Predictors of Depressive Symptoms among Family Caregivers of Patients with Dementia in Java, Indonesia

Authors

DOI:

https://doi.org/10.33192/Smj.2021.71

Keywords:

Depressive symptoms, dementia, caregiver, burden, social support

Abstract

Objective: Depressive symptoms are common mental health problems among the family caregivers of patients with dementia. However, little is known about the prevalence of depressive symptoms among the family caregivers of patients with dementia in Indonesia. This study aimed to examine: 1) the factors predicting depressive symptoms, 2) the mediating role of social support in the relationship between burden and depressive symptoms, and 3) the association between depressive symptoms and healthcare utilization among family caregivers.
Materials and Methods: This was a cross-sectional study involving 250 family caregivers of patients with dementia recruited from four hospitals in Java, Indonesia. Data were collected by Zarit Burden Interview (ZBI); the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Mastery scale, the Multidimensional Scale of Perceived Social Support, and the Center for Epidemiologic Studies Depression (CES-D) Scale. Descriptive statistics, chi-square test, hierarchical multiple linear regression, and Baron and Kenny's regression method were used to analyze the data.
Results: The results revealed that about a quarter of the participants (24.8%) experienced depressive symptoms. Caregiver burden, mastery, behavioral and psychological symptoms of dementia, and social support explained 45.5% of the variance in the prevalence of depressive symptoms among family caregivers (R2=0.455). Social support also partially mediated the association between caregiver burden and depressive symptoms. There was no association between depressive symptoms and the use of healthcare services among the family caregivers.
Conclusion: The findings revealed that social support is a mediating factor affecting the relationship between caregiver burden and depressive symptoms. Interventions targeting social support to help alleviate caregiver burden would be effective in helping reduce depressive symptoms in the family caregivers of patients with dementia.

References

Alzheimer’s Disease International. Dementia statistics | Alzheimer’s Disease International [Internet]. Alzheimer’s Disease International. 2016 [cited 2020 Sep 21]. p. 1. Available from: https://www.alz.co.uk/research/statistics

Alzheimer’s Indonesia. Statistik tentang Demensia - Alzheimer Indonesia. Yayasan Alzheimer Indonesia, 2019.

National Institute on Aging. What Is Dementia? Symptoms, Types, and Diagnosis [Internet]. National Institute on Aging. 2017 [cited 2020 Oct 25]. Available from: https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

World Health Organization. Dementia [Internet]. World Health Organization. 2020 [cited 2020 Oct 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia

Kim MH, Dunkle RE, Lehning AJ, Shen HW, Feld S, Perone AK. Caregiver stressors and depressive symptoms among older husbands and wives in the United States. J Women Aging 2017;29:494–504.

Sallim A Bin, Sayampanathan AA, Cuttilan A, Chun-Man Ho R. Prevalence of Mental Health Disorders Among Caregivers of Patients With Alzheimer Disease. J Am Med Dir Assoc 2015;16:1034–41.

Joling KJ, Van Marwijk HWJ, Veldhuijzen AE, Van Der Horst HE, Scheltens P, Smit F, et al. The two-year incidence of depression and anxiety disorders in spousal caregivers of persons with dementia: Who is at the greatest risk? Am J Geriatr Psychiatry 2015;23:293–303.

Bremer P, Cabrera E, Leino-Kilpi H, Lethin C, Saks K, Sutcliffe C, et al. Informal dementia care: Consequences for caregivers’ health and health care use in 8 European countries. Health Policy (New York) 2015;119:1459–71.

Vitaliano PP, Murphy M, Young HM, Echeverria D, Borson S. Does caring for a spouse with dementia promote cognitive decline? A hypothesis and proposed mechanisms. J Am Geriatr Soc 2011;59:900–8.

O’Dwyer ST, Moyle W, Zimmer-Gembeck M, De Leo D. Suicidal ideation in family carers of people with dementia: a pilot study. Int J Geriatr Psychiatry 2013;28:1182–8.

Zhu CW, Scarmeas N, Ornstein K, Albert M, Brandt J, Blacker D, et al. Health-care use and cost in dementia caregivers: Longitudinal results from the Predictors Caregiver Study. Alzheimer’s Dement 2015;11:444–54.

Pearlin LI, Mullan JT, Semple SJ, Skaff MM. Caregiving and the stress process: An overview of concepts and their measures. Gerontologist 1990;30:583–94.

Omranifard V, Haghighizadeh E, Akouchekian S. Depression in Main Caregivers of Dementia Patients: Prevalence and Predictors. Adv Biomed Res 2018;7:1–5.

