title: Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers.
abstract: OBJECTIVE
  We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories.
  
  
  METHODS
  Data on 172 stroke survivor-caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates.
  
  
  RESULTS
  Three stroke survivor depressive symptom trajectories (low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories (low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement).
  
  
  CONCLUSIONS
  Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor-caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor-caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore; Centre for Ageing Research and Education, Duke-NUS Graduate Medical School, Singapore. Electronic address: rahul.malhotra@duke-nus.edu.sg.
authors.forename: Rahul
authors.initials: R
authors.lastname: Malhotra
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Choy-Lye
authors.initials: CL
authors.lastname: Chei
authors.affiliation: Saint Andrew's Community Hospital, Singapore.
authors.forename: Edward
authors.initials: E
authors.lastname: Menon
authors.affiliation: Health Services Research, Eastern Health Alliance, Singapore.
authors.forename: Wai Leng
authors.initials: WL
authors.lastname: Chow
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Stella
authors.initials: S
authors.lastname: Quah
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore; Centre for Ageing Research and Education, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Angelique
authors.initials: A
authors.lastname: Chan
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: David Bruce
authors.initials: DB
authors.lastname: Matchar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D012959:Socioeconomic Factors; D020521:Stroke / Q000523:psychology*; D017741:Survivors / Q000523:psychology*
keywords: Singapore; Stroke; caregivers; depression; longitudinal studies