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Hidden Morbidity in Cancer: Spouse Caregivers
Open accessAbstract
PURPOSE: This study assesses psychological distress among advanced cancer patients and their spouse caregivers, while examining the relative contribution of caregiving burden and relational variables (attachment orientation and marital satisfaction) to depressive symptoms in the spouse caregivers. METHODS: A total of 101 patients with advanced GI or lung cancer and their spouse caregivers were recruited for the study. Measures included Beck Depression Inventory-II (BDI-II), Caregiving Burden scale, Experiences in Close Relationships scale, and ENRICH Marital Satisfaction scale. RESULTS: A total of 38.9% of the caregivers reported significant symptoms of depression (BDI-II > or = 15) compared with 23.0% of their ill spouses (P < .0001). In a hierarchical regression predicting caregiver's depression, spouse caregiver's age and patient's cancer site were entered in the first step, objective caregiving burden was entered in the second step, subjective caregiving burden was entered in the third step, caregiver's attachment scores were entered in the fourth step, and caregiver's marital satisfaction score was entered in the fifth step. The final model accounted for 37% of the variance of caregiver depression, with subjective caregiving burden (beta = .38; P < .01), caregiver's anxious attachment (beta = .21; P < .05), caregiver's avoidant attachment (beta = .20; P < .05), and caregiver's marital satisfaction (beta = -.18; P < .05) making significant contributions to the model. CONCLUSION: Spouse caregivers of patients with advanced cancer are a high-risk population for depression. Subjective caregiving burden and relational variables, such as caregivers' attachment orientations and marital dissatisfaction, are important predictors of caregiver depression.
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“Family caregivers of cancer patients exhibit high levels of stress and depression, lower subjective well-being, worse physical health, and higher mortality compared to non-caregivers [2–8, 19–25], yet few studies focus on improving outcomes for caregivers [26].”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]
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“A cancer diagnosis is associated with high levels of distress, leading to frequent anxiety, depression, fear of recurrence/progression, sleep disturbance, and fatigue in both patients and caregivers [1–8].”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]
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“Conversely, longer survival comes at a cost for caregivers: the negative effects of caregiving, including a higher mortality rate, are most pronounced in caregivers of patients with advanced cancer [2, 3, 20], particularly when patients have a protracted disease course [25] and are receiving palliative care [4, 21].”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]
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“Distress in caregivers contributes to distress in patients [24], in addition to negatively impacting the health of caregivers themselves [2–4, 20, 21, 25], and likely other family members (e.g. many of our participants had young children).”
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“A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers.”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]
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“Yet we found comparable distress levels in patients and caregivers, and emotional distress in particular may be even higher in caregivers, corroborating previous findings [2–6].”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [2]
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Mosher, C. E., Champion, V. L., Hanna, N., Jalal, S. I., Fakiris, A. J., Birdas, T. J., Okereke, I. C., Kesler, K. A., Einhorn, L. H., Given, B. A., et al. (2013) · Psycho-Oncology · doi:10.1002/pon.3168 · Cited by 65
“What factors might explain the observation that despite caregivers of cancer patients reporting high rates of distress [7,8,12], they tend to report low rates of mental health service use [21]? Knowledge about caregivers’ interest in a range of support services and a greater understanding of factors that are predictiv…”
BackgroundCaregiving styles and attachment orientations in couples facing advanced cancer
Braun, M., Hales, S., Gilad, L., Mikulicer, M., Rydall, A. C., & Rodin, G. (2011) · Psycho-Oncology · doi:10.1002/pon.1988 · Cited by 65
Self-citationMosher, C. E., Jaynes, H., Hanna, N., & Ostroff, J. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1532-6 · Cited by 72
Caregivers’ morbidity in palliative care unit: predicting by gender, age, burden and self-esteem
Costa‐Requena, G., Cristòfol, R., & Cañete, J. (2011) · Supportive Care in Cancer · doi:10.1007/s00520-011-1233-6 · Cited by 64
Porter, L. S., Keefe, F. J., Davis, D., Rumble, M. E., Scipio, C. D., & Garst, J. L. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-011-1367-6 · Cited by 64
Milbury, K., Li, J., Weathers, S.-P. S., Mallaiah, S., Armstrong, T., Li, Y., Bruera, E. D., & Cohen, L. G. (2018) · Neuro-Oncology Practice · doi:10.1093/nop/npy052 · Cited by 63
Psychological interventions targeting partners of cancer patients: A systematic review
Kleine, A., Hallensleben, N., Mehnert, A., Hönig, K., & Ernst, J. (2019) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2019.05.008 · Cited by 63
Ugalde, A., Krishnasamy, M., & Schofield, P. E. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0338 · Cited by 62
Documentation of Caregivers as a Standard of Care
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Fear of cancer recurrence and death anxiety: unaddressed concerns for adult neuro-oncology patients
Loughan, A. R., Lanoye, A., Aslanzadeh, F. J., Villanueva, A. A. L., Boutte, R., Husain, M., & Braun, S. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-019-09690-8 · Cited by 60
Depression, anxiety and disease-related distress in couples affected by advanced lung cancer
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Moreira, H., & Canavarro, M. C. (2013) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2013.778934 · Cited by 57
Shaffer, K. M., Jacobs, J. M., Nipp, R. D., Carr, A. L., Jackson, V. A., Park, E. R., Pirl, W. F., El-Jawahri, A. R., Gallagher, E. R., Greer, J. A., et al. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3488-4 · Cited by 60
Metadata
- Authors
- Braun, M., Mikulincer, M., Rydall, A., Walsh, A., & Rodin, G.
- Affiliations
- University Health Network (CA)
- Venue
- Journal of Clinical Oncology
- Published
- 2007-10-20
- Volume
- 25
- Issue
- 30
- Pages
- 4829-4834
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2132645593
- Cited by
- 526
- References
- 58
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 26 · 2023: 20 · 2022: 32 · 2021: 30 · 2020: 41 · 2019: 30 · 2018: 35 · 2017: 26 · 2016: 30 · 2015: 32 · 2014: 40 · 2013: 44 · 2012: 43
- FWCI
- 55.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Princess Margaret Hospital Foundation
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing care and research
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- spousal caregivers, caregiver depression, advanced cancer, caregiver burden, attachment orientation, marital satisfaction, gastrointestinal cancer, lung cancer, psychological distress, marital relationships
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Depression, Emotions, Female, Humans, Male, Middle Aged, Morbidity, Neoplasms, Palliative Care, Risk Factors, Terminal Care, Caregivers
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