Longitudinal Changes in and Modifiable Predictors of the Prevalence of Severe Depressive Symptoms for Family Caregivers of Terminally Ill Cancer Patients over the First Two Years of Bereavement
Restricted accessResearch articleFirst published online January, 2017
Longitudinal Changes in and Modifiable Predictors of the Prevalence of Severe Depressive Symptoms for Family Caregivers of Terminally Ill Cancer Patients over the First Two Years of Bereavement
Bereaved families endure tremendous grief. However, few studies have longitudinally investigated caregivers' bereavement grief for more than one year postloss and none is from family-oriented Asian countries.
Objectives:
We explored longitudinal changes in and modifiable predictors of severe depressive symptoms for Taiwanese family caregivers of terminally ill cancer patients over the first two years postloss.
Design:
For this descriptive, longitudinal study, severe depressive symptoms (Center for Epidemiological Studies Depression Scale score ≥16) were measured 1, 3, 6, 13, 18, and 24 months postloss. To identify modifiable factors (preloss depressive symptom levels, subjective caregiving burden, objective caregiving load, preparedness for patient death, and postloss social support) associated with postloss severe depressive symptoms, we used multivariate logistic regression modeling with the generalized estimating equation.
Setting/Participants:
Bereaved caregivers (N = 285) were recruited by convenience from a medical center in northern Taiwan.
Results:
Bereaved family caregivers' prevalence of severe depressive symptoms peaked one month postloss (73.3%) and significantly decreased to 15.2% 24 months after the patient's death. After adjusting for confounders, bereaved caregivers were more likely to have severe depressive symptoms if they had heavy objective caregiving load and higher preloss depressive symptom levels. However, their likelihood of severe depressive symptoms was buffered by being better prepared for the patients' death and having greater social support.
Conclusions:
Bereaved family caregivers' severe depressive symptoms decreased significantly over the first two years postloss. Healthcare professionals should appropriately assess at-risk bereaved caregivers when patients are still alive and provide effective interventions to facilitate caregivers' return to normal life.
Get full access to this article
View all access options for this article.
References
1.
LaiDW: Filial piety, caregiving appraisal, and caregiving burden. Res Aging, 2010; 32:200–223.
2.
StroebeM, SchutH, StroebeW: Health outcomes of bereavement. Lancet, 2007; 370:1960–1973.
3.
LingSF, ChenML, LiCY, et al.: Trajectory and influencing factors of depressive symptoms in family caregivers before and after the death of terminally ill patients with cancer. Oncol Nurs Forum, 2013; 40:32–40.
4.
BornsteinP, ClaytonP, HalikasJ, et al.: The depression of widowhood after thirteen months. Br J Psychiat, 1973; 122:561–566.
5.
ClaytonP, HerjanicM, MurphyG: Mourning and depression: Their similarities and differences. Can Psychiatr Assoc J, 1974; 19:309–312.
6.
HarlowSD, GoldbergEL, ComstockGW: A longitudinal study of the prevalence of depressive symptomatology in elderly widowed and married women. Arch Gen Psychiat, 1991; 48:1065–1068.
7.
BarryLC, KaslSV, PrigersonHG: Psychiatric disorders among bereaved persons: The role of perceived circumstances of death and preparedness for death. Am J Geriat Pychiat, 2002; 10:447–457.
8.
Chentsova-DuttonY, ShucterS, HutchinS, et al.: Depression and grief reactions in hospice caregivers: From pre-death to 1 year afterwards. J Affect Disord, 2002; 69:53–60.
9.
GuldinMB, O'ConnorM, SokolowskiI, et al.: Identifying bereaved subjects at risk of complicated grief: Predictive value of questionnaire items in a cohort study. BMC Palliat Care, 2011; 10:9.
10.
ZisookS, ShuchterSR: Major depression associated with widowhood. Am J Geriat Psychiat, 1993; 1:316–326.
11.
ZisookS, PaulusM, ShuchterSR, et al.: The many faces of depression following spousal bereavement. J Affect Disord, 1997; 45:85–95.
12.
AllenJY, HaleyWE, SmallBJ, et al.: Bereavement among hospice caregivers of cancer patients one year following loss: Predictors of grief, complicated grief, and symptoms of depression. J Palliat Med, 2013; 16:745–751.
13.
KrisAE, CherlinEJ, PrigersonH, et al.: Length of hospice enrollment and subsequent depression in family caregivers: 13-month follow-up study. Am J Geriat Psychiat, 2006; 14:264–269.
14.
KingM, VasanthanM, PetersenI, et al.: Mortality and medical care after bereavement: A general practice cohort study. PLoS One, 2013; 8:e52561.
15.
StephenAI, MacduffC, PetrieDJ, et al.: The economic cost of bereavement in Scotland. Death Stud, 2015; 39:151–157.
16.
StroebeMS, FolkmanS, HanssonRO, et al.: The prediction of bereavement outcome: Development of an integrative risk factor framework. Soc Sci Med, 2006; 63:2440–2451.
17.
BassDM, BowmanK: The transition from caregiving to bereavement: The relationship of care-related strain and adjustment to death. Gerontologist, 1990; 30:35–42.
18.
LiLW: From caregiving to bereavement: Trajectories of depressive symptoms among wife and daughter caregivers. J Gerontol B Psychol Sci Soc Sci, 2005; 60:190–198.
19.
SchulzR, BoernerK, KlingerJ, et al.: Preparedness for death and adjustment to bereavement among caregivers of recently placed nursing home residents. J Palliat Med, 2015; 18:127–133.
20.
HebertRS, DangQ, SchulzR: Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: Findings from the REACH study. J Palliat Med, 2006; 9:683–693.
