| Senile dementia is a degenerative disease features with symptoms of progressive cognitive disorders and behavioral impairments, including the impairment of cognition, personality behavior, and other neuropsychiatric symptoms, and it usually occurs at senium and presenium. As the population aging, the incidence of senile dementia is continuously increasing. The prevalence of dementia will be increased in two times with the extension of life expectation in the next five years. Now, dementia is a worldwide health problem. Global Health Report issued by WHO in 2006 described that nervous system disease is the first enemy of mankind, and dementia is the fourth leading cause of death, after cardiovascular diseases, cancers and strokes, which is the main culprit for the elder health in developed countries. In 2006, the global population over 65-year-old was 0.484 billion, while it was up to 0.134 billion in China. The first epidemiological study in China in 2005 reported that the prevalence of dementia among the people over 65-year-old was 7.8%, which increased with age growing. It is estimated that the population of elderly dementia in China is about 8 million, and by the middle of the twenty-first century the elderly population in China will be up to 0.4 billion, of which dementia patients will be about 20 million, making China country with the largest and fastest increasing population of elderly dementia in the world.Most senile dementia patients won't be able to take care of themselves in daily life with the progression of disease; therefore, they would gradually be dependent on caregivers and eventually most of them would need care completely. At present, senile dementia patients in China are generally attended at home by family members, including spouse, brothers, sisters, daughters, sons and relatives, among whom spouse usually takes up the largest proportion about 71.7%, while that proportion of daughters and/or sons is relatively small, just about 15.0%. As the main caregiver, patients poouses have to spend almost the full time and energy on the attendance of the daily life of the patient, which bring heavy burden physically, psychologically and economically. In the end, they usually feel tired and nervous, and even has negative emotions like depression, anxiety and hostility, etc. Their living quality and health level would be severely affected after attending patient for a long time.During the treatment for the patients and attentions to their living quality, it is prerequisite to the caregiver with physical and mental health, but we should actively and initially focus on the psychological and physical condtions of their spouses, trying to mobilize their enthusiasms to offer great attendance and family support for the patients. According to relevant literatures, the prevalence rate of social psychological diseases among the family caregivers is much higher than ordinary social groups, while their depression and anxiety would directly affect the quality of the attendance to the patients; besides, the long suffering of such negative emotions would be seriously harmful to their physical and mental health. Therefore, paying close attentions to the psychological health condition and its causes of the spouses of senile dementia patients could provide a basis for establishing well targeted intervention measures, having great significance in the improvement of physical and mental health level of the spouses and further in the enhancement of the support abilities for the patients.Purpose:The aim of this study was investigated the senile dementia spouses'status of depression, anxiety and the related factors under Chinese special social culture, trying to provide an evidence on establishing a strategy about the physical intervention of the patients'spouse to improve their living quality and psychological health condition, further enhancing their attendance and support abilities for dementia patients. We surveyed 90 dementia patients and their spouses about the spouses' statuses of depression, anxiety, social support as well as the relevant factors.Methods:The 90 objects were senile dementia patients and their spouses from the out and in-hospital department of our institute from October,2007 to May,2009. The investigators had been well trained before this study. To ensure the reliability of the acquired information, the dementia patients and their spouse were isolated during the interviews to supply enough time and suitable space for their investigation. The questionnaires were composed of Zung self-rating depression scale (SDS), Zung self-rating anxiety scale (SAS), social support rating scale (SSRS); clinical dementia rating (CDR), self-designed general scale and base information of the patient. According to the score, SDS was classed into<42 normal and≥42 depression; SAS was classed into<40normal;≥40anxiety; CDR were classed into suspectable dementia (0.5 score), mild (1 score), moderate (2 score) and severe dementia (3score). All the statistics analyses were performed with SPSS13.0 software, and P≤0.05 showed statistical difference.Results:(1) The depression and anxiety conditions of the spouses of dementia patients:self-rating depression score and self-rating anxiety score were 42.47±10.9 and 38.61±11.4, respectively, both of them were obviously higher than domestic norm in normal people (P<0.05). The patient's spouses with depression symptoms took up 52.2%, and those with anxiety symptoms took up 42%, the incidence of the two symptoms was remarkablly higher than that of domestic normal population, too (depression 6.0% vs anxiety 11.2%).(2) Social support conditions of the patients' spouses:The scores of subjective and objective support as well as the utilization of social support of the patients'spouses in depression group were lower than non-depression group; the scores of objective support and the utilization of social support of the patients' spouses in anxiety group were lower than non-anxiety group, with all the differences having remarkable statistical significance.(3) The causes of the prevalence rate of depression and anxiety disorder of patients' spouses:The statistical analysis of the causes of depression and anxiety disorder of patients' spouses showed:the dementia severity of the patients, family economic situation, the spouses' self-pressure perception and educational level showed remarkable statistical significance in the groups of depression and non-depression and the groups of anxiety and non-anxiety, respectively (P<0.05)(4) Taking whether the patients'spouses have depression as dependent variable, the results of the multinomial Logistic gradual regression analysis showed:the spouses' self-rating depression score had correlation with the dementia severity of the patients, the spouses'self pressure perception and utilization of social support, having a negative correlation with the utilization of social support. Taking whether the patients'spouses have anxiety as dependent variable, the result of the multinomial Logistic gradual regression analysis showed:the spouses' self-rating anxiety score had correlation with their self pressure perception and objective support, having a negative correlation with the objective support.Conclusion:According to the results of this survey, as main caregivers, the spouses of senile dementia patients usually have obvious depression and anxiety emotions, with significantly higher depression and anxiety rating scores than domestic norm of the normal people; the results also show that those with depression disorder take up 52.2% and those with