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Length of Hospice Enrollment and Subsequent Depression in Family Caregivers: 13-Month Follow-Up Study

From the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut (AEK, EJC, MDAC, SVK, EHB); the Center for Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and the Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts (HP); and The Connecticut Hospice and the John D. Thompson Hospice Institute for Education, Training, and Research, Branford, Connecticut (RJ-H).

Objective: Although more people are using hospice than ever before, the average length of hospice enrollment is decreasing. Little is known about the effect of hospice length of enrollment on surviving family caregivers. The authors examine the association between patient length of hospice enrollment and major depressive disorder (MDD) among the surviving primary family caregivers 13 months after the patient’s death.

Methods: The authors conducted a three-year longitudinal study of 175 primary family caregivers of patients with terminal cancer who consecutively enrolled in the participating hospice from October 1999 through September 2001. Interviews were conducted with the primary family caregiver when the patient first enrolled with hospice and again 13 months after the patient’s death. The authors used multivariate logistic regression models to estimate caregivers’ adjusted risk at 13 months postloss for MDD, assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID).

Results: The effect of very short hospice length of enrollment (three days or less) compared with longer lengths of enrollment on caregiver MDD 13 months after their loss was nonsignificant in unadjusted analyses. The adjusted risk of MDD was significantly elevated for caregivers of patients who had very short hospice enrollments (adjusted odds ratio: 8.76, 95%confidence interval: 1.09–70.19) only after adjusting for baseline MDD, caregiver gender, caregiver age, kinship relationship to patient, caregiver education, caregiver chronic conditions, and caregiver burden. The adjustment for caregiver burden resulted in the greatest increase in odds ratio for very short hospice length of enrollment on risk of caregiver MDD 13 months after the loss.

Conclusions: This study identifies a potential target group of family caregivers, characterized by hospice length of enrollment and several caregiver features, who might be most in need of mental health interventions.

Key Words: Hospice • depression • caregiver