Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Mood Disorders | Research article

Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia

Authors: Lara Kürten, Nikolas Dietzel, Peter L. Kolominsky-Rabas, Elmar Graessel

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

The care of people with dementia is usually carried out by their family members, which can cause objective und subjective burden and raise their risk of depressiveness. Thus, the aim of this study is to identify predictors of the change in depressiveness of informal caregivers over 1 year in order to be able to derive hypotheses for interventions that promise success.

Methods

The Bavarian Dementia Survey (BayDem) is a multi-center, longitudinal study conducted at three different sites in Bavaria, Germany. Participants were people with dementia and their informal caregivers. Data was collected at baseline and after 12 months by standardized face-to-face interviews in cooperation with local players. The informal caregivers’ depressiveness was assessed with the WHO-5. Data was also collected on the people with dementia’s cognition (MMSE), behavioral symptoms (NPI) and comorbidities (Charlson Comorbidity Index) as well as caregivers’ social inclusion (LSNS), time spent on care and care contribution (RUD). For statistical analysis, a multiple regression model was used.

Results

The data of 166 people with dementia and their informal caregivers was analyzed. Of the latter, 46% were categorized as “likely depressed”. The change in depressiveness over a year was significantly predicted by baseline depressiveness as well as an increase in the time informal caregivers spent supervising the person with dementia.

Conclusions

Informal caregivers of people with dementia are at high risk of depression. The time spent supervising the person with dementia has a significant impact on increasing depressiveness. This highlights the importance of support services to provide the informal caregiver with relief and possibly reduce depressiveness.

Sallim AB, Sayampanathan AA, Cuttilan A, Ho R. Prevalence of mental health disorders among caregivers of patients with Alzheimer disease. J Am Med Dir Assoc. 2015;16(12):1034–41. https://doi.org/10.1016/j.jamda.2015.09.007.CrossRefPubMed

Ma M, Dorstyn D, Ward L, Prentice S. Alzheimers’ disease and caregiving: a meta-analytic review comparing the mental health of primary carers to controls. Aging Ment Health. 2018;22(11):1395–405. https://doi.org/10.1080/13607863.2017.1370689.CrossRefPubMed

Deutsche Gesellschaft für Psychiatrie Psychotherapie und Neurologie (DGPPN). Unipolare Depression: Langfassung; 2015. https://www.leitlinien.de/mdb/downloads/nvl/depression/depression-2aufl-vers5-lang.pdf Accessed 18 Feb 2020

Statista/TK. Anzahl der Arbeitsunfähigkeitstage in Deutschland nach Diagnose* in den Jahren 2014 bis 2018 (AU-Tage je 100 Versicherungsjahre). 2019. https://de.statista.com/statistik/daten/studie/195977/umfrage/anzahl-der-arbeitsunfaehigkeitstage-nach-diagnose/. Accessed 26 Aug 2019.

Zhu CW, Scarmeas N, Ornstein K, Albert M, Brandt J, Blacker D, et al. Health-care use and cost in dementia caregivers: longitudinal results from the predictors caregiver study. Alzheimers Dement. 2015;11(4):444–54. https://doi.org/10.1016/j.jalz.2013.12.018.CrossRefPubMed

O'Dwyer ST, Moyle W, Zimmer-Gembeck M, De Leo D. Suicidal ideation in family carers of people with dementia. Aging Ment Health. 2016;20(2):222–30. https://doi.org/10.1080/13607863.2015.1063109.CrossRefPubMed

Mittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006;67(9):1592–9. https://doi.org/10.1212/01.wnl.0000242727.81172.91.CrossRefPubMed

Coehlo DP, Hooker K, Bowman S. Institutional placement of persons with dementia: what predicts occurrence and timing? J Fam Nurs. 2007;13(2):253–77. https://doi.org/10.1177/1074840707300947.CrossRefPubMed

Mausbach BT, Patterson TL, Rabinowitz YG, Grant I, Schulz R. Depression and distress predict time to cardiovascular disease in dementia caregivers. Health Psychol. 2007;26(5):539–44. https://doi.org/10.1037/0278-6133.26.5.539.CrossRefPubMed

10.