21.
HauksdóttirA, SteineckG, FürstCJ, et al.: Long-term harm of low preparedness for a wife's death from cancer—A population-based study of widowers 4–5 years after the loss. Am J Epidemiol, 2010; 172:389–396.
22.
StroebeW, ZechE, StroebeMS, et al.: Does social support help in bereavement?. J Soc Clin Psychol, 2005; 24:1030–1050.
23.
LynchT, ConnorS, ClarkD: Mapping levels of palliative care development: A global update. J Pain Symptom Manage, 2013; 45:1094–1106.
24.
Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press, 2014.
25.
BonannoGA, KaltmanS: The varieties of grief experience. Clin Psychol Rev, 2001; 21:705–734.
26.
Galatzer-LevyIR, BonannoGA: Beyond normality in the study of bereavement: Heterogeneity in depression outcomes following loss in older adults. Soc Sci Med, 2012; 74:1987–1994.
27.
KimY, KashyDA, KawCK, et al.: Sampling in population-based cancer caregivers research. Qual Life Res, 2009; 18:981–989.
28.
BonannoGA, PapaA, LalandeK, et al.: Grief processing and deliberate grief avoidance: A prospective comparison of bereaved spouses and parents in the United States and the People's Republic of China. J Consult Clin Psychol, 2005; 73:86–98.
29.
SongJI, ShinDW, ChoiJY, et al.: Quality of life and mental health in the bereaved family members of patients with terminal cancer. Psychooncology, 2012; 21:1158–1166.
30.
TanimukaiH, HitoshiH, HiraiK, et al.: Association between depressive symptoms and changes in sleep condition in the grieving process. Supportive Care Cancer, 2015; 23:1925–1931.
31.
RadloffLS: The CES-D scale: A self-report depression scale for research in the general population. Appl Psych Meas, 1977; 1:385–401.
GivenCW, GivenB, StommelM, et al.: The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Res Nurs Health, 1992; 15:271–283.
34.
TangST, LiCY, ChenCCH: Trajectory and determinants of the quality of life of family caregivers of terminally ill cancer patients in Taiwan. Qual Life Res, 2008; 17:387–395.
35.
LeeKC, ChangWC, ChouWC, et al.: Longitudinal changes and predictors of caregiving burden while providing end-of-life care for terminally ill cancer patients. J Palliat Med, 2013; 16:632–637.
36.
EmanuelEJ, FaircloughDL, SlutsmanJ, et al.: Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients. New Engl J Med, 1999; 341:956–963.
37.
SherbourneCD, StewartAL: The MOS social support survey. Soc Sci Med, 1991; 32:705–714.
38.
ShyuYIL, TangWR, LiangJ, et al.: Psychometric testing of the Social Support Survey on a Taiwanese sample. Nurs Res, 2006; 55:411–417.
39.
IpEH, SnowJA, HeckertDA, et al.: Latent Markov model for analyzing temporal configuration for violence profiles and trajectories in a sample of batterers. Sociol Methods Res, 2010; 39:222–255.
40.
BurtonP, GurrinL, SlyP: Extending the simple linear regression model to account for correlated responses: An introduction to generalized estimating equations and multi-level mixed modelling. Stat Med, 1998; 17:1261–1291.
41.
NakaiM, KeW: Review of the methods for handling missing data in longitudinal data analysis. Int J Math Analysis, 2011; 5:1–13.
42.
MaJH, RainaP, BeyeneJ, et al.: Comparison of population-averaged and cluster-specific models for the analysis of cluster randomized trials with missing binary outcomes: A simulation study. BMC Med Res Methodol, 2013; 13:9.
43.
WrightAA, ZhangB, RayA, et al.: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 2008; 300:1665–1673.
44.
TangST, LiuTW, LaiMS, et al.: Congruence of knowledge, experiences and preferences for disclosure of diagnosis and prognosis between terminally-ill cancer patients and their family caregivers in Taiwan. Cancer Invest, 2006; 24:360–366.
45.
LamontEB, ChristakisNA: Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med, 2001; 134:1096–1105.
46.
WeeksJC, CookEF, O'DaySJ, et al.: Relationship between cancer patients' predictions of prognosis and their treatment preferences. JAMA, 1998; 279:1709–1714.
47.
ChristakisNA. Death Foretold: Prophecy and Prognosis in Medical Care. Chicago, IL: University of Chicago Press, 2001.
48.
ChuHY: The funeral custom of Taiwan by “Seven days in heaven.”. Zhishan, 2011; 10:5–34.
49.
LinCY: Social culture and bereaved reaction. J Life Death Stud, 2005; 2:107–127.
50.
TsaiPJ: Pattern of grief expression in Chinese families. Taiwan Counsel Quar, 2012; 4:16–38.
51.
MossMS, MossSZ: Widowhood in old age: Viewed in a family context. J Aging Stud, 2014; 29:98–106.
52.
ChowAY, ChanCL, HoSM: Social sharing of bereavement experience by Chinese bereaved persons in Hong Kong. Death Stud, 2007; 31:601–618.
53.
AsaiM, AkizukiN, FujimoriM, et al.: Psychological states and coping strategies after bereavement among spouses of cancer patients: A quantitative study in Japan. Support Care Cancer, 2012; 20:3189–3203.
54.
BoernerK, SchulzR, HorowitzA: Positive aspects of caregiving and adaptation to bereavement. Psychol Aging, 2004; 19:668–675.
55.
BuckleyT, SpinazeM, BartropR, et al.: The nature of death, coping response and intensity of bereavement following death in the critical care environment. Aust Crit Care, 2015; 28:64–70.
