Chang Cheng-Chen, Wang Wen-Fu, Li Yi-Ying, Chen Yu-An, Chen Yen-Jen, Liao Yi-Cheng, Jhang Kai-Ming, Wu Hsin-Hung
Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.
Risk Manag Healthc Policy. 2021 Jul 12;14:2953-2963. doi: 10.2147/RMHP.S316361. eCollection 2021.
The purpose of this study was to identify the caring scenarios that result in severe depression in caregivers caring for dementia patients.
A cross-sectional study with 1111 dementia patients and their caregivers in Taiwan from October 2015 to January 2020 was conducted. Gender, age, type of dementia, clinical dementia rating, walking ability, mood symptoms, behavioral symptoms, and psychological symptoms were the variables from the dementia patients. Age, relation to the patient, employment, type of primary care, frequency of care, mood symptoms, and the score from the Center for Epidemiologic Studies Depression Scale were the variables from the caregivers. A comprehensive viewpoint of both dementia patients and their caregivers was evaluated by the Apriori algorithm to find the attributes resulting in different caregiving depressions.
Forty-seven rules were found with 18 rules of mild depressive symptomatology, 17 rules of moderate depressive symptomatology, and 12 rules of severe depressive symptomatology. A total of 7 general rules were summarized to be the severe depressive symptomatology. The results showed that an unemployed or retired caregiver with the mood symptoms such as helplessness, anger, emotional liability, or anxiety who took care of AD patients or AD patients with a moderate severity would have severe depression. Increased care frequencies (≥6 days per week) and multiple mood problems from caregivers result in severe depression. The composition of adult children, patients' aggression, and caregivers' helplessness as well as the combinations of male patients aged 75-84 years with the caregiver's mood of helplessness or nervousness and hopelessness were highly associated with severe depression.
For those caring for AD patients, severe depression was associated with the combination of different parameters to constitute each of these seven scenarios. Unlike previous studies which often evaluated one or two variables related to caregiver's depression, this study provided a more comprehensive viewpoint that enabled the collaborative team to efficiently identify and manage different scenarios by summarizing the rules of caregivers with severe depression from a systematic viewpoint.
本研究旨在确定导致照顾痴呆患者的照料者出现重度抑郁的照护情景。
对2015年10月至2020年1月期间台湾地区的1111名痴呆患者及其照料者进行了一项横断面研究。痴呆患者的变量包括性别、年龄、痴呆类型、临床痴呆评定、行走能力、情绪症状、行为症状和心理症状。照料者的变量包括年龄、与患者的关系、就业情况、主要照护类型、照护频率、情绪症状以及流行病学研究中心抑郁量表的得分。通过Apriori算法从痴呆患者及其照料者的综合视角进行评估，以找出导致不同照护抑郁情况的属性。
共发现47条规则，其中18条为轻度抑郁症状规则，17条为中度抑郁症状规则，12条为重度抑郁症状规则。共总结出7条一般规则为重度抑郁症状。结果显示，失业或退休的照料者，若存在无助、愤怒、情绪易激惹或焦虑等情绪症状，且照料的是阿尔茨海默病（AD）患者或中度严重程度的AD患者，会出现重度抑郁。照料频率增加（每周≥6天）以及照料者出现多种情绪问题会导致重度抑郁。成年子女的构成、患者的攻击性、照料者的无助感，以及75 - 84岁男性患者与照料者无助或紧张及绝望情绪的组合与重度抑郁高度相关。
对于那些照料AD患者的人来说，重度抑郁与构成这七种情景的不同参数组合有关。与以往通常评估一两个与照料者抑郁相关变量的研究不同，本研究提供了一个更全面的视角，使协作团队能够通过从系统角度总结重度抑郁照料者的规则，有效地识别和管理不同情景。
