Caregiver strain link to depression mediated by rumination

By Mark Cowen, Senior medwireNews Reporter

Caregiving strain is associated with depressive symptoms among family members of patients with bipolar disorder, US study results show.

However, Jodi Gonzalez (University of Texas Health Science Center, San Antonio) and team report that the association is partially mediated by ruminative style.

"The results indicate that strains associated with caregiving do not, in and of themselves, invariably result in depressive symptoms," they comment. "The tendency of caregivers who experience high strain to ruminate on their difficulties and shortcomings predisposes them to depression."

The researchers studied 149 male (n=55) and female (n=94) caregivers of patients enrolled in the Systemic Treatment Enhancement Program for Bipolar Disorder ‑ a national longitudinal study evaluating treatment effectiveness and outcomes in patients with the mood disorder.

All of the caregivers were evaluated for depression, caregiver burden (strain), and rumination using the Center for Epidemiologic Studies-Depression Scale (CES-D), the Social Behavior Assessment Scale (SBAS), and a 10-item shortened form of the Ruminative Style Questionnaire (RSQ), respectively.

The researchers found that mean CES-D scores for men and women were above the standard cutoff point of 16 for depression, at 16.38 and 18.11, respectively, indicating mild levels of depression. The difference in scores between men and women was not significant.

Both men and women also showed similarly moderate-to-high levels of strain, with SBAS scores of 7.71 and 10.05, respectively.

There was also no significant difference between men and women regarding scores for rumination, with RSQ scores of 21.95 and 23.22, respectively.

Further analysis showed that caregiver strain was significantly and positively associated with CES-D scores. However, RSQ score accounted for around 50% of the association between strain and CES-D.

Neither caregiver gender nor the interaction of caregiver gender with RSQ score was significantly associated with CES-D scores.

Gonzalez et al conclude in Acta Scandinavica Psychiatrica: "Rumination helps explain depressive symptoms experienced by both male and female caregivers of patients with bipolar disorder."

They add: "Interventions for caregivers targeted at decreasing rumination should be considered."

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