Patterson C. World Alzheimer Report 2018. In: The state of the art of dementia research: New frontiers. London: Alzheimer’s Disease International (ADI); 2018. https://www.alz.co.uk/research/WorldAlzheimerReport2018.pdf. Accessed 25 July 2019.

11.

Bickel H. Informationsblatt 1. In: Die Häufigkeit von Demenzerkrankungen; 2018. https://www.deutsche-alzheimer.de/fileadmin/alz/pdf/factsheets/infoblatt1_haeufigkeit_demenzerkrankungen_dalzg.pdf. Accessed 25 July 2019.

12.

World Health Organization. Dementia. A public health priority. 2012. http://apps.who.int/iris/bitstream/handle/10665/75263/9789241564458_eng.pdf;jsessionid=F0AFAE529500B048DC14401811425F8F?sequence=1. Accessed 24 Nov 2020.

13.

Wimo A, Gauthier S, Prince M. Global estimates of informal care. London: Alzheimer’s Disease International (ADI); 2018. https://www.alz.co.uk/adi/pdf/global-estimates-of-informal-care.pdf. Accessed 24 Nov 2020

14.

Ornstein K, Gaugler JE. The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. Int Psychogeriatr. 2012;24(10):1536–52. https://doi.org/10.1017/S1041610212000737.CrossRefPubMedPubMedCentral

15.

Watson B, Tatangelo G, McCabe M. Depression and anxiety among partner and offspring carers of people with dementia: a systematic review. Gerontologist. 2019;59(5):e597–610. https://doi.org/10.1093/geront/gny049.CrossRefPubMed

16.

van der Lee J, Bakker TJ, Duivenvoorden HJ, Droes RM. Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Res Rev. 2014;15:76–93. https://doi.org/10.1016/j.arr.2014.03.003.CrossRefPubMed

17.

Omranifard V, Haghighizadeh E, Akouchekian S. Depression in main caregivers of dementia patients: prevalence and predictors. Adv Biomed Res. 2018;7:34.PubMedPubMedCentral

18.

Lee SM, Lee Y, Choi SH, Lim TS, Moon SY. Caregivers of Alzheimer’s disease research investigators. Clinical and demographic predictors of adverse outcomes in caregivers of patients with dementia. Dement Neurocogn Disord. 2019;18(1):10–8. https://doi.org/10.12779/dnd.2019.18.1.10.CrossRefPubMedPubMedCentral

19.

Piercy KW, Fauth EB, Norton MC, Pfister R, Corcoran CD, Rabins PV, et al. Predictors of dementia caregiver depressive symptoms in a population: the Cache County dementia progression study. J Gerontol B Psychol Sci Soc Sci. 2013;68(6):921–6. https://doi.org/10.1093/geronb/gbs116.CrossRefPubMed

20.

Lou Q, Liu S, Huo YR, Liu M, Liu S, Ji Y. Comprehensive analysis of patient and caregiver predictors for caregiver burden, anxiety and depression in Alzheimer’s disease. J Clin Nurs. 2015;24(17–18):2668–78. https://doi.org/10.1111/jocn.12870.CrossRefPubMed

21.

Covinsky KE, Newcomer R, Fox P, Wood J, Sands L, Dane K, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med. 2003;18(12):1006–14. https://doi.org/10.1111/j.1525-1497.2003.30103.x.CrossRefPubMedPubMedCentral

22.

Pearlin LI, Mullan JT, Semple SJ, Skaff MM. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990;30(5):583–94. https://doi.org/10.1093/geront/30.5.583.CrossRefPubMed

23.

Kolominsky-Rabas PL, Graessel E, Chilla T, et al. Bayerischer Demenz Survey (BayDem). Bericht für die Projektphase 2015–2018. 2020. https://www.bestellen.bayern.de/application/eshop_app000002?SID=567426054&ACTIONxSESSxSHOWPIC (BILDxKEY:%27stmgp_pflege_046%27,BILDxCLASS:%27Artikel%27,BILDxTYPE:%27PDF%27). Accessed 19 Aug 2020.

