Mental health of caregivers of individuals with disabilities: Relation to Suicidal Ideation

Suicidal Thoughts and Behaviors in Parents Caring for Children with Disabilities and Long-Term Illnesses

OBJECTIVE

There is a growing body of evidence on suicide risk in family carers, but minimal research on parents caring for children with disabilities and long-term illnesses. The aim of this study was to conduct the first dedicated research on suicide risk in parent carers and identify: (1) the number of parent carers experiencing suicidal thoughts and behaviors, and (2) the risk and protective factors for suicidality in this population.

METHOD

A cross-sectional survey of parent carers in England (n = 750), co-produced with parent carers. Suicidal thoughts and behaviors were measured with questions from the Adult Psychiatric Morbidity Survey. Frequencies summarized the proportion of carers experiencing suicidal thoughts and behaviors. Logistic regressions identified risk and protective factors.

RESULTS

42% of parents had experienced suicidal thoughts and behaviors while caring for a disabled or chronically ill child. Only half had sought help for these experiences. Depression, entrapment, dysfunctional coping, and having a mental health diagnosis prior to caring, were significant risk factors.

CONCLUSION

Parent carers contemplate suicide at levels that exceed those of other family carers and the general public. There is an urgent need, in policy and practice, to recognize parent carers as a priority group for prevention and intervention.

Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis

OBJECTIVE

Caregiving burden is set to increase with the rising incidence of cancer globally. The meta-analysis seeks to investigate the prevalence of suicide, suicidal ideation and self-harm among the caregivers of patients with cancer (CPCs).

METHODS

This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the prevalence of suicide, suicidal ideation and self-harm in CPCs. Random effects meta-analyses were used for primary analysis.

RESULTS

Eleven studies were included. Meta-analyses indicated that the prevalence of suicidal ideation in CPCs was 11% (95%CI:6-18), suicide prevalence was 6% (95%CI:3-12), and self-harm prevalence was 15% (95%CI:8-26). Subgroup analyses revealed that CPCs above the age of 50 experienced a greater prevalence of suicidal ideation (17%, 95%CI:10-28) as compared to CPCs below 50 (6%, 95%CI:3-12). Family caregivers particularly spouses were also found to have a higher prevalence of suicidal ideation (17%, 95%CI:13-23), as compared to children (5%, 95%CI:2-10) or mothers (3%, 95%CI:1-8). Systematic review found that having a pre-existing mental health condition and lower socioeconomic status increased likelihood of suicidality.

CONCLUSION

We highlight the need for more support of CPCs at risk of suicidality. Additional research is warranted to identify other risk and protective factors.

The Morbidity and Associated Factors of Depression in Caregivers of Patients with Depressive Disorder

Objective

Depressive disorder significantly impacts patients' daily living activities and quality of life. Caregivers of patients with depression may also suffer from psychological distress related to the chronic burden of caring for the patient's mood changes. The purpose of this study was to evaluate the morbidity and associated factors of depression in caregivers of patients with depressive disorder.

Methods

In this study, we used a cross-sectional design with consecutive sampling. Study subjects were recruited from the psychiatric outpatient clinic of a medical center from August 2021 to June 2022. Caregivers of depressive disorder patients were enrolled and assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale (HADS), Suicide Assessment Scale (SAS), Stigma Scale of the Explanatory Model Interview Catalogue (EMIC), and Family APGAR Index.

Results

Of the 120 caregivers that completed the study, 59.2% (n=71) were females. The most common psychiatric diagnosis was depressive disorders (25.8%), followed by anxiety disorders (17.5%) and insomnia disorder (15.8%); 54.2% of the caregivers had a psychiatric diagnosis. Using logistic regression analysis, we found that anxiolytics/hypnotics use (OR=5.58; 95% CI, 1.84-16.96; p<0.01), higher suicide risk (SAS) (OR=1.10; 95% CI, 1.05-1.16; p<0.001), and lower family support (APGAR scores) (OR=0.82; 95% CI, 0.71-0.94; p<0.01) were three significant associated factors.

Conclusion

Depression was the most prevalent psychiatric diagnosis in caregivers of patients with depressive disorder. Early psychiatric diagnosis for caregivers of patients with depression is crucial to offering suitable support and treatment and may improve caregivers' quality of life.

Benefits and challenges of mobility and medical alert service dogs for caregivers of service dog recipients

PURPOSE

Mobility and medical alert service dogs are an assistive technology for individuals with disabilities or chronic conditions. Informal caregivers of individuals with disabilities are subject to physical and emotional stress due to their responsibilities. Understanding how service dogs, an increasingly common assistive technology, may add to or subtract from caregiver stress is crucial for promoting caregiver well-being. The purpose of this study was to analyze caregiver accounts to understand their perspective on benefits and challenges they face with mobility and medical alert service dogs.

