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      The occurrence and persistence of thoughts of suicide, self‐harm and death in family caregivers of people with dementia: a longitudinal data analysis over 2 years

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          Abstract

          Objective

          Family caregivers of people with dementia often report high levels of stress and depression, but little is known about those who contemplate suicide or self‐harm. This study explores thoughts of suicide, self‐harm and death in dementia caregivers and investigates the characteristics that distinguish them from those without such thoughts.

          Methods

          Data were collected every 3 months, for 24 months, from 192 family caregivers of people with dementia living in the Netherlands. Caregivers did not have a clinical depression or anxiety disorder at baseline. Suicide‐related thoughts were measured with an item from the Mini International Neuropsychiatric Interview, a diagnostic instrument for DSM‐IV mental disorders. Fisher exact, analysis of variance or Kruskal–Wallis tests compared the characteristics of caregivers who had contemplated suicide with two comparison groups.

          Results

          Within 24 months, 76 caregivers reported symptoms of a potential depression and were further assessed for suicidal thoughts. Nine carers (11.8%, 4.7% of the total sample) reported suicidal thoughts with three of those at multiple points. Caregivers with suicidal thoughts had more severe depressive and anxious symptoms, had a lower sense of competence and mastery, felt less happy and experienced more health problems, less family support and more feelings of loneliness than caregivers who had not.

          Conclusion

          Suicidal thoughts are present in dementia caregivers and can persist across the care trajectory. Various psychological and social characteristics significantly distinguish caregivers with suicidal thoughts from those without. More research is needed to enable the identification of high‐risk caregivers and provide an evidence base for the development of preventive strategies and interventions. © 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

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          Most cited references 20

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          Caregiver burden among dementia patient caregivers: a review of the literature.

          To identify current evidence of factors influencing dementia-related caregiver burden (CB), describe patient and caregiver characteristics associated with CB, and describe evidence-based interventions designed to lessen the burden of caregiving. Comprehensive literature review of Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Psych Info was performed for the years 1996-2006 of peer-reviewed journals using keywords CB and dementia. Dementia caregiving has been associated with negative effects on caregiver health and early nursing home placement for dementia patients. Many factors influence the impact of the caregiving experience such as gender, relationship to the patient, culture, and personal characteristics. Although various interventions have been developed with the goal of alleviating CB, evidence suggests that individually developed multicomponent interventions including a diversity of services will decrease burden, improve quality of life, and enable caregivers to provide at-home care for longer periods prior to institutionalization. The ability to properly assess the dementia patient-caregiver dyad related to CB is critical to decreasing its negative physical and psychological health outcomes. Appropriately tailored interventions can improve the health and well-being of both caregiver and patient.
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            Mental Disorders, Comorbidity and Suicidal Behavior: Results from the National Comorbidity Survey Replication

            Mental disorders are among the strongest predictors of suicide attempts. However, little is known about which disorders are uniquely associated with suicidal behavior due to high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans, and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9,282 US adults. Results revealed that approximately 80% of suicide attempters in the US have a temporally prior mental disorder. Anxiety, mood, impulse-control, and substance disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (odds ratios=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (e.g., PTSD) and poor impulse-control (e.g., conduct disorder, substance disorders) predict which suicide ideators go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.
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              The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments.

               C Given,  M Stommel,  S. King (1992)
              The development and testing of a multidimensional instrument to assess the reactions of family members caring for elderly persons with physical impairments, Alzheimer's disease, and cancer is reported. Forty items were administered to a sample of 377 caregivers of persons with physical impairments and Alzheimer's disease. Five dimensions of caregivers' reactions were identified through exploratory factor analysis. Using confirmatory factor analysis on an independent sample (N = 377), these dimensions were tested for factorial invariance across spouse and nonspouse caregivers and between caregivers of persons with cancer and those caring for persons with Alzheimer's disease. The subscales also had a high level of factorial invariance across a three-wave panel study (N = 185). The subscales appeared consistent with first order tests of construct validity.
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                Author and article information

                Contributors
                k.joling@vumc.nl
                Journal
                Int J Geriatr Psychiatry
                Int J Geriatr Psychiatry
                10.1002/(ISSN)1099-1166
                GPS
                International Journal of Geriatric Psychiatry
                John Wiley and Sons Inc. (Hoboken )
                0885-6230
                1099-1166
                05 April 2017
                February 2018
                : 33
                : 2 ( doiID: 10.1002/gps.v33.2 )
                : 263-270
                Affiliations
                [ 1 ] Amsterdam Public Health research institute VU University Medical Centre Amsterdam The Netherlands
                Author notes
                [* ] Correspondence to: K. J. Joling, E‐mail: k.joling@ 123456vumc.nl
                Article
                GPS4708 GPS-16-0471.R1
                10.1002/gps.4708
                5811919
                28379646
                © 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Page count
                Figures: 0, Tables: 2, Pages: 8, Words: 3791
                Product
                Funding
                Funded by: ZonMw
                Award ID: 2620.00003
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                gps4708
                February 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:14.02.2018

                Geriatric medicine

                self‐harm, suicidal thoughts, family caregivers, dementia

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