Associations between cognitive impairment in advanced cancer patients and psychiatric disorders in their caregivers.

OBJECTIVE

This study examined whether cognitive impairment in advanced cancer patients is associated with a heightened frequency of psychiatric disorders in their primary caregivers.

METHODS

Three hundred fifty-six patient-caregiver dyads were interviewed and administered the Short Portable Mental Status Questionnaire and the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition approximately 3.4 months before the patient's death. The Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition was administered to caregivers again approximately 6 months after the patient's death.

RESULTS

Forty-six (12.9%) patients displayed signs of mild cognitive impairment at the baseline interview. After adjustment for relevant confounders, patient cognitive impairment was significantly associated with caregiver pre-loss major depressive disorder [OR 6.88 (95% CI 1.32-35.92); p = 0.02], without associated increases in suicidality. There were no significant associations between patient cognitive impairment and caregiver pre-loss generalized anxiety disorder, posttraumatic stress disorder, panic disorder, or grief. Likewise, there were no significant associations between patient cognitive impairment and caregiver post-loss psychiatric disorders, but caregivers of cognitively impaired patients appeared to be less satisfied with the patient's manner of death (p = 0.01).

CONCLUSIONS

Caregivers of cognitively impaired advanced cancer patients appear at heightened risk of major depression that resolves after the patient's death. Further study with a larger sample and more sensitive longitudinal cognitive measures is indicated.