Length of hospice enrollment and subsequent depression in family caregivers: 13-month follow-up study
Length of hospice enrollment and subsequent depression in family caregivers: 13-month follow-up study
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DOI：
10.1097/01.jgp.0000194642.86116.ce
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发表时间：
2006-03-01
影响因子：
7.2
通讯作者：
Bradley, EH
中科院分区：
文献类型：
--
作者：
Kris, AE;Cherlin, EJ;Bradley, EH
目的：虽然越来越多的人比以往任何时候都使用临终关怀，临终关怀的平均长度正在减少。临终关怀登记的长度对幸存的家庭照顾者的影响知之甚少。作者在患者死亡后13个月，在幸存的主要家庭照顾者中，研究了临终关怀登记患者的时间与重度抑郁症（MDD）之间的关系。研究方法：作者对175名晚期癌症患者的主要家庭照顾者进行了为期三年的纵向研究，这些患者从1999年10月至2001年9月连续参加了临终关怀。访谈进行了与主要家庭照顾者时，病人第一次登记与临终关怀，并再次13个月后，病人的死亡。作者使用多变量逻辑回归模型来估计照顾者在丧失后13个月的MDD调整风险，使用精神疾病诊断和统计手册第四版（SCID）的结构化临床访谈进行评估。结果如下：在未调整的分析中，与较长的入组时间相比，极短的临终关怀住院时间（三天或更短）对护理人员去世13个月后的MDD影响并不显着。仅在调整基线MDD、护理者性别、护理者年龄、与患者的亲属关系、护理者教育、护理者慢性病和护理者负担后，短期入组临终关怀患者的护理者MDD的调整后风险显著升高（调整后比值比：8.76，95%置信区间：1.09-70.19）。调整照顾者负担后，极短的临终关怀登记时间对失去后13个月照顾者MDD风险的优势比增加最大。结论：本研究确定了一个潜在的目标群体的家庭照顾者，其特点是临终关怀的注册长度和几个照顾者的功能，谁可能是最需要的心理健康干预。
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.