title: The impact of perceived stage of cancer on carers' anxiety and depression during the patients' final year of life.
abstract: OBJECTIVE
  This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year.
  
  
  METHODS
  A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation.
  
  
  RESULTS
  Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression.
  
  
  CONCLUSIONS
  Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Australia. l.burridge@.uq.edu.au
authors.forename: Letitia H
authors.initials: LH
authors.lastname: Burridge
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Barnett
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Clavarino
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology* / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D012737:Sex Factors; D012803:Sick Role; D013727:Terminal Care / Q000523:psychology*