Burden, secondary depression, and role of antidepressants: The complexity of family caregiving for Alzheimer's disease

This study explored the relationship among caregivers between objective and subjective burden, measured by Activities of Daily Living Scale and Zarit Burden Interview, to positive aspects of caring and desire to institutionalize the Alzheimer's disease (AD) patients. Caregivers of family members with AD provide daily care, which can lead to feelings of role strain and personal strain. While research has found that burden often leads to depression, there are gaps in the literature. First, the literature rarely discerns between objective (the tasks) and subjective (the feelings) burden. There is also a lack of information on medication use for depression in caregivers. Additionally, depression is the end point of most studies. Conceptualizing depression as leading to further problems, instead of the final problem, can highlight the consequences associated with not treating it effectively and early. The purpose of the present study was to address these shortcomings using Pearlin's stress processing model as a theoretical framework with an existing data set of dyads (caregivers and care-recipients) from the Resources to Enhance Alzheimer Caregiver Health (REACH II) study (N = 637). It also explored the potential mediator effects of depression measured by Center for Epidemiology Depression Scale and moderator effects of medication use. Data were analyzed through multiple regression and univariate analyses. Depression mediated the relationships between subjective burden and both outcome variables. Antidepressants may buffer subjective burden in caregivers using antidepressants. The implications for social change from this study result from the evidence provided here of the need to attend to depression in caregivers. This attention may result in more positive appraisals of the caregiving experience and a reduced desire to institutionalize which may ease financial burden to families and society.