MATERIALS AND METHODS

Open ended survey responses from 117 caregivers of service dog recipients (N = 72 with a service dog, N = 45 on the waitlist) were analysed through a conventional content analysis.

RESULTS

Four major themes were found regarding caregiver and service dog: Family Benefits, Caregiver Benefits, Assistance Through Service Dog's Training, and Drawbacks.

CONCLUSIONS

Findings suggest that benefits and challenges of mobility and medical service dogs extend beyond the service dog recipient, affecting the caregiver and other family members as well. Future studies should further explore this interaction to determine the best way to support caregivers of individuals with disabilities.IMPLICATIONS FOR REHABILITATIONMobility and medical alert service dogs are increasingly partnered with individuals with disabilities or chronic diseases as an assistive technology but few studies have focussed on the experience of the caregivers of service dog recipients. Caregivers of individuals with disabilities or chronic diseases may be subject to both psychological and physiological stressors as a result of their caregiver duties.Results found that caregivers perceive both benefits to themselves and to their families in terms building a bond with the animal that helps to reduce worry and offers emotional support. The most commonly mentioned drawbacks include general maintenance of the service dog, grooming needs and travel restrictions.This research is important in order to offer appropriate support to caregivers of individuals with disabilities.

Multifaceted risk for non-suicidal self-injury only versus suicide attempt in a population-based cohort of adults

BACKGROUND

Non-suicidal self-injury and suicide attempt represent significant public health concerns. While these outcomes are related, there is prior evidence that their etiology does not entirely overlap. Efforts to directly differentiate risk across outcomes are uncommon, particularly among older, population-based cohorts.

METHODS

This research has been conducted using the UK Biobank. Data on individuals' self-reported history of non-suicidal self-injury only versus suicide attempt (maximum N = 6643) were analyzed. Applying LASSO and standard logistic regression, participants reporting one of these outcomes were assessed for differences across a range of sociodemographic, behavioral, and environmental features.

RESULTS

Sociodemographic features most strongly differentiated between the outcomes of non-suicidal self-injury only versus suicide attempt. Specifically, Black individuals were more likely to report a suicide attempt, as were those of mixed race, those endorsing higher levels of depressive symptoms or trauma history, and those who had experienced financial problems (odds ratios 1.02-3.92). Those more likely to engage in non-suicidal self-injury only were younger, female, had higher levels of education, those who resided with a partner, and those who had a recently injured relative.

LIMITATIONS

Differences in timing across correlates and outcomes preclude the ability to establish causal pathways.

CONCLUSIONS

The factors identified in the current study as differentially associated with non-suicidal self-injury only versus suicide attempt provide further evidence of at least partially distinct correlates, and warrant follow-up in independent samples to investigate causality.

Suicidal ideation in mothers of asthmatic children and adolescents in a subspecialty outpatient practice

We aimed to investigate prevalence and factors associated with Suicide ideation (SI) in mothers of asthmatic children. This cross-sectional study included 362 dyads of mothers and children with asthma aged 2 to 14 years who attended two pediatric outpatient clinics in Brazil. We assessed the presence of SI (Self-Report Questionnaire-20), the occurrence of stressful events and maternal social support. The prevalence of SI was 8.6%. Low maternal education, exposure to serious illness, and low perception of social support in its affective–social interaction dimension remained significantly associated with SI in the final model. Thus, life stressors, social support and low maternal education accounted for most of the variation in prevalence of maternal SI. There were no effects of child asthma severity on maternal SI in this study.

Combining Yoga Exercise with Rehabilitation Improves Balance and Depression in Patients with Chronic Stroke: A Controlled Trial

Background: We combined yoga with standard stroke rehabilitation and compared it to the rehabilitation alone for depression and balance in patients. Methods: Forty patients aged from 30 to 80 who had suffered a stroke 90 or more days previously were divided evenly with age stratification and patients’ will (hence not randomized). In the intervention group 16 completed 8-week stroke rehabilitation combined with 1 h of yoga twice weekly. Another 19 patients completed the standard rehabilitation as the control group. Results: The yoga group showed significant improvement in depression (Taiwanese Depression Questionnaire, p = 0.002) and balance (Berg Balance Scale, p < 0.001). However, the control group showed improvement only in balance (p = 0.001) but not in depression (p = 0.181). Further analysis showed both sexes benefitted in depression, but men had a greater improvement in balance than women. Depression in left-brain lesion patients improved more significantly than in those with right-brain lesion, whereas balance improved equally despite lesion site. For patients under or above the age of 60, depression and balance both significantly improved after rehabilitation. Older age is significantly related to poor balance but not depression. Conclusions: Combining yoga with rehabilitation has the potential to improve depression and balance. Factors related to sex, brain lesion site and age may influence the differences.