24.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8.CrossRef

25.

Lubben JE. Assessing social networks among elderly populations. Fam Commun Health. 1988;11(3):42–52. https://doi.org/10.1097/00003727-198811000-00008.CrossRef

26.

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res. 1975;12(3):189–98. https://doi.org/10.1016/0022-3956(75)90026-6.CrossRef

27.

Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–14. https://doi.org/10.1212/WNL.44.12.2308.CrossRefPubMed

28.

Wimo A, Gustavsson A, Jonsson L, Winblad B, Hsu MA, Gannon B. Application of resource utilization in dementia (RUD) instrument in a global setting. Alzheimers Dement. 2013;9(4):429–35 e17. https://doi.org/10.1016/j.jalz.2012.06.008.CrossRefPubMed

29.

Graessel E, Berth H, Lichte T, Grau H. Subjective caregiver burden: validity of the 10-item short version of the burden scale for family caregivers BSFC-s. BMC Geriatr. 2014;14(1):23. https://doi.org/10.1186/1471-2318-14-23.CrossRefPubMedPubMedCentral

30.

Pendergrass A, Malnis C, Graf U, Engel S, Graessel E. Screening for caregivers at risk: extended validation of the short version of the burden scale for family caregivers (BSFC-s) with a valid classification system for caregivers caring for an older person at home. BMC Health Serv Res. 2018;18(1):229. https://doi.org/10.1186/s12913-018-3047-4.CrossRefPubMedPubMedCentral

31.

Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, et al. Mini-mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;1:CD011145.

32.

Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci. 2000;12(2):233–9. https://doi.org/10.1176/jnp.12.2.233.CrossRefPubMed

33.

Frenkel WJ, Jongerius EJ, Mandjes-van Uitert MJ, van Munster BC, de Rooij SE. Validation of the Charlson comorbidity index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc. 2014;62(2):342–6. https://doi.org/10.1111/jgs.12635.CrossRefPubMed

34.

Chen TB, Yiao SY, Sun Y, Lee HJ, Yang SC, Chiu MJ, et al. Comorbidity and dementia: a nationwide survey in Taiwan. PLoS One. 2017;12(4):e0175475. https://doi.org/10.1371/journal.pone.0175475.CrossRefPubMedPubMedCentral

35.

Bech P, Gudex C, Johansen KS. The WHO (ten) well-being index: validation in diabetes. Psychother Psychosom. 1996;65(4):183–90. https://doi.org/10.1159/000289073.CrossRefPubMed

36.

Topp CW, Ostergaard SD, Sondergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76. https://doi.org/10.1159/000376585.CrossRefPubMed

37.

Jessen FSA, Deuschl G, Jansen S, Maier W. S3-Leitlinie Demenzen. Berlin: Springer; 2017.

38.

National Institute for Health and Care Excellence. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease. 2011. https://www.nice.org.uk/guidance/ta217/resources/donepezil-galantamine-rivastigmine-and-memantine-for-the-treatment-of-alzheimers-disease-pdf-82600254699973. Accessed 23 Jan 2021.

39.

Brähler E, Mühlan H, Albani C, Schmidt S. Teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL Lebensqualität-Index und des WHO-5 Wohlbefindens-Index. Diagnostica. 2007;53(2):83–96. https://doi.org/10.1026/0012-1924.53.2.83.CrossRef

40.

Pinquart M, Sorensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging. 2003;18(2):250–67. https://doi.org/10.1037/0882-7974.18.2.250.CrossRefPubMed

41.

Brodaty. Family caregivers of people with dementia. Dialogues Clin Neurosci. 2009;11(2):217–28.CrossRef

42.

