Caregiver Depression Associated With Parkinson Disease Outcomes, Long-Term Trajectory
Elevated caregiver depression risk corresponds to increased emergency department usage, hinting at a pivotal link between caregiver well-being and patient healthcare utilization.
Rudmila Rashid, MD
Using 15 Parkinson’s Foundation Centers of Excellence within the US, findings from a retrospective cohort study showed that caregiver depression significantly impacts the quality of life (QoL) and frequency of emergency department (ED) visits for patients with Parkinson disease (PD). All told, patients with caregivers at higher risk of depression were more likely to have worse QoL and increased ED visits than those who had caregivers not a higher risk.
Led by Rudmila Rashid, MD, a research assistant at the University of Pennsylvania, the trial aimed to clarify more about the eventual implications of caregiver burden on the prognosis of patients with PD. Among a cohort of 454 patient-clinician dyads, self-reported QoL was measured through the 39-item Parkinson Disease Questionnaire (PDQ-39) while depression was identified in caregivers through the Center for Epidemiologic Studies Depression Scale (CES-D), a self-report 4-factor, 20-item assessment.
Patient QoL, number of self-reported hospitalizations, and number of self-reported ED visits were collected annually at baseline and all follow-up visits. Mean follow-up was 2.0 (SD, 1.4) annual visits. At the conclusion of the study, caregivers with a higher risk of depression, as indicated by CES-D scores of greater than 16, were associated with worse patient QoL as measured by PDQ-39 (patients with caregivers who had depressive symptoms: mean score, 33.78 [SD, 17.71] vs those without: mean score, 24.50 [SD, 14.19]; ß = 6.89; 95% CI, 4.09-9.69; P <.001). This same association occurred when the CES-D score was treated as a continuous variable (ß = 0.43; 95% CI, 0.28-0.58; P <.001).
"This study’s findings suggest that systematic screening for caregiver depression and more support of caregivers is important for the health of patients with PD and their caregivers," Rashid et al wrote. "Innovative approaches, such as interdisciplinary home visits and peer mentoring programs, cognitive behavioral therapy for caregivers, outpatient palliative care, and comprehensive knowledge and skill training, can successfully reduce caregiver strain."
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When CES-D score was treated as a continuous variable, the data identified a link between caregiver depressive symptoms and an increase in ED visits (ß = 0.02; 95% CI, 0-0.04; P = .03); however, this association went away when using the CES-D score cutoff of 16 (ß = 0.15; 95% CI, –0.18 to 0.48; P = .38). Of note, there was no association between depression scores and hospitalizations when using the CES-D score cutoff of 16 (ß = 0.20; 95% CI, –0.13 to 0.54; P = .24) or when treating the CES-D score as a continuous variable (ß = 0.02; 95% CI, –0.01 to 0.03; P = .10).
Among caregivers, the group with depression symptoms had a higher proportion of women (82.7%) than the group without (68.8%; P = .007). Patients who had caregivers without depression symptoms also had higher verbal fluency scores (mean, 18.6 [SD, 8.7]) compared with patients who had caregivers with depression symptoms (mean, 17.0 [SD, 6.2]; P = .03). The group with vs without depression symptoms also had a higher proportion of those who reported their financial status as not having enough to make ends meet (3.1% vs 1.1%; P = .005) and those who self-reported their health status as fair or poor (14.3% vs 4.8%; P <.001).
The study was limited by the fact that caregivers only completed the CES-D at baseline, as more data points would have aided in the analyses. Although the study tried to control for common measures of PD severity, investigators noted that it might be possible that confounding due to unmeasured factors played a role in the observed findings. In addition, the CES-D is a self-report screening questionnaire, it could not be asserted that caregiver depression was present. Furthermore, patients in the sample were also highly educated and had access to specialty movement disorder clinics, which limited the generalizability of these study findings for underserved populations.