Suicidal Ideation among Older Family Caregivers for a Person with Dementia

OBJECTIVES

This pilot study aimed to describe the phenomenon of suicidal ideation among caregivers who were aged 60 and over and who provided care for a person with dementia.

METHODS

A qualitative study was conducted, using a descriptive method. Semi-structured interviews were administered to caregivers who had or were having suicidal thoughts whilst caring for a relative with dementia.

RESULTS

Six caregivers were interviewed. Four caregivers reported experiencing active suicidal ideation whilst caregiving. Two subjects mentioned wishing for the death of their care recipient. While saturation criteria were not all met themes regarding suicidal ideation types and developmental contexts emerged. Findings suggest that family conflicts, placement difficulties, exhaustion, feelings of injustice, and loneliness contributed to the development of suicidal ideation.

CONCLUSIONS

Suicidal distress can emerge from the dementia caregiving context and these findings highlight a complex phenomenon among caregivers. The understanding of caregivers' suicidal distress is of great importance to guide screening and intervention efforts. Research is needed to keep the implication and well-being of older caregivers.

CLINICAL IMPLICATIONS

Screening efforts should consider the caregiving context as a conducive environment for suicidal distress and clinicians could use this knowledge to provide specific interventions to distressed carers.

Suicide probability in psychiatric patients' primary caregivers: The role of care burden, alexithymia and some risk factors

BACKGROUND

Although suicidal ideation seems to be related with both burden of care and alexithymia, there is no study investigating the correlation between these factors and suicide probability in informal caregivers of psychiatric patients in the literature.

AIM

In this study, it was aimed to determine the suicide probability in psychiatric patients' primary caregivers, and to evaluate the effects of care burden, alexithymia and some risk factors on suicide probability.

METHODS

This study was conducted with 262 caregivers between February 2019 and December 2019. Data were collected with the Personal Information Form, Suicide Probability Scale, Zarit Burden Interview, Toronto Alexithymia Scale.

RESULTS

The mean score the caregivers obtained from the Suicide Probability Scale was 79.75 ± 59.29, and 17.9% of them were at risk for suicide. Also, caregivers' suicide probability was related to variables such as caregivers' sex, economic status, presence of any disease, duration of care, and patients' education level, psychiatric diagnosis, duration of illness, presence of physical illness, compliance with treatment. In addition, caregivers' burden and alexithymia levels were significantly associated with the participating caregivers' suicide probability.

CONCLUSIONS

This study demonstrates that approximately one out of every five caregivers was at risk for suicide. Therefore, hospital and community-based intervention strategies to support caregivers should be developed.

Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review

An emerging body of international research suggests family caregivers may be a high-risk group for suicide, but the evidence has not been synthesised. Forty-eight peer-reviewed journal articles were included in this review, spanning low-, middle-, and high-income countries and a variety of illnesses and disabilities. The proportion of caregivers experiencing suicidal ideation ranged from 2.7% to 71%, with evidence of suicide attempts, deaths by suicide, and deaths by homicide-suicide also reported. Risk and protective factors varied across studies and there was little consideration of differences by caregiving relationship, type of illness/disability, or country. There is sufficient evidence to warrant concern for caregivers around the world and prompt action in policy and practice, but more rigorous research is required to draw clear, nuanced conclusions about risk and inform evidence-based prevention and intervention.

Phenotypes of caregiver distress in military and veteran caregivers: Suicidal ideation associations

The United States (US) has been at war for almost two decades, resulting in a high prevalence of injuries and illnesses in service members and veterans. Family members and friends are frequently becoming the caregivers of service members and veterans who require long-term assistance for their medical conditions. There is a significant body of research regarding the physical, emotional, and social toll of caregiving and the associated adverse health-related outcomes. Despite strong evidence of the emotional toll and associated mental health conditions in family caregivers, the literature regarding suicidal ideation among family caregivers is scarce and even less is known about suicidal ideation in military caregivers. This study sought to identify clusters of characteristics and health factors (phenotypes) associated with suicidal ideation in a sample of military caregivers using a cross-sectional, web-based survey. Measures included the context of caregiving, physical, emotional, social health, and health history of caregivers. Military caregivers in this sample (n = 458) were mostly young adults (M = 39.8, SD = 9.9), caring for complex medical conditions for five or more years. They reported high symptomology on measures of pain, depression, and stress. Many (39%) experienced interruptions in their education and 23.6% reported suicidal ideation since becoming a caregiver. General latent variable analyses revealed three distinct classes or phenotypes (low, medium, high) associated with suicidality. Individuals in the high suicidality phenotype were significantly more likely to have interrupted their education due to caregiving and live closer (within 25 miles) to a VA medical center. This study indicates that interruption of life events, loss of self, and caring for a veteran with mental health conditions/suicidality are significant predictors of suicidality in military caregivers. Future research should examine caregiver life experiences in more detail to determine the feasibility of developing effective interventions to mitigate suicide-related risk for military caregivers.

