E-05). There was evidence of reverse causality between insomnia and subjective well-being (β = −0.821, 95% CI = −1.012 to −0.630, P = 4.0E-17).ConclusionsMR analysis indicates bidirectional causal associations of insomnia with depressive symptoms and subjective well-being. People should give serious attention to and attempt to resolve the problems of insomnia, depressive symptoms, and subjective well-being, whichever comes first.     

The relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia

Background

Depressive symptoms are common in schizophrenia and are considered core features of the disorder. The purpose of the present study was to examine the relationship between depressive symptoms and subjective well-being in newly admitted patients with schizophrenia.

Methods

Eighty newly admitted patients were comprehensively evaluated for subjective well-being, schizophrenic symptoms, and depressive symptoms using the Subjective Well-Being Under Neuroleptics Scale (SWN), the Positive and Negative Syndrome Scale (PANSS), and the Beck Depression Inventory. Correlation coefficients were obtained between depressive symptoms and subjective well-being while controlling for the influence of the severity of psychotic symptoms, extrapyramidal side effect, and subjective attitude toward antipsychotics, as assessed by the PANSS, the Drug-Induced Extrapyramidal Symptoms Scale, and the Drug Attitude Inventory, respectively.

Results

The SWN score had a significant negative correlation with the PANSS depression factor score (P < .001). Correlation analysis also revealed a significant negative correlation between the SWN score and the Beck Depression Inventory score (P < .001).

Conclusions

The results of our study suggest that depressive symptoms are significantly associated with a low subjective well-being in newly admitted patients with schizophrenia and that the relationship is significant even after controlling for the influence of potential confounding variables. Detection and appropriate management of depressive symptoms in schizophrenic patients may affect their perceptions of their own well-being.     

Associations of mindfulness with depressive symptoms and well-being in older adults: the moderating role of neuroticism

Objective: To investigate whether observed interactions of mindfulness with the personality trait neuroticism extend to older adults and to aspects of psychological functioning other than depressive symptoms, and whether effects of mindfulness training in this population depend on levels of neuroticism.

Method: We performed a secondary analysis of data from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) for community-dwelling older adults. We investigated whether neuroticism moderates associations of dispositional mindfulness with various aspects of psychological and physical functioning at baseline, as well as effects of MBSR on these outcomes.

Results: Significant two-way interactions showed that greater mindfulness was associated with fewer depressive symptoms and less negative affect at baseline in individuals with average or higher levels of neuroticism. In contrast, mindfulness was associated with greater positive affect and vitality and fewer physical symptoms regardless of the level of neuroticism. There were no effects of MBSR on these outcomes at any level of neuroticism.

Conclusion: Mindfulness may be more protective against psychological ill-being in older adults with higher levels of neuroticism, but conducive to positive psychological and physical well-being regardless of this personality trait. The potential moderating role of neuroticism should be further evaluated in studies of mindfulness-based interventions in older adults.     

The relationship of depression and stressors to immunological assays: a meta-analytic review

This is a broad meta-analysis of the relations of both depression and stressors to immunological assays. The number of study samples (greater than 180) and measures (greater than 40) is much more extensive than any so far. Analyses are done by both fixed and random effects. By a fixed-effects analysis, both major depression and naturally occurring acute stressors are associated with (1) an overall leukocytosis, (2) mild reductions in absolute NK-cell counts and relative T-cell proportions, (3) marginal increases in CD4/CD8 ratios, and (4) moderate decreases in T- and NK-cell function. However, the degree of heterogeneity of the studies' results raises questions about their robustness. Therefore, we also did the first random effects analysis to estimate what is likely to appear in future studies. For depression, the analysis showed the immunological correlates included (1) an overall leukocytosis, manifesting as a relative neutrophilia and lymphoenia; (2) increased CD4/CD8 ratios; (3) increased circulating haptoglobin, PGE(2), and IL-6 levels; (4) reduced NK-cell cytotoxicity; and (5) reduced lymphocyte proliferative response to mitogen. For stressors, the random effects analysis showed that future studies are likely to find the following effects: (1) an overall leukocytosis, manifesting as an absolute lymphocytosis; (2) alterations in cytotoxic lymphocyte levels, CD4/CD8 ratios, and natural killer cell cytotoxicity with the direction of change depending on the chronicity of the stressor; (3) a relative reduction of T-cell levels; (3) increased EBV antibody titers; (4) reduced lymphocyte proliferative response and proportion of IL-2r bearing cells following mitogenic stimulation; and (5) increased leukocyte adhesiveness. The random-effects analysis revealed that for both major depression and naturally occurring stressors the following effects are shared: leukocytosis, increased CD4/CD8 ratios, reduced proliferative response to mitogen, and reduced NK cell cytotoxicity. The implications for these findings for disease susceptibility and the pathophysiology of these conditions is discussed.     

