Risk Factors for Common Mental Disorder in Caregiving and Bereavement

Context. Longitudinal studies that have described the trajectory of familial caregiving and bereavement outcomes have often failed to include a comprehensive range of carer and caregiving variables or any patient assessments, and only a few have used a recognized structured interview for psychiatric disorders. Objectives. To address these limitations, this study aimed to establish links between symptoms of CMD in carers of patients (with advanced disease) during the caregiving phase and their subsequent bereavement. Methods. To identify the risk factors for poor caregiving and bereavement outcomes, we assessed patients and caregivers using a wide range of measures in a prospectively acquired sample. The main outcome, CMD, was measured through the use of a standardized interview (Revised Clinical Interview Schedule). One hundred carers of patients with advanced disease (more than 95% of patients had a cancer diagnosis) were interviewed shortly after the patient was referred to a U. K. hospice. Interviews were repeated at three and six months after the death of the patient. Results. Multivariate analyses revealed that carers who perceived their caring experience as more burdening had more symptoms of CMD while caring for their loved one. Carer mental health during the caregiving experience was predictive of their mental health at three and six months after death. No relationships were observed between family relations, levels of social support, levels of religious or spiritual beliefs, carers' coping strategies, quality of death in the patient, and caregiving and bereavement outcomes. Conclusion. Our findings suggest that much psychological distress detected during caregiving continues into bereavement. J Pain Symptom Manage 2010;40:844-856. (C) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.