Department of Social and Behavioral Health, Massey Cancer Center, School of Medicine, Virginia Commonwealth University, VA 23298, USA.
Psychooncology. 2010 Dec;19(12):1285-93. doi: 10.1002/pon.1696.
This study investigated depressive symptomatology in lung cancer patients and their identified caregiver.
We conducted semi-structured interviews and administered measures of family environment, depressive symptomatology, and the extent to which the caregiver blamed the cancer on the patient not having taken better care of him/herself to 190 patient-caregiver dyads. Multivariate two-level models were used to estimate the unique effects for each dyad member and cross-partner effects while controlling for interdependencies in the data.
More than half the patients (55%) were male, whereas 74% of caregivers were female. The majority (57.4%) were spouses, followed by offspring, and other family or friends. The baseline model with covariates showed that younger caregivers, spouse caregivers, and caregivers who blamed the patient for the cancer had higher depressive symptom scores. When examining the unique effect for each dyad member, with the exception of patient report of familial conflict, patient and caregiver reports of lower familial cohesion and expressiveness and higher conflict were associated with higher depression scores for patient and caregiver, respectively. When examining cross-partner effects, patient reports of lower cohesion, lower expressiveness, and greater conflict were associated with higher caregiver depression scores. Offspring caregivers reported less depression than non-offspring caregivers.
The family environment and blaming the patient during times of illness can affect both patient and caregiver depression. Findings suggest that quality of the family dynamic is important for patients, but may be particularly influential for caregivers. Future research should aid clinicians' assessment of family environment when making treatment plans.
本研究调查了肺癌患者及其指定照顾者的抑郁症状。
我们对 190 对患者-照顾者进行了半结构化访谈，并进行了家庭环境、抑郁症状以及照顾者将癌症归咎于患者没有更好地照顾自己的程度的测量。使用多变量两层模型来估计每个对偶成员的独特效应和交叉伙伴效应，同时控制数据的相关性。
超过一半的患者（55%）为男性，而 74%的照顾者为女性。大多数（57.4%）是配偶，其次是子女，以及其他家庭或朋友。带有协变量的基线模型显示，年轻的照顾者、配偶照顾者和将癌症归咎于患者的照顾者的抑郁症状评分较高。当检查每个对偶成员的独特效应时，除了患者报告的家庭冲突外，患者和照顾者报告的家庭凝聚力和表达力较低以及冲突较高分别与患者和照顾者的抑郁评分较高相关。当检查交叉伙伴效应时，患者报告的凝聚力、表达力较低以及冲突较大与照顾者的抑郁评分较高相关。子女照顾者的抑郁程度低于非子女照顾者。
家庭环境和在患病期间归咎于患者会影响患者和照顾者的抑郁。研究结果表明，家庭动态的质量对患者很重要，但对照顾者可能更具影响力。未来的研究应有助于临床医生在制定治疗计划时评估家庭环境。