Association between subjective well-being and depressive symptoms in treatment-resistant schizophrenia before and after treatment with clozapine

Background

We examined the relationship between subjective well-being and depressive symptoms in patients with treatment-resistant schizophrenia before and after treatment with clozapine to contribute to the growing body of research regarding the determinants of patients' perspective of their own well-being in schizophrenia.

Methods

Forty patients with treatment-resistant schizophrenia were comprehensively evaluated for subjective well-being, schizophrenic symptoms, and depressive symptoms before and 8 weeks after the initiation of treatment with clozapine. Correlation analysis and Fisher's z-transformation statistics were performed.

Results

There were significant improvements in all Positive and Negative Syndrome Scale (PANSS) factor scores and Beck Depression Inventory (BDI) score over the treatment period (P < .05). Before clozapine administration, the subjective well-being score had significant negative correlations with the PANSS depression factor score (P < .05) and the BDI score (P < .05). After clozapine treatment, the subjective well-being score still had significant negative correlations with the PANSS depression factor score (P < .05) and the BDI score (P < .05) and no new associations emerged with treatment. Fisher's z-transformation statistics revealed that the correlations between the subjective well-being score and the depression score were not significantly different before and after clozapine treatment.

Conclusions

These results indicate that depressive symptoms are significantly associated with low subjective well-being in patients with treatment-resistant schizophrenia. The association was equally significant before and after treatment with clozapine, suggesting that the relationship does not change with clozapine treatment, even when depressive symptoms improve significantly, and that there may be a common pathophysiological basis for depressive symptoms and the subjective appraisal of well-being in schizophrenia.     

Informal caregiving transitions,subjective well-being and depressed mood: Findings from the English Longitudinal Study of Ageing

Objectives: To prospectively investigate the impact of transitions in informal caregiving on emotional well-being over two years in a large population study of older people.

Methods: Information on provision of unpaid care in 2004/2005 and 2006/2007 was available for 6571 participants in the English Longitudinal Study of Ageing. Three well-being domains were also assessed on each occasion: life satisfaction (measured with the Satisfaction with Life Scale); quality of life (assessed with the CASP-19 scale); and depression symptoms (measured using the Centers for Epidemiologic Studies Depression Scale). Multivariable analyses of the impact on well-being of two-year caregiving transitions (caregiving entry and caregiving exit, or continued caring) were conducted separately for spousal/child carers and carers of other family/non-relatives.

Results: Compared to non-caregiving, entry into spousal/child caregiving was associated with decline in quality of life (B = ?1.60, p < .01) whereas entry into caregiving involving other kin relations increased life satisfaction (B = 1.02, p < .01) and lowered depression symptoms (B = ?0.26, p < .05). Contrary to expectations, caregiving exit was related to increased depression in both spousal/child (B = 0.44, p < .01) and non-spousal/child (B = 0.25, p < .05) carers. Continued spousal/child caregiving was also related to decline in quality of life (B = ?1.24, p < .05). Other associations were suggestive but non-significant.

Conclusion: The emotional impact of different caregiving transitions in later life differs across kin relationships; notably, spousal and child carers' well-being was consistently compromised at every stage of their caregiving career over the two-year study period.     

Associations between religiosity and anxiety,depressive symptoms,and well-being in Korean adults living with epilepsy

PurposeReligiosity can be important in the everyday life of persons with epilepsy (PWE). How PWE live with religiosity can be influenced by their cultural background. We determined whether religiosity is associated with anxiety, depressive symptoms, and well-being in Korean adults with epilepsy.MethodsThis multicenter cross-sectional study was conducted in the outpatient clinics of five university hospitals in Korea. Religiosity was assessed using the five-item Duke University Religion Index (DUREL). The WHO-Five Well-Being Index (WHO-5) and Hospital Anxiety Depression Scale were used. The participants were categorized into three subgroups bounded by the 33rd and 66th percentiles of their DUREL scores.ResultsOf a total of 226 participants, 61.1% declared that they had religious affiliation. The median DUREL score was 11 (interquartile ranges 6, 18). All three subscales of the DUREL were significantly related to WHO-5 (p < 0.01). Non-organizational religious activities such as prayer and meditation were also inversely related to anxiety (p < 0.05) and depressive symptoms (p < 0.01). After controlling for confounding variables, anxiety and depressive symptoms were more extensive in the low religiosity subgroup than in the high or no religiosity subgroup (p < 0.01) and well-being was higher in the high or low religiosity subgroup than in the no religiosity subgroup (p < 0.05).ConclusionsReligiosity is significantly associated with anxiety, depressive symptoms, and well-being in Korean adults with epilepsy.     

