Table of Contents    
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 73-77  

The impact of caregiving on anxiety and depression symptoms in caregivers of hospitalized geriatric patients


1 Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
2 Department of Internal Medicine, Division of Psychosomatic, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
3 Department of Internal Medicine, Division of Geriatric, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
4 Department of Internal Medicine, Division of Hematology and Medical Oncology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Date of Web Publication14-Jan-2020

Correspondence Address:
Rudi Putranto
Department of Internal Medicine, Division of Psychosomatic, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta 10430
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsbm.JNSBM_75_19

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   Abstract 


Objective: Research focusing on anxiety and depression among caregivers of hospitalized geriatric patients is lacking. The objective of this study was to determine the prevalence of anxiety and depression among caregivers of hospitalized geriatric patients for 1 week. Subjects and Methods: A prospective cohort study of caregivers of geriatric patients who were hospitalized at Cipto Mangunkusumo Hospital was conducted from February to May of 2018; levels of anxiety and depression symptoms were assessed on the 1st day of hospitalization compared with those from the 7th day using the Hospital Anxiety and Depression Scale questionnaire. The analysis was conducted using SPSS Statistics for bivariate and multivariate logistic regression. Results: On the 1st day of hospitalization, 29.1% of the caregivers had mild anxiety symptoms, 5.1% had moderate anxiety symptoms, and 2.6% had mild depression symptoms. On the 7th day, 44.4% of the caregivers had mild anxiety symptoms, 23.1% had moderate anxiety symptoms, and 3.4% had severe anxiety symptoms, whereas 49.6% had mild and 12.8% had moderate depression symptoms. The duration of caregiving ≥8 h/day (P = 0.041; odds ratio [OR]: 4.228; 95% confidence interval [CI]: 1.060–16.860 for anxiety and P = 0.008; OR: 8.392; 95% CI: 1.723–40.880 for depression) and ≥6 days/week (P = 0.019; OR: 2.500; 95% CI: 1.163–5.375 for anxiety and P < 0.001; OR: 4.184; 95% CI: 1.982–9.256 for depression) significantly increased symptoms of anxiety and depression. Conclusion: Caregiving for hospitalized geriatric patients can aggravate anxiety and depression, and the duration of caregiving ≥8 h/day and ≥6 days/week significantly increased both symptoms.

Keywords: Anxiety, depression, geriatric patient caregivers, Hospital Anxiety and Depression Scale


How to cite this article:
Sihombing SS, Putranto R, Harimurti K, Rinaldi I. The impact of caregiving on anxiety and depression symptoms in caregivers of hospitalized geriatric patients. J Nat Sc Biol Med 2019;10, Suppl S1:73-7

How to cite this URL:
Sihombing SS, Putranto R, Harimurti K, Rinaldi I. The impact of caregiving on anxiety and depression symptoms in caregivers of hospitalized geriatric patients. J Nat Sc Biol Med [serial online] 2019 [cited 2020 Jan 25];10, Suppl S1:73-7. Available from: http://www.jnsbm.org/text.asp?2019/10/3/73/275601




   Introduction Top


Any person who provides care to another person with physical or mental limitations, with or without income, is known as a caregiver and can experience physical, emotional, and economical burdens resulting from that caregiving. Inpatient care services that aim to treat patients can have a negative impact on caregivers by increasing their burdens. These burdens are even greater for geriatric patient caregivers and can lead to psychological symptoms such as anxiety and depression that impair their quality of life and the quality of caregiving they provide.[1],[2],[3],[4],[5]

The psychological well-being of caregivers is not routinely assessed by health-care providers, and only a few existing studies focus on the impact of providing care for geriatric patients during hospitalization on anxiety and depression symptoms in caregivers. The objective of this study was to determine the prevalence of anxiety and depression symptoms among caregivers of geriatric patients who were hospitalized for 1 week using the Hospital Anxiety and Depression Scale (HADS) Questionnaire [Table 1]. The HADS questionnaire is an instrument used to detect symptoms of anxiety and depression in the past week and has already been translated into and validated for several languages, including Indonesian.[6],[7],[8]
Table 1: Hospital Anxiety and Depression Scale questionnaire

