Abstract
BackgroundFamily carers are an important source of care for older people. Although several studies have reported that subjective caregiver burden is related to depressive symptoms there are no systematic reviews quantifying this association.ObjectiveTo establish the extent to which subjective caregiver burden is associated with depressive symptoms and whether this association would vary by study or care characteristics.MethodsWe searched major databases such as PubMed, CINAHL, PsycINFO, Scopus and ISI Proceedings up to March 2018, and conducted a meta-analysis of included studies. Summary estimates of the association were obtained using a random-effects model to improve generalisation of findings.ResultsAfter screening of 4,688 articles, 55 studies were included providing a total of 56 independent comparisons with a total of 9,847 carers from data across 20 countries. There was a large, positive association between subjective caregiver burden and depressive symptoms ( = 0.514; 95% CI = 0.486, 0.541), with very low heterogeneity amongst individual studies (I2 = 8.6%). Sensitivity analyses showed no differences between cross-sectional or repeated measures ( = 0.521; 95% CI = 0.491, 0.550; 51 samples) and longitudinal studies ( = 0.454; 95% CI = 0.398, 0.508; 6 samples). We found a higher effect size for those caring for people living with dementia compared to those caring for frail older people, and stroke survivors. Carer sex, age and kinship did not change the estimate of the effect.ConclusionsSubjective caregiver burden is a significant risk factor for depressive symptoms in carers of older people and may precipitate clinical depression. Those caring for people with dementia experience greater burden. There is a need for longitudinal evaluations examining the effects of potential mediators of the association of subjective burden and depressive symptoms. Future interventions should test whether minimizing subjective burden may modify the risk of developing depression in carers of older relatives.
Highlights
Current trends in population aging in many countries mean that as the population of older people increases so does the need for provision of informal care by family members [1]
There was a large, positive association between subjective caregiver burden and depressive symptoms ( r = 0.514; 95% confidence intervals (CIs) = 0.486, 0.541), with very low heterogeneity amongst individual studies (I2 = 8.6%)
Sensitivity analyses showed no differences between cross-sectional or repeated measures ( r = 0.521; 95% CI = 0.491, 0.550; 51 samples) and longitudinal studies ( r = 0.454; 95% CI = 0.398, 0.508; 6 samples)
Summary
Current trends in population aging in many countries mean that as the population of older people increases so does the need for provision of informal care by family members [1]. Family carers are the main source of support of older dependents [1]. This uncompensated support is an important societal asset, it is associated with substantial health burden for family carers representing a highly vulnerable population [3]. The emotional and psychological consequences of caring are mainly represented by subjective burden, anxiety and depressive symptoms [4,5,6]. Prevalence studies have shown that depressive symptoms in carers of older relatives is 40.2% for those caring for stroke survivors [5] and up to 34% for carers of people living with Alzheimer’s disease [6]. Several studies have reported that subjective caregiver burden is related to depressive symptoms there are no systematic reviews quantifying this association
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