Caregiver Depressive Symptoms Research Articles

Course and predictors of depressive symptoms among family caregivers of terminally ill cancer patients until their death

Few studies have investigated the impact of providing end-of-life care on family caregivers' depressive symptoms over time, especially until the patient's death. The purpose of this study was to identify the course and predictors of depressive symptoms in caregivers of terminally ill cancer patients until they died. For this prospective, longitudinal study of 193 caregivers, data were collected using the Center for Epidemiological Studies Depression Scale, Symptom Distress Scale, Medical Outcomes Study Social Support Survey, and Caregiver Reaction Assessment scale. The course and predictors of depressive symptoms were analyzed using the generalized estimating equation model. Caregivers' depressive symptoms increased as the patient's death approached. Spousal or adult child family caregivers suffered more depressive symptoms if they self-identified as lacking social support and confidence in offering substantial assistance for younger terminally ill cancer patients with higher levels of symptom distress. Caregivers were susceptible to higher levels of depressive symptoms if they were heavily burdened by caregiving, that is, experienced more disruptions in schedules, greater health deterioration, stronger sense of family abandonment, and lower caregiver esteem. Psychological well-being of caregivers of terminally ill cancer patients deteriorated in response to progression of the patient's disease and impending death. Effective interventions should be developed and provided to high-risk caregivers as identified in our study. Increasing caregivers' strength of perceived social support, facilitating their confidence in caregiving, and alleviating their subjective burden may lessen the development of depressive symptoms in caregivers of terminally ill cancer patients throughout the dying process.

Can classroom emotional support enhance prosocial development among children with depressed caregivers?

Preschool children from economically disadvantaged families often experience difficulties in developing prosocial behavior. Risk associated with depressive symptomatology in caregivers (parents and guardians) may further compound these difficulties. The overall objective of the present study was to examine the compensatory effect of Head Start classroom environments on the development of prosocial behavior among children with caregivers high in depressive symptomatology. We initially examined the association between caregiver depressive symptoms and children's starting levels of prosocial behavior and then tested classroom emotional support as a moderator of the relation between caregivers’ depressive symptoms and children's prosocial behavior development during the school year. The sample of 194 Head Start preschoolers in 28 classrooms was part of a larger study designed to test the effects of an emotion-based prevention program. As expected, caregivers’ levels of depressive symptoms predicted lower starting levels of prosocial behavior. However, classroom emotional support promoted improvements in prosocial behavior for the children of the caregivers high in depressive symptomatology. The implications of these findings for the development of preventive interventions are discussed.

A home‐based training program improves Taiwanese family caregivers' quality of life and decreases their risk for depression: a randomized controlled trial

Little is known about the longitudinal effects of training programs on family caregivers' health-related quality of life (HRQoL) and depressive symptoms over time. Therefore, the purpose of this study was to examine the effects of a home-based caregiver training program on HRQoL and depressive symptoms for family caregivers of older persons with dementia. Outcomes (caregivers' HRQoL and depressive symptoms) were assessed before the training program (baseline), and at 2 weeks, 3 months, and 6 months afterwards. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version. Depressive symptoms were measured using the Chinese version Center for Epidemiologic Studies Depression Scale. Family caregivers who received the individualized home-based training program had better health outcomes in bodily pain (b = 12.37, p < 0.013), role disability due to emotional problems (b = 17.74, p < 0.013), vitality (b = 12.40, p < 0.001), better mental summary score (b = 5.14, p < 0.003), and decreased risk for depression (odds ratio = 0.15, confidence interval = 0.04-0.65, p < 0.013) than those in the control group during the 6 months following the training program. Our home-based caregiver training program improved caregivers' HRQoL, especially role limitations due to emotional problems, and decreased their risk for depression.

