Preloss Psychosocial Resources Predict Depressive Symptom Trajectories Among Terminally Ill Cancer Patients' Caregivers in Their First Two Years of Bereavement

Abstract

Context. Postloss depressive symptom trajectories are heterogeneous and predicted by preloss psychosocial resources, but this evidence was from one old study on caregivers of patients with terminal cancer for whom these issues are highly relevant. Objectives. To identify depressive symptom trajectories among cancer patients' bereaved caregivers and examine if they are predicted by preloss psychosocial resources while considering caregiving burden. Methods. Preloss psychosocial resources (sense of coherence and social support) were measured among 282 caregivers. Depressive symptoms were measured by the Center for Epidemiological StudieseDepression scale at one, three, six, 13, 18, and 24 months after loss (Center for Epidemiological StudieseDepression scores $16 indicate severe depressive symptoms). Distinct depressive symptom trajectories and their predictors were identified by latent-class growth analysis. Results. We identified five depressive symptom trajectories (prevalence): endurance (47.2%), resilience (16.7%), transient reaction (20.2%), prolonged symptomatic (11.7%), and chronically distressed (4.2%). Over two years after loss, the endurance group never experienced severe depressive symptoms. Severe depressive symptoms lasted six, seven to 12, and 18 months for the resilience, transient-reaction, and prolonged-symptomatic groups, respectively. The chronically distressed group's severe depressive symptoms persisted. The endurance and chronically distressed groups had the best and weakest psychological resources, respectively. Endurance-group caregivers perceived the greatest social support, whereas the resilience and transient-reaction groups had higher social support than the prolonged-symptomatic group. Conclusions. Most (84.1%) caregivers' depressive symptoms subsided within one year after loss. Preloss psychosocial resources predicted depressive symptom trajectories for bereaved caregivers. Health care professionals can help caregivers adjust their bereavement by providing support to enhance their sense of coherence and encouraging social contacts while they are providing end-of-life care.

The Expert Caregiver Intervention Targeting Former Caregivers in Finland: A Co-Design and Feasibility Study Using Mixed Methods

“…A future study with a larger group of participants should continue to assess the effects on well-being outcomes and analyse whether this type of intervention is more suitable for certain subgroups of individuals with experience of informal caregiving. Previous research on former caregivers in general suggests that the post-caregiving experiences and outcomes may depend on, amongst other things, the characteristics of the past caregiving situation such as pre-loss levels of social support [ 8 , 9 ], pre-loss levels of depressive symptoms [ 7 , 9 ], and whether the care recipient died in the preferred setting [ 44 ].…”

“…Given the high prevalence of informal caregivers throughout Europe [ 2 , 6 ], a considerable proportion of the population are also former caregivers, that is, caregivers who have ceased caring as the care recipient has died or been admitted to a nursing home. Negative health effects such as insomnia and depressive symptoms may prevail post-caregiving [ 7 ], but most former caregivers seem to recover from such effects within one to two years [ 8 , 9 ]. In fact, it is not uncommon for former caregivers to take up the caregiving role again or at least report being ready to do so if needed [ 10 , 11 ].…”

“…Public Health 2021, 18, 10133 2 of 19 nursing home. Negative health effects such as insomnia and depressive symptoms may prevail post-caregiving [7], but most former caregivers seem to recover from such effects within one to two years [8,9]. In fact, it is not uncommon for former caregivers to take up the caregiving role again or at least report being ready to do so if needed [10,11].…”

Correlates of Symptom Burden of Hemodialysis Patients

“…This finding is in agreement with that of a previous study in patients with cancer (Tang et al, 2017), suggesting that sense of coherence, especially meaningfulness and manageability, might be an important predictor of symptom burden. The reason might be that patients with strong meaningfulness and manageability tend to attribute meaning to the stresses, understand their challenges, and are relatively proactive in mobilizing available resources around them to cope, thereby alleviating symptom burden as well as maintaining their health (Kuo et al, 2019). As limited evidence can be found in the existing literature on sense of coherence in hemodialysis patients, including its relationship with symptom burden among this population, attention should then be paid to the role of sense of coherence in alleviating symptom burden among hemodialysis patients and its underlying mechanisms.…”

“…There is evidence that the symptom experience of advanced cancer and cardiopulmonary disease can be influenced by self-management (Auld et al, 2018), sense of coherence (Kuo et al, 2019), and social support (Lyons et al, 2020). Self-management is commonly known as a wide range of behavioral and lifestyle adjustments to minimize functional limitations and disabilities of patients with chronic disease (Siantz & Aranda, 2014).…”