Graduate School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
Psychooncology. 2013 Dec;22(12):2702-10. doi: 10.1002/pon.3334. Epub 2013 Jun 13.
The course of caregivers' depressive symptoms may not be homogenous. This study identified trajectories of depressive symptoms among caregivers providing end-of-life care to cancer patients and profiled the unique characteristics of caregivers within each trajectory.
Trajectories of depressive symptoms were explored in 447 caregivers who completed the Center for Epidemiological Studies Depression Scale over four periods close to the patient's death (1-30, 31-90, 91-180, and >180 days). Distinct trajectories were identified by latent class analysis.
Four trajectories were identified as endurance, resilience, moderately symptomatic, and chronically distressed and contained 32.0%, 11.4%, 36.9%, and 19.7% of the sample, respectively. Caregivers in the endurance trajectory were relatively well-adjusted individuals with less education, adequate financial support, and ample psychological resources but provided care to older patients with greater symptom distress. They perceived less subjective caregiving burden than caregivers with moderate or chronic depressive symptoms. Caregivers in the resilience trajectory were in a more vulnerable position than those in other trajectories when they first transitioned into the caregiving role because they were more likely to be the patient's spouse, have greater educational attainment and insufficient finances, provide higher intensity assistance to a younger relative, and have weaker psychological resources. However, they were older, reported greater confidence in caregiving, and perceived less caregiving burden than caregivers in other trajectories. The moderately symptomatic and chronically distressed trajectories were differentiated only by the strength of psychological resources.
Caregivers of terminally ill cancer patients follow distinct depressive-symptom trajectories while providing end-of-life care.
照顾者的抑郁症状过程可能并不相同。本研究确定了为癌症临终患者提供护理的照顾者的抑郁症状轨迹，并分析了每个轨迹中照顾者的独特特征。
对 447 名照顾者进行了研究，他们在患者死亡前后的四个时期（1-30 天、31-90 天、91-180 天和>180 天）完成了《流行病学研究中心抑郁量表》。通过潜在类别分析确定了不同的轨迹。
确定了四种轨迹，分别为：耐力、韧性、中度症状和慢性困扰，分别包含样本的 32.0%、11.4%、36.9%和 19.7%。处于耐力轨迹的照顾者是相对适应良好的个体，教育程度较低，经济支持充足，心理资源丰富，但照顾的是症状困扰更大的老年患者。他们感知到的主观照顾负担比中度或慢性抑郁症状的照顾者少。处于韧性轨迹的照顾者在最初过渡到照顾角色时比其他轨迹中的照顾者处于更脆弱的地位，因为他们更有可能是患者的配偶，教育程度更高但资金不足，为更年轻的亲属提供更高强度的帮助，并且心理资源较弱。然而，他们年龄较大，对照顾更有信心，感知到的照顾负担比其他轨迹中的照顾者少。中度症状和慢性困扰轨迹仅在心理资源的强度上有所区别。
在为癌症临终患者提供护理时，照顾者的抑郁症状表现出不同的轨迹。
