Patients’ Depression Often Carries Over to Care Partners

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More disability and higher levels of depression in Parkinson’s disease patients predicted an increase in burden and depression of their care partners, such as family and friends, over two years, a study concluded.

The findings underscore the need to monitor the burden of care partners over time.

Treatment targeting disease severity, such as medication management, may ease care partner burden, while interventions aimed at alleviating patient depression could prevent future care partner depression, the researchers noted.

Because care partners for those with Parkinson’s provide care for several years, early intervention may help the emotional well-being of both the patients and their care partners, they added.

The study, “Prospective Predictors of Care Partner Burden and Depression in Parkinson’s disease,” was published in the International Journal of Geriatric Psychiatry.

People with Parkinson’s disease face physical and mental disabilities. As a result, they often rely on others for physical, emotional, social, and economic support. This includes informal caregivers, or those without formal training, such as family and friends.

Cross-sectional studies — those conducted at one point in time — suggest higher levels of burden and depression in care partners of Parkinson’s patients.

Due to Parkinson’s progressive nature, it is important to understand changes in care partner burden and depression over time (longitudinally) to identify factors contributing to caregiving burden. Such knowledge may provide key information for assessing and treating depression and burden in care partners of individuals with Parkinson’s.

Scientists based at the VA San Diego Healthcare System in California followed a group of 88 adult Parkinson’s patients without dementia and an equal number of self-identified care partners for two years to assess burden and depression.

“This is the first longitudinal study to examine changes in and predictors of care partner burden and depression in [Parkinson’s disease] over time,” the scientists wrote.

Statistical profiles
Participants with Parkinson’s were primarily male (72%), older than 65, and college educated, while their care partners were primarily female (71%), older than 60, and college educated. Among the care partners, 88.64% were spouses, 6.82% were their children, 3.41% were friends, and 1.14% were siblings.

At the beginning of the study (baseline) and about two years later (mean 2.42 years), care partner burden was evaluated with the Zarit burden inventory (ZBI). Care partner depression was assessed with the geriatric depression scale (GDS).

At the same time, patients underwent standard clinical examinations for disability, dementia, and depression, as well as self-reported questionnaires for anxiety and apathy. At baseline, the average disease duration was five years.

Mean patient GDS scores at baseline and follow-up met the clinical criteria for depression. Of care partners, 27.3% met the criteria for depression at baseline and follow-up.

There was no significant difference between patient baseline and follow-up MDS-UPDRS Part-III scores for motor function, and levodopa equivalent dose (LED), the combined total of Parkinson’s medications. In patients, there was a small, significant decline in global cognitive abilities as assessed by the Mattis dementia rating scale.

On average, baseline ZBI total scores indicated mild-to-moderate burden, with 20.5% of the care partners scoring within the clinically significant range. At follow-up, ZBI total scores also showed mild-to-moderate burden, with 33% scoring within the clinically significant range.

Notably, 13 care partners who were not burdened at baseline became clinically burdened at follow-up. In contrast, two care partners who were burdened at baseline did not meet the follow-up criteria for clinical burden.

The mean baseline and follow-up GDS scores suggested clinically significant depression in care partners, with 9.1% meeting clinically significant depression at baseline and 12.5% at follow-up. Here, five participants’ depressive symptoms increased to clinical significance from baseline to follow-up, while two care partners were no longer clinically significant at follow-up.

Compared to Parkinson’s patients, the care partner group had significantly fewer depressive symptoms.

Increased care partner burden
Based on these findings, statistical analysis revealed significantly greater care partner burden and depression at follow-up compared to baseline. Over time, an increased burden was experienced by 61.5% of care partners, 8% remained stable, and 31% reported a decreased burden. Depression increased for 45% of care partners, remained stable in 25%, and declined in 30% of these participants.

At both baseline and follow-up, the care partner’s depression and burden also were associated significantly.

Higher baseline disability (Hoehn and Yahr staging), LED, and longer disease duration in patients was correlated significantly with increased care partner burden over the two-year follow-up.

All other patient and care partner demographics and patient psychiatric measures were unrelated to changes in care partner burden. Moreover, baseline care partner burden scores were not associated with changes in partner burden scores.

In comparison, increases in care partner depression over two years were significantly correlated with higher patient apathy, anxiety, and depression at baseline. All other care partner characteristics were not related to changes in care partner depression over time, including care partner depression at baseline.

Finally, at baseline, greater patient disability predicted increased care partner burden over time, while higher levels of patient depression significantly predicted higher care partner depression over time.

“The best predictors of care partner burden and depression were both [Parkinson’s disease] patient symptoms, rather than care partner factors, suggesting that these distinct phenomena could benefit from different, targeted treatments,” the researchers concluded.

“Treatments aimed at controlling disease severity associated with disease stage (e.g., medication management) may prevent worsening of care partner burden, while interventions focused on ameliorating patient depression could prevent future care partner depression,” the researchers added.

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