2205Caregivers with persistent depressive symptoms are at high risk of having poor health status over 1 year of caregiving
Authors: Chung M L , Lee S J , Moser D K , King R B 
Published: October 2019

Abstract

Background
Depressive symptoms are a substantial psychological problem in caregivers of stroke survivors, but there is limited knowledge about the trajectory of depressive symptoms and the consequence in longitudinal study. The purposes of this study were to (1) identify patterns for trajectory of depressive symptoms in caregivers who provided caregiving for stroke survivors for 1 year post-discharge, and (2) examine associations of depressive symptom trajectories with caregivers' burden, family function, social support, and health status over time.

Methods
In this secondary analysis of a longitudinal study, caregivers of stroke survivors completed a survey at post-discharge and 1 year follow up. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression scale (CES-D). Caregiving burden, family function, and social support were assessed using the Zarit Burden Interview, the Family Assessment Device, and the Interpersonal Support Evaluation List. Health status was assessed using two items from the SF-36. Pattern of depressive symptom trajectory (i.e., symptom-free, symptom improved, symptom developed, and persistent symptom) were identified by the presence of depressive symptoms (CES-D ≥16) at post-discharge and 1 year follow up. ANOVA, and multinomial logistic regression were used.

Results
Of the 102 caregivers (mean age=58 years, 66% female), 32.4% experienced depressive symptoms at post-discharge; 30.4% experienced depressive symptoms at 1-year follow up. During the first year of the caregiving experience, 57.8% of caregivers were symptom-free but 20.6% experienced persistent depressive symptoms; 11.8% had improved depressive symptoms, and 9.8% developed depressive symptoms. Caregivers with persistent depressive symptoms reported the highest level of burden (p<0.001), and the lowest levels of family function (p=0.02) and interpersonal support (p=0.0001) among the 4 groups at post-discharge and the results were unchanged at 1 year follow up. Furthermore, 33% of caregivers with persistent depressive symptoms reported their health as fair or poor at 1 year follow up and 42% of them reported their health became worse at 1 year follow up. Caregivers who developed depressive symptoms had the 2nd lowest score of interpersonal support (p=0.047) at 1 year follow up. Compared to symptom-free caregivers, caregivers with persistent depressive symptoms were 7 times more likely to have fair or poor health at 1 year follow up (95% CI, 1.55–32.87, p=0.012).

Conclusions
Trajectory of depressive symptoms was associated with caregiving burden, family function, and interpersonal support. The persistence of depressive symptoms is substantial for caregivers of stroke survivors and they are at high risk to have poor health status at 1 year of caregiving. Management of depressive symptoms at the early caregiving stage may be beneficial to prevent the development and persistence of depressive symptoms in caregivers of stroke survivors.

Acknowledgement/Funding
National Institute for Nursing Research R01NR02416