Depression, Anxiety and Sleep Alterations in Caregivers of Persons With Dementia After 1-Year of COVID-19 Pandemic

Abstract

Background: Social isolation due to COVID-19 pandemic has an important psychological impact particularly in persons with dementia and their informal caregivers.

Aim: To assess frequency and severity of long-term stress-related symptoms in caregivers of patients with dementia 1-year after the beginning of COVID-19 pandemic and to identify predictors of psychological outcomes.

Methods: Eighty-five caregivers were involved in a longitudinal study with 1-year follow-up during pandemic in Italy. At baseline in April 2020 a telephone interview assessed socio-demographic characteristics of caregivers and self-perception of distress symptoms. After 1 year, between March and April 2021, the same standardized interview was delivered to the caregivers' sample. In addition, scales assessing levels of depression and anxiety (DASS-21), sleep disturbances (PSQI) and coping strategies (COPE-NVI) were administered to the caregivers and to 50 age and sex-matched non-caregivers subjects. Linear regression analysis was performed to investigate the power of baseline variables to predict long-term psychological outcomes.

Results: After 1 year of pandemic frequency of caregivers' stress-related symptoms increased respect to baseline: depression (60 vs. 5, 9%; p < 0.001), anxiety (45, 9 vs. 29, 4%; p = 0.035), irritability (49, 4 vs. 24, 7%; p < 0.001), and anguish (31, 7 vs. 10, 6%; p < 0.001). Frequency of severe depression was higher in caregivers than in non-caregivers (p = 0.002) although mean levels of depression were comparable in the two groups. Long-term higher depression was predicted by a model built on baseline information (r² = 0.53, p < 0.001) where being female (t = -3.61, p < 0.001), having lower education (t = -2.15, p = 0.04), presence of feelings of overwhelm (t = 2.29, p = 0.02) and isolation (t = 2.12, p = 0.04) were significant predictors. Female sex was also predictive of anxiety (t = -2.7, p = 0.01) and poor sleep quality (t = -2.17, p = 0.03).

Discussion: At 1 year follow-up caregivers of patients with dementia reported higher prevalence of all stress-related symptoms respect to the acute phase of lockdown, particularly depression. Long-lasting stressful conditions may cause exhaustion of resilience factors and increased depression. Planning interventions should support caregivers to enable them to continue with their role during pandemic.

Keywords: COVID; burden; caregivers; dementia; depression; lockdown.

Figure 1

Frequency of stress-related symptoms reported by caregivers during the first lockdown (T1, March 2020; light green) and 1 year after first restrictions (T2, March-April 2021, dark green). T1 and T2 proportion of answers were compared by means of a series of McNemar's χ² tests for paired comparisons. *Bonferroni-corrected significant difference.

Figure 2

(A) Comparisons between caregivers (C), non-caregivers (nC) for PSQI-Sleep Quality Perception, PSQI-Sleep Efficiency, DASS-Depression, DASS-Anxiety, COPE-NVI-Social Support and COPE-NVI-Avoidance Strategies scores. Dashed lines indicated normative data (ND) level for each component. Higher values for the PSQI quality perception and efficiency scores mean worse performance (bad quality perception and bad habitual efficiency). *significant difference with the normative data. (B) Radar plots show the results of the investigation of the role of different components of caregivers' stress on depression, anxiety, sleep abnormalities and coping strategies in T2. Factor 1 (being a caregiver) was analyzed by comparing caregivers and non-caregivers (both in pandemic). Factor 2 (being in a pandemic) was investigated by comparing non-caregivers with normative data (i.e., not collected during a pandemic). Finally, we investigated both Factor 1 and Factor 2 (being a caregiver in pandemic) by comparing caregivers and normative data. The radar plots show the comparison between two groups, with one group used as reference (i.e., the scores of one group were z-scored on the reference group). For Factor 1 the non-caregivers were the reference group, for Factor 2 and 3 we used the normative data as reference.

Figure 3

Frequency distribution of DASS-21 Anxiety and Depression levels of severity in caregivers (red) and non-caregivers (blue) 1 year after first restrictions (T2, March-April 2021), Recommended cut-off scores for severity levels were considered as following: depression = normal 0–9, mild 10–13, moderate 14–20, severe > 21; anxiety = normal 0–7, mild 8–9, moderate 10–14, severe > 15 (23).

Figure 4

Comparison results of DASS-21-Depression scores at T2 between those caregivers who answered “Yes” or “No” to the first survey items (T1) regarding the presence of insomnia (sleep disturbances), depression and anxiety. *p < 0.001.