The Impact of Depression on Quality of Life in Caregivers of Cancer Patients: A Moderated Mediation Model of Spousal Relationship and Caring Burden
Abstract
:1. Introduction
1.1. Depression and QoL in Family Caregivers of Cancer Patients
1.2. Theoretical Framework
2. Materials and Methods
2.1. Sample and Data
2.2. Measures
2.2.1. Depression
2.2.2. Caring Burden
2.2.3. Quality of Life
2.2.4. Family Relationship with Patient
2.3. Data Analysis
3. Results
3.1. Descriptive Statistics
3.2. Results of the Correlation Analysis
3.3. Moderated Mediation Models
3.3.1. Mediation Model for Quality of Life
3.3.2. Moderated Mediation Model for Quality of Life
4. Discussion
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Cancer. 2022. Available online: http://www.who.int/cancer/en/ (accessed on 4 May 2022).
- National Cancer Information Center. Cancer in statistics. 2021. Available online: https://www.cancer.go.kr/ (accessed on 21 January 2022).
- Ferrell, B.; Wittenberg, E. A review of family caregiving intervention trials in oncology. CA Cancer J. Clin. 2017, 67, 318–325. [Google Scholar] [CrossRef] [PubMed]
- Lee, E.E.; Lee, S.Y. Caregiving experiences of Korean family caregivers of cancer patients: An integrative literature review. Psychooncology 2020, 29, 1486–1503. [Google Scholar] [CrossRef] [PubMed]
- Kent, E.E.; Rowland, J.H.; Northouse, L.; Litzelman, K.; Chou, W.Y.; Shelburne, N.; Timura, C.; O’Mara, A.; Huss, K. Caring for caregivers and patients: Research and clinical priorities for informal cancer caregiving. Cancer 2016, 122, 1987–1995. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kim, Y.; Baek, W. Caring experiences of family caregivers of patients with pancreatic cancer: An integrative literature review. Support. Care Cancer 2022, 30, 3691–3700. [Google Scholar] [CrossRef] [PubMed]
- Cochrane, A.; Reid, O.; Woods, S.; Gallagher, P.; Dunne, S. Variables associated with distress amongst informal caregivers of people with lung cancer: A systematic review of the literature. Psychooncology 2021, 30, 1246–1261. [Google Scholar] [CrossRef]
- Kim, Y.; Kim, H.; Suh, S.Y.; Park, H.; Lee, H. Association between inflammatory cytokines and caregiving distress in family caregivers of cancer patients. Support. Care Cancer 2022, 30, 1715–1722. [Google Scholar] [CrossRef] [PubMed]
- Pinquart, M.; Sörensen, S. Correlates of physical health of informal caregivers: A meta-analysis. J. Gerontol B Psychol. Sci. Soc. Sci 2007, 62, P126–P137. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Geng, H.M.; Chuang, D.M.; Yang, F.; Yang, Y.; Liu, W.M.; Liu, L.H.; Tian, H.M. Prevalence and determinants of depression in caregivers of cancer patients: A systematic review and meta-analysis. Medicine 2018, 97, e11863. [Google Scholar] [CrossRef]
- Li, M.; Kouzmina, E.; McCusker, M.; Rodin, D.; Boutros, P.C.; Paige, C.J.; Rodin, G. Cytokines and depression in cancer patients and caregivers. Neuropsychiatr. Dis. Treat. 2017, 13, 2903–2911. [Google Scholar] [CrossRef] [Green Version]
