Network Analysis of Comorbid Depressive and Anxious Symptoms in Family Caregivers of People with Dementia

ABSTRACT

Objectives

The aim of this study is an in-depth approach to depressive-anxious comorbidity in caregivers according to stress reactivity to disruptive behaviors using network analysis.

Methods

The sample was composed of 317 primary family caregivers recruited through Day Care Centers and Neurology Services. The sample was split into low and high stress reactivity groups, based on their reports of reaction to disruptive behaviors. Depressive and anxious symptoms, daily hours dedicated to caregiving, time of caring, frequency of disruptive behaviors, co-residence, and kinship were also cross-sectionally measured.

Results

The sample had a mean age of 62.38 years (SD = 12.97) and 68.5% were women. Regarding the network analysis, while the low reactivity group presents a sparse network, with no connection between anxious and depressive symptoms, the high reactivity group shows a high connection of intra and intercategory symptoms, with apathy, sadness, feeling depressed, and tension being the bridge symptoms between disorders.

Conclusions

Caregivers’ stress reaction to disruptive behaviors might be a key factor for understanding comorbidity between depressive and anxious symptoms.

Clinical implications

Tension, apathy, sadness, and feeling depressed should be clinical targets in the interventions, as they act as bridge symptoms between anxious and depressive symptomatology.

KEYWORDS:

• Behavioral symptoms
• comorbidity
• dementia
• family caregivers
• network analysis

Clinical Implications

• Stress reactivity to disruptive behaviors is a potentially relevant variable related to comorbid depressive and anxious symptoms in family caregivers of people with dementia.

• Family caregivers of people with dementia with high-stress reactivity show higher connectivity between symptoms, compared with caregivers with low-stress reactivity, displaying a comorbid depressive and anxious symptoms network.

Acknowledgments

We thank all the caregivers for their participation in the study and also the following centers for collaborating with us in the project: Hospital Gregorio Marañón, Centros de día STIMA, Cognitiva Unidad de Memoria, Centros de día Albertia, FOGAR, AFA Valdemoro, Centro de día Pirámides, Activa Edades, MIT centro de día, and Asociación de Familiares de Enfermos de Alzheimer de Madrid (AFEAM).

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [IC], upon reasonable request.

Additional information

Funding

This work was supported by the Spanish Ministry of Science and Innovation under Grant PID2019-106714RB-C22, by the Spanish Ministry of Economy and Competitiveness under Grants PSI2015-65152-C2-1-R and the Spanish Ministry of Economy and Competitiveness under Grant PSI2012-31293. Laura Mérida-Herrera is supported by a Pre-Doctoral Grant from the Spanish Ministry of Science and Innovation (FPI/525644).