title: Bereavement among hospice caregivers of cancer patients one year following loss: predictors of grief, complicated grief, and symptoms of depression.
abstract: BACKGROUND
  Informal caregivers are an integral part of end-of-life care for hospice patients with cancer. Although adjustment following loss is highly individual, many caregivers have significant psychological distress after the death of a loved one. This study investigated risk factors that may predict psychological distress, which could aid hospice bereavement departments in targeting bereavement services.
  
  
  METHODS
  Demographic characteristics, patient impairment, caregiver baseline symptoms of depression, and caregiver resources were assessed among 188 cancer patient-caregiver dyads. Regression analyses identified predictors of symptoms of depression, grief, and complicated grief one year following loss.
  
  
  RESULTS
  Over 50% of bereaved caregivers had clinically significant depressive symptoms one year after death of their relative. Caregivers with fewer years of education and more baseline symptoms of depression had significantly worse grief, complicated grief, and depression. Younger patient age was a significant predictor of poorer outcomes for grief and complicated grief; and less patient impairment was a significant predictor of more post-loss symptoms of depression. Lower social support satisfaction was correlated with worse grief and complicated grief but was not a significant multivariate predictor of poorer outcomes.
  
  
  CONCLUSIONS
  Despite having access to hospice bereavement services, many former caregivers had high psychological distress one year following loss. Bereavement departments could consider utilizing readily available risk factors to target services to former caregivers who may benefit from bereavement services. Bereavement departments might also consider including brief, standardized screenings of caregiver depression in initial risk assessments. Future studies should investigate evidence-based approaches for assessment and interventions among highly distressed former hospice caregivers.
authors.affiliation: Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA. jessica12.allen@rutgers.edu
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Allen
authors.forename: William E
authors.initials: WE
authors.lastname: Haley
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Small
authors.forename: Ron S
authors.initials: RS
authors.lastname: Schonwetter
authors.forename: Susan C
authors.initials: SC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy; D011368:Professional-Family Relations; D012044:Regression Analysis; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology