title: The two-year incidence of depression and anxiety disorders in spousal caregivers of persons with dementia: who is at the greatest risk?
abstract: OBJECTIVE
  Caregivers of persons with dementia play an important and economically valuable role within society, but many may do so at a considerable cost to themselves. Knowing which caregivers have the highest risk of developing a mental disorder may contribute to better support of ultra-high-risk groups with preventive interventions. This study aims to describe the incidence of depression and anxiety disorders in caregivers and to identify its significant predictors.
  
  
  METHODS
  Prospective cohort study with a follow-up of 24 months.
  
  
  METHODS
  181 spousal caregivers of persons with dementia without a clinical depression or anxiety disorder at baseline.
  
  
  METHODS
  Memory clinics, case management services, and primary care settings in the Netherlands.
  
  
  METHODS
  The onset of depression and anxiety was measured every 3 months with the MINI International Neuropsychiatric Interview, a structured diagnostic instrument for DSM-IV mental disorders. Potential predictors were assessed at baseline.
  
  
  RESULTS
  60% of the caregivers developed a depressive and/or anxiety disorder within 24 months: 37% a depression, 55% an anxiety disorder, and 32% both disorders. Sub-threshold depressive symptoms (Wald χ2=6.20, df=1, OR: 3.2, 95% CI: 1.28-8.03, p=0.013) and poor self-reported health of the caregiver (Wald χ2=5.56, df=1, OR: 1.17, 95% CI: 1.03-1.34, p=0.018) at baseline were significant predictors of disorder onset.
  
  
  CONCLUSIONS
  Spousal caregivers of persons with dementia have a high risk to develop a mental disorder. Indicators related to the caregiver's (mental) health rather than environmental stressors such as patient characteristics or interruption of caregivers' daily activities predict disorder onset and can be used to identify caregivers for whom supporting preventive interventions are indicated.
authors.affiliation: Departments of General Practice & Elderly Care Medicine, VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Amsterdam, The Netherlands. Electronic address: k.joling@vumc.nl.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Joling
authors.affiliation: Departments of General Practice & Elderly Care Medicine, VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Amsterdam, The Netherlands.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: Departments of General Practice & Elderly Care Medicine, VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Amsterdam, The Netherlands.
authors.forename: Aaltje E
authors.initials: AE
authors.lastname: Veldhuijzen
authors.affiliation: Departments of General Practice & Elderly Care Medicine, VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Department of Neurology, VUmc Alzheimer Center, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: Departments of Clinical Psychology and Epidemiology & Biostatistics, VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Amsterdam, The Netherlands; Trimbos Institute (Netherlands Institute for Mental Health and Addiction), Utrecht, The Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.affiliation: Departments of General Practice & Elderly Care Medicine, VU University Medical Centre, EMGO+ Institute for Health and Health Care Research, Amsterdam, The Netherlands.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data*; D003704:Dementia / Q000451:nursing*; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Depression; anxiety; caregivers; dementia; incidence; predictors; prevention