From Burden to Depressive Symptoms in Informal Caregivers during the COVID-19 Pandemic: A Path Analysis.

Tatjana Rajovic,Natasa Milic,Milutin Vracevic,Slavica Krsmanovic,Igor Grbic,Dejana Stanisavljevic,Rosa Sapic,Vedrana Pavlovic,Nina Rajovic,Marijana Vukmirovic,Andrija Pavlovic,Natasa Todorovic,Tamara Stanisavljevic,Ksenija Markovic,Tanja Mostic

doi:10.3390/ijerph18189577

Abstract

Background: The objective of this study was to assess the complex relationship between the multiple determinants of the caregiving process, the caregiver burden, and depression during the COVID-19 pandemic in Serbia. Methods: A cross-sectional study was conducted on a nationally representative sample (n = 798) during the COVID-19 pandemic in Serbia from March to September 2020. A nine-section questionnaire designed for this study included the characteristics of caregivers, characteristics of care and care recipients, COVID-19 related questions, and the following standardized instruments: 12-Item Short-Form Health Survey, Fatigue Severity Scale, Activities of Daily Living Scale and Instrumental Activities of Daily Living Scale, Zarit Caregiver Burden Scale, and Beck Depression Inventory. Path analysis was used for the simultaneous assessment of the direct and indirect relationships of all determinants. Results: More than two thirds (71.9%) of informal caregivers experienced a burden, and more than one quarter (27.1%) had depression symptomatology. Self-rated physical health, need for psychosocial support, and caregiver burden were the main direct predictors of depression. Multiple determinants of the caregiving process had indirect effects on depressive symptomatology via the caregiver burden as a mediating factor. Conclusions: The subjective burden presented a significant risk factor for depressive symptoms in caregivers during the COVID-19 pandemic. The provision of psychosocial support was identified as an important opportunity to reduce depressive risk in informal caregivers.

Highlights

The COVID-19 pandemic has led to an unprecedented response from health care workers, causing their mental and physical health to be stretched to the limit
The objective of this study was to assess the complex relationship between the multiple determinants of the caregiving process, caregiver burden, and depression, using a path analysis, on a representative sample of informal caregivers during the COVID-19 pandemic in Serbia
A total of 798 informal caregivers from 41 municipalities in Serbia were enrolled in the study

Summary

Introduction

The COVID-19 pandemic has led to an unprecedented response from health care workers, causing their mental and physical health to be stretched to the limit. Studies conducted before the COVID-19 pandemic identified being female, having a low educational level, living in a joint household with the care recipient, financial stress, social isolation, a longer duration of daily care, and a lack of choice in being a caregiver as risk factors for caregiver burden [5,6]. While some informal caregivers can cope with these demands, others cannot and are at greater risk of experiencing physical (health problems due to chronic stress) or psychological distress symptoms (development of depression or anxiety) [3,7,8,9,10,11,12,13,14]. The objective of this study was to assess the complex relationship between the multiple determinants of the caregiving process, the caregiver burden, and depression during the COVID-19 pandemic in Serbia. The provision of psychosocial support was identified as an important opportunity to reduce depressive risk in informal caregivers

Objectives

Methods

Results

Discussion

Conclusion