Shikimoto R, Sado M, Ninomiya A, Yoshimura K, Ikeda B, Baba T, et al. Predictive factors associated with psychological distress of caregivers of people with dementia in Japan: a cross-sectional study. Int Psychogeriatr. 2018;30(8):1089–98. https://doi.org/10.1017/S1041610217002289.CrossRefPubMed

43.

Del-Pino-Casado R, Rodriguez Cardosa M, Lopez-Martinez C, Orgeta V. The association between subjective caregiver burden and depressive symptoms in carers of older relatives: a systematic review and meta-analysis. PLoS One. 2019;14(5):e0217648. https://doi.org/10.1371/journal.pone.0217648.CrossRefPubMedPubMedCentral

44.

Pozzebon M, Douglas J, Ames D. Spouses' experience of living with a partner diagnosed with a dementia: a synthesis of the qualitative research. Int Psychogeriatr. 2016;28(4):537–56. https://doi.org/10.1017/S1041610215002239.CrossRefPubMed

45.

Haro JM, Kahle-Wrobleski K, Bruno G, Belger M, Dell’Agnello G, Dodel R, et al. Analysis of burden in caregivers of people with Alzheimer’s disease using self-report and supervision hours. J Nutr Health Aging. 2014;18(7):677–84. https://doi.org/10.1007/s12603-014-0500-x.CrossRefPubMed

46.

Chong MS, Tan WS, Chan M, Lim WS, Ali N, Ang YY, et al. Cost of informal care for community-dwelling mild-moderate dementia patients in a developed southeast Asian country. Int Psychogeriatr. 2013;25(9):1475–83. https://doi.org/10.1017/S1041610213000707.CrossRefPubMed

47.

Nordberg G, von Strauss E, Kareholt I, Johansson L, Wimo A. The amount of informal and formal care among non-demented and demented elderly persons-results from a Swedish population-based study. Int J Geriatr Psychiatry. 2005;20(9):862–71. https://doi.org/10.1002/gps.1371.CrossRefPubMed

48.

Nordberg G, Wimo A, Jonsson L, Kareholt I, Sjolund BM, Lagergren M, et al. Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen project--a population based study in Sweden. Int J Geriatr Psychiatry. 2007;22(7):639–48. https://doi.org/10.1002/gps.1724.CrossRefPubMed

49.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: L. Erlbaum Associates; 1988.

50.

Wimo A, Jonsson L, Zbrozek A. The resource utilization in dementia (RUD) instrument is valid for assessing informal care time in community-living patients with dementia. J Nutr Health Aging. 2010;14(8):685–90. https://doi.org/10.1007/s12603-010-0316-2.CrossRefPubMed

51.

Wimo A, von Strauss E, Nordberg G, Sassi F, Johansson L. Time spent on informal and formal care giving for persons with dementia in Sweden. Health Policy. 2002;61(3):255–68. https://doi.org/10.1016/S0168-8510(02)00010-6.CrossRefPubMed

52.

Wimo A, Nordberg G, Jansson W, Grafström M. Assessment of informal services to demented people with the RUD instrument. Int J Geriatr Psychiatry. 2000;15(10):969–71. https://doi.org/10.1002/1099-1166(200010)15:10<969::AID-GPS272>3.0.CO;2-9.CrossRefPubMed

53.

Jimenez-Gonzalo L, Romero-Moreno R, Pedroso-Chaparro MDS, Fernandes-Pires JA, Barrera-Caballero S, Olazaran J, et al. The role of caregivers’ sleep problems in the association between behavioral symptoms of dementia and caregiving depression and anxiety. Behav Sleep Med. 2020:1–12. https://doi.org/10.1080/15402002.2020.1835662.

54.

Joling KJ, van Marwijk HW, Veldhuijzen AE, van der Horst HE, Scheltens P, Smit F, et al. The two-year incidence of depression and anxiety disorders in spousal caregivers of persons with dementia: who is at the greatest risk? Am J Geriatr Psychiatry. 2015;23(3):293–303. https://doi.org/10.1016/j.jagp.2014.05.005.CrossRefPubMed

55.