- Tan, J.Y.; Molassiotis, A.; Lloyd-Williams, M.; Yorke, J. Burden, emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study. Eur. J. Cancer Care 2018, 27, ecc.12691. [Google Scholar] [CrossRef]
- Dionne-Odom, J.N.; Hull, J.G.; Martin, M.Y.; Lyons, K.D.; Prescott, A.T.; Tosteson, T.; Li, Z.; Akyar, I.; Raju, D.; Bakitas, M.A. Associations between advanced cancer patients’ survival and family caregiver presence and burden. Cancer Med. 2016, 5, 853–862. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Caruso, R.; Nanni, M.G.; Riba, M.B.; Sabato, S.; Grassi, L. The burden of psychosocial morbidity related to cancer: Patient and family issues. Int. Rev. Psychiatry 2017, 29, 389–402. [Google Scholar] [CrossRef]
- Streck, B.P.; Wardell, D.W.; LoBiondo-Wood, G.; Beauchamp, J.E.S. Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature. Psychooncology 2020, 29, 974–989. [Google Scholar] [CrossRef] [PubMed]
- Trevino, K.M.; Prigerson, H.G.; Maciejewski, P.K. Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder. Psychooncology 2018, 27, 243–249. [Google Scholar] [CrossRef] [PubMed]
- Zarit, S.H.; Reever, K.E.; Bach-Peterson, J. Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist 1980, 20, 649–655. [Google Scholar] [CrossRef] [Green Version]
- Schulz, R.; Beach, S.R. Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. JAMA 1999, 282, 2215–2219. [Google Scholar] [CrossRef] [Green Version]
- Yoon, S.J.; Kim, J.S.; Jung, J.G.; Kim, S.S.; Kim, S. Modifiable factors associated with caregiver burden among family caregivers of terminally ill Korean cancer patients. Support. Care Cancer 2014, 22, 1243–1250. [Google Scholar] [CrossRef]
- Park, B.; Kim, S.Y.; Shin, J.-Y.; Sanson-Fisher, R.W.; Shin, D.W.; Cho, J.; Park, J.-H. Prevalence and predictors of anxiety and depression among family caregivers of cancer patients: A nationwide survey of patient–family caregiver dyads in Korea. Support. Care Cancer 2013, 21, 2799–2807. [Google Scholar] [CrossRef]
- Pearlin, L.I.; Mullan, J.T.; Semple, S.J.; Skaff, M.M. Caregiving and the stress process: An overview of concepts and their measures. Gerontologist 1990, 30, 583–594. [Google Scholar] [CrossRef]
- Kim, Y.; Chung, M.L.; Lee, H. Caregivers of patients with cancer: Perceived stress, quality of life and immune function. BMJ Support. Palliat Care. 2022, bmjspcare-2021-003205. [Google Scholar] [CrossRef]
- Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach; Guilford Publications: New York, NY, USA, 2017. [Google Scholar]
- Radloff, L.S. The CES-D scale: A self-report depression scale for research in the general population. Appl. Psychol. Meas. 1977, 1, 385–401. [Google Scholar] [CrossRef]
- Rhee, Y.S.; Shin, D.O.; Lee, K.M.; Yu, H.J.; Kim, J.W.; Kim, S.O.; Lee, R.; Lee, Y.O.; Kim, N.S.; Yun, Y.H. Korean version of the caregiver quality of life index-cancer (CQOLC-K). Qual Life Res. 2005, 14, 899–904. [Google Scholar] [CrossRef] [PubMed]
- Weitzner, M.A.; Jacobsen, P.B.; Wagner, H., Jr.; Friedland, J.; Cox, C. The Caregiver Quality of Life Index-Cancer (CQOLC) scale: Development and validation of an instrument to measure quality of life of the family caregiver of patients with cancer. Qual. Life Res. 1999, 8, 55–63. [Google Scholar] [CrossRef] [PubMed]
