Symptoms of depression in caregivers may predict future health problems

Caregivers of stroke survivors who show signs of depression may have a higher risk of suffering their own health challenges down the line, according to research presented today at ESC Congress 2019 together with the World Congress of Cardiology.

The findings highlight the importance of attending to the mental health of caregivers and bring to mind the airline-safety metaphor: 'Secure your own oxygen mask before helping someone else.'

"Caregiving is becoming more common and more demanding," says study first author Professor Misook L. Chung of the University of Kentucky College of Nursing in the United States. "More attention needs to be paid, especially early on, to managing depressive symptoms in caregivers. They must realise that self-care is not selfish."

Stroke is a leading cause of long-term disability around the world and often exerts a heavy toll on those in a supporting position. Providing assistance to patients, including helping the survivor with eating, dressing, going to the bathroom and showering, not to mention taking care of meals, organizing a home and supervising medical care, can become a full-time job—with a deep emotional component.

The current project is the first longitudinal study to address the issue of persistent depressive symptoms and their effect on physical health as well as changes in health during the first year of stroke caregiving.

The research team enrolled 102 caregivers with a mean age of 58. Two-thirds were female and about 70% were spouses. The rest consisted of other family members, although two or three were family friends, says study senior author Rosemarie King, a retired research professor at Northwestern University School of Medicine in Chicago, Illinois, USA.

Participants answered questionnaires at two points in time: six to ten weeks after the patient was discharged from the hospital and again one year later.

The overall proportion of individuals reporting symptoms of depression like poor appetite or trouble focusing, declined slightly over the course of the study: 32.4% versus 30.4 More than half the participants (57.8%) said they had no issues of mental distress at all, but 20.6% (or one in five) suffered persistent depressive symptoms in the first year of caregiving.

The mental health of people with chronic signs of depression was closely associated with their physical health. One-third of caregivers in the study reported their physical health as fair or poor after one year, while 43% said they felt their health had deteriorated. Compared to caregivers who did not have signs of depression, those with ongoing challenges were seven times more likely to report problems with their health after one-year of caregiving for stroke survivors.

Individuals with persistent symptoms of depression during the first year of caregiving reported heavier caregiving duties, poor family functioning and low interpersonal support.

One limitation of the study is that the researchers did not track primary health outcomes such as diagnoses of physical illness. Instead, they relied on self-reports of caregivers' health status and changes in health status. There was also a high attrition rate, with a third of study participants dropping out. Longer-term studies, with objective measures of caregiver health status, are required.

The conclusions suggest the need for earlier interventions and long-term follow-up of caregivers.

"We haven't paid enough attention to caregivers' health," stresses Prof Chung. "Self-care intervention programmes should include depressive symptom management for caregivers."

A pilot study conducted by Prof Chung found benefits in a more holistic approach incorporating stress management and self-care management for caregivers. "Cognitive behavioural therapy has shown promise, as have interventions that teach caregivers how to better manage patients' and their own emotions", she concluded.