Depressive Symptoms Among Dementia Caregivers: Role of Mediating Factors

Objective: To compare depressive symptoms between caregivers to persons with dementia and other illnesses and determine whether caregiver role captivity and care recipient disruptive behaviors mediate this association. Methods: Prospective cohort study of older women in four U. S. communities followed from 1999 to 2009. Home-based interviews were used in 345 caregiving participants from the Caregiver-Study of Osteoporotic Fractures. Caregiver status was based on self-report of performing one or more instrumental or basic activities of daily living for a care recipient. Depressive symptoms were measured using the 20-item Center for Epidemiologic Studies Depression Scale. Scores of 16 or greater represented high depressive symptoms. Caregiver role captivity and care recipient problematic behaviors were measured using validated instruments. Results: Approximately one third of the caregivers cared for a person with dementia. High depressive symptoms were more common among dementia caregivers (22.8% versus 11.2%, p < 0.001) (unadjusted odds ratio: 2.12; 95% confidence interval [CI]: 1.20-3.74). This association was completely mediated by caregiver role captivity and care recipient problematic behaviors. In adjusted results, high depressive symptoms were associated with middle and highest tertiles of role captivity (adjusted odds ratios [AOR]: 5.01; 95% CI: 2.31-11.05 and AOR: 9.41; 95% CI: 3.95-22.40 for the middle and highest tertiles, respectively) and care recipient problematic behaviors (AOR: 2.52; 95% CI: 1.02-6.19 and AOR: 5.26; 95% CI: 2.00-13.8 for the middle and highest tertiles, respectively). Conclusion: Older caregivers to persons with dementia are at increased risk of high depressive symptoms. Targeting problematic behaviors among dementia patients and addressing aspects of dementia care that result in role captivity may ameliorate caregiver depression.