Relationships Between Anxiety Symptoms, Hopelessness and Suicidal Ideation Among Parental Caregivers of Mandarin-Speaking Children With Speech Impairment: The Mediating Effect of Depressive Symptoms

Background: Determining the mental health status of parents who chronically care for a child with speech impairment is important for developing appropriate interventions to improve both parents' and children's health and achieve a win-win situation. Unfortunately, no study in China has explored this issue. This study investigated the differences in four aspects of mental health between maternal and paternal caregivers for the Mandarin-speaking children with speech impairment and determine whether depressive symptoms mediate the relationships between anxiety symptoms and suicidal ideation, hopelessness and suicidal ideation. Methods: This cross-sectional questionnaire survey was conducted in February 2020 by sending a link to the predesigned electronic questionnaire in WeChat. Standardized assessment tools were employed. Hierarchical multiple logistic regression was conducted to examine the associations between various factors and suicidal ideation, and two separate structural equation models were performed to evaluate the mediating effects of depressive symptoms in the relationship between anxiety symptoms and suicidal ideation as well as between hopelessness and suicidal ideation. Results: This study included 446 parental caregivers of Mandarin-speaking children with speech impairment. Paternal caregivers had greater score than maternal caregivers on loss of motivation (one of the subdomains of hopelessness). Somatic complications of the child (OR = 2.73, 95% CI: 1.09-6.67) and depressive symptoms (OR = 3.38, 95% CI: 1.83-6.30) were positively associated with caregivers' suicidal ideation. Having speech therapy of child (OR = 0.54, 95% CI: 0.29-0.98) was negatively correlated with caregivers' suicidal ideation. There was direct effect of depressive symptoms on suicidal ideation. Depressive symptoms play mediating roles on the relationships between anxiety symptoms (β = 0.171, p < 0.001) as well as between hopelessness and suicidal ideation (β = 0.187, p < 0.001). Conclusions: Paternal and maternal caregivers of Mandarin-speaking children with speech impairment suffered from mental health problems. Preventive strategies and interventions to ameliorate parental psychological well-being, and health care policies to increase the accessibility to speech therapy care of children with speech impairment are imperative.

Risk factors for suicidal thoughts in informal caregivers: results from the population-based Netherlands mental health survey and incidence Study-2 (NEMESIS-2)

BACKGROUND

Previous research suggests that family caregivers contemplate suicide at a higher rate than the general population. Much of this research has been disease specific and in relatively small samples. This study aimed to compare suicidal thoughts between non-caregivers and informal caregivers of people with a variety of conditions, in a large representative sample, and to identify significant risk factors.

METHODS

The general population study NEMESIS-2 (N at baseline = 6646) included 1582 adult caregivers at the second wave (2010-2012) who also participated at the third wave (2013-2015). Suicidal thoughts were assessed over 4 years, with the Suicidality Module of the Composite International Diagnostic Interview 3.0. The presence of suicidal thoughts was estimated and risk factors for suicidal thoughts were assessed with logistic regression analyses adjusted for age and gender.

RESULTS

Thirty-six informal caregivers (2.9%) reported suicidal thoughts during the 4 year study period. The difference between caregivers and non-caregivers (3.0%) was not significant. Among caregivers, significant risk factors for suicidal thoughts included being unemployed, living without a partner, having lower levels of social support, having a chronic physical disorder, a mood disorder or an anxiety disorder, and having impaired social, physical and emotional functioning. These risk factors were also found in non-caregivers. No caregiving-related characteristics were associated with suicidal thoughts.

CONCLUSION

There was no elevated rate of suicidal thoughts in caregivers and risk factors for suicidal thoughts in caregivers were consistent with risk factors in non-caregivers. No association between caregiving characteristics and suicidal thoughts was found. Caregivers with limited resources and in poorer health might still benefit from prevention and intervention efforts.

Research Commentary: A Carer's Roadmap for Research, Practice, and Policy on Suicide, Homicide, and Self-Harm

Academic researchers are increasingly asked to engage with the wider world, both in terms of creating impact from their work, and in telling the world what goes on in university research departments. An aspect of this engagement involves working with patients, carers or members of the public as partners in research. This means working with them to identify important research questions and designing studies to address those questions. This commentary was jointly written by two researchers and people with relevant caring experience for this special issue. It brings to the forefront the concerns of carers who are also involved in research as partners. The aim is to highlight their perspectives to inform future research, policy, and practice.