title: Trajectory and influencing factors of depressive symptoms in family caregivers before and after the death of terminally ill patients with cancer.
abstract: OBJECTIVE
  To explore the occurrence of depressive symptoms and factors that affect them in family caregivers before and 1, 3, 6, and 13 months after the death of a care recipient with cancer.
  
  
  METHODS
  Descriptive, longitudinal study.
  
  
  METHODS
  A medical center in northern Taiwan.
  
  
  METHODS
  Convenience sample of 186 primary family caregivers.
  
  
  METHODS
  Changes in caregivers' depressive symptoms and their influencing factors during bereavement were analyzed with the generalized estimating equation, which uses robust standard error estimates to account for within-subject correlations of scores during the follow-up period.
  
  
  METHODS
  Caregivers' depressive symptoms; potential influencing factors included intrapersonal risk or protective factors, social resources, caregiving situation, and time in relation to the patient's death.
  
  
  RESULTS
  Caregivers' depressive symptoms peaked at one month and decreased significantly during the first 13 months after the patient's death. Bereaved caregivers experienced a lower level of depressive symptoms if they had cared for older patients, reported a higher level of subjective caregiving burden during the patient's dying process, and had greater social support. Caregivers reported a higher level of depressive symptoms after bereavement if they had a higher level of depressive symptoms before the patient's death, had poorer health, and were the patient's spouse.
  
  
  CONCLUSIONS
  Caregivers' depressive symptoms improved significantly from one month before to 13 months after the patient's death.
  
  
  CONCLUSIONS
  Nurses should increase their ability to identify factors influencing caregivers' depressive symptoms before and after the death of their terminally ill family member and provide appropriate care to facilitate caregivers' psychological adjustments to bereavement.
  
  
  CONCLUSIONS
  Healthcare professionals should pay special attention to caregivers who are the patient's spouse, have poorer health, and suffer from a higher level of depressive symptoms. Appropriate care before and after the patient's death is needed to facilitate caregivers' psychological adjustment to the loss of their relative.
authors.affiliation: School of Nursing, Cardinal Tien College of Healthcare and Management, Taipei, Taiwan.
authors.forename: Sing-Fang
authors.initials: SF
authors.lastname: Ling
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Chen
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chang
authors.forename: Wen Chi
authors.initials: WC
authors.lastname: Shen
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001601:Bereavement; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D009859:Oncology Nursing; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult