Abstract
BackgroundSuicidal ideation (SI) affects approximately 30–40% of those with major depressive disorder (MDD). To date, studies have examined the substantial humanistic and economic burden to caregivers of persons with MDD, however little is known of the impact of caring for persons with MDD when SI is present. This study examined the additional burden imposed on caregivers for persons with unipolar depression and SI in five major European countries.MethodsA retrospective, cross-sectional analysis was conducted in five European countries using 2020 Europe National Health Wellness Survey (France, Germany, Italy, Spain and the United Kingdom) to compare differences in health and economic outcomes between caregivers of adults with unipolar depression and SI (CAUD-SI) and caregivers of adults with unipolar depression without SI (CAUD-nSI). The outcomes assessed included health-related quality of life (HRQoL; Medical Outcomes Study Short Form [SF-12v2]), health status (Short-Form 6 Dimension [SF-6D], EuroQol 5-Dimension 5-Level [EQ-5D-5L]), Work productivity and activity impairment (WPAI) and healthcare resource utilization (HRU). Linear mixed models and generalized linear mixed models adjusted for covariates were used to compare the two groups on outcomes of interest.ResultsOf 62,319 respondents, 0.89% (n = 554) were CAUD-SI and 1.34% (n = 837) were CAUD-nSI. In adjusted models, CAUD-SI reported greater humanistic burden than CAUD-nSI, with lower HRQoL (PCS: 42.7 vs. 45.0, p < 0.001 and MCS: 37.5 vs. 38.9, p = 0.007) and health status (SF-6D: 0.57 vs 0.60, p < 0.001 and EQ-5D-5L: 0.58 vs 0.66, p < 001). CAUD-SI respondents reported significantly higher economic burden than CAUD-nSI respondents for WPAI (percent activity impairment: 64.9% vs. 52.5%, p = 0.026) and HRU (provider visits: 10.0 vs. 7.9, p < 0.001, emergency room visits: 1.49 vs. 0.73, p < 0.001 and hospitalizations: 1.03 vs. 0.52, p < 0.001).ConclusionIn five European countries, caregivers of adults with depression and SI experience additional humanistic and economic burden than caregivers of adults with depression and no SI. Distinguishing caregiver groupings and their unique burden provide important insights for providing targeted support and interventions for both the patient and caregiver.
Highlights
Suicidal ideation (SI) affects approximately 30–40% of those with major depressive disorder (MDD)
Using the overall 2020 Europe National Health and Wellness Survey (NHWS) sample of 62,319 respondents, we identified caregivers of adults with unipolar depression based on affirmative response to the survey query “Are you currently caring for an adult relative with any of the following conditions = depression?” Excluded were those who reported caring for an adult relative with bipolar disease or schizophrenia, since these patients have different underlying psychopathological factors even though their patterns of depressive episodes may be similar to adults with unipolar depression [29, 30]
Unadjusted comparisons showed that all caregivers, regardless of subgroup, were more often women (CAUDSI = 53.8% vs. CAUD-nSI = 58.2%, p = 0.106), married (CAUD-SI = 65.5% vs. CAUD-nSI = 64.9%, p = 0.831), and reported lower annual household income (CAUDSI = 76.9% vs. CAUD-nSI = 76.6%, p = 0.906) (Table 1)
Summary
Suicidal ideation (SI) affects approximately 30–40% of those with major depressive disorder (MDD). This study examined the additional burden imposed on caregivers for persons with unipolar depression and SI in five major European countries. In Europe, the lifetime prevalence of major depressive disorder (MDD) is estimated to be 11.3% [4] It is the primary risk factor associated with suicide and suicidal ideation (SI) [5, 6] affecting 30–40% of those with MDD [7]. The additional burden on persons with depression and SI was demonstrated in a recent crosssectional survey of five European countries [13] The consequences of these burdens and impairments include an increased dependency and reliance on long-term assistance for daily activities [15]. This resultant spillover effect [16] on informal caregivers can result in physical, emotional, social, and financial strain [17, 18]
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