Psychiatric Disorders and Mental Health Service Use Among Caregivers of Advanced Cancer Patients

Department of Pediatrics, Yale University, New Haven, Connecticut, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 11/2005; 23(28):6899-907. DOI: 10.1200/JCO.2005.01.370
Source: PubMed


Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers.
Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use.
Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patient's cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patient's cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services.
Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.

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    • "). Hirst (2004a) also found a similar association between caring and mental health. Panic and anxiety disorders were most prevalent amongst carers in the current study, as noted by others (Vanderwerker et al., 2005; Cooper et al., 2007). Fatigue has also been widely reported in carers, which may be an indirect reflection of the degree of primary stressors but may also be seen as an intermediate outcome on the pathway to CMD (Singleton, 2002; Maher and Green, 2002). "
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    ABSTRACT: This study investigates potential explanations of the association between caring and common mental disorder, using the English Adult Psychiatric Morbidity Survey 2007. We examined whether carers are more exposed to other stressors additional to caring – such as domestic violence and debt – and if so whether this explains their elevated rates of mental disorder. We analysed differences between carers and non-carers in common mental disorders (CMD), suicidal thoughts, suicidal attempts, recent stressors, social support, and social participation. We used multivariate models to investigate whether differences between carers and non-carers in identifiable stressors and supports explained the association between caring and CMD, as measured by the revised Clinical Interview Schedule. The prevalence of CMD (OR = 1.64 95% CI 1.37–1.97), suicidal thoughts in the last week (OR = 2.71 95% CI 1.31–5.62) and fatigue (OR = 1.33 95% CI 1.14–1.54) was increased in carers. However, caring remained independently associated with CMD (OR = 1.58 1.30–1.91) after adjustment for other stressors and social support. Thus caring itself is associated with increased risk of CMD that is not explained by other identified social stressors. Carers should be recognized as being at increased risk of CMD independent of the other life stressors they have to deal with. Interventions aimed at a direct reduction of the stressfulness of caring are indicated. However, carers also reported higher rates of debt problems and domestic violence and perceived social support was slightly lower in carers than in non-carers. So carers are also more likely to experience stressors other than caring and it is likely that they will need support not only aimed at their caring role, but also at other aspects of their lives.
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    • "A study by Vanderwerker and colleagues found that many caregivers (13%) for advanced cancer patients either met the criteria for psychiatric problems or were being treated for those problems, including panic disorder (8%), major depressive disorder (4.5%), posttraumatic stress disorder (4%), and generalized anxiety disorder (3.5%). Additionally, fewer than half of the caregivers with a DSM – IV (Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition) disorder had discussed their mental health with a clinician since time of the patient's cancer diagnosis (Vanderwerker et al., 2005). "
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    ABSTRACT: Objective: Caregivers play a key role in the management of patients with cancer. However, some studies have suggested that caregivers have even more unmet needs than the patients. Method: To better identify the needs and changes in the lifestyles of the caregivers in our practice and to plan a targeted support project to decrease caregiver burden, we administered the Caregiver's QoL Index–Cancer (CQoLC) to 200 consecutive caregivers. This questionnaire assesses psychological well-being, the relationship with healthcare professionals, administration of finances, lifestyle disruption, and positive adaptation. Results: Our data showed that being a caregiver to a patient with metastatic disease negatively affected females mostly with regard to mental and emotional burden, while men complained more about their sexual life (42.3 vs. 33.6%), although this result was not significant. Some 93.5% of caregivers reported that they were pleased with their role, while 83.4% were concerned about financial difficulties. Significance of results: We strongly believe that early supportive care directed not only at patients but also to caregivers may improve the quality of life (QoL) in this population. We are currently developing a targeted support project to decrease caregiver burden.
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    • ", as well as other metabolic, autoimmune, inflammatory , and psychiatric conditions (Vanderwerker et al. 2005; Rohleder et al. 2009). Physiological measures may help to explain the associations between caregiving and illness, much earlier than the manifestation of chronic diseases (Vitaliano et al. 2003). "
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