Caregivers Need Sustained Support against Depression

Summarized by Robert W. Griffith, MD
June 3, 2005

Introduction

Members of the family who care for Alzheimer's patients are at great risk of developing depression. This risk persists even after caregiving ends with the death of the patient. Although it's obvious that psychological support would benefit such caregivers, it's not always easy to get this paid for under most medical payment systems. Moreover, some caregivers may resist, saying they don't need support, or that it wouldn't do any good. A study published in the American Journal of Psychiatry provides the necessary evidence that shows the need for this kind of assistance. Here's a summary of the study.

What was done

The participants, located in the New York area, were spouses of Alzheimer's patients who had primary responsibility for the patient's care. The patients were living at home with their caregiver at baseline. There were two enrollment phases - 206 spouses were recruited between 1987 and 1990, and another 200 between 1991 and 1996.

After assessment at baseline, the caregivers were randomly assigned to one of two groups. The first group received special psychosocial counseling and support, and the other group received the usual care offered to caregivers at the University Alzheimer's Disease Center.

All the caregivers were interviewed every 4 months during the first year and every six months after that. They were followed for 2 years after the patient's death.

The special counseling given to the first group consisted of two individual and four family-group sessions (without the patient); the sessions included education about the disease and how to communicate within the family effectively. After this, these caregivers were encouraged to join a support group that met weekly. Additional counseling was available on an as-needed basis.

Depression was assessed in every participant at baseline, and again at every follow-up visit, using the Geriatric Depression Scale (similar to the self-test we have on this site - see the first link below).

What was found

At baseline, the average age of the participants was 71; they consisted of 244 wives and 162 husbands. The wives had higher baseline depression scores than the husbands; 43% of the caregivers overall had scores suggestive of possible clinical depression. Only 7% of the caregivers voluntarily dropped out of the study during follow-up, which averaged 3.1 years.

In the first year of the study, there was a gradual decrease in the symptoms of depression in the group of caregivers receiving the special counseling, while there was an increase in the usual-care group. By the end of the first year, only 30% of the special counseling group had scores suggesting clinical depression, compared with 45% of those getting usual care.

During years 2 to 5 the difference between the two groups decreased. The percentage of people with depression in the special counseling group fell further - it was 26% at year 3 and 27% at year 5 - but so did that in the usual-care group - 32% at year 3, and 30% at year 5. Depressive symptoms decreased significantly after nursing home placement or death of the patient, but the special counseling group continued to experience a beneficial effect even after these events.

What this means

Clearly, specialized counseling and support is effective in improving depression in caregivers for Alzheimer's patients. But a more important finding in this study was the high frequency of depression in these caregivers.

It's not uncommon for caregivers to be offered counseling and support at the time of diagnosis of Alzheimer's, or if a crisis occurs. If the first opportunity is missed, it may be harder to achieve benefit when this support is only instituted in an emergency.

It's also important to ensure that psychosocial support is continued throughout the patient's illness and after its resolution (death or nursing home placement). Further studies will clarify if the regime used (a short period of intensive counseling followed by readily available supportive maintenance) is the ideal, or if another approach can produce equally good results.

Source

• Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. MS. Mittelman, DL. Roth, DW. Coon, WE. Haley, Am J Psychiatry, 2004, vol. 161, pp. 8850--8856

Related Links
A Test for Depression in Older People
How To Talk With The Doctor About Alzheimer's
The Hidden Cost of Caregiving

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