Impact of Behavioral and Psychological Symptoms of Dementia (BPSD) on Caregiver Mental Health
DOI:
https://doi.org/10.48047/jdwnwb17Keywords:
Behavioral and psychological symptoms of dementia, BPSD, caregiver burden, caregiver depression, caregiver anxiety, Neuropsychiatric Inventory, PHQ-9, GAD-7, Zarit Burden InterviewAbstract
Background: Behavioral and psychological symptoms of dementia (BPSD) are very common and are identified to be the major causes of distress among caregivers. Although much research has been made on cognitive impairment in dementia, less attention has been given to the effect of neuropsychiatric symptoms on the mental health of caregivers, such as depression, anxiety, and perceived burden. This paper attempted to determine the correlation between the severity of BPSD and caregiver psychological outcome and the identification of the critical sociodemographic and caregiving-associated factors that predict caregiver distress.
Methods: A cross sectional study was done among 120 primary caregivers of patients with clinically diagnosed dementia who were identified in neurology and geriatric outpatient clinics. Behavioral and psychological symptoms were evaluated through the Neuropsychiatric Inventory (NPI), whereas the caregiver outcomes were evaluated through the Patient Health Questionnaire-9 (PHQ-9) scale of depression, the Generalized Anxiety Disorder-7 (GAD-7) scale of anxiety, and the Zarit Burden Interview (ZBI) scale of caregiver burden. Sociodemographic and care giving variables, such as age, gender, relationship with the patient, duration, and number of hours of care giving per day, were collected. Correlation, multivariate regression and interaction analyses were used as the statistical analyses. Visualizations of associations were done using advanced graphical analyses, such as regression overlays and interaction plots.
Results: The average total NPI score was 34.6246.15, which represented a moderate level of BPSD burden. The BPSD domains that were the most prevalent were agitation/aggression (62.5%), depression/dysphoria (58.3%), and anxiety (55.8%). In caregivers, the levels of depression (PHQ-9: 11.2 ± 5.6), anxiety (GAD-7: 9.6 ± 4.8), and moderate-severe burden (ZBI: 38.4 ± 14.2) were moderate. Caregiver depression (r = 0.61), anxiety (r = 0.58) and burden (r = 0.67; p < 0.001 all) were positively correlated with total BPSD severity. Multivariate regression analysis revealed that the severity of BPSD, female gender, spousal relationship, extended period of care giving, and more hours of daily care giving were important predictors of caregiver distress. The analysis of interactions revealed that female caregivers were disproportionately higher burdened with increase in BPSD severity. The overlays that were confirmed through regression showed strong linear relationships between NPI scores and caregiver psychological outcomes.
Conclusion: Dementia behavioral and psychological symptoms are a serious threat to the mental health of the caregivers, and the symptoms of agitation, depressive symptoms, and sleeping problems are the main reasons. The female and spousal caregivers, and those giving long-term and intensive care, are highly susceptible. These results indicate that combined, caregiver-based dementia care approaches that are sensitive to the effects of neuropsychiatric symptoms of patients and psychological support of caregivers are necessary. To enhance patient and caregiver outcomes, it is necessary to identify high-risk caregivers at an early stage and implement interventions to improve outcomes
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