有无自杀意念抑郁症患者抑郁情绪、认知应对策略及应激的比较研究

目的:探讨有无自杀意念抑郁症患者抑郁情绪、认知应对策略及应激性生活事件的差异。方法:对143例抑郁症患者进行自编一般情况问卷、Beck抑郁自评量表(BDI)、认知情绪调节问卷中文版(CERQ-C)评定。结果:有自杀意念抑郁症发作患者BDI总分、婚姻家庭应激及社会生活应激分及CERQ-C适应性策略与不适应性策略总分显著高于无自杀意念抑郁症患者(P<0.05或P<0.01)。有自杀意念抑郁症患者抑郁总分与工作学习应激、婚姻家庭应激、社会生活应激及CERQ-C不适应性策略分呈显著正相关(r=0.569,0.470,0.341,0.303,P<0.05或P<0.01);无自杀意念抑郁症患者抑郁总分仅与婚姻家庭应激呈显著正相关(r=0.361,P<0.01)。结论:有自杀意念较无自杀意念抑郁症患者经历更多的负性生活事件,存在更严重的抑郁情绪,较多地采用认知应对策略。     

Understanding caregiver health behaviors: depressive symptoms mediate caregiver self-efficacy and health behavior patterns

Previous research on female caregivers of elderly relatives with dementia has demonstrated that caregiving self-efficacy (SE) is associated with reduced cumulative health risk. The overarching aim of the current study was to expand on that research by exploring whether depressive symptoms mediate the relationship between 3 domains of caregiving SE and cumulative health risk associated with health behavior patterns. Data from 256 female family caregivers of patients with dementia are presented. Path analysis revealed a significant mediated effect for depressive symptoms as both SE for obtaining respite and SE for controlling upsetting Thoughts had a significant, indirect effect on cumulative health risk. There were no direct effects between caregiver SE and cumulative health risk. The current study sheds light on the complex pathway between caregiver SE and health and speaks to the importance of skills-based interventions designed to enhance efficacy beliefs and minimize depression in dementia caregivers.     

Downward social comparison and subjective well-being in late life: The moderating role of perceived control

Objective: Drawing from Heckhausen and Schulz's Motivational Theory of Life-span Development, this study examined perceived control as a moderator of the protective relationship between downward social comparison and subjective well-being among older adults.

Methods: Community-dwelling older adults (N?=?97, 63% female, ages 79–97) were interviewed in their own homes at three time-points over a nine-year period. Interviews assessed older adults’ perceived control over daily tasks, their use of downward social comparison in response to task restriction, and their subjective well-being.

Results: Regression analyses yielded a significant interaction between downward social comparison and perceived control for three subjective well-being outcomes: life satisfaction, perceived stress, and depressive symptoms. Follow-up analyses revealed that downward social comparison was associated with greater subjective well-being at low levels of perceived control; but was unrelated to subjective well-being at high levels of perceived control.

Conclusion: These findings corroborate Heckhausen and Schulz's theorized goal-opportunity congruence premise and have implications for quality-of-life interventions to assist community-dwelling older adults.     

Sleep disturbances in CHARGE syndrome: types and relationships with behavior and caregiver well-being

Children with CHARGE syndrome frequently develop moderate to severe behavior difficulties and are often diagnosed with obsessive–compulsive disorder, attention deficit disorder, Tourette syndrome, and autism. Anecdotal reports have indicated that sleep is also affected. However, the prevalence and types of sleep disturbance have not been identified. This study investigated sleep disturbances in 87 children with CHARGE syndrome, aged 6 to 18 years (mean 11y, SD 3y 8mo). There were 52 males and 35 females represented. Instruments included measures of sleep (Sleep Disturbances Scale for Children [SDSC]), behavior (Developmental Behaviour Checklist [DBC]), and carer well-being (Malaise Inventory). On the SDSC, 57.5% received scores considered significant for sleep disturbances, with disorders of initiating and maintaining sleep, sleep breathing, and sleep–wake transition being the most common. The SDSC was significantly correlated with the DBC ( p =0.010) and the Malaise Inventory ( p =0.003). Regression analysis found that both problem behavior and sleep disturbances contributed to the prediction of scores on the Malaise Inventory. Being both deaf and blind ( p =0.001), experiencing frequent middle-ear infections ( p =0.015), and starting to walk at an older age ( p =0.007) were associated with more sleep disturbance. Craniofacial anomalies were not. The study highlights the importance of addressing the sleep difficulties associated with CHARGE syndrome relating both to airway management and to disorders of initiating sleep.