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   Subjects and Methods Top


A prospective cohort study approved by the Ethics Committee of the Faculty of Medicine, University of Indonesia, with protocol number 18-01-0045 was conducted from February to May of 2018 at Cipto Mangunkusumo Hospital in Jakarta, Indonesia. Cipto Mangunkusumo Hospital is a national referral center hospital which provides primary, secondary, and tertiary cares. Participants in this study were caregivers of hospitalized geriatric patients. The inclusion criterion was being a caregiver of a hospitalized geriatric patient (a patient aged 60 years or older) who was willing to join the study. Data were collected using a consecutive sampling method, and the HADS questionnaire was used to assess both anxiety and depression symptoms among caregivers on the 1st day and the 7th day of hospitalization. Caregivers with severe anxiety or depressive symptoms on the 1st day of hospitalization according to the HADS questionnaire were excluded, and caregivers of geriatric patients who were hospitalized for <7 days were considered dropouts. HADS questionnaire assessed both anxiety and depression symptoms by reflecting how the respondent felt in the past week. Total scores of 0–7 for either anxiety or depression symptoms were considered normal, scores of 8–10 indicated mild symptoms, scores of 11–14 indicated moderate symptoms, and scores of 15–21 indicated severe symptoms.[7],[9]

In addition to HADS, the participants completed a questionnaire containing items related to demographic data and the duration of caregiving they provided during hospitalizations per day and per week. Collected data were processed using the Statistical Package for the Social Sciences version 20.0 (IBM Corp. SPSS Statistics for Windows, Armonk, NY, USA). Variables consisting of caregiving duration during hospitalizations per day and per week were included in bivariate and multivariate analyses. Bivariate analysis was conducted using a 2 × 2 table to determine the odds ratio (OR), 95% confidence interval range (95% CI), and P value using a Chi-square test. Logistic regressions were done for multivariate analysis.


   Results Top


From February to May of 2018, 121 caregivers of hospitalized geriatric patients met the inclusion criteria. Four patients were hospitalized for <7 days, and their caregivers were considered dropouts. In the end, 117 participants were included in the data analysis.

The majority of the caregivers were women aged 26–49 years from the Javanese and Sundanese tribes who were high school graduates. Almost all of the caregivers were family members who were providing care for at least 8 h a day and 6 days a week in the hospital. The caregiver characteristics are shown in [Table 2].
Table 2: Caregiver characteristics (n=117)

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On the 1st day of hospitalization, 65.8% of the caregivers reported anxiety symptoms in the normal range, 29.1% reported mild anxiety symptoms, and 5.1% reported moderate symptoms. A total of 97.4% of the caregivers reported depression symptoms in the normal range and 2.6% of the caregivers reported mild depression symptoms. On the 7th day of hospitalization, only 29.1% of the caregivers were categorized as being in the normal range for anxiety symptoms, whereas 44.4% of the caregivers reported mild anxiety symptoms, 23.1% reported moderate anxiety symptoms, and 3.4% reported severe anxiety symptoms. For depression symptoms, 37.6% of the caregivers were categorized as being in the normal range, 49.6% reported mild depression, and 12.8% had moderate depression symptoms. Overall, 58.1% of the caregivers of hospitalized geriatric patients experienced increased anxiety symptoms, and 60.7% of the caregivers experienced increased depression symptoms on the 7th day of hospitalization. The comparison of caregivers' symptoms of anxiety and depression on the 1st and 7th days of hospitalization is shown in [Table 3].
Table 3: Comparison of caregivers' anxiety and depression symptoms on the 1st and 7th days of hospitalization (n=117)