Burden and Well-Being Among a Diverse Sample of Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease Caregivers

ContextThree important causes of death in the U.S. (cancer, congestive heart failure, and chronic obstructive pulmonary disease) are preceded by long periods of declining health; often, family members provide most care for individuals who are living with serious illnesses and are at risk for impaired well-being. ObjectivesTo expand understanding of caregiver burden and psychosocial-spiritual outcomes among understudied groups of caregivers—cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers—by including differences by disease in a diverse population. MethodsThe present study included 139 caregiver/patient dyads. Independent variables included patient diagnosis and function; and caregiver demographics, and social and coping resources. Cross-sectional analyses examined distributions of these independent variables between diagnoses, and logistic regression examined correlates of caregiver burden, anxiety, depressive symptoms, and spiritual well-being. ResultsThere were significant differences in patient functioning and caregiver demographics and socioeconomic status between diagnosis groups but few differences in caregiver burden or psychosocial-spiritual outcomes by diagnosis. The most robust social resources indicator of caregiver burden was desire for more help from friends and family. Anxious preoccupation coping style was robustly associated with caregiver psychosocial-spiritual outcomes. ConclusionCaregiver resources, not patient diagnosis or illness severity, are the primary correlates associated with caregiver burden. Additionally, caregiver burden is not disease specific to those examined here, but it is rather a relatively universal experience that may be buffered by social resources and successful coping styles.

Self-efficacy Is Associated With Less Burden and More Gains From Behavioral Problems of Alzheimer's Disease in Hong Kong Chinese Caregivers

To test the effects of different self-efficacy beliefs on caregiver appraisals and depressive symptoms. We hypothesized that self-efficacy has a direct effect on depression while moderating the effects of behavioral problems on both negative (i.e., burden) and positive (i.e., uplifting) appraisals. Ninety-nine Chinese caregivers of relatives with Alzheimer's disease responded to measures of self-efficacy, positive gains, burden, depression, and care recipient behavioral problems. Data were analyzed using confirmatory factor analysis and multiple regression. Confirmatory factor analysis supported a 3-factor structure for the Revised Scale for Caregiving Self-Efficacy (obtaining respite, responding to disruptive behaviors, and controlling upsetting thoughts). Interaction effects in regression showed that caregivers with higher self-efficacy in controlling upsetting thoughts had more positive gains and less burden when confronted with more behavioral problems. Self-efficacy in obtaining respite had direct effects on burden and depression, and self-efficacy in responding to disruptive behaviors had a direct effect on positive gains, but not moderating effects. The results supported the multidimensional structure of caregiver self-efficacy and showed that efficacy in controlling upsetting thoughts was most important in buffering the effects of behavioral problems on burden and positive gains among Chinese caregivers. Interventions for dementia caregivers may be more effective if more emphasis is given on changing negative thoughts.

Patterns of depressive symptoms in caregivers of mechanically ventilated critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge

To examine trajectories of depressive symptoms in caregivers of critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge and explore patient and caregiver characteristics associated with differing trajectories. Longitudinal descriptive study. Medical intensive care unit in a tertiary university hospital. Fifty caregivers and 47 patients on mechanical ventilation for ≥4 days. None. Caregivers completed measures assessing depressive symptoms (Short version Center for Epidemiologic Studies-Depression Scale 10-items), burden (Brief Zarit Burden Interview), and health risk behaviors (caregiver health behaviors) during intensive care unit admission, at intensive care unit discharge, and 2 months postintensive care unit discharge. Group-based trajectory analysis was used to identify patterns of change in shortened Center for Epidemiologic Studies-Depression Scale scores over time. Two trajectory groups emerged: 1) caregivers who had clinically significant depressive symptoms (21.0±4.1) during intensive care unit admission that remained high (13.6±5) at 2 months postintensive care unit discharge (high trajectory group, 56%); and 2) caregivers who reported scores that were lower (10.6±5.7) during intensive care unit admission and decreased further (5.7±3.6) at 2 months postintensive care unit discharge (low trajectory group, 44%). Caregivers in the high trajectory group tended to be younger, female, an adult child living with financial difficulty, and less likely to report a religious background or preference. More caregivers in the high trajectory group reported greater burden and more health risk behaviors at all time points; patients tended to be male with poorer functional ability at intensive care unit discharge. Caregivers' responses during intensive care unit admission did not differ in regard to number of days patients were on mechanical ventilation before enrollment. Findings suggest two patterns of depressive symptom response in caregivers of critically ill adults on mechanical ventilation from intensive care unit admission to 2 months postintensive care unit discharge. Future studies are necessary to confirm these findings and implications for providing caregiver support.

