title: Depressive symptom trajectories and associated risks among bereaved Alzheimer disease caregivers.
abstract: OBJECTIVE
  A recent study concluded that depressive symptoms among caregivers decline on average from before to after the Alzheimer disease (AD) patient's death. The present study sought to determine if subgroups of bereaved AD caregivers follow distinctive depressive symptom trajectories and the characteristics associated with membership in depressive symptom subgroups.
  
  
  METHODS
  Latent class mixture models sought to identify clusters of homogeneous participants in the Resources for Enhancing Alzheimer's Caregiver Health study-a multisite, randomized caregiver intervention trial.
  
  
  METHODS
  One hundred eighty-two community-based bereaved caregivers were included in the study.
  
  
  METHODS
  The Center for Epidemiologic Studies Depression Scale assessed depressive symptoms among the AD caregivers at baseline and three follow-up visits.
  
  
  RESULTS
  Three postloss depressive symptom trajectories emerged: persistently syndromal depression (N = 30, 16.5%); syndromal-becoming-threshold level depression (N = 62, 34.0%); and persistently absent depression (N = 90, 49.5%). Lower income, higher preloss depression levels, greater caregiver behavioral burden, less family support, and adverse health behaviors (e.g., smoking, skipped meals, and lack of exercise) after loss were risk factors for syndromal and syndromal-becoming-threshold level depression after loss.
  
  
  CONCLUSIONS
  Early intervention to reduce caregiving behavioral burden and enhance family support and promote healthier behaviors of bereaved AD caregivers may decrease the risk of syndromal or syndromal-becoming-threshold level depression after loss.
authors.affiliation: Center for Psycho-oncology and Palliative Care Research, Dana Farber Cancer Institute, Boston, MA 02115, USA. baohui_zhang@dfci.harvard.edu
authors.forename: Baohui
authors.initials: B
authors.lastname: Zhang
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Kara Z
authors.initials: KZ
authors.lastname: Bambauer
authors.forename: Rich
authors.initials: R
authors.lastname: Jones
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support