- Kline, R.B. Principles and Practice of Structural Equation Modeling; Guilford Publications: New York, NY, USA, 2015. [Google Scholar]
- Hayes, A.F. An Index and Test of Linear Moderated Mediation. Multivar. Behav Res. 2015, 50, 1–22. [Google Scholar] [CrossRef] [PubMed]
- Grant, J.S.; Graven, L.J. Problems experienced by informal caregivers of individuals with heart failure: An integrative review. Int J. Nurs Stud. 2018, 80, 41–66. [Google Scholar] [CrossRef] [PubMed]
- Li, Y.; Li, J.; Zhang, Y.; Ding, Y.; Hu, X. The Effectiveness of e-Health Interventions on Caregiver Burden, Depression, and Quality of Life in Informal Caregivers of Patients with cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int. J. Nurs. Stud. 2022, 127, 104179. [Google Scholar] [CrossRef]
- Ştefǎnuţ, A.M.; Vintilǎ, M.; Tudorel, O.I. The Relationship of Dyadic Coping with Emotional Functioning and Quality of the Relationship in Couples Facing Cancer—A Meta-Analysis. Front. Psychol 2020, 11, 594015. [Google Scholar] [CrossRef]
- Berg, C.A.; Upchurch, R. A developmental-contextual model of couples coping with chronic illness across the adult life span. Psychol. Bull. 2007, 133, 920–954. [Google Scholar] [CrossRef]
- Oken, M.M.; Creech, R.H.; Tormey, D.C.; Horton, J.; Davis, T.E.; McFadden, E.T.; Carbone, P.P. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. 1982, 5, 649–655. [Google Scholar] [CrossRef]
- Tang, C.C.; Draucker, C.; Tejani, M.; Von Ah, D. Symptom experiences in patients with advanced pancreatic cancer as reported during healthcare encounters. Eur. J. Cancer Care 2018, 27, ecc12838. [Google Scholar] [CrossRef]
- Aylaz, G.; Akyol, C.; Kocaay, A.F.; Gökmen, D.; Yavuzarslan, A.B.; Erkek, A.B.; Kuzu, M.A. Quality of life after colorectal surgery: A prospective study of patients compared with their spouses. World J. Gastrointest. Surg. 2021, 13, 1050. [Google Scholar] [CrossRef] [PubMed]
- Janda, M.; Neale, R.E.; Klein, K.; O’Connell, D.L.; Gooden, H.; Goldstein, D.; Merrett, N.D.; Wyld, D.K.; Rowlands, I.J.; Beesley, V.L. Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 2017, 17, 321–327. [Google Scholar] [CrossRef] [PubMed]
Variables | n (%) | M ± SD | t | p |
---|---|---|---|---|
Age | 52.1 ± 15.4 | |||
Gender | 0.26 | 0.797 | ||
Male | 26 (28.0) | 76.04 ± 16.70 | ||
Female | 67 (72.0) | 74.82 ± 21.72 | ||
Spouse of the patient | −4.28 | <0.001 | ||
Yes | 38 (40.9) | 64.95 ± 20.34 | ||
No | 55 (59.1) | 82.22 ± 17.28 | ||
Living with the patient | −2.98 | 0.004 | ||
Yes | 59 (63.4) | 70.73 ± 20.52 | ||
No | 34 (36.6) | 82.85 ± 17.89 | ||
Education | −1.87 | 0.065 | ||
~High school | 51 (54.8) | 71.63 ± 23.13 | ||
Above college | 42 (45.2) | 79.45 ± 15.60 | ||
Employment status | −0.07 | 0.943 | ||
Employed | 44 (47.3) | 75.00 ± 20.25 | ||
Not employed | 49 (52.7) | 75.31 ± 20.67 | ||
Care setting of patient | 0.88 | 0.382 | ||
Outpatient | 43 (46.2) | 77.16 ± 20.00 | ||
Inpatient | 50 (53.8) | 73.44 ± 20.71 | ||
