Exploring effects of an intervention for family caregivers on care recipients' symptoms of depression: A pilot study
Saltzman, Susan L
MetadataShow full item record
From 5 to 7 million Americans are informal caregivers (CG) to chronically ill and disabled older adults, and they are a significant segment of the U.S. health care system. The deleterious stress-related health effects of caregiving are well-documented. The care-receiving role is much less studied, yet depression related to care-receiving stress is also prevalent. This contributes significantly to CR disability, progression of medical illness, mortality, reduced quality of life, and to CG psychological illness. The Powerful Tools for Caregivers (PTC) course is a standardized, widely-disseminated group psychoeducational intervention for caregivers of older adults with chronic illness. The intervention is theoretically grounded in the Stress Process Model of Lazarus and Folkman. Research provides evidence that the PTC impacts positively on CGs' psychological health (depression, self-efficacy, and self-care). The primary purposes of this study were (1) to evaluate whether the PTC intervention would also improve CRs' depressive symptoms, (2) to pilot test a new tool for measuring these symptoms via caregiver's report, and (3) to study CGs' emotional responses to CR depressive and/or disruptive (dep/dis) behaviors. A secondary purpose was to begin to test a newly proposed model of Caregiving System Dynamics (CGSD) that was developed from literature on "care-receiving" in informal caregiving/care-receiving dyads. A new 21-item Care Recipient Depression Questionnaire (CRDQ-dep/dis) for caregiver informants was developed by modifying and expanding the Geriatric Depression Scale-Informant Version (GDS-I) and the Revised Memory and Behavior Problems Checklist (RMBPC). All items from the GDS-15/5 item version are represented, as are the complete depression subscale and 5 disruptive behavior items from the RMBPC. Both instruments have been found to be valid and reliable for CGs' surrogate reporting of CRs' depression. The CRDQ was then added to the CG-oriented PTC evaluation tool developed by Mather Lifeways Institute on Aging. This combined tool was given to caregiver participants in PTC courses in a Western New York State city from June through November, 2005. The data consisted of 49 pretests and 23 post-tests. The 21-item CRDQ-dep/dis was found to be internally consistent (alpha = .90), All item subsets from the CRDQ were internally consistent (alpha > .80) as well, except for the five disruptive behavior items (alpha=.62) and the GDS-5 item subset (alpha = .74). CR depressive symptom scores as measured by the GDS-5 item subset, and CRDQ-dep/dis scores were reduced to a marginally statistically significant degree (n = 20, p < .05, direction predicted). Relationships among CRDQ items and CG variables provided evidence of construct validity when examined at baseline. When regression adjusted change scores were examined, the relationships of CRDQ items and item subsets with CG items and scales were consistent with predictions based on the CGSD model. CR disruptive behavior was correlated with CG depression at baseline (n = 44, r = .307, p < .05). After controlling for baseline, change scores for CR depression and disruptive behaviors were significantly correlated with change scores for CGs angry feelings (n = 17, r = .52, p < .05) and CGs' depression change scores (n = 17, r = .51, p < .05). Change scores for CGs' reactions to CRs' depressive and disruptive behaviors were strongly correlated with CRs' change scores for these behaviors (n = 19, r = .84, p < .01). The CRDQ appears to be a reliable and valid tool for measuring depressive and/or disruptive behavior. The CGSD model was useful, and its predictions were generally confirmed. Both the CRDQ tool and the CGSD model should be tested further.