Difficulties assessing depressive-like reactions to chronic severe external stress as exemplified by spouse caregivers of Alzheimer patients.

Abstract

Problems in making differential diagnoses and severity ratings of depressive-like reactions in chronically, heavily stressed persons are described. These assessment concerns are especially pertinent to older persons. The assessment concern discussed relates to difficulties in determining the extent to which stress reactions are inevitable consequences of stressor demands versus excessive pathological reactions versus natural manifestations of aging. The newly revised criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III-R) and its associated structured interviews do not lessen the difficulties described. However, they reflect progress in specifying the amount of cross-sectional and longitudinal consistency required before maladaptive behaviours meet diagnostic and/or severity criteria as pathological indicators. Stressor level is important among the criteria for the less severe DSM-III-R depression-related disorders, but the specific response demands of the stressors are ignored. By contrast, biomedical factors are consistently given significant weight. To clarify these matters, the five DSM-III-R diagnostic axes, depressive diagnostic criteria, and associated structured interviews for eliciting relevant data are reviewed.

Depression among Alzheimer's caregivers: Identifying risk factors

“…[34][35][36] The many functional incapacities associated with increasing severity of dementia places the caregiver at increased risk for depression, anxiety, social isolation, and stress-related physical symptoms. [36][37][38] In this awkward situation, many caregivers find it difficult to express their own depressive symptoms. Others feel that their situation is an inevitable, nontreatable consequence of caring for their loved one with dementia.…”

“…5 Identified risk factors for caregiver depression include social isolation, reduced control over their lives, fear of inadequacy, inappropriate guilt, loss of a previously joyous relationship and lack of positive reinforcement. 1,6,7 Moreover, caregivers themselves may suffer from medical, social, or financial burdens. This places additional strain on individuals providing care for the dementia patient.…”

A Randomized Trial of Family Caregiver Support in the Home Management of Dementia

“…This may lead caregivers to feel a sense of despair. Becker and Morrissey 51 have advocated that the research agenda should include the differentiation of clinical depression from depressive symptomatology and despair among caregivers. The two former manifestations may require treatment; despair may be an existential issue.…”

Chronic stress and depressive disorders in older adults.

“…Dysthymic disorder and depressive disorder NOS have not been strongly associated with personal or family history; however, major depressive disorder is strongly associated with personal and family history (Becker & Morrissey, 1988), and certainly might be expected to have made a prior appearance in older adults whose average age was 68. The reliably elevated rates of major depression found across studies of care givers (Cohen & Eisdorfer, 1988;Coppel et al, 1985;Gallagher et al, 1989) are significantly in excess of population base rates for older adults (Blazer et air 1987), and provide convergent evi-dence that dementia care giving may elicit episodes of major depression even when no personal or family history of depression is present.…”

“…As suggested by Becker and Morrissey (1988) and Gallagher et al (1989), interviewers were careful to attribute symptoms to depression only when their presence or intensity was not explicable simply on the basis of gross characteristics of the care-giving situation itself or related to normal changes associated with aging. For example, in evaluating changes in sleep, interviewers inquired about current sleep quality compared with the last few years, not current sleep quality compared with that at a much earlier age; similarly, if a dementia patient had a disrupted diurnal wake/sleep cycle and woke the care giver, this was not considered a sleep disturbance.…”