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From the multivariate analysis, we found that a duration of caregiving ≥8 h/day (P = 0.041; OR: 4.228; 95% CI: 1.060–16.860 for anxiety and P = 0.008; OR: 8.392; 95% CI: 1.723–40.880 for depression) and a duration of caregiving ≥6 days/week (P = 0.019; OR: 2.500; 95% CI: 1.163–5.375 for anxiety and P < 0.001; OR: 4.184; 95% CI: 1.982–9.256 for depression) during hospitalization significantly increased both anxiety and depression symptoms. The bivariate and multivariate analyses data are shown in [Table 4] and [Table 5].
Table 4: Bivariate analysis of increased anxiety and depression symptoms

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Table 5: Multivariate analysis of increased anxiety and depression symptoms

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   Discussion Top


Before caregiving for hospitalized geriatric patients, caregivers are already faced with physical, emotional, and economic burdens which can lead to psychological symptoms such as anxiety and depression.[1],[2] In this study, we found that most caregivers were already having anxiety symptoms on the 1st day of hospitalization, and there was a significant increase in levels of anxiety and depression among caregivers over the course of a 7-day hospitalization. The increasing symptoms of anxiety and depression among caregivers during hospitalization of geriatric patients is understandable because, like the patients, caregivers must adapt to the new hospital environment. While caregiving in the hospital, caregivers tend to experience sleep disturbances and are required to provide more help than usual due to the increased dependency of hospitalized patients. Feeling ignored or lacking communication from the doctors taking care of the patient also can add weight to a caregiver's burden, leading to anxiety and depression.[2],[3],[5]

Previous studies have reported that the duration of caregiving in a day was associated with anxiety and depression experienced by the caregivers; our study found that over a 7-day period, caregiving for 8 h or more per day and 6 days or more per week significantly increased anxiety and depression symptoms experienced by caregivers of hospitalized geriatric patients. Our findings regarding anxiety and depression symptoms experienced by caregivers of hospitalized geriatric patients were similar to those of Covinsky et al. and Longacre et al. Longer duration of caregiving means doing more work and providing more help to the patients they cared for in the hospital, and it increases caregivers' burdens, leading to symptoms of anxiety and depression.[10],[11],[12],[13]

The results of this study indicate that caregiving in the hospital should be provided in alternating shifts, with each shift less than 8 h/day and 6 days/week. Caregiving for hospitalized patients 8 h or more per day or 6 days or more per week significantly increased anxiety and depression symptoms among caregivers, and it can interfere with the quality of caregiving provided and adversely affect their quality of life. The poor quality of caregiving will certainly hinder the healing and recovery process of the geriatric patients for whom they cared.

As far as we know, our study is the first prospective cohort study to address increased symptoms of anxiety and depression among caregivers of geriatric patients during 1-week hospitalizations. However, most caregivers in this study were caring for geriatric patients in nonsurgical wards. The result of this study may be useful not only for health-care providers, including the physicians who treat geriatric patients, but also for caregivers. Caregivers should receive more attention, and this study emphasizes the importance of awareness and early detection of anxiety and depression among caregivers.


   Conclusion Top


Caregiver can experience physical, emotional, and economical burdens during caregiving. In this study, we found that caregiving for hospitalized geriatric patients can aggravate anxiety and depression among caregivers. Duration of caregiving ≥8 h/day and caregiving ≥6 days/week significantly increased symptoms of both anxiety and depression during hospitalization.

Acknowledgment

We are thankful to all study participants for giving their time to participate in our study. We also would like to thank the Internal Medicine Department, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, for providing scientific institution approval to carry out our study.

Financial support and sponsorship

The 3rd ICE on IMERI Committee supported the peer review and manuscript preparation of this article.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Bernabeu-Mora R, García-Guillamón G, Montilla-Herrador J, Escolar-Reina P, García-Vidal JA, Medina-Mirapeix F. Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: A prospective study. Int J Chron Obstruct Pulmon Dis 2016;11:3199-205.  Back to cited text no. 11
    
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Covinsky KE, Newcomer R, Fox P, Wood J, Sands L, Dane K, et al. Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med 2003;18:1006-14.  Back to cited text no. 12
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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