The burden of caring for adults with depression and suicidal ideation in five large European countries: analysis from the 2020 National Health and Wellness Survey

Abstract

Background Suicidal ideation (SI) affects approximately 30–40% of those with major depressive disorder (MDD). To date, studies have examined the substantial humanistic and economic burden to caregivers of persons with MDD, however little is known of the impact of caring for persons with MDD when SI is present. This study examined the additional burden imposed on caregivers for persons with unipolar depression and SI in five major European countries. Methods A retrospective, cross-sectional analysis was conducted in five European countries using 2020 Europe National Health Wellness Survey (France, Germany, Italy, Spain and the United Kingdom) to compare differences in health and economic outcomes between caregivers of adults with unipolar depression and SI (CAUD-SI) and caregivers of adults with unipolar depression without SI (CAUD-nSI). The outcomes assessed included health-related quality of life (HRQoL; Medical Outcomes Study Short Form [SF-12v2]), health status (Short-Form 6 Dimension [SF-6D], EuroQol 5-Dimension 5-Level [EQ-5D-5L]), Work productivity and activity impairment (WPAI) and healthcare resource utilization (HRU). Linear mixed models and generalized linear mixed models adjusted for covariates were used to compare the two groups on outcomes of interest. Results Of 62,319 respondents, 0.89% (n = 554) were CAUD-SI and 1.34% (n = 837) were CAUD-nSI. In adjusted models, CAUD-SI reported greater humanistic burden than CAUD-nSI, with lower HRQoL (PCS: 42.7 vs. 45.0, p < 0.001 and MCS: 37.5 vs. 38.9, p = 0.007) and health status (SF-6D: 0.57 vs 0.60, p < 0.001 and EQ-5D-5L: 0.58 vs 0.66, p < 001). CAUD-SI respondents reported significantly higher economic burden than CAUD-nSI respondents for WPAI (percent activity impairment: 64.9% vs. 52.5%, p = 0.026) and HRU (provider visits: 10.0 vs. 7.9, p < 0.001, emergency room visits: 1.49 vs. 0.73, p < 0.001 and hospitalizations: 1.03 vs. 0.52, p < 0.001). Conclusion In five European countries, caregivers of adults with depression and SI experience additional humanistic and economic burden than caregivers of adults with depression and no SI. Distinguishing caregiver groupings and their unique burden provide important insights for providing targeted support and interventions for both the patient and caregiver.

Impact of tardive dyskinesia on patients and caregivers: a survey of caregivers in the United States

“…Caregivers in this study also reported 46% overall activity impairment, with impairments of 44%, 43%, and 53% for caregivers of patients with TD and underlying SCZ, BD, and MDD, respectively. The overall activity impairment observed here for caregivers of patients with TD and MDD (53%) was greater than that recently reported for caregivers of patients with unknown TD status with MDD alone (40%), or MDD and suicidal ideation (49%) [ 30 ]. For each of the cited studies work impairment was assessed via WPAI, which is a standardized questionnaire for assessing work and activity impairment.…”

“…Caregivers of patients with TD and SCZ also reported greater impact on work absenteeism (12%) and presenteeism (42%) than previously reported for caregivers of patients with SCZ with unknown TD status (absenteeism, 5%; presenteeism, 25%) [ 37 ]. Likewise, caregivers of patients with TD and MDD reported higher levels of presenteeism (52%) and overall work impairment (57%) than previously reported for caregivers of patients with MDD without suicidal ideation (presenteeism, 35%; overall work impairment, 40%) [ 30 ]. Caregivers in this study also reported 46% overall activity impairment, with impairments of 44%, 43%, and 53% for caregivers of patients with TD and underlying SCZ, BD, and MDD, respectively.…”

Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis

“…Fourteen quantitative studies involving 12 cohorts were included (Borisonik & Kholmogorova, 2018; Cerel et al., 2006; Chessick et al., 2007, 2009; Chiang et al., 2015; Crasta et al., 2021; Jaffe et al., 2021; Katz et al., 2015; Kjellin & Östman, 2005; Lawn & McMahon, 2015; Magne‐Ingvar & Öjehagen, 1999a, 1999b; Maple et al., 2021; McDonell et al., 2003). Study designs included descriptive and analytical cross‐sectional studies with samples totalling 3705 carer participants (14 were bereaved by suicide).…”

“…Articles linked to the themes and subthemes are presented in Table 4. -Doku et al, 2017;Castelli Dransart & Guerry, 2017;Chessick et al, 2007Chessick et al, , 2009Dempsey et al, 2019;Fogarty et al, 2018;Giffin, 2008;Jaffe et al, 2021;Katz et al, 2015;Kjellin & Östman, 2005;Magne-Ingvar & Öjehagen, 1999b;Maple et al, 2021;McLaughlin et al, 2014McLaughlin et al, , 2016Nosek, 2008;Nygaard et al, 2019;Sellin et al, 2017;Spillane et al, 2020;Sun & Long, 2008;Talseth et al, 2001;Vandewalle et al, 2021;Wand et al, 2019;Wayland et al, 2021 Learning a new role Asare-Doku et al, 2017;Castelli Dransart & Guerry, 2017;Dempsey et al, 2019;Fogarty et al, 2018;Giffin, 2008;Magne-Ingvar & Öjehagen, 1999b;Nosek, 2008;Sellin et al, 2017;Spillane et al, 2020;Talseth et al, 2001;Vandewalle et al, 2021;Wand et al, 2019;Wayland et al, 2021 Own life on hold Asare-Doku et al, 2017;Castelli Dransart & Guerry, 2017;Dempsey et al, 2019;…”

“…Jaffe et al, 2021;Katz et al, 2015;Kjellin & Östman, 2005;Lawn & McMahon, 2015;Magne-Ingvar & Öjehagen, 1999a, 1999bMaple et al, 2021;McDonell et al, 2003). Study designs included descriptive and analytical cross-sectional studies with samples totalling 3705 carer participants (14 were bereaved by suicide).…”