WIC Participation and Attenuation of Stress-Related Child Health Risks of Household Food Insecurity and Caregiver Depressive Symptoms

To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks. Cross-sectional family stress and cumulative stress models from January 1, 2000, through December 31, 2010. Families recruited from emergency departments and/or primary care in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, Philadelphia, and Washington, DC. Participants included 26,950 WIC-eligible caregivers and children younger than 36 months; 55.2% were black, 29.9% were Hispanic, and 13.0% were white. Caregivers' mean age was 25.6 years; 68.6% were US-born, 64.7% had completed high school, 38.0% were married, and 36.5% were employed. Of the participants, 24.0% had household food insecurity and 24.4% had depressive symptoms; 9.1% had both stressors, 29.9% had 1 stressor, and 61.0% had neither; 89.7% were WIC participants. Caregivers reported child health, lifetime hospitalizations, and developmental risk. Weight and length were measured. We calculated weight-for-age and length-for-age z scores and the risk of underweight or overweight. The well-child composite comprised good/excellent health, no hospitalizations, no developmental risk, and neither underweight nor overweight. In multivariate analyses adjusted for covariates, as stressors increased, odds of fair/poor health, hospitalizations, and developmental risk increased and odds of well-child status decreased. Interactions between WIC participation and stressors favored WIC participants over nonparticipants in dual stressor families on 3 child health indicators: (1) fair/poor health: WIC participants, adjusted odds ratio (aOR), 1.89 (95% CI, 1.66-2.14) vs nonparticipants, 2.35 (2.16-4.02); (2) well-child status: WIC participants, 0.73 (0.62-0.84) vs nonparticipants, 0.34 (0.21-0.54); and (3) overweight: WIC participants, 1.01 (0.88-1.16) vs nonparticipants, 1.48 (1.04-2.11) (P = .06). As stressors increased, child health risks increased. WIC participation attenuates but does not eliminate child health risks.

Depressive Symptoms and Diurnal Salivary Cortisol Patterns Among Female Caregivers of Stroke Survivors

Informal caregivers of stroke survivors experience elevated chronic stress and are at risk of developing depressive symptoms. The cumulative effects of chronic stress can increase allostatic load and dysregulate biological processes, thus increasing risk of stress-related disease. Stress-induced alterations in the pattern of cortisol secretion vary with respect to stressor onset, intensity, and chronicity. Little is known about the psychoendocrine response to stress in female caregivers of stroke survivors. The purpose of this study was to examine perceived stress, caregiver burden, and the association between caregiver depressive symptoms and diurnal cortisol in 45 females caring for a significant other who experienced a stroke within the past year. Women completed the Center for Epidemiologic Studies Depression Scale (CES-D) and collected saliva for cortisol upon awakening, 30 min postawakening, noon, and bedtime for 2 consecutive days. Results revealed that women had high levels of perceived stress and caregiver burden. In women with CES-D scores ≥ 16, salivary cortisol levels were significantly lower across the day relative to women with CES-D scores < 16. This difference persisted after adjusting for age, number of caregiving hours per week, perceived social support, and quality of sleep. Younger age was associated with more depressive symptoms as well as lower levels of cortisol at awakening and 30 min postawakening. Results demonstrate that the burden of caregiving increases risk of depressive symptoms and hypocortisolism across the day. Hypocortisolism may contribute to increased risk of depressive symptoms as a result of the loss of glucocorticoid attenuation of stress-induced inflammation.

