Gonçalves-Pereira Manuel, Marques Maria J, Alves Regina F, Jelley Hannah, Wolfs Claire, Meyer Gabriele, Bieber Anja, Irving Kate, Hopper Louise, Zanetti Orazio, Portolani Daniel M, Selbaek Geir, Røsvik Janne, Sköldunger Anders, Sjölund Britt-Marie, de Vugt Marjolein, Verhey Frans, Woods Bob
NOVA Medical School | Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, CHRC, Associated Laboratory REAL (LA-REAL); Lisboa, Portugal.
National School of Public Health, Universidade NOVA de Lisboa, CHRC, Associated Laboratory REAL (LA-REAL), Lisboa, Portugal.
J Affect Disord. 2025 Mar 15;373:1-11. doi: 10.1016/j.jad.2024.12.078. Epub 2024 Dec 21.
Sense of coherence (SOC) is a disposition to perceive things as comprehensible, manageable and meaningful. Lower SOC is associated with subjective burden and psychological morbidity in family caregivers, including in dementia. However, the evidence-base mainly comprises small-scale or cross-sectional studies. More should be known about SOC stability, causal relationships, and international contexts. We aimed to study longitudinal links between dementia caregivers' SOC, subjective burden, and anxiety and depression symptoms in a multinational sample.
We analyzed the EU-Actifcare cohort (451 dyads of community-dwelling people with mild-moderate dementia and their caregivers). Caregivers' assessments included: SOC scale, Relatives' Stress Scale, Hospital Anxiety and Depression Scale. A cross-lagged panel model was used to investigate associations between these measures at baseline, 6 and 12-month follow-ups, controlling for covariates.
Caregivers' subjective burden, anxiety and depression symptoms increased over time, SOC remaining overall stable. Considering the first six-month follow-up, we found bidirectional relationships between SOC and subjective burden, and SOC and anxiety symptoms, while lower SOC predicted depression symptoms but not vice versa. For the remaining follow-up period, both anxiety and depression symptoms predicted lower SOC but not vice versa.
Convenience sampling precludes full generalizability.
This large longitudinal study shed more light on interplays between SOC, subjective burden and mental health outcomes in dementia caregivers. Findings were consistent with SOC potential protective role against burden and psychological morbidity. However, they also supported reverse causality regarding part of the associations. Caregivers' SOC levels may be directly influenced by subjective burden and psychological morbidity.
连贯感（SOC）是一种将事物视为可理解、可掌控且有意义的倾向。较低的连贯感与家庭照料者的主观负担和心理疾病相关，包括痴呆症照料者。然而，证据基础主要由小规模或横断面研究组成。关于连贯感的稳定性、因果关系以及国际背景，还有更多需要了解的地方。我们旨在研究多国样本中痴呆症照料者的连贯感、主观负担与焦虑和抑郁症状之间的纵向联系。
我们分析了欧盟积极照护队列（451对患有轻度至中度痴呆症的社区居民及其照料者）。照料者的评估包括：连贯感量表、亲属压力量表、医院焦虑和抑郁量表。采用交叉滞后面板模型来研究这些测量指标在基线、6个月和12个月随访时的关联，并控制协变量。
照料者的主观负担、焦虑和抑郁症状随时间增加，而连贯感总体保持稳定。考虑到前六个月的随访，我们发现连贯感与主观负担之间、连贯感与焦虑症状之间存在双向关系，而较低的连贯感预测了抑郁症状，但反之不然。在其余的随访期内，焦虑和抑郁症状都预测了较低的连贯感，但反之不然。
便利抽样妨碍了完全的普遍性。
这项大型纵向研究更深入地揭示了痴呆症照料者的连贯感、主观负担和心理健康结果之间的相互作用。研究结果与连贯感对负担和心理疾病的潜在保护作用一致。然而，它们也支持了部分关联的反向因果关系。照料者的连贯感水平可能直接受到主观负担和心理疾病的影响。
