Kurtz M E, Kurtz J C, Given C W, Given B
Department of Family Medicine, Michigan State University, East Lansing 48824, USA.
Support Care Cancer. 1997 Jan;5(1):53-60. doi: 10.1007/BF01681962.
The present study investigated two aspects of the sequelae of recent bereavement among family caregivers following the death of their cancer patient: (1) the extent to which depressive symptomatology among family caregivers measured following the death of their patient could be predicted by their levels of depressive symptomatology in the months prior to death, their physical health, the setting in which the patient's death occurred, patient age, gender of the caregiver, consanguinity, financial stress, social support from family and friends during the terminal stage, impact of caregiving activities on caregiver's daily schedule, caregiver optimism, perceived esteem attributed to caregiving, the time between the prebereavement assessment and death, and the time between death and the postbereavement assessment; and (2) whether these same explanatory variables could successfully differentiate those bereaved caregivers whose psychological health improved during the first 3 months following bereavement from those who did not improve. A sample of 114 family caregivers of cancer patients were surveyed for approximately 3 months before and 3 months after the death of their patient. A multivariate analysis of variance using the regression approach was undertaken to determine the primary predictors of postbereavement depressive symptomatology. In addition, a logistic regression analysis was used to attempt to predict those caregivers whose depressive symptomatology would improve during the postbereavement period. Critical factors in determining levels of postbereavement depressive symptomatology were caregiver optimism, prebereavement depressive symptomatology, and levels of social support from friends. Caregiver optimism and prebereavement depressive symptomatology were important in predicting whether caregivers' depressive symptomatology would improve or not. Physicians must be aware that if the social history of a patient reveals that he/ she is anticipating or has recently experienced the loss of a family member for whom they were the primary caregiver, this information may be critical in determining whether the illness behavior exhibited by the patient has medical or psychosocial origins.
（1）患者去世后所测量的家庭照顾者抑郁症状的程度，能否通过其在患者去世前几个月的抑郁症状水平、身体健康状况、患者死亡的环境、患者年龄、照顾者性别、血缘关系、经济压力、临终阶段来自家人和朋友的社会支持、照顾活动对照顾者日常安排的影响、照顾者的乐观情绪、对照顾的感知尊重、丧亲前评估与死亡之间的时间，以及死亡与丧亲后评估之间的时间来预测；（2）这些相同的解释变量能否成功区分丧亲后前3个月心理健康状况改善的照顾者与未改善的照顾者。对114名癌症患者的家庭照顾者在其患者去世前约3个月和去世后3个月进行了调查。采用回归方法进行多变量方差分析，以确定丧亲后抑郁症状的主要预测因素。此外，使用逻辑回归分析来尝试预测那些在丧亲后抑郁症状会改善的照顾者。决定丧亲后抑郁症状水平的关键因素是照顾者的乐观情绪、丧亲前的抑郁症状以及朋友的社会支持水平。照顾者的乐观情绪和丧亲前的抑郁症状对于预测照顾者的抑郁症状是否会改善很重要。医生必须意识到，如果患者的社会史显示他/她预期或最近经历了其作为主要照顾者的家庭成员的死亡，那么这些信息对于确定患者表现出的疾病行为是源于医学还是心理社会因素可能至关重要。
