Trajectories of depressive symptoms for bereaved family members of chronically ill patients: a systematic review

Kuo, Su‐Ching; Sun, Jia Ling; Tang, Siew Tzuh

doi:10.1111/jocn.13720

Cited by 12 publications

(21 citation statements)

References 56 publications

(128 reference statements)

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“…The prolonged‐symptomatic trajectory was the third and the least prevalent trajectories for depressive and PGD symptoms, respectively. Prevalence for the prolonged‐symptomatic trajectory for depressive and PGD symptoms identified in this study, using preset clinical cutoffs, is consistent with 35 or lower than 37 prevalence reported in systematic reviews, probably due to cultural variations in grief manifestation. In Taiwanese culture, funerals occur 7 days, 7 weeks, and 100 days after a relative's death, during which the bereaved are encouraged to publicly display their sorrow and grief but after 100 days, bereaved individuals are expected to internalize their grief, 38 especially for the typical PGD symptoms of “yearning for and/or preoccupation with the deceased,” substantially decreasing the prevalence of prolonged‐symptomatic trajectory for PGD symptoms.…”

Section: Discussionsupporting

confidence: 85%

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Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

et al. 2020

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Objective: Grief reactions in bereaved caregivers of cancer patients have been identified individually as distinct prolonged grief disorder (PGD)-and major depressive disorder (MDD)-symptom trajectories, but no research has examined whether the patterns of change (trajectories) for PGD and MDD symptoms synchronize during bereavement. We conducted a secondary analysis study to investigate the construct distinctiveness of PGD and MDD by simultaneously identifying and examining similarities and differences between bereaved caregivers' PGD-and depressive-symptom trajectories from immediately post-loss through 2 years later. Methods: PGD and depressive symptoms were measured for 849 cancer patients' caregivers over their first 2 years of bereavement using 11 grief-symptom items of the prolonged grief-13 scale (PG-11) and the center for epidemiologic studies-depression (CES-D) scale, respectively. PGD-and depressive-symptom trajectories were identified using latent class growth analysis with continuous latent-class indicators (total PG-11 and CES-D scores). Concordance of caregiver participants' membership in PGD-and depressive-symptom trajectories was examined by a percentage and a kappa value. Results: Five distinct symptom trajectories were identified for both PGD and MDD, with four shared trajectories (endurance, transient-reaction, resilience, and prolongedsymptomatic) having different prevalence rankings. Nonetheless, unique trajectories were identified for PGD (potential recurrence) and depressive symptoms (chronically distressed), respectively. Concordance between membership in PGD-and depressivesymptom trajectories was moderate (61.3%, kappa [95% CI]: 0.49 [0.44, 0.53]). Conclusion: PGD and MDD are related but distinct constructs indicated by the unique trajectories identified for each, different prevalence rankings for PGD-and depressive-symptom trajectories, and moderate concordance between membership in PGD-and depressive-symptom trajectories, respectively.

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Section: Discussionsupporting

confidence: 85%

“…We individually identified five distinct symptom trajectories for both PGD and MDD. The five depressive‐symptom trajectories align with those synthesized in a six‐study systematic review (1994‐2012) 35 . However, no identical PGD‐symptom trajectories have been identified 16‐19 .…”

Section: Discussionsupporting

confidence: 56%

Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

et al. 2020

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“…5 Bereaved family members' depressive symptom trajectories are heterogeneous 6 and were classified in a systematic review into five groups. 6 The first group (prevalence ¼ 54.2%) endured well the hardship of losing a beloved, as indicated by their depressive symptom levels remaining below the Center for Epidemiological StudieseDepression [CES-D] cutoff score (#16) for severe depressive symptoms throughout four to five years of bereavement. The second bereaved-caregiver group (8.8%) suffered severe depressive symptoms when they first transitioned into bereavement but quickly recovered within three to six months after loss.…”

Section: Introductionmentioning

confidence: 99%

“…The final two groups (19.4% and 9.9%) experienced prolonged periods of severe depressive symptoms, which improved gradually only for the fourth bereaved-caregiver group. 6 Caregiving outcomes are mediated by a complex web of 1) contextual factors, 2) caregiving burden, 3) available psychosocial resources, and 4) appraisal of caregiving. 7 Predictors of bereaved family members' distinct depressive symptom trajectories include their demographics (contextual factors), 8e12 caregiving stress, 8,12 psychological (coping) resources, 8e11, 13 and social support.…”

Section: Introductionmentioning

confidence: 99%

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

Kuo

Wen

Chen

et al. 2019

Journal of Pain and Symptom Management

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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.

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“…Additionally, certain classes of events are especially likely to provoke depression. A line of research has demonstrated that people who lose their loved ones (e.g., death of family members) have a greater risk of developing depression [ 20 , 29 , 30 ]. Specifically, their anhedonia is elevated after deaths and romantic losses [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Depressive symptoms and negative life events: What psycho-social factors protect or harm left-behind children in China?

Feng

Yang

et al. 2017

BMC Psychiatry

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BackgroundIn China, children under 18 years old who are left at rural residences for at least 6 months by either one or both of their parents migrating to work in cities are called “left-behind children (LBC)”. Due to restricted family support, they are at a greater risk of developing depressive symptoms than non-left-behind children (NLBC). The objective of this study is to explore how depressive symptoms and stress induced by negative life events such as interpersonal conflicts, punishment and loss, as well as their relationships vary for LBC with different left-behind-related characteristics.MethodsUsing data from a large school-based survey conducted in Chongqing between December 2012 and June 2013, we first identified the differences in depressive symptoms and negative-event-induced stress between LBC and NLBC, and then analyzed the variances among LBC with different left-behind-related characteristics. The data was analyzed with Chi-square test, MANCOVA, ANCOVA, ANOVA, T-test and hierarchical multiple regression analyses.ResultsWe found that LBC were more stressed when experiencing negative events and had more depressive symptoms than NLBC. Children left behind by both parents were most depressed. Negative-event-induced stress and communication on life difficulties with migrant parents were risk factors for depressive symptoms, whereas adequate communication on academic performance or children’s feelings was a protective factor against depressive symptoms. Communication duration and frequency, communication by visiting, communication on academic performance, life difficulties and children’s feelings moderated the relationship between stress and depressive symptoms, respectively. Duration of separation, communication duration and frequency, communication on academic performance, learning difficulties and children’s feelings moderated the relation between the type of parental migration and depressive symptoms, respectively.ConclusionsOur findings suggest that children left behind by both parents should be the focus of public attention for their higher susceptibility to stress-related depression. To help LBC stay mentally healthy, governments need to formulate regulations contributing to LBC’s family reunion, communities need to involve more residents to attend LBC as “surrogate parents” and teach migrant parents to communicate with LBC properly, and schools need to teach LBC how to deal with stress and communicate with migrant parents.

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Trajectories of depressive symptoms for bereaved family members of chronically ill patients: a systematic review

Abstract: Guided by the synthesised distinct trajectories of depressive symptoms, clinicians should identify bereaved families' depressive-symptom trajectories and provide suitable interventions to facilitate adjustment of those with chronic depressive symptoms.

Cited by 12 publications

References 56 publications

Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

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

Depressive symptoms and negative life events: What psycho-social factors protect or harm left-behind children in China?

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