Depression in Caregivers of Patients with Breast Cancer: A Cross-Sectional Study from a Cancer Research Center in South India

By Sahadevan, Sreeja; Namboodiri, Vasudevan | Indian Journal of Psychiatry, May-June 2019 | Go to article overview

Depression in Caregivers of Patients with Breast Cancer: A Cross-Sectional Study from a Cancer Research Center in South India


Sahadevan, Sreeja, Namboodiri, Vasudevan, Indian Journal of Psychiatry


Byline: Sreeja. Sahadevan, Vasudevan. Namboodiri

Context: Existing literature suggests an alarming rate of depression in cancer caregivers, which is comparable to or even higher than in patients themselves. There are no studies on depression among caregivers of breast cancer from India. Aims: The aim is to study the prevalence and determinants of depression in caregivers of breast cancer. Settings and Design: This is a cross-sectional study of 384 patient-caregiver dyads at a cancer research center in South India. Materials and Methods: Based on the International Classification of Diseases, 10th Revision Diagnostic Criteria for Research depression was diagnosed, and the severity of depression was assessed using the Hamilton rating scale for depression. A semi-structured pro forma was used to collect the clinical data under patient, caregivers, and care characteristics. Results: The prevalence of depression in caregivers was 52.5%. Among them, 35% had mild depression, 16% had moderate depression, and 2% had severe depression. Spousal caregivers, those who resided with the patient, those providing financial support and those with noncaring domestic responsibilities appeared as vulnerable determinants in univariate analysis. However, multivariate analysis did not support the same. Conclusion: Depression is common among caregivers of patients with breast cancer. There is a need for focused interventions for this group, which may improve the outcome of the patient as well.

Introduction

Cancer remains an important cause of death and increasingly, a chronic illness, with its baggage of burden. Pronouncing the word cancer is related to a life-threatening situation in spite of the increasing awareness of medical knowledge in India.[1],[2] The diagnosis of cancer evokes significantly greater emotional reaction than the diagnosis of any other disease, regardless of mortality rate, or treatment options.[3] The gap of knowledge, fear, and uncertainty regarding cancer is attributable to this dilemma.[1]

In India, the total cancer cases of 979,786 in 2010 are predicted to rise to 1.1 million by 2020.[4] The diagnosis of cancer affects not only the patients but also the principal caregivers who are involved in the care of the patient.[5] Studies have shown that depression is greater in cancer caregivers than in the general population[6],[7] and caring for patients with cancer may increase the risk for, sleep disruption, depression, anxiety, and finally diminish the quality of life (QoL).[8],[9],[10],[11],[12] Ramirez reported a high prevalence of depression and anxiety in cancer caregivers (39% and 46%, respectively).[13] Studies have shown the efficacy of psychological interventions such as cognitive behavioral therapy (CBT), psycho educative and supportive therapies, family therapies or group therapies among cancer caregivers.[14] Lack of medical attention and services to caregivers is a gap in health care.[15]

Breast cancer is the most commonly diagnosed malignancy in women worldwide (22%).[16] In India, breast cancer ranks second to cervical cancer (18.5% of cases).[16] The age-standardized incidence rate of breast cancer in India varies from 9 to 32/100,000 women.[16] Advances in screening and biomedical treatment modalities have changed the face of breast cancer from a terminal illness to a chronic illness with the bio-psycho-social features.[15] In our society, the principal caregivers, commonly close relatives are the backbone of support and care for the patient.[17] Western society and the Asian Society are markedly different in the structure, familial organization, and the social support from Government and other agencies. According to data from a study in Karnataka, the majority of principal caregivers had to give up work permanently, leading to a significant dent in their personal finances, in situ ations of cancer in their loved ones.[18] The studies of psychological distress of principal caregivers are mostly from outside India, and family caregivers of patients with cancer received limited attention in published literature in India. …

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