Does depression in caregivers affect the prognosis of Parkinson’s disease patients?

By Pooja Toshniwal PahariaAug 17 2023Reviewed by Sophia Coveney

In a recent study published in JAMA Network Open, researchers assessed the relationship between care providers with depressive symptoms and the quality of life (QoL), hospital admissions, and emergency department (ED) consultations of Parkinson’s disease (PD) patients.

Background

Care providers are invaluable sources of emotional and physical support for PD patients. Care provider presence is linked to additional benefits, including more informative visits to healthcare facilities, delayed placement in nursing homes, and lowered healthcare costs.

However, due to the financial, emotional, and physical care provider investment, this role can negatively affect care providers’ health, leading to care provider burnout and lower care provider efficacy.

Studies have reported that care provider strain is associated with increased motor symptoms, cognitive impairments, sleep disruptions, and a lack of reciprocity (mutuality or the sharing of feelings and actions in relationships) among PD patients. However, data on the impact of care providers’ health on PD patient outcomes are limited.

About the study

In the present study, researchers investigated whether care providers’ mental health status could impact PD patient outcomes.

The team conducted the study at 15 PD Foundation Centers of Excellence across the United States (US). The PD Foundation’s (PF) Parkinson Outcomes Project (POP) data were utilized to obtain baseline information between 1 January 2016 and 31 December 2018, with yearly follow-up visits until 31 July 2020. Data analysis was performed between 5 August 2020 and 9 June 2023.

In total, 454 PD patients and their care providers were enrolled during regular consultations with mobility disorder specialists by convenience sampling. The team included individuals diagnosed with PD by physicians who resided at their homes and had at least one follow-up visit within two years of study initiation.

The study’s exposure variable was depression symptoms among caregivers, assessed based on the Center for Epidemiologic Studies Depression Scale (CES-D) scores.

The study outcome measures were patient health-associated QoL [assessed using the 39-item PD Questionnaire (PDQ-39)], the number of emergency department consultations, and hospitalizations per year. Linear mixed-effects and Poisson repeated-measures regression modeling were performed to determine the relationship between care providers’ depressive symptoms and PD patient outcomes.

Results

In total, 663 patient-care provider dyads participated in the PF-POP care provider sub-study, of which 209 were excluded due to inadequate follow-up information, initial follow-up after two years of study initiation, or missing care provider data on depressive symptoms. As a result, 454 dyads were considered for the final analysis. The mean age of the PD patients was 67 years, and 320 (71%) were male, whereas the mean age was 66 years, and 326 (72%) were female.

The study participants were followed up for two study visits. Most care providers were white [435 (97%)] and non-Latinx [384 (98%)]. Among PD patients, 275 out of 434 (64%) had attained bachelor’s or graduate-level education. Among the care providers, 356 did not have increased depression risks, whereas 98 were prone to depression.

An increase in depressive symptoms among care providers was related to worse QoL among PD patients, as determined using the PDQ (mean score, 34, among PD patients whose care providers had depressive symptoms versus 25 among those with care providers without depression symptoms) and increase in the frequency of yearly emergency department consultations but not in hospitalizations.

Among PD patients, the mean CES-D score was 9.8, with scores of 22 and 6.6 among those with care providers who had depression risks and no depression risks, respectively. Patients who had care providers with no depression symptoms had higher verbal fluency scores than those who had care providers with depression symptoms.

In terms of yearly emergency department visits, there were 686 patient-year data points among 978 events (71%) during which there were no emergency department visits by patients who had care providers with no increased depression risk, compared to 159 patient-year data points among 257 events (63%) during which there were no emergency department consultations by patients with care providers who were prone to depression.

The findings indicated a significant difference in yearly emergency department consultations per patient-year between the two groups.

Concerning annual hospital admissions, PD patients with care providers without any depression risk had 743 data points among 981 events (76%) during which there were no hospitalizations whereas patients with care providers at an increased risk of depression had 180 data points among 258 events (70%) during which there were no hospitalizations, indicating significant differences in the annual hospitalization frequencies between the two groups.

Conclusions

Overall, the study findings showed that PD patients with care providers who had increased depression risks had a higher likelihood of having a worse QoL and more emergency department visits compared to patients whose care providers had no such risk.

Depression can hinder care provider capacity to perform their tasks, and improving caregiver support and emphasizing their mental health could potentially improve PD patient outcomes.

Innovative methods, such as peer mentoring programs, interdisciplinary home visits, cognitive behavioral treatment for care providers, comprehensive skill and knowledge training, and outpatient palliative care, can lower the care provider burden. Future studies could evaluate the beneficial effects of caregiver depression therapy on PD patients’ health-related outcomes and healthcare usage costs.