Журнал депрессии и тревоги
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Perceived Stigma in Caregivers of Persons with Dementia and its Impact on Depressive Symptoms

Megan F Liu, Kathleen Buckwalter and Sandy Burgener

Objective: To examine the relationship between perceived stigma and depressive symptoms among caregivers of persons with dementia (PwD).

Methods:A descriptive longitudinal study of 51 caregivers of persons with dementia and 47 PwD, recruited from memory disorders and diagnostic centers and the VA Healthcare system. Modified Labeling Theory served as the organizing framework. Data were collected at baseline, 6, 12 and 18 months to assess changes in perceived stigma and depressive symptoms over the early-mid disease stages as part of a multisite study. Caregivers provided information on ethnic background, geographic location (rural/urban), knowledge of dementia, perceived stigma, depressive symptoms, and the PwD’s behavioral symptoms and their reactions to the behaviors. PwD were assessed on their mental ability and disease stage. Inclusion criteria for PwD included a physician-confirmed dementia diagnosis within the last 12-18 months, a Mini Mental State Examination score >15 (to target early-mid disease stage participants), and residence in the community or assisted living facility. Caregivers were non-paid primary caregivers who had ≥ 3 contacts weekly with the PwD, and were ≥21 years old. A linear mixed model analysis was used to determine the relationship between variables, and to examine missing data.

Results:Caregivers’ perceptions of stigma were significantly associated with depressive symptoms both at baseline (r=0.36, p=0.017) and over 18 months (p=0.004). Results also indicated that caregivers of PwD felt more depressed when they perceived more stigma (p=0.016), despite differences in ethnicity/race, geographic location as well as different levels of cognitive impairment of the person with dementia, and caregiver reactions in response to PwD memory and behavior problems. We also found that perceived stigma minimally mediated the effect between caregivers’ reaction toward PwD’s memory and behavior problems and depressive symptoms (13.7% decrease in the coefficient).

Conclusions:Caregivers of persons with dementia felt more depressed when they perceived more stigma after adjusting for other covariates in the model. Perceived stigma minimally mediated the effect between caregivers’ reactions toward the PwD’s memory and behavior symptoms and depressive symptoms. Results underscore the effects of stigma in relation to caregiver depressive symptoms. Effective interventions to combat caregiver perceived stigma are needed to enhance caregiver psychological well-being and to increase positive responses to PwD behaviors.