Anticipatory Grief in New Family Caregivers of Persons With Mild Cognitive Impairment and Dementia

Anticipatory grief is the process of experiencing normal phases of bereavement in advance of the loss of a significant person. To date, anticipatory grief has been examined in family caregivers to individuals who have had Alzheimer disease (AD) an average of 3 to 6 years. Whether such grief is manifested early in the disease trajectory (at diagnosis) is unknown. Using a cross-sectional design, we examined differences in the nature and extent of anticipatory grief between family caregivers of persons with a new diagnosis of mild cognitive impairment (MCI, n=43) or AD (n=30). We also determined whether anticipatory grief levels were associated with caregiver demographics, caregiving burden, depressive symptoms, and marital quality. The mean anticipatory grief levels were high in the total sample, with AD caregivers endorsing significantly more anticipatory grief than MCI caregivers. In general, AD caregivers endorsed difficulty in functioning, whereas MCI caregivers focused on themes of "missing the person" they once knew. Being a female caregiver, reporting higher levels of objective caregiving burden, and higher depression levels each had independent, statistically significant relationships with anticipatory grief. Given these findings, family caregivers of individuals with mild cognitive deficits or a new AD diagnosis may benefit from interventions specifically addressing anticipatory grief.

Depressive symptoms among informal caregivers of older adults: insights from the Singapore Survey on Informal Caregiving

This paper determines care recipient and caregiver characteristics and caregiving dimensions - associated with depression among caregivers of older adults, using path analysis and assesses whether the identified path model differs between spousal and adult child caregivers. Data from 1,190 dyads comprising care recipients (community-dwelling adults aged ≥ 75 years with at least one activity of daily living (ADL) limitation) and caregivers (family member/friend most involved in providing care/ensuring provision of care to care recipient), who were interviewed through the Singapore Survey on Informal Caregiving (2010-2011), were used. Using path analysis, we assessed the direct and indirect associations between primary stressors (care recipient's ADL and instrumental ADL status, and memory and behavior problems), caregiver health status, receipt of assistance from a foreign domestic worker/maid, amount of caregiving, negative reaction to caregiving, caregiver's self-esteem, perceived emotional support, and caregiver depressive symptoms. Our analysis showed that primary stressors, receipt of assistance from a foreign domestic worker/maid, perceived emotional support, and caregiver health status were directly or indirectly associated with caregiver depressive symptoms, and this association was mediated by negative reaction to caregiving. Caregiver self-esteem mediated the relationship between perceived emotional support and negative reaction to caregiving only among adult child caregivers. The results provide insights into factors associated with depressive symptoms among spousal and adult child caregivers, and help identify targeted interventions for improving caregiver mood.

Caregiver burden and depression in mild cognitive impairment.

Little is known about contributors to burden and depression in caregivers of patients with mild cognitive impairment (MCI) even though these patients experience cognitive, emotional, and behavioral changes. We examined caregiver burden and depression in 43 caregivers for patients with MCI as well as their associations with patients' neuropsychological status and behavioral symptoms. Almost 30% of caregivers reported clinically significant burden, whereas <5% reported significant depression. Increased caregiver burden was associated with greater disinhibited behaviors by patients, whereas increased caregiver depressive symptoms were associated with greater disinhibited behaviors as well as instrumental activity of daily living (ADL) impairments. Caregiver burden and depression were not associated with patients' neuropsychological performance. Results suggest these caregivers would benefit from interventions addressing both practical methods to provide ADL assistance and behavioral methods to address inappropriate behaviors in patients in the predementia stages.