Alfakhri AS, Alshudukhi AW, Alqahtani AA, Alhumaid AM, Alhathlol OA, Almojali AI, et al. Depression among caregivers of patients with dementia. Inq (United States) 2018;55:4–9.

Zhong Y, Wang J, Nicholas S. Social support and depressive symptoms among family caregivers of older people with disabilities in four provinces of urban China: The mediating role of caregiver burden. BMC Geriatr 2020;20(1):1–10.

De Fazio P, Ciambrone P, Cerminara G, Barbuto E, Bruni A, Gentile P, et al. Depressive symptoms in caregivers of patients with dementia: Demographic variables and burden. Clin Interv Aging 2015;10:1085–90.

Piercy KW, Fauth EB, Norton MC, Pfister R, Corcoran CD, Rabins PV., et al. Predictors of dementia caregiver depressive symptoms in a population: The cache county dementia progression study. Journals Gerontol - Ser B Psychol Sci Soc Sci 2013;68:921–6.

Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry 1999;14:936–40.

World Health Organization. The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. ICD-10 Classif Ment Behav Disord Diagnostic criteria Res. 1993;xiii+248p.

Huang CY, Sousa VD, Perng SJ, Hwang MY, Tsai CC, Huang MH, et al. Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer’s disease. J Clin Nurs 2009;18:502–11.

Knofczynski GT, Mundfrom D. Sample sizes when using multiple linear regression for prediction. Educ Psychol Meas 2008;8:431–42.

Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist 1980;20:649–55.

Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000;12:233–9.

Pearlin LI, Schooler C. The Structure of Coping. J Health Soc Behav 1978;19:2–21.

Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess 1988;52:30–41.

Radloff LS. The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Appl Psychol Meas 1977;1:385–401.

Baron RM, Kenny DA. The Moderator-Mediator Variable Distinction in Social Psychological Research. Conceptual, Strategic, and Statistical Considerations. J Pers Soc Psychol 1986;51:1173–82.

Arai Y, Kumamoto K, Mizuno Y, Washio M. Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: A large-scale population-based study in Japan. Aging Ment Heal 2014;18:81–91.

Huang SS, Liao YC, Wang WF. Association between caregiver depression and individual behavioral and psychological symptoms of dementia in Taiwanese patients. Asia-Pacific Psychiatry 2015;7:251–9.

Pillemer S, Davis J, Tremont G. Gender effects on components of burden and depression among dementia caregivers. Aging Ment Health 2018;22:1156–61.

Kristanti MS, Effendy C, Utarini A, Vernooij-Dassen M, Engels Y. The experience of family caregivers of patients with cancer in an Asian country: A grounded theory approach. Palliat Med 2019;33:676–84.

Bejjani C, Snow AL, Judge KS, Bass DM, Morgan RO, Wilson N, et al. Characteristics of Depressed Caregivers of Veterans with Dementia. Am J Alzheimers Dis Other Demen 2015;30:672–8.

Lou Q, Liu S, Huo YR, Liu M, Liu S, Ji Y. Comprehensive analysis of patient and caregiver predictors for caregiver burden, anxiety and depression in Alzheimer’s disease. J Clin Nurs 2015;24:2668–78.

Miller VJ, Killian MO, Fields N. Caregiver identity theory and predictors of burden and depression: Findings from the REACH II study. Aging Ment Heal 2018;24:212–20.

Chan EY, Glass G, Chua KC, Ali N, Lim WS. Relationship Between Mastery and Caregiving Competence in Protecting Against Burden, Anxiety and Depression Among Caregivers of Frail Older Adults. J Nutr Heal Aging 2018;22:1238–45.

Strom JL, Egede LE. The Impact of social support on outcomes in adult patients with type 2 diabetes: A systematic review. Curr Diab Rep 2012;12:769–81.

Díaz M, Estévez A, Momene J, Ozerinjauregi N. Social support in the relationship between perceived informal caregiver burden and general health of female caregivers. Ansiedad y Estrés www.el. 2019;25:20–7. DOI: 10.1016/j.anyes.2019.04.001

Pandis N. The chi-square test. Am J Orthod Dentofac Orthop 2016;150:898–9.

George PP, Heng BH, De Castro Molina JA, Wong LY, Wei Lin NC, Cheah JTS. Self-reported chronic diseases and health status and health service utilization - Results from a community health survey in Singapore. Int J Equity Health 2012;11:1–7.

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Published

01-08-2021

How to Cite

Yossie Susanti Eka Putri, Sitthimongkol, Y., Wirojratana, V. ., & Chansatitporn, N. . (2021). Predictors of Depressive Symptoms among Family Caregivers of Patients with Dementia in Java, Indonesia. Siriraj Medical Journal, 73(8), 549–558. https://doi.org/10.33192/Smj.2021.71

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Original Article