Trajectory and influencing factors of depressive symptoms in family caregivers before and after the death of terminally ill patients with cancer

Purpose/Objectives: To explore the occurrence of depressive symptoms and factors that affect them in family caregivers before and 1, 3, 6, and 13 months after the death of a care recipient with cancer. Design: Descriptive, longitudinal study. Setting: A medical center in northern Taiwan. Sample: Convenience sample of 186 primary family caregivers. Methods: Changes in caregivers' depressive symptoms and their influencing factors during bereavement were analyzed with the generalized estimating equation, which uses robust standard error estimates to account for within-subject correlations of scores during the follow-up period. Main Research Variables: Caregivers' depressive symptoms; potential influencing factors included intrapersonal risk or protective factors, social resources, caregiving situation, and time in relation to the patient's death. Findings: Caregivers' depressive symptoms peaked at one month and decreased significantly during the first 13 months after the patient's death. Bereaved caregivers experienced a lower level of depressive symptoms if they had cared for older patients, reported a higher level of subjective caregiving burden during the patient's dying process, and had greater social support. Caregivers reported a higher level of depressive symptoms after bereavement if they had a higher level of depressive symptoms before the patient's death, had poorer health, and were the patient's spouse. Conclusions: Caregivers' depressive symptoms improved significantly from one month before to 13 months after the patient's death. Implications for Nursing: Nurses should increase their ability to identify factors influencing caregivers' depressive symptoms before and after the death of their terminally ill family member and provide appropriate care to facilitate caregivers' psychological adjustments to bereavement. Knowledge Translation: Healthcare professionals should pay special attention to caregivers who are the patient's spouse, have poorer health, and suffer from a higher level of depressive symptoms. Appropriate care before and after the patient's death is needed to facilitate caregivers' psychological adjustment to the loss of their relative.