title: Depressed Spousal Caregivers Have Psychological Stress Unrelated to the Progression of Alzheimer Disease: A 3-Year Follow-Up Report, Kuopio ALSOVA Study.
abstract: OBJECTIVE
  To explore family caregiver (FC) long-term psychological distress after Alzheimer disease (AD) diagnosis in a family member.
  
  
  METHODS
  FC (n = 236) and patients with AD were prospectively followed up to 36 months after AD diagnosis. FC psychological distress was evaluated using the General Health Questionnaire (GHQ). Furthermore, caregiver depressive symptoms and sense of coherence, along with AD patient measurements, were measured at baseline and annually. Generalized estimating equation models were applied to study associations of these baseline factors to caregiver GHQ.
  
  
  RESULTS
  After 36 months of follow-up, spousal caregivers (SCs) GHQ was significantly higher (P < .001) than in the nonspousal caregivers (NSCs). The difference in GHQ scores was associated by depressive symptoms (P < .001) at baseline, and the depressed SCs have more severe distress than NSCs over the observation period.
  
  
  CONCLUSIONS
  During longitudinal caregiving, spousal and depressed caregivers of patients with AD report higher and increasing psychological stress than nonspousal and nondepressed caregivers. Spousal relationship, caregivers' depressive symptoms, and the severity of patients' neuropsychological symptoms at the time of AD diagnosis predict the trajectory of psychological distress. The current study highlights the need for evaluating AD caregiver mental health and level of coping.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland Unit of Nursing Development, Clinical Education and Research, Kuopio University Hospital, Kuopio, Finland tarja.valimaki@uef.fi.
authors.forename: Tarja H
authors.initials: TH
authors.lastname: Välimäki
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Janne A
authors.initials: JA
authors.lastname: Martikainen
authors.affiliation: Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Ilona T
authors.initials: IT
authors.lastname: Hallikainen
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Saku T
authors.initials: ST
authors.lastname: Väätäinen
authors.affiliation: Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Koivisto
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological; D013997:Time Factors
keywords: Alzheimer disease; depressive symptoms; distress; family caregivers; spousal caregivers