Regular Research Article
The Two-Year Incidence of Depression and Anxiety Disorders in Spousal Caregivers of Persons with Dementia: Who is at the Greatest Risk?

https://doi.org/10.1016/j.jagp.2014.05.005Get rights and content

Objective

Caregivers of persons with dementia play an important and economically valuable role within society, but many may do so at a considerable cost to themselves. Knowing which caregivers have the highest risk of developing a mental disorder may contribute to better support of ultra-high-risk groups with preventive interventions. This study aims to describe the incidence of depression and anxiety disorders in caregivers and to identify its significant predictors.

Design

Prospective cohort study with a follow-up of 24 months.

Participants

181 spousal caregivers of persons with dementia without a clinical depression or anxiety disorder at baseline.

Setting

Memory clinics, case management services, and primary care settings in the Netherlands.

Measurements

The onset of depression and anxiety was measured every 3 months with the MINI International Neuropsychiatric Interview, a structured diagnostic instrument for DSM-IV mental disorders. Potential predictors were assessed at baseline.

Results

60% of the caregivers developed a depressive and/or anxiety disorder within 24 months: 37% a depression, 55% an anxiety disorder, and 32% both disorders. Sub-threshold depressive symptoms (Wald χ2 = 6.20, df = 1, OR: 3.2, 95% CI: 1.28–8.03, p = 0.013) and poor self-reported health of the caregiver (Wald χ2 = 5.56, df = 1, OR: 1.17, 95% CI: 1.03–1.34, p = 0.018) at baseline were significant predictors of disorder onset.

Conclusion

Spousal caregivers of persons with dementia have a high risk to develop a mental disorder. Indicators related to the caregiver's (mental) health rather than environmental stressors such as patient characteristics or interruption of caregivers' daily activities predict disorder onset and can be used to identify caregivers for whom supporting preventive interventions are indicated.

Section snippets

Design and Setting

Data were derived from the Family Meetings study (FAME). The design of the FAME study has been described elsewhere.12, 13 Briefly, FAME tested the (cost-) effectiveness of a family meetings intervention aimed at preventing the onset of mental disorders in family caregivers of persons with dementia in The Netherlands. Data for 192 dyads of family caregivers and their relatives with dementia living at home at intake were collected during 24 months. Participants were recruited from memory clinics

Study Sample

Participants were recruited from November 2007 to November 2009. The baseline characteristics of the study sample are described in Table 1. A flow chart of the study sample and missing measurement points is presented in Figure 1. The 84 caregivers with missing outcome data on at least one follow-up assessment were caring more often for a patient with Alzheimer disease compared with other dementias than the caregivers with complete follow-up data (Wald χ2 = 4.90, df = 1, odds ratio [OR]: 1.98,

Main Findings

In this study, over the course of two years, 60% of the family caregivers developed a depressive and/or anxiety disorder. Incident anxiety disorders were more frequent than depressive disorders. This shows that many spouses provided care at a considerable cost to themselves. Caregiver sub-threshold depressive symptoms and poor self-reported health at baseline predicted the onset of a depressive and/or anxiety disorder as well as the onset of these disorders separately. If caregivers of patients

Conclusion

In conclusion, a majority of the spousal caregivers developed a depression and/or an anxiety disorder within two years. Although it is already known that caring for a dementia patient appears to be a very stressful type of caregiving compared with patients with other illnesses,42 this very high incidence underscores the extreme vulnerability of this group. The specific demands that dementia poses on the caregiver such as being “on duty” 24 hours a day and the fact that caregiving for dementia

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