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Psychological and physiological effects of caring for patients with treatment-resistant depression.

Abstract

BACKGROUND

Carers of patients with psychiatric disorders show high levels of anxiety and depression, possibly mediated through disruption of the hypothalamo-pituitary-adrenal (HPA) axis. Among carers of patients with treatment-resistant depression (TRD), we set out to determine the psychological and physiological (HPA axis) consequences of caring, and the association of these consequences with long-term outcome in patients.

METHOD

Thirty-five informal carers of patients with severe TRD requiring in-patient treatment were recruited and compared with 23 controls. HPA-axis activity was assessed by measuring post-awaking salivary cortisol. The Involvement Evaluation Questionnaire (IEQ) and the General Health Questionnaire-12 (GHQ-12) were administered to measure carer burden and psychiatric caseness respectively. Independent t tests were used to compare differences between carers and controls and a linear regression model was used to determine the association of post-awakening cortisol with carer status while controlling for confounding variables. Data on long-term patient outcome (12 to 83 months), measured using the Hamilton Depression Rating Scale (HAMD), were also obtained and linear regression was used to determine the association between cortisol output in carers and remission status in patients.

RESULTS

Carers experienced high carer burden and high psychiatric caseness. Carers showed reduced cortisol output after awakening, calculated as the area under the curve with respect to ground (AUCg), which remained significant after controlling for potential confounders. In a linear regression model, non-remission in patients was associated with reduced cortisol output in carers.

CONCLUSIONS

Caring for patients with TRD is associated with adverse psychological and physiological changes suggesting hypocortisolism post-awakening. These changes are associated with poor patient outcome.

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  • Authors+Show Affiliations

    ,

    Section of Neurobiology of Mood Disorders, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, London, UK. lena.rane@kcl.ac.uk

    , , , , ,

    Source

    Psychological medicine 42:9 2012 Sep pg 1825-33

    MeSH

    Adult
    Aged
    Caregivers
    Case-Control Studies
    Depression
    Depressive Disorder, Treatment-Resistant
    Female
    Humans
    Hydrocortisone
    Hypothalamo-Hypophyseal System
    Linear Models
    Male
    Middle Aged
    Pituitary-Adrenal System
    Saliva
    Stress, Psychological
    Surveys and Questionnaires
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22251699

    Citation

    Rane, L J., et al. "Psychological and Physiological Effects of Caring for Patients With Treatment-resistant Depression." Psychological Medicine, vol. 42, no. 9, 2012, pp. 1825-33.
    Rane LJ, Fekadu A, Papadopoulos AS, et al. Psychological and physiological effects of caring for patients with treatment-resistant depression. Psychol Med. 2012;42(9):1825-33.
    Rane, L. J., Fekadu, A., Papadopoulos, A. S., Wooderson, S. C., Poon, L., Markopoulou, K., & Cleare, A. J. (2012). Psychological and physiological effects of caring for patients with treatment-resistant depression. Psychological Medicine, 42(9), pp. 1825-33. doi:10.1017/S0033291711003035.
    Rane LJ, et al. Psychological and Physiological Effects of Caring for Patients With Treatment-resistant Depression. Psychol Med. 2012;42(9):1825-33. PubMed PMID: 22251699.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Psychological and physiological effects of caring for patients with treatment-resistant depression. AU - Rane,L J, AU - Fekadu,A, AU - Papadopoulos,A S, AU - Wooderson,S C, AU - Poon,L, AU - Markopoulou,K, AU - Cleare,A J, Y1 - 2012/01/17/ PY - 2012/1/19/entrez PY - 2012/1/19/pubmed PY - 2012/12/19/medline SP - 1825 EP - 33 JF - Psychological medicine JO - Psychol Med VL - 42 IS - 9 N2 - BACKGROUND: Carers of patients with psychiatric disorders show high levels of anxiety and depression, possibly mediated through disruption of the hypothalamo-pituitary-adrenal (HPA) axis. Among carers of patients with treatment-resistant depression (TRD), we set out to determine the psychological and physiological (HPA axis) consequences of caring, and the association of these consequences with long-term outcome in patients. METHOD: Thirty-five informal carers of patients with severe TRD requiring in-patient treatment were recruited and compared with 23 controls. HPA-axis activity was assessed by measuring post-awaking salivary cortisol. The Involvement Evaluation Questionnaire (IEQ) and the General Health Questionnaire-12 (GHQ-12) were administered to measure carer burden and psychiatric caseness respectively. Independent t tests were used to compare differences between carers and controls and a linear regression model was used to determine the association of post-awakening cortisol with carer status while controlling for confounding variables. Data on long-term patient outcome (12 to 83 months), measured using the Hamilton Depression Rating Scale (HAMD), were also obtained and linear regression was used to determine the association between cortisol output in carers and remission status in patients. RESULTS: Carers experienced high carer burden and high psychiatric caseness. Carers showed reduced cortisol output after awakening, calculated as the area under the curve with respect to ground (AUCg), which remained significant after controlling for potential confounders. In a linear regression model, non-remission in patients was associated with reduced cortisol output in carers. CONCLUSIONS: Caring for patients with TRD is associated with adverse psychological and physiological changes suggesting hypocortisolism post-awakening. These changes are associated with poor patient outcome. SN - 1469-8978 UR - https://www.unboundmedicine.com/medline/citation/22251699/Psychological_and_physiological_effects_of_caring_for_patients_with_treatment_resistant_depression_ L2 - https://www.cambridge.org/core/product/identifier/S0033291711003035/type/journal_article DB - PRIME DP - Unbound Medicine ER -