CES-D score | 17.6 ± 7.8 | 9.72 | <0.001 | |
>16 | 45 (48.4) | 90.09 ± 14.58 | ||
≤16 | 48 (51.6) | 61.17 ± 14.11 | ||
Caring burden | 33.4 ± 17.3 | |||
Quality of life | 75.2 ± 20.4 |
Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
---|---|---|---|---|---|---|---|---|---|
r (p) | r (p) | r (p) | r (p) | r (p) | r (p) | r (p) | r (p) | r (p) | |
1. Age | 1 | ||||||||
2. Gender * | 0.13 (0.211) | 1 | |||||||
3. Spouse of a patient * | −0.60 (<0.001) | −0.03 (0.772) | 1 | ||||||
4. Living with a patient * | −0.25 (0.017) | −0.03 (0.815) | 0.54 (<0.001) | 1 | |||||
5. Education * | −0.31 (0.003) | −0.14 (0.564) | 0.36 (<0.001) | 0.54 (<0.001) | 1 | ||||
6. Employment status * | 0.28 (0.006) | 0.42 (<0.001) | −0.17 (0.095) | 0.36 (<0.001) | 0.04 (0.720) | 1 | |||
7. Care setting of patient * | −0.01 (0.989) | 0.14 (0.171) | 0.02 (0.858) | −0.17 (0.095) | −0.01 (0.514) | 0.03 (0.787) | 1 | ||
8. Depression | 0.10 (0.324) | 0.04 (0.700) | 0.04 (0.700) | 0.02 (0.858) | −0.31 (0.003) | −0.01 (0.927) | 0.09 (0.396) | 1 | |
9. Caring burden | 0.24 (0.019) | −0.04 (0.735) | −0.04 (0.735) | −0.41 (<0.001) | −0.11 (0.185) | −0.07 (0.523) | −0.00 (0.981) | 0.62 (<0.001) | 1 |
10. Quality of life | −0.16 (0.134) | −0.27 (0.797) | 0.42 (<0.001) | 0.29 (0.005) | 0.19 (0.065) | 0.01 (0.943) | −0.09 (0.382) | −0.85 (<0.001) | −0.75 (<0.001) |
Predictors | Caring Burden (M) | Quality of Life (Y) | ||||
---|---|---|---|---|---|---|
B (SE) | 95% CI | p | B (SE) | 95% CI | p | |
Depression (X) | 1.63 (0.27) | 1.10 to 2.16 | <0.001 | −1.60 (0.16) | −1.91 to −1.28 | <0.001 |
Caring burden (M) | −0.43 (0.07) | −0.58 to −0.29 | <0.001 | |||
Spousal relationship (W) | 12.59 (8.31) | −3.93 to 29.12 | 0.133 | |||
Depression × Spousal relationship (X × W) | −0.80 (0.39) | −1.58 to −0.03 | 0.042 | |||
R2 | 0.45 | 0.80 | ||||
F | 14.20 | 90.20 | ||||
p | <0.001 | <0.001 | ||||
Difference between conditional indirect effect | Index | B (SE) | 95% CI | |||
Spousal relationship (X→M→Y) | 0.35 | 0.16 | 0.04 to 0.66 |
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Kim, Y. The Impact of Depression on Quality of Life in Caregivers of Cancer Patients: A Moderated Mediation Model of Spousal Relationship and Caring Burden. Curr. Oncol. 2022, 29, 8093-8102. https://doi.org/10.3390/curroncol29110639
Kim Y. The Impact of Depression on Quality of Life in Caregivers of Cancer Patients: A Moderated Mediation Model of Spousal Relationship and Caring Burden. Current Oncology. 2022; 29(11):8093-8102. https://doi.org/10.3390/curroncol29110639
Chicago/Turabian StyleKim, Yoonjoo. 2022. "The Impact of Depression on Quality of Life in Caregivers of Cancer Patients: A Moderated Mediation Model of Spousal Relationship and Caring Burden" Current Oncology 29, no. 11: 8093-8102. https://doi.org/10.3390/curroncol29110639
APA StyleKim, Y. (2022). The Impact of Depression on Quality of Life in Caregivers of Cancer Patients: A Moderated Mediation Model of Spousal Relationship and Caring Burden. Current Oncology, 29(11), 8093-8102. https://doi.org/10.3390/curroncol29110639