anxiety disorder take up 42.2%, both sharply higher than domestic normal people. According to Sansoni's survey of the spouses of senile dementia patients, who are the main caregivers:42.0% of them have depression symptoms,76.0% have anxiety symptoms, with a higher proportion of anxiety symptoms among the caregiver. Some western researchers have found that the spouses of senile dementia patients as caregivers are more vulnerable to depression and anxiety disorder, although they subjectively feel less stressed than non spouse caregivers. The severer the burdens on the spouse caregivers, the more frequent the occurrence of the dementia patients'pathologic behaviors; therefore, the caregivers would have to send the patients to hospital, nursing home and welfare house more frequently and the spouses would be more vulnerable to depression and anxiety disorder. Researches abroad also suggested that the effects caused by the burdens endured by spouse caregivers appear not only during the attendance, but the caregivers would still continuously have depression and anxiety emotions in three years after the attendance. In accordance with some literature researches, the largest pressure of spouse caregivers is relating to social communication, for the attendance of patients takes up most of their time and energy, after taking on the burden of looking after the patients most spouses are isolated with the society, which greatly affects their social communication and the consequent social depression and anxiety pressures are the main reason for the unstable emotions of the spouses.We've found during this survey that if the score of the spouses'self pressure perception is over 50, they are more vulnerable to depression and anxiety disorder than those with scores lower than 50. The reason may be that the spouses of senile dementia patients couldn't normally exchange and communicate with the patients due to their cognitive disorders and different degrees of mental behavior symptoms; besides, the dementia patients' spouses would spend most of their time taking care of the daily life of the patients, they seldom have enough time for normal rest let alone opportunities for leisure, thus they suffer great from psychological pressures and mental burdens and their living quality is worse than ordinary healthy people as well as those spouses of non-dementia patients. Therefore, it is suggested that attendance of senile dementia patients have resulted in significant psychological health influences of their spouses, which is the main difference between spouses of senile dementia patients and those of non-dementia patients.As for the causes of the depression and anxiety emotions of the spouses of senile dementia patients, according to the analysis of the results of this study, the spouses are more vulnerable to depression and anxiety emotions under serious dementia severity of the patients, poor family economic situation, the spouses'strong self pressure perception, low educational level as well as lack of social support. The result of the multivariate Logistic gradual regression analysis shows:the spouses' depression emotions have a positive correlation with the dementia severity of the patients and their self pressure perception and a negative correlation with the utilization of social support; the spouses' anxiety emotions have a positive correlation with their self pressure perception and a negative correlation with objective support. Relevant domestic literatures report:as main caregivers, the spouses' depression and anxiety degree has a significant correlation with serious dementia severity of the patients, poor family income, the spouses'low educational level and unhealthy lifestyle (smoking, drinking and lacking of exercises) as well as low family member and social support, in which the dementia severity of the patients has great influence on the spouses' depression and anxiety condition, with a positive correlation between them. Schulz R considers that the pressures and burdens endured by the caregivers of senile dementia patients, especially the spouse caregivers, usually increase as the dementia severity deteriorates; Campbell's survey result also suggests:the severity of dementia patients' mental behavior disorder has a positive correlation with the general burden and the depression and anxiety symptoms of the caregivers, i.e., the more serious the dementia severity of the patients, the stronger burdens the caregivers would have to endure, so are the symptoms of depression and anxiety. Shurgot and others have put forward:for caregivers of dementia patients, the lack of social or family support would cause more burdens; while with good social or family support, the caregivers would endure less burdens, consequently having sounder psychological health condition. Researches abroad also suggest that the dementia severity of the patients is the determinant of the caregivers'burdens. The depression and anxiety emotions also have correlation with educational level and income, if the caregivers with higher educational level and income, their depression and anxiety emotions would be lighter. In domestic, there're also such reports that the lower educational level of the caregivers, the less knowledge about dementia and the stronger burdens they would have.Senile dementia is a severe disability decease with the most social burden throughout the world, causing significant pressure to the family and the society, which would severely influence the spouses' social functions and physical and mental health. The continuously increasing psychological burdens would threaten the spouse caregivers' health conditions as well as the living quality of the dementia patients. According to the results of this survey, we should pay more attentions to the pressures of psychology and emotions of depression and anxiety in the spouses of dementia patients, providing effective help and psychological intervention for them. In accordance with relevant literatures, if the main caregivers are the family members, the improvement of the relationships between the family members and the increase of the caregivers' understanding of relevant disease knowledge as well as the learning of attendance skills would help reduce the caregivers' pressures and improve their emotions; the caregivers' negative emotions such as the attendance burdens, psychological pressures as well as depression and anxiety emotions caused by long time care for dementia patients could be reduced through remote psychological intervention measures like telephone, internet and so on. The domestic researches about the interventions of the caregivers of dementia patients are still on starting stage wile there're already lots of exploratory researches in accordance with Chinese national conditions, including the improvement of attendance skills through the enhancement of health education and attendance skill training for the caregivers; the reduction of the caregivers' direct attendance time through the combination of family attendance with hospital attendance and community service; together with stronger family and social support through the offering of mutual consultation services for caregivers in the community and special psychological consultation, etc. These intervention measures have to certain degree reduced the spouses'negative emotions like attendance pressures and depression and anxiety and so on, whereas how to effectively alleviate the spouses' depression and anxiety symptoms still needs further researches and discusses.
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