Saha S, Lim CCW, Cannon DL, Burton L, Bremner M, Cosgrove P, et al. Co-morbidity between mood and anxiety disorders: a systematic review and meta-analysis. Depress Anxiety. 2020:1–21.

56.

Ludecke D, Bien B, McKee K, Krevers B, Mestheneos E, Di Rosa M, et al. For better or worse: Factors predicting outcomes of family care of older people over a one-year period. A six-country European study. PLoS One. 2018;13(4):e0195294.CrossRef

57.

Allgaier AK, Kramer D, Saravo B, Mergl R, Fejtkova S, Hegerl U. Beside the geriatric depression scale: the WHO-five well-being index as a valid screening tool for depression in nursing homes. Int J Geriatr Psychiatry. 2013;28(11):1197–204. https://doi.org/10.1002/gps.3944.CrossRefPubMed

58.

Krieger T, Zimmermann J, Huffziger S, Ubl B, Diener C, Kuehner C, et al. Measuring depression with a well-being index: further evidence for the validity of the WHO well-being index (WHO-5) as a measure of the severity of depression. J Affect Disord. 2014;156:240–4. https://doi.org/10.1016/j.jad.2013.12.015.CrossRefPubMed

59.

Englbrecht M, Alten R, Aringer M, Baerwald CG, Burkhardt H, Eby N, et al. Validation of standardized questionnaires evaluating symptoms of depression in rheumatoid arthritis patients: approaches to screening for a frequent yet underrated challenge. Arthritis Care Res. 2017;69(1):58–66. https://doi.org/10.1002/acr.23002.CrossRef

60.

Lethin C, Leino-Kilpi H, Roe B, Soto MM, Saks K, Stephan A, et al. Formal support for informal caregivers to older persons with dementia through the course of the disease: an exploratory, cross-sectional study. BMC Geriatr. 2016;16(1):32. https://doi.org/10.1186/s12877-016-0210-9.CrossRefPubMedPubMedCentral

61.

Phillipson L, Jones SC, Magee C. A review of the factors associated with the non-use of respite services by carers of people with dementia: implications for policy and practice. Health Soc Care Commun. 2014;22(1):1–12. https://doi.org/10.1111/hsc.12036.CrossRef

62.

Karrer L, Dietzel N, Wolff F, Kratzer A, Hess M, Grassel E, et al. Use of outpatient care services by people with dementia: results of the Bavarian dementia survey (BayDem). Gesundheitswesen. 2020;82(1):40–9. https://doi.org/10.1055/a-1071-7851.CrossRefPubMed

63.

Dietzel N, Kürten L, Karrer L, Reichold M, Köhler L, Nagel A, et al. The digital dementia registry Bavaria – digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open. 2021;11(2):e043473. https://doi.org/10.1136/bmjopen-2020-043473.CrossRefPubMedPubMedCentral

64.

Straubmeier M, Behrndt EM, Seidl H, Ozbe D, Luttenberger K, Graessel E. Non-pharmacological treatment in people with cognitive impairment. Dtsch Arztebl Int. 2017;114(48):815–21. https://doi.org/10.3238/arztebl.2017.0815.CrossRefPubMedPubMedCentral

Title: Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia
Authors: Lara Kürten
Nikolas Dietzel
Peter L. Kolominsky-Rabas
Elmar Graessel
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Dementia
Affective Disorder
Dementia
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03164-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Predictors of the one-year-change in depressiveness in informal caregivers of community-dwelling people with dementia

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Correction to: Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx)

The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews

ILC-OPI: impulsive lifestyle counselling versus cognitive behavioral therapy to improve retention of patients with opioid use disorders and externalizing behavior: study protocol for a multicenter, randomized, controlled, superiority trial

Recommendations for occupational therapy interventions for adults with ADHD: a consensus statement from the UK adult ADHD network

Is preexisting mental illness associated with lower patient satisfaction for older trauma patients? A cross-sectional descriptive study

Suicidal ideation associated with depression and social support: a survey-based analysis of older adults in South Korea