title: One extra month of depression: the effects of caregiving on depression outcomes in the IMPACT trial.
abstract: BACKGROUND
  Depression occurs in 5-10% of older adults and there are nearly 6 million informal caregivers aged 65 or older. Prior research has focused on vulnerability to psychological distress in caregivers. Research has not addressed the caregiving burden of depressed elderly patients or how that burden affects depression treatment outcomes.
  
  
  OBJECTIVE
  To describe the self-reported caregiving burden in a large, representative cohort of depressed elderly patients and compare depression treatment outcomes between caregivers and non-caregivers.
  
  
  METHODS
  Univariate and multiple regression analyses were performed comparing 24-month depression outcomes (measured as depression free days) in those providing care at any time over the 24-month trial to those who never reported a caregiving burden.
  
  
  RESULTS
  At 3, 6, 12, 18, and 24 months, nearly 10% of cohabitating elderly depressed patients provided care for basic activities such as bathing or dressing while nearly 20% reported providing care for other activities such as making phone calls or taking medication. Over 24 months, after adjusting for marital status, intervention status, and number of medical comorbidities, those reporting any caregiving burden had over 30 more days with depression compared to those with no caregiving burden. The IMPACT collaborative care model did not modify the effect of caregiving on depression outcomes.
  
  
  CONCLUSIONS
  Caregiving is common in depressed older adults and appears to affect response to depression treatment. In the future, interventions for depressed older adults should consider and specifically address caregiving activities in addition to specific depression treatment.
authors.affiliation: University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195-6560, USA. awthomp@u.washington.edu
authors.forename: Alex
authors.initials: A
authors.lastname: Thompson
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006701:Home Nursing / Q000523:psychology*; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014481:United States