title: Depressive symptoms among dementia caregivers: role of mediating factors.
abstract: OBJECTIVE
  To compare depressive symptoms between caregivers to persons with dementia and other illnesses and determine whether caregiver role captivity and care recipient disruptive behaviors mediate this association.
  
  
  METHODS
  Prospective cohort study of older women in four U.S. communities followed from 1999 to 2009. Home-based interviews were used in 345 caregiving participants from the Caregiver-Study of Osteoporotic Fractures. Caregiver status was based on self-report of performing one or more instrumental or basic activities of daily living for a care recipient. Depressive symptoms were measured using the 20-item Center for Epidemiologic Studies Depression Scale. Scores of 16 or greater represented high depressive symptoms. Caregiver role captivity and care recipient problematic behaviors were measured using validated instruments.
  
  
  RESULTS
  Approximately one third of the caregivers cared for a person with dementia. High depressive symptoms were more common among dementia caregivers (22.8% versus 11.2%, p <0.001) (unadjusted odds ratio: 2.12; 95% confidence interval [CI]: 1.20-3.74). This association was completely mediated by caregiver role captivity and care recipient problematic behaviors. In adjusted results, high depressive symptoms were associated with middle and highest tertiles of role captivity (adjusted odds ratios [AOR]: 5.01; 95% CI: 2.31-11.05 and AOR: 9.41; 95% CI: 3.95-22.40 for the middle and highest tertiles, respectively) and care recipient problematic behaviors (AOR: 2.52; 95% CI: 1.02-6.19 and AOR: 5.26; 95% CI: 2.00-13.8 for the middle and highest tertiles, respectively).
  
  
  CONCLUSIONS
  Older caregivers to persons with dementia are at increased risk of high depressive symptoms. Targeting problematic behaviors among dementia patients and addressing aspects of dementia care that result in role captivity may ameliorate caregiver depression.
authors.affiliation: Hebrew Senior Life Institute for Aging Research, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: JaneGivens@hsl.harvard.edu.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Givens
authors.affiliation: School of Public Health, Boston University, Boston, MA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mezzacappa
authors.affiliation: School of Public Health, Boston University, Boston, MA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: School of Public Health, Boston University, Boston, MA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fredman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D016022:Case-Control Studies; D003704:Dementia / Q000451:nursing*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011446:Prospective Studies; D013727:Terminal Care / Q000523:psychology; D014481:United States / Q000453:epidemiology
keywords: Caregiver burden; dementia; depression