Abstract

Unpaid caregivers providing care to persons with dementia have been identified as a group at elevated risk for depression. The purpose of the study was to investigate the association between physical health and depressive symptoms among unpaid caregivers over a five-year period. Caregivers' physical health was found to be a predictor of depressive symptomatology five years later. The study highlights the potential negative impact on the health care system if the mental health of unpaid caregivers of persons with cognitive impairment is in fact deteriorating as a result of their roles as caregivers. Background: Unpaid caregivers providing care to persons with dementia have been identified as a group at elevated risk for depression. The prevalence of clinical depression among unpaid caregivers of persons with dementia is estimated to be 76% higher compared to community-dwelling older adults. Caregivers may be vulnerable to detrimental outcomes in both physical and mental health for several reasons including the chronic and escalating care demands of those with cognitive impairment, reduced economic means, and social isolation. The purpose of the study was to investigate the association between physical health and depressive symptoms among unpaid caregivers over a five-year period. Understanding this association is an essential clinical and social policy objective.

Methods: A longitudinal study was conducted involving both care recipients and unpaid caregivers. Older adults with dementia were screened using a Modified Mini-Mental State Examination. Caregivers were identified as those who are most responsible for day-to-day decisions regarding care. Caregivers were administered a series of interviews in order to measure patient illness characteristics and caregiver variables. Patient illness characteristics were measured using various scales. The results obtained from these measures as well as from the clinical examination were used to diagnose the severity of patient dementia. Caregiver variables were measured using interviews containing questions related to level of burden and perceived caregiver health problems, and a depression scale. These were measured at the beginning of the study, and again five years later.

Findings: Caregivers' physical health, measured at the onset of the study, was found to be a predictor of depressive symptomatology five years later. However, depressive symptoms measured during the initial stages of the study do not seem to be a predictor of physical health five years later. In both analyses, sociodemographic variables of caregivers, patient illness characteristics, and caregivers' health at baseline were controlled.

Conclusions: An association was found between physical illness and depression symptoms among caregivers of persons with cognitive impairment. Additional studies must be conducted to gain further knowledge as to why physical illness predicts depressive symptomatology, whereas the opposite does not seem to hold true. The study highlights the potential negative impact on the health care system if the mental health of unpaid caregivers of persons with cognitive impairment is in fact deteriorating as a result of their roles as caregivers.

Reference: O'Rourke, N, Cappeliez, P, Guindon, S. Depressive Symptoms and Physical Health of Caregivers of Persons With Cognitive Impairment: Analysis of Reciprocal Effects Over Time. Journal of Aging and Health 2003; 15(4), Nov: 688-712.