Caregiver burden among nocturnal home hemodialysis patients

Recent studies have suggested improvements in quality of life (QOL) in patients on quotidian dialysis compared with conventional hemodialysis. Few studies have focused on the burden and QOL in caregivers of patients with end-stage renal disease (ESRD) on nocturnal home hemodialysis (NHD). We aim to assess the caregivers' burden, QOL, and depressive symptoms and to compare these parameters with their patients' counterparts. Cross-sectional surveys were sent to 61 prevalent NHD patients and their caregivers. Surveys assessed demographics, general self-perceived health using the 12-Item Short Form Health Survey (SF-12) and the presence of depression using the Beck Depression Inventory. Subjective burden on caregivers was assessed by the Caregiver Burden scale and was compared with perceived burden by the patients. Thirty-six patients and 31 caregivers completed the survey. The majority of caregivers were female (66%), spouse (81%) with no comorbid illness (72%). Their mean age was 51 ± 11 years. Patients were mostly male (64%) with a median ESRD vintage of 60 months (interquartile range [IQR], 18-136 months) and a mean age of 52 ± 10 years. Compared to caregivers, patients had lower perceived physical health score but had similar mental health score. Depression criteria were present in 47% of patients and 25% of caregivers. Total global burden perceived by either caregivers or patients is relatively low. Although there is a relatively low global burden perceived by caregivers and patients undergoing NHD, a significant proportion of both groups fulfilled criteria for depression. Further innovative approaches are needed to support caregivers and patients performing NHD to reduce the intrusion of caring for a chronic illness and the risk of developing depression.

Does a Family Meetings Intervention Prevent Depression and Anxiety in Family Caregivers of Dementia Patients? A Randomized Trial

BackgroundFamily caregivers of dementia patients are at increased risk of developing depression or anxiety. A multi-component program designed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers. However, the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated. This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients.MethodsA randomized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients. Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline. Participants were randomized to the family meetings intervention (n = 96) or usual care (n = 96) condition. The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year. Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms (primary outcomes), caregiver burden and quality of life (secondary outcomes). Intention-to-treat as well as per protocol analyses were performed.ResultsA substantial number of caregivers (72/192) developed a depressive or anxiety disorder within 12 months. The intervention was not superior to usual care either in reducing the risk of disorder onset (adjusted IRR 0.98; 95% CI 0.69 to 1.38) or in reducing depressive (randomization-by-time interaction coefficient = −1.40; 95% CI −3.91 to 1.10) or anxiety symptoms (randomization-by-time interaction coefficient = −0.55; 95% CI −1.59 to 0.49). The intervention did not reduce caregiver burden or their health related quality of life.ConclusionThis study did not demonstrate preventive effects of family meetings on the mental health of family caregivers. Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose, when applied for therapeutic purposes or targeted towards subgroups of caregivers.Trial RegistrationControlled-Trials.com ISRCTN90163486

Factors associated with strain in informal caregivers of stroke patients

Stroke is one of the most prevalent causes of adult disability and handicap. Informal caregivers play an important role in poststroke care. However, informal caregivers may experience strain, which threatens the recovery of stroke subjects. This study aimed to describe changes in strain experienced by informal caregivers from 3 to 6 months after the stroke, and identify the predicting factors. We recruited pairs of inpatients with ischemic stroke and informal caregivers from a tertiary referral hospital and interviewed them at 3 and 6 months after the stroke. Caregiver strain was evaluated using the Caregiver Strain Index (CSI), with a CSI ≥ 7 indicating considerable caregiver strain. Various factors associated with caregiver strain were analyzed using generalized estimating equations. Eighty-nine stroke patients and caregivers completed the study. Considerable strain was reported in 46% and 43% of the caregivers at the 3rd and 6th month, respectively. Patient factors such as severe disabilities (Barthel Index ≤ 60), poor cognition (Mini-Mental State Examination ≤ 23), depression (Beck Depression Inventory [BDI] ≥ 10), and recurrent stroke were predictors for caregiver strain. Caregiver factors, such as changed employment status, help from formal caregivers, and depression (BDI ≥ 10) were also associated with considerable caregiver strain. Nearly 50% of caregivers experienced considerable strain. Interventions aimed at reducing the caregivers' strain should focus on enhancing the functional and emotional status of stroke subjects, prevention of recurrent stroke, and efficient management of depression symptoms in caregivers.

