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Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan

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Abstract

Purpose

The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents’ family caregivers in Taiwan.

Methods

Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression.

Results

The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds = 0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds = 3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident’s main caregiver before admission.

Conclusion

These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers’ priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.

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References

  1. Amer MM, Hovey JD (2012) Anxiety and depression in a post-September 11 sample of Arabs in the USA. Soc Psychiatry Psychiatr Epidemiol 47(3):409–418

    Article  PubMed  Google Scholar 

  2. American Psychological Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th edn (Text Revision)

  3. Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med 40:77–84

    Google Scholar 

  4. Bertrand RM, Fredman L, Saczynski J (2006) Are all caregivers created equal? Stress in caregivers to adults with and without dementia. J Aging Health 18:534–551

    Article  PubMed  Google Scholar 

  5. Boey WK (1999) Cross-validation of a short form of the CES-D in Chinese elderly. Int J Geriatr Psychiatry 14:608–617

    Article  PubMed  CAS  Google Scholar 

  6. Chou YC, Wang CY, Lin LC (2007) Caregiving burden and social Support of older female caregivers in Taiwan—elderly caregivers among aging adults with intellectual disabilities and mental illness. Ministry of the Interior Report, Taipei

    Google Scholar 

  7. Dempsey NP, Pruchno RA (1993) The family’s role in the nursing home: predictors of technical and nontechnical assistance. J Gerontol Soc Work 21:127–145

    Article  Google Scholar 

  8. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  9. Fu CC, Lee YM, Chen JD (2003) Association between depressive symptoms and twelve-year mortality among elderly in a rural community in Taiwan. J Formos Med Assoc 102:234–239

    PubMed  Google Scholar 

  10. Gaugler JE, Leitsch SA, Zarit SH, Pearlin LI (2000) Caregiver involvement following institutionalization: effects of preplacement stress. Res Aging 22:337–359

    Article  Google Scholar 

  11. Gaugler JE, Anderson KA, Zarit SH, Pearlin LI (2004) Family involvement in nursing homes: effects on stress and well-being. Aging Ment Health 8:65–75

    Article  PubMed  CAS  Google Scholar 

  12. Gaugler JE, Pot AM, Zarit SH (2007) Long-term adaptation to institutionalization in dementia caregivers. Gerontologist 47:730–740

    Article  PubMed  Google Scholar 

  13. Gaugler JE, Mittelman MS, Hepburn K, Newcomer R (2009) Predictors of change in caregiver burden and depressive symptoms following nursing home admission. Psychol Aging 24:385–396

    Article  PubMed  Google Scholar 

  14. Hair J, Black W, Babin B, Anderson R, Tatham R (2006) Multivariate data analysis, 6th edn. Pearson Prentice Hall, Upper Saddle River

    Google Scholar 

  15. Hsieh SJ, Cheng WHP (2005) The influencing factors of caregiving for the functionally disabled elderly in Taiwan: 1989–1999. Taiwan J Soc Welf 4:177–219

    Google Scholar 

  16. Joling KJ, Hout HP, Scheltens P, Vernooy-Dassen MJ, Berg B, Bosmans J, Gillissen F, Mittelman M, Marwijk HW (2008) (Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial. BMC Geriatr 8:2

    Google Scholar 

  17. Juratovac E (2009) Effort in caregiving and its relationship to caregiver depressive symptoms (Doctoral dissertation, Case Western Reserve University). Available from ProQuest Dissertations & Theses database, AAT 3368061

    Google Scholar 

  18. Lee AE, Chokkanathan S (2008) Factor structure of the 10-item CES-D scale among community dwelling older adults in Singapore. Int J Geriatr Psychiatry 23:592–597

    Article  PubMed  Google Scholar 

  19. Lee MD, Grace J, Li H (2004) Cultural role expectation and attachment style among Taiwanese intergenerational caregivers of cognitively impaired aging relatives. Paper presented at the International Sigma Theta Tau 15th International Nursing Research Congress, Dublin, Ireland, July 2004

  20. Levy-Storms L, Miller-Martinez D (2005) Family caregiver involvement and satisfaction with institutional care during the 1st year after admission. J Appl Gerontol 24:160–174

    Article  Google Scholar 

  21. Lin LC, Wang TG, Chen MY, Wu SC, Portwood MJ (2005) Depressive symptoms in long-term care residents in Taiwan. J Adv Nurs 51:30–37

    Article  PubMed  Google Scholar 

  22. Lin PC, Wang HH, Huang HT (2007) Depressive symptoms among older residents at nursing homes in Taiwan. J Clin Nurs 16:1719–1725

