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Published online before print January 11, 2008, 10.1097/JGP.0b013e318157caec
Am J Geriatr Psychiatry 16:145-155, February 2008
© 2008 American Association for Geriatric Psychiatry
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Article

Depressive Symptom Trajectories and Associated Risks Among Bereaved Alzheimer Disease Caregivers

Baohui Zhang, M.S., Susan L. Mitchell, M.D., Kara Z. Bambauer, Ph.D., Rich Jones, Sc.D., and Holly G. Prigerson, Ph.D.

From the Center for Psycho-oncology and Palliative Care Research, Dana Farber Cancer Institute, Boston, MA (BZ, HGP); the Hebrew Senior Life Institute for Aging Research, Boston, MA (SLM, RJ); Veterans Administration, Health Services, Research and Development, Serious Mental Illness, Treatment Research and Evaluation Center, Ann Arbor, MI (KZB); the Department of Psychiatry, University of Michigan, Medical School, Ann Arbor, MI (KZB); the Department of Psychiatry, Brigham and Women's Hospital, Boston, MA (HGP); and Harvard Medical School Center for Palliative Care, Boston, MA (HGP).

Objectives: A recent study concluded that depressive symptoms among caregivers decline on average from before to after the Alzheimer disease (AD) patient's death. The present study sought to determine if subgroups of bereaved AD caregivers follow distinctive depressive symptom trajectories and the characteristics associated with membership in depressive symptom subgroups.

Design: Latent class mixture models sought to identify clusters of homogeneous participants in the Resources for Enhancing Alzheimer's Caregiver Health study—a multisite, randomized caregiver intervention trial.

Participants: One hundred eighty-two community-based bereaved caregivers were included in the study.

Measurements: The Center for Epidemiologic Studies Depression Scale assessed depressive symptoms among the AD caregivers at baseline and three follow-up visits.

Results: Three postloss depressive symptom trajectories emerged: persistently syndromal depression (N = 30, 16.5%); syndromal-becoming-threshold level depression (N = 62, 34.0%); and persistently absent depression (N = 90, 49.5%). Lower income, higher preloss depression levels, greater caregiver behavioral burden, less family support, and adverse health behaviors (e.g., smoking, skipped meals, and lack of exercise) after loss were risk factors for syndromal and syndromal-becoming-threshold level depression after loss.

Conclusions: Early intervention to reduce caregiving behavioral burden and enhance family support and promote healthier behaviors of bereaved AD caregivers may decrease the risk of syndromal or syndromal-becoming-threshold level depression after loss.

Key Words: bereavement • caregiver • depression • trajectory • Alzheimer disease






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