Frequency of Depression in Primary Caregivers of Older Adults

    

    

    Graphic 1:  Descriptive analysis of the distribution by depression degree.
    
    

Conclusion: The importance of the results found in this study determines that primary caregivers are a population at risk of depression and at some point in their lives may require psychosocial and medical attention due to the stress to which they are exposed.

Keywords: Depression; Primary Caregivers; Older Adults

Introduction

According to the World Health Organization (1999), the primary caregiver is "the person in the patient's environment who voluntarily assumes the role of responsible in a broad sense; this individual is willing to make decisions for the patient and to cover basic needs directly or indirectly" [1]. The work of caregivers contributes to the maintenance of people in their social environment. The overload that supports the caregiver, once exceeded the available resources, can have a negative impact on his health affecting mainly the psychic aspect (anxiety and depression), physical, social isolation, lack of free time and the quality of life [2]. The role of the primary caregiver has a great social relevance, it works as a support to the dependents people by reducing the use of healthcare resources. However, taking care of a dependent person can affect the psychological well-being. Mood disorders, specifically depression, are among the mental health problems experienced by caregivers. This disorder can be especially problematic in caregivers, since it can interfere with the proper performance of the care of the dependent person [3]. The importance of the primary caregiver increases as the patient's disability progresses, sometimes the caregivers understand care as a feeling of obligation; all these changes in the life of the primary caregiver can contribute to development psychological affectations such as anxiety and depression [4].

Depressive disorders are characterized by the presence of sadness, feeling of emptiness, irritation, changes in cognitive functioning and somatic symptoms that significantly hinder the daily activity of the individual, affecting the social, work and personal environment. Major depressive disorder represents the classic condition of this type of disorders [5]. Among the psychosocial variables associated with depression are: a) being a woman; b) low socioeconomic level; c) unemployment; d) social isolation; e) legal problems; f) experiences of violence; g) addictive substances; h) migration. Environmental factors such as violence, insecurity or economic crises increase the risk of presenting depressive symptoms [6]. When depression occurs with other physical illnesses, the decrease in health is higher. The presence of comorbidities makes it difficult to seek help, diagnosis, the quality of medical attention and treatment; it negatively affects the results of the treatment including an increase in the mortality related to the disease. The comorbidity between depression and medical illnesses is very frequent and this association is bidirectional, so that depression can be cause or consequence of the same [7].

The onset of depression in caregivers is related to the stress of care. Therefore, the theoretical models used to explain the onset of this depression are based on the transactional stress theory of Lazarus and Folkman. In this model, caregiver stress and its consequences are the result of sources of stress in the care situation. The sources of stress are defined by the needs of the person receiving the care: functional status, cognitive impairment and behavioral problems. The assessment of the magnitude of these stressors can lead to the evaluation of perceived load and, as a result, also to psychological outcomes, such as depression among caregivers [8]. Based on the above, the main objective of the study is to determinate the frequency of depression in primary caregivers of older adults in Tijuana, Mexico.

Materials and Methods

A descriptive cross-sectional study was carried out, in the Family Medicine Unite #27, of the Instituto Mexicano del Seguro Social (IMSS), located in Tijuana, Mexico; in patients which were selected by a consecutive sampling techniques; that met the following inclusion criteria: age greater than 20 years, primary caregivers of adults over 60 years old, that accepted and signed the informed consent; patients with diagnosis of depression were excluded and patients with incomplete information were eliminated. The following data were obtained directly from participants or medical records: age, sex, marital status, schooling, kinship of primary care and depression. The procedure for the data collection was as follows: age was calculated in years according to the year of birth; marital status, schooling and kinship was obtained directly from patients and depression was evaluated with The Depression Inventory of Beck- II (BDI-II), a test used for depression that has demonstrated strong psychometric properties in diverse environments and populations. The test, which consists of 21 items, aims to identify and measure the severity of symptoms typical of depression in adults and adolescents from 13 years, can be self-applied with an estimated time of 5-10 minutes. The BDI-II items are consistent with the DSM-V criteria for the diagnosis of depressive disorders. In 2015, Gonzalez et al carried out the adaptation of the Beck Depression Inventory in Mexico. It has a Cronbach alpha of 0.92 [9]. The recollected data was integrated into data collection sheets and analyzed using the SPSS program version 20 in Spanish, where we applied descriptive statistics; for qualitative variables, frequencies and percentages were used and for quantitative variables, mean and standard deviation were used. The Kolmogorov- Smirnoff test was used to establish the normality of the data. The Protocol was authorized by the Local Committee of Research and Ethics in Health Research.

Results

385 primary caregivers were included in the study in the period between October to December 2018, of whom 71.2% (n= 274) were women and 28.8% (n= 111) men (Table 1). The mean age was 49.30 ± 13.8 years, 44.9% of the participants were in the age group of 40-59 years. In school, 5% of the patients did not have any type of studies (n= 20), 53% (n= 204) had basic education, 24.9% (n= 96) secondary education and 16.9% (n= 65) higher education. In marital status, 72.7% were married or in a free union (n= 280), 15.8% single, 5.5% divorced and 6% widowed. In kinship, 52% of the caregivers (n= 201) were sons and daughters of the elderly, 23.1% (n= 89) couples, 9.1% siblings and 15.6% had no family relationship with the older adult. Of the 385 caregivers interviewed, almost one third (30.1%) suffered some degree of depression (Graphic 1); 16.1% (n=62) mild depression, 9.1% (n=35) moderate depression and 4.9% (n=19) severe depression according to the Beck II Depression Inventory.

  

    
Variable
    
 
    
N
    
%
    
�
    
SD (±)
  
  

    
Age (years)
    
 
    
 
    
 
    
49.30
    
13.8
  
  

    
Age group
    
20-39 years
    
104
    
27
    
 
    
 
  
  

    
40-59 years
    
173
    
44.9
    
 
    
 
  
  

    
= 60 years
    
108
    
28.1
    
 
    
 
  
  

    
Sex
    
Women
    
274
    
71.2
    
 
    
 
  
  

    
Men
    
111
    
28.8
    
 
    
 
  
  

    
Schooling
    
No schooling
    
20
    
5.2
    
 
    
 
  
  

    
Primary
    
101
    
26.2
    
 
    
 
  
  

    
Secondary
    
103
    
26.8
    
 
    
 
  
  

    
High School
    
96
    
24.9
    
 
    
 
  
  

    
Bachelor's degree
    
65
    
16.9
    
 
    
 
  
  

    
Marital Status
    
Single
    
61
    
15.8
    
 
    
 
  
  

    
Married
    
210
    
54.5
    
 
    
 
  
  

    
Free union
    
70
    
18.2
    
 
    
 
  
  

    
Divorced
    
21
    
5.5
    
 
    
 
  
  

    
Widowed
    
23
    
6
    
 
    
 
  
  

    
Kinship
    
Sons/daughters 
    
201
    
52.2
    
 
    
 
  
  

    
Couple
    
89
    
23.1
    
 
    
 
  
  

    
Siblings
    
35
    
9.1
    
 
    
 
  
  

    
No kinship 
    
60
    
15.6
    
 
    
 
  

Table 1: Characteristics of primary caregivers.