The impact of a problem-solving intervention on increasing caregiver assistance and improving caregiver health

There is a paucity of research evaluating the impact of symptom management interventions on increasing family caregiver involvement in symptom management and on caregivers' emotional health. In addition, most caregiver interventions are delivered by a health care professional, which can be costly to implement in clinical practice. The purpose of this study was to determine whether, in patients with solid tumors, a nurse-delivered symptom management intervention was more effective than a coach-led intervention in increasing caregiver involvement in symptom management and improving caregivers' emotional health. Both caregivers and care recipients were recruited for the study. Inclusion criteria for patients were ≥40 years of age, English speaking, cognitively intact, and having a diagnosis of stage III or IV tumor. Dyads were randomized to a nurse-delivered symptom management intervention (N = 88) versus the coach-led group (N = 81). Data were collected via telephone interviews at baseline, 10, and 16 weeks. There was no significant main effect of the problem-solving intervention on symptom assistance at 10 weeks, but there were two significant interactions, between trial arm and depressive symptoms and between baseline assistance with symptoms and relationship to the patient. Caregivers with lower depressive symptoms were more likely (OR = 1.99, 95% CI = 1.45-2.76) to provide assistance at 10 weeks if they received the nurse-delivered intervention. Spousal (versus non-spouses) caregivers who provided assistance at baseline were less likely to provide assistance at 10 weeks (OR = 0.58, 95% CI 0.36-0.94). No significant trial arm effects were found on caregiver emotional health, but assistance with greater number of symptoms was associated with worse caregiver depressive symptoms (p < 0.01) and burden (impact on schedule, p < 0.01). Findings suggest that a nurse-delivered problem-solving intervention increases family caregivers' level of assistance in symptom management for caregivers with lower levels of depressive symptoms. Data also suggest interventions focused solely on care recipient symptom management may not be effective in improving caregivers' emotional health.

The importance of assessing for depression with HRQOL in treatment seeking obese youth and their caregivers

The purpose of this manuscript is to (1) explore the health-related quality of life (HRQOL) of youth attending a tertiary obesity treatment center compared to healthy population reference data; (2) compare the congruence between the HRQOL of youth self-reports and caregiver proxy reports; and (3) examine the associations between youth HRQOL and (a) teen and (b) caregiver depression. The sample included 267 youth and caregiver dyads. A cross-sectional descriptive design was used. Analyses included paired t tests, analyses of variance, correlations, and Chi-square cross-tabulations. Overweight youth reported significantly (P<0.001) lower scores than a previously published healthy sample on all totals and subscales of the PedsQL. For younger overweight children and caregivers, there was closer agreement on social (r=0.45) and emotional functioning (r=0.32); whereas teens and caregivers agreed most on school functioning (r=0.47) and emotional functioning (r=0.44). Regardless of age, youth and caregivers disagreed most on physical functioning. Caregivers who reported higher depressive symptoms had less agreement with their child on their perceived HRQOL; however, teens with more depressive symptoms had stronger agreement with their caregivers on their previewed HRQOL. Based on our findings, there is not consistent agreement between youth and caregiver perceptions of youth HRQOL domains (physical, emotional, social, and school) and inconsistency in age groups (children and teens). Depressive symptoms in caregivers and teens can provide mechanistic insights into youth and caregiver HRQOL congruence. These findings underscore the importance of a comprehensive biopsychosocial assessment when providing treatment to overweight youth and their families.

Gender differences in sexual behaviors of AD patients and their relationship to spousal caregiver well-being

Objectives: Little is known about gender differences in sexuality among community-dwelling heterosexual couples in which one partner has Alzheimer's disease (AD). Few studies have examined gender differences in specific sexual behaviors or their associations with caregiver well-being. This study evaluated the impact of gender differences on intimacy and sexual satisfaction in marital relationships in which one partner has AD. Method: Baseline measures were collected from 162 AD patients and their partners enrolled in a multi-site study between 2001 and 2009 to evaluate gender differences in measures of intimacy, caregiver well-being, and patient sexual behaviors. Results: While over 70% of all patients initiated physically intimate activities (i.e., kissing, hugging, and intercourse), most did not initiate intercourse specifically. Female caregivers reported higher levels of stress and depressive symptoms than male caregivers (p < 0.01). Satisfaction with intimacy was significantly associated with fewer stress and depressive symptoms in female caregivers (r = −0.29, p < 0.01). Caregiver gender, satisfaction with intimacy, and caring for a patient with mild AD were significant predictors of caregiver depressive symptoms (p's < 0.05). Conclusion: The majority of couples dealing with AD reported engaging in intimacy, suggesting its importance in the relationship. Female caregivers who reported less sexual satisfaction reported more frequent stress and depressive symptoms. Caregiver gender, satisfaction with intimacy, and the AD patient's level of cognitive functioning significantly contributed to caregiver well-being. Gender-specific therapies to address patient sexual difficulties and caregiver well-being could potentially maintain or improve the marital relationship.

