Huo Zhaohua, Yip Benjamin Hon-Kei, Lee Allen Ting-Chun, Cheng Sheung-Tak, Chan Wai Chi, Fung Ada Wai-Tung, Ma Suk Ling, Cheng Calvin Pak-Wing, Lai Frank Ho-Yin, Wong Samuel Yeung-Shan, Lam Linda Chiu-Wa
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
BMC Geriatr. 2025 Jul 14;25(1):524. doi: 10.1186/s12877-025-06147-6.
Psychological distress is common in family caregivers of individuals with neurocognitive disorders (NCDs). This study examined the prevalence of suicidal ideation in this population, and explored the moderating role of positive aspects of caregiving (PAC) in mitigating such severe psychological difficulties.
445 older adults (NCDs: 322, normal cognition: 123) and their family caregivers were recruited from the population-based Hong Kong Mental Morbidity Survey for Older Persons. Caregivers' suicidal ideation was screened by positive response to Item 9 of the Patient Health Questionnaire-9: thoughts of being better off dead or self-harm in the past two weeks. PAC were measured using a validated scale. A conceptual model was developed to test the mediation and moderation effects among caregiving burden, psychological distress, suicidal ideation, and PAC.
Nearly one in ten (9%) dementia caregivers reported suicidal ideation in the past two weeks. Higher prevalence was observed among female carers, those with comorbid mood disorders, and those caring for individuals with high comorbidity or functional dependence. Psychological distress significantly mediated the relationship between caregiving burden and suicidal ideation (80.5%, p = 0.023). PAC moderated this pathway: higher levels of PAC were associated with reduced suicidal ideation among carers with moderate-to-high caregiving burden (p < 0.05). However, a rebound in suicidal ideation was observed in caregivers experiencing both high burden and high PAC.
Suicidal ideation among NCD caregivers is closely linked to caregiving burden and psychological distress. PAC plays a complex and non-linear moderating role in this relationship. Psychological intervention that strengthens PAC should be integrated into comprehensive caregiver support programmes, particularly for those experiencing high burden and high distress.
心理困扰在神经认知障碍（NCD）患者的家庭照料者中很常见。本研究调查了该人群中自杀意念的患病率，并探讨了照料积极方面（PAC）在缓解此类严重心理困难中的调节作用。
从基于人群的香港老年人心智健康调查中招募了445名老年人（患有NCD的322人，认知正常的123人）及其家庭照料者。通过对患者健康问卷-9第9项的肯定回答来筛查照料者的自杀意念：在过去两周内有不如死了或自我伤害的想法。使用经过验证的量表测量PAC。建立了一个概念模型来测试照料负担、心理困扰、自杀意念和PAC之间的中介和调节作用。
近十分之一（9%）的痴呆症照料者报告在过去两周内有自杀意念。在女性照料者、患有共病情绪障碍的照料者以及照料合并症多或功能依赖程度高的患者的照料者中，患病率更高。心理困扰显著介导了照料负担与自杀意念之间的关系（80.5%，p = 0.023）。PAC调节了这一途径：较高水平的PAC与中高照料负担的照料者自杀意念减少相关（p < 0.05）。然而，在经历高负担和高PAC的照料者中观察到自杀意念反弹。
NCD照料者的自杀意念与照料负担和心理困扰密切相关。PAC在这种关系中起复杂的非线性调节作用。应将增强PAC的心理干预纳入全面的照料者支持计划，特别是针对那些经历高负担和高困扰的人。