    Article  PubMed  Google Scholar 

  23. Mahoney FI, Barthel DW (1965) Functional evaluation: The Barthel Index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  24. Majerovitz SD (2007) Predictors of burden and depression among nursing home family caregivers. Aging Ment Health 11:323–329

    Article  PubMed  Google Scholar 

  25. Mathers CD, Sadana R, Salomon JA, Murray CJL, Lopez AD (2000) Estimates of DALE for 191 countries: methods and results. Geneva, Switzerland. World Health Organization (Global Programme on Evidence for Health Policy Discussion Paper No. 16)

  26. Pinquart M, Sorensen S (2003) Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol 58:112–128

    Article  Google Scholar 

  27. Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  28. Ramírez García JI, Hernández B, Dorian M (2009) Mexican American caregivers’ coping efficacy: associations with caregivers’ distress and positivity to their relatives with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 44(2):162–170

    Article  PubMed  Google Scholar 

  29. Schreiner AS, Morimoto T, Arai Y, Zarit S (2006) Assessing family caregiver’s mental health using a statistically derived cut-off score for the Zarit Burden Interview. Aging Ment Health 10:107–111

    Article  PubMed  CAS  Google Scholar 

  30. Schulz R, Belle SH, Czaja SJ, McGinnis KA, Stevens A, Zhang S (2004) Long-term care placement of dementia patients and caregiver health and well-being. JAMA 292:961–967

    Article  PubMed  CAS  Google Scholar 

  31. Schulz R, Williamson GM (1991) A 2-year longitudinal study of depression among Alzheimer’s caregivers. Psychol Aging 6:569–578

    Article  PubMed  CAS  Google Scholar 

  32. Sherwood PR, Given CW, Given BA, Von Eye A (2005) Caregiver burden and depressive symptoms: analysis of common outcomes in caregivers of elderly patients. J Aging Health 17:125–147

    Article  PubMed  Google Scholar 

  33. Sheu S (1997) Filial Piety (Hsiao) and filial caregiving Experiences of Chinese families in the San Francisco Bay Area. University of California, San Francisco (Unpublished doctoral dissertation)

  34. Suominen K, Isometsa E, Lonnqvist J (2004) Elderly suicide attempters with depression are often diagnosed only after the attempt. Int J Geriatr Psychiatry 19:35–40

    Article  PubMed  Google Scholar 

  35. Tsai HH, Tsai YF (2010) Older nursing home residents’ experiences with videoconferencing to communicate with family members. J Clin Nurs 19:1538–1543

    Article  PubMed  Google Scholar 

  36. Tsai HH, Tsai YF, Wang HH, Chang YC, Chu HH (2010) Videoconference program enhances social support, loneliness, and depressive status of elderly nursing home residents. Aging Ment Health 14:947–954

    Article  PubMed  Google Scholar 

  37. Tsai HH, Tsai YF (2012) Family members’ perceived meaning of visiting nursing home residents in Taiwan. J Adv Nurs 68:302–311

    Article  PubMed  Google Scholar 

  38. Tsai HH, Tsai YF, Huang TS (2012) Development and validation of the family meaning of nursing-home visits scale. J Clin Nurs 21:2108–2117

    Article  PubMed  Google Scholar 

  39. Tsai YF, Chung JWY, Wong TKS, Huang CM (2005) Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong. Int J Geriatr Psychiatry 20:315–321

    Article  PubMed  Google Scholar 

  40. Whitlatch CJ, Schur D, Noelker LS, Ejaz FK, Looman WJ (2001) The stress process of family caregiving in institutional settings. Gerontologist 41:462–473

    Article  PubMed  CAS  Google Scholar 

  41. World Health Organization (2010) ICD-10 Vol 2 Instruction Manual. Retrieved January 1, 2013, from http://www.who.int/classifications/icd/en/

  42. Zhang B, Mitchell SL, Bambauer KZ, Jones R, Prigerson HG (2008) Depressive symptom trajectories and associated risks among bereaved Alzheimer disease caregivers. Am J Geriatr Psychiatry 16:145–155

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was funded by the National Science Council, an agency of the Taiwan government (NSC 98-2314-B-182-055-MY2).

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Authors and Affiliations

  1. School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan

    Hsiu-Hsin Tsai & Yun-Fang Tsai

  2. Department of Nursing, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Yun-Fang Tsai

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  1. Hsiu-Hsin Tsai
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  2. Yun-Fang Tsai
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Correspondence to Yun-Fang Tsai.

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Tsai, HH., Tsai, YF. Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan. Soc Psychiatry Psychiatr Epidemiol 48, 1145–1152 (2013). https://doi.org/10.1007/s00127-013-0652-8

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  • DOI: https://doi.org/10.1007/s00127-013-0652-8

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