D'Aoust Rita F, Brewster Glenna, Rowe Meredeth A
College of Nursing, University of South Florida, Tampa, FL, USA.
Int J Older People Nurs. 2015 Mar;10(1):14-26. doi: 10.1111/opn.12043. Epub 2014 Jan 17.
Worldwide, there are more than 35 million individuals diagnosed with Alzheimer's disease. Many of these individuals are cared for at home by unpaid caregivers who often report high levels of depressive symptoms and depression. The majority of studies conducted to predict which caregivers are at risk for depression have examined non-modifiable risk factors. Therefore, it is important to discover modifiable factors that may be associated with risk for depression in caregivers.
The aims of this research were to identify a set of factors that are modifiable and known to be associated with high levels of depression/depressive symptomology (D/DS) in other populations and to determine whether these factors are predictive of D/DS after controlling for non-modifiable, demographic, and clinical factors.
Secondary data analysis.
Fifty-three participants provided direct care to a person with dementia with night-time activity. Inclusion criteria included not undergoing treatment for sleep disorders; living with the care recipient; and a Mini-Mental Status Exam score > 27. Baseline data collected by questionnaires, sleep diary and actigraphy.
In multivariate analyses of the modifiable factors, only high levels of negative affect predicted higher levels of depressive symptomatology. When non-modifiable factors were included in the model, negative affect and high levels of perceived caregiver burden predicted 52.6% of the variance in depressive symptomology. In secondary analyses, wake after sleep onset misperception was associated with higher depression scores.
While negative affect had a moderate effect on depressive symptoms, modifiable factors often associated with depressive symptoms in other studies were not associated with caregiver depression in this study. Possibly caregivers' overall poor sleep causes a floor effect and masks a potential relationship.
Both caregivers' affect and perceived burden are strongly related to depressive symptoms, so healthcare practitioners need to frequently assess both so as to provide timely interventions.
在全球范围内，有超过3500万人被诊断患有阿尔茨海默病。这些人中的许多由无薪照料者在家中照顾，而这些照料者经常报告有高水平的抑郁症状和抑郁症。为预测哪些照料者有患抑郁症风险而进行的大多数研究都考察了不可改变的风险因素。因此，发现可能与照料者患抑郁症风险相关的可改变因素很重要。
本研究的目的是识别一组在其他人群中可改变且已知与高水平抑郁/抑郁症状（D/DS）相关的因素，并确定在控制了不可改变的人口统计学和临床因素后，这些因素是否能预测D/DS。
二次数据分析。
53名参与者为一名有夜间活动的痴呆患者提供直接照料。纳入标准包括未接受睡眠障碍治疗；与受照料者同住；简易精神状态检查表得分>27。通过问卷、睡眠日记和活动记录仪收集基线数据。
在对可改变因素的多变量分析中，只有高水平的消极情绪能预测更高水平的抑郁症状。当模型中纳入不可改变因素时，消极情绪和高水平的照料者负担感知可预测抑郁症状52.6% 的变异。在二次分析中，睡眠起始后觉醒误判与更高的抑郁得分相关。
虽然消极情绪对抑郁症状有中等程度影响，但在本研究中，其他研究中常与抑郁症状相关的可改变因素与照料者抑郁无关。可能照料者总体睡眠不佳导致了下限效应并掩盖了潜在关系。
照料者的情绪和负担感知都与抑郁症状密切相关，因此医疗从业者需要经常对两者进行评估，以便及时提供干预措施。
