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Depression linked to premature health decline in cancer caregivers
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Depression predicted the premature physical health decline of cancer caregivers, according to study results.
Thus, depressive symptoms should be assessed and addressed early in the cancer survivorship trajectory, according to the researchers.
“Prior research had shown that caregivers report higher distress than the general population and that caregivers are at risk for premature disease development relative to noncaregivers,” Kelly M. Shaffer, PhD, postdoctoral research fellow in the department of psychiatry and behavioral sciences at Memorial Sloan Kettering Cancer Center, told HemOnc Today. “Better understanding how these phenomena interrelate was important to targeting interventions to the most vulnerable caregivers so we might reduce these health disparities.”
Shaffer and colleagues evaluated data from 664 caregivers (mean age, 53.2 years) from 34 states who participated in a nationwide study at 2, 5 and 8 years after a family member’s cancer diagnosis. At each timepoint, caregivers self-reported physical health levels using the 12-items Medical Outcomes Study Short Form Health Survey, in which higher scores reflect better physical health (U.S. population normalized score, M = 50).
At the first timepoint, caregivers also reported possible predictors of later physical health, including age, sex, education, employment status and household income. They provided information on stress using the Stress Overload subscale of the Pearlin Stress Scale, esteem using the Caregiver Esteem subscale of the Caregiving Reaction Assessment, social support using the Interpersonal Support Evaluation List, and depressive symptoms using the Center for Epidemiology Studies Depression scale.
Researchers also used medical records to evaluate the patients’ cancer stage, type and severity.
Two years after the cancer patient’s diagnosis, caregivers reported slightly better physical health than the U.S. population (M = 51.22; P = .0022). However, researchers observed physical health decline from this timepoint to year 8 (Mslope = –0.27; P < .001). On average, caregivers’ physical health declined an average of one-quarter point per year (M = –0.27; 95% CI, –0.41 to –0.12).
Depressive symptoms were the only significant predictor of more rapid physical health decline (B = –.0.02; P = .004).
“Our finding that elevated depressive symptoms was the only predictor of caregivers’ physical health decline, of the many psychosocial factors studied, was quite striking to me,” Shaffer said. “Although adverse effects of depression on physical health have been well documented in the general population, these findings clearly demonstrate the importance of depression specifically to caregivers’ premature physical health decline.”
Conversely, initial health 2 years postdiagnosis appeared related to several factors. Those who were older, men, not the patient’s spouse and unemployed, and who had a high school education or less and a household income less than $40,000 reported poorer physical health.
Caregiving stress appeared to be the only psychosocial factor related to lower initial health.
“Family caregivers are a critical member of the patient’s health care team, and acknowledgement of their essential and challenging role from oncology health care providers can go a long way,” Shaffer said. “Validating the challenges of the role, and encouraging the family caregiver to access support, and providing a list of known resources within the provider’s hospital and community will help caregivers care for themselves alongside their loved one.”
Additional research should identify strategies to screen caregivers for depression to connect those in need with psychosocial services, Shaffer added. – by Alexandra Todak
For more information:
Kelly M. Shaffer, PhD, can be reached at Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 541 Lexington Ave., 7th Floor, New York, NY 10022; email: shafferk@mskcc.org.
Disclosure: The researchers report no relevant financial disclosures.
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