Department of International Business, Soochow University, Taipei, Taiwan, ROC.
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC.
J Pain Symptom Manage. 2021 Oct;62(4):699-708. doi: 10.1016/j.jpainsymman.2021.03.018. Epub 2021 Mar 29.
Family caregivers' distinct depressive-symptom trajectories are understudied and have been examined independently during end-of-life (EOL) caregiving or bereavement, making it difficult to validate two competing hypotheses (wear-and-tear vs. relief) of caregiving effects on bereavement. Existing studies may also miss short-term heterogeneity in depressive symptoms during the immediate postloss period due to lengthy delays in the first postloss assessment.
This secondary-analysis study examined distinct depressive-symptom trajectories for caregivers of advanced cancer patients from EOL caregiving through the first 2 bereavement years with closely spaced assessments.
Depressive symptoms were measured monthly during EOL caregiving and 1, 3, 6, 13, 18, and 24 months postloss among 661 caregivers using the Center for Epidemiologic Studies-Depression scale. Depressive-symptom trajectories were identified using latent-class growth analysis while controlling for gender and age.
We identified seven distinct depressive-symptom trajectories (prevalence) characterized by the timing, intensity, and duration of depressive symptoms: minimal-impact resilience (20.4%), recovery (34.0%), preloss-grief only (21.6%), delayed symptomatic (9.1%), relief (5.9%), prolonged symptomatic (6.5%), and chronically persistent distressed (2.5%).
Caregivers of advanced cancer patients responded heterogeneously to the stresses of EOL caregiving and bereavement. The majority of caregivers was resilient while providing caregiving and quickly rebounded to healthy levels of psychological functioning during bereavement, whereas a minority experienced delayed-symptomatic, prolonged-symptomatic, or chronically-persistent-distressing depressive-symptom trajectories. Linking caregivers' psychological experiences from caregiving through bereavement by closely spaced assessments can more comprehensively illustrate their depressive-symptom trajectories, which confirm both the wear-and-tear and relief hypotheses, and help in targeting interventions for distinct depressive-symptom trajectories.
家庭照顾者明显的抑郁症状轨迹研究不足，并且在临终关怀或丧亲期间分别进行了研究，这使得验证照顾对丧亲的两种竞争假说（磨损与缓解）变得困难。由于在首次丧亲后评估中存在较长的延迟，现有研究也可能错过了丧失后立即出现的抑郁症状的短期异质性。
本二次分析研究通过密切间隔的评估，检查了晚期癌症患者临终关怀期间至第一个丧亲后 2 年期间照顾者的不同抑郁症状轨迹。
使用流行病学研究中心抑郁量表（Center for Epidemiologic Studies-Depression scale），在 661 名照顾者中，每月评估临终关怀期间和丧亲后 1、3、6、13、18 和 24 个月的抑郁症状。通过潜在类别增长分析，同时控制性别和年龄，确定抑郁症状轨迹。
我们确定了七种不同的抑郁症状轨迹（患病率），其特点是抑郁症状的发生时间、强度和持续时间：最小影响的恢复力（20.4%）、恢复（34.0%）、仅预丧期悲伤（21.6%）、延迟症状性（9.1%）、缓解（5.9%）、持续症状性（6.5%）和慢性持续困扰（2.5%）。
晚期癌症患者的照顾者对临终关怀和丧亲的压力反应不同。大多数照顾者在提供护理时具有恢复力，并在丧亲期间迅速恢复到健康的心理功能水平，而少数照顾者则经历了延迟症状性、持续症状性或慢性持续困扰性抑郁症状轨迹。通过密切间隔的评估将照顾者的心理体验从临终关怀到丧亲联系起来，可以更全面地说明他们的抑郁症状轨迹，这既证实了磨损和缓解假说，也有助于针对不同的抑郁症状轨迹进行干预。
