title: Trajectories of caregiver depressive symptoms while providing end-of-life care.
abstract: OBJECTIVE
  The course of caregivers' depressive symptoms may not be homogenous. This study identified trajectories of depressive symptoms among caregivers providing end-of-life care to cancer patients and profiled the unique characteristics of caregivers within each trajectory.
  
  
  METHODS
  Trajectories of depressive symptoms were explored in 447 caregivers who completed the Center for Epidemiological Studies Depression Scale over four periods close to the patient's death (1-30, 31-90, 91-180, and >180 days). Distinct trajectories were identified by latent class analysis.
  
  
  RESULTS
  Four trajectories were identified as endurance, resilience, moderately symptomatic, and chronically distressed and contained 32.0%, 11.4%, 36.9%, and 19.7% of the sample, respectively. Caregivers in the endurance trajectory were relatively well-adjusted individuals with less education, adequate financial support, and ample psychological resources but provided care to older patients with greater symptom distress. They perceived less subjective caregiving burden than caregivers with moderate or chronic depressive symptoms. Caregivers in the resilience trajectory were in a more vulnerable position than those in other trajectories when they first transitioned into the caregiving role because they were more likely to be the patient's spouse, have greater educational attainment and insufficient finances, provide higher intensity assistance to a younger relative, and have weaker psychological resources. However, they were older, reported greater confidence in caregiving, and perceived less caregiving burden than caregivers in other trajectories. The moderately symptomatic and chronically distressed trajectories were differentiated only by the strength of psychological resources.
  
  
  CONCLUSIONS
  Caregivers of terminally ill cancer patients follow distinct depressive-symptom trajectories while providing end-of-life care.
authors.affiliation: Graduate School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
authors.forename: Guan-Hua
authors.initials: GH
authors.lastname: Huang
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wei
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chang
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D055500:Resilience, Psychological; D012944:Social Support; D013727:Terminal Care / Q000523:psychology*
keywords: cancer; depressive symptoms trajectories; end-of-life care; family caregivers; latent class analysis; longitudinal study; oncology