Effects of the TCARE(R) Intervention on Caregiver Burden and Depressive Symptoms: Preliminary Findings From a Randomized Controlled Study

We examined the effects of a manualized care management protocol specifically designed for care managers working with caregivers, the Tailored Caregiver Assessment and Referral® (TCARE®) protocol, on caregiver identity discrepancy, burden, and depressive symptoms. Preliminary data from a longitudinal, randomized, controlled intervention study with 266 family caregivers served by 52 care managers in 4 states were analyzed using repeated measures random effects regression procedures. Caregivers in the intervention and control groups were repeatedly assessed for up to 9 months on caregiver identity discrepancy, 3 areas of caregiving burden-objective, relationship, and stress burdens; depression; and intention for nursing home placement. We found significant group by time interaction effects for caregiver identity discrepancy, relationship burden, stress burden, depression, and intention for nursing home placement. Caregivers in the intervention group experienced significant improvement on these measures, whereas caregivers in the control group worsened on these measures over time. The preliminary findings provide strong support for effectiveness of the TCARE® protocol on improving caregiver well-being and mental health outcomes.

450 Depressive Symptomatology in Care-Givers of Patients with Alzheimer Diseases

Background: The stress and strain of being an Alzheimer's caregiver can cause physical and mental problems. Nearly half of all Alzheimer's caregivers report that they have suffered from depression at some point, according to the Alzheimer’s Association. The objective of this study was to identify depressive symptoms in caregivers of patients with Alzheimer’s disease. Method: A descriptive study was carried out in the Department of psychiatry, Pakistan Institute of Medical Sciences (PIMS), Islamabad from May 2010 to September 2010. Thirty caregivers participated in the study. Informed written consent was obtained. The Beck Depressive Inventory (BDI) was used. Results: 57 % of caregivers met criteria for depression. The females scored more on the depressive scale compared to males (Female = 73 %, Male = 40 %). Conclusion: Female caregivers are more prone to depression. Caring for the carer is as important as caring for the individual with Alzheimer’s disease.

Subjective experiences of family caregivers of patients with dementia as predictive factors of quality of life

The aim of the present study was to investigate predictive factors of quality of life (QOL) in home caregivers of patients with dementia. A total of 118 home caregivers (48 male, 70 female) were asked to complete the World Health Organization (WHO) Quality of Life 26 (WHO/QOL-26) questionnaire, the Pines Burnout Measure (BM), and the Beck Depression Inventory, second edition (BDI-II). Patient demographics and clinical data regarding cognitive impairment, neuropsychiatric symptoms, and dementia severity were obtained from medical records. Spearman rank correlation coefficients revealed that caregiver QOL was significantly correlated with patients' neuropsychiatric symptoms (r=-0.19; P < 0.05), as well as depressive symptoms (r=-0.59, P < 0.01) and burnout (r=-0.59, P < 0.01) in caregivers. Stepwise multiple regression analysis revealed that depressive symptoms in caregivers was the strongest predictor for caregiver QOL (R(2) = 0.37, P < 0.001) and that caregiver QOL was best predicted by the combination of depressive symptoms, burnout, and the cognitive impairment of patients (R(2) = 0.46, P < 0.05). The results of the present study demonstrate that subjective experiences of caregivers are more strongly correlated with caregiver QOL than patient-related variables and are thus powerful determinants of caregiver QOL. These findings suggest that caregiver intervention, which aims to increase QOL, may benefit from the incorporation of strategies to reduce depressive symptoms and burnout.