kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.3.192 kjhp-16-192 Original Article Moderating Effects of Optimism and Family Support on the Depression of Family Caregivers of Cancer Patients ChoiKyoungwon 1 ChoiDae Ro 2 ZangDae Young 3 ParkYoung Suk 4 KangSeok Yun 5 YoonHyunsook 1 LimYeon Ok 6 KimYojin 1 NamIlsung 7 LeeHyen Joo 8 Department of Social Welfare, Hallym University, Chuncheon, Korea Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea Divisions of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Division of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea Institute of Aging, Hallym University, Chuncheon, Korea Department of Family Welfare, Daegu University, Gyeongsan, Korea Department of Social Welfare, Hallym Polytechnic University, Chuncheon, Korea Corresponding author: Dae Ro Choi, MD, PhD Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Korea Tel: +82-33-240-5623, Fax: +82-33-255-4291 E-mail: choidr2@gmail.com 01 2016 20 01 2016 16 3 192 202 07012016 10052016 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

This study examined moderating effects of optimism and family support on the depression of family caregivers of cancer patients aged 55 and over by adopting stress process model.

 Methods

359 family caregivers who accompanied with cancer patients to out-patient clinics were recruited and completed questionnaire at three university hospitals located in Seoul and Gyeonggi province. Exploratory factor analysis was applied to test validity of the construction of the scale. Hierarchical multiple regression analysis was used to determine moderating effects of optimism and family support on depression after making mean centering of each variable.

 Results

Results showed that spouse caregivers have more depression than do adult children as the nursing period gets longer. Education and income status were significant variables affecting depression of family caregivers. Optimism and family support for family caregivers have moderating effects on the association between stressors (emotional functioning of cancer patients and role overload of family caregivers) and depression of family caregivers.

 Conclusions

The findings suggest that more attentions are needed to the depression of spouse caregivers. Interventions are strongly recommended for health professionals to provide cancer patients and their family caregivers with "holding environments" caring for emotions and facilitating adjustment.

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Socio-demographic characteristics of caregivers of patients with cancer (n=354)

Characteristics
Gender Male 92 (26.0)
  Female 262 (74.0)
Age   54.38±14.03
  Less than 40 55 (15.8)
  41–50 90 (25.8)
  51–60 75 (21.5)
  61–70 75 (21.5)
  71–80 51 (14.6)
  More than 81 3 (0.9)
Relationships with Spouse 175 (49.4)
patients Children 179 (50.6)
Education Less than primary school 34 (9.6)
  Primary school 81 (22.9)
  Junior school 145 (41.0)
  High school 79 (22.3)
  College or more 15 (4.2)
Self-rated health Excellent 117 (33.1)
  Good 100 (28.3)
  Fair 85 (24.0)
  Poor 27 (7.6)
  Bad 24 (6.8)
Employment Employed 183 (52.2)
  Not employed 171 (47.5)
Nursing period 38.90±32.14
(months) Less than 12 16 (4.5)
  13–24 122 (34.5)
  25–36 93 (26.3)
  37–48 44 (12.4)
  49–60 27 (7.6)
  61–84 30 (8.5)
  85–120 10 (3.4)
  More than 120 12 (3.4)
Marital status Married 297 (84.4)
  Widowed 4 (1.1)
  Divorced/separated 8 (2.3)
  Single; never married 43 (12.2)
Subjective Much better than 6 (1.7)
economic status contemporaries
  Better than contemporaries 32 (9.0)
  Same as contemporaries 131 (37.0)
  Worse than contemporaries 103 (29.1)
  Much worse than 82 (23.2)
  contemporaries

Values are presented as N(%) or mean±SD unless otherwise indicated.

Cancer characteristics of the patients (n=354)

Characteristics
Gender Male 224 (63.3)
  Female 130 (36.7)
Age   71.24±7.03
  51–60 23 (6.5)
  61–70 130 (36.7)
  71–80 171 (48.3)
  More than 81 30 (8.5)
Cancer Lung 42 (11.9)
Diagnosis Stomach 117 (33.1)
  Colorectal 139 (39.3)
  Liver & ancreas 32 (9.0)
  Kidney 13 (3.7)
  Prostate 11 (3.1)
Patient's QoL Physical 63.75±25.46
QoL Emotional 72.85±22.56
  Role 65.82±29.91
  Cognitive 76.69±22.24
  Social 73.12±28.47
Recurrence of Recurrence 70 (19.8)
cancer No recurrence 284 (80.2)
Spouse Yes 297 (83.9)
  No 57 (16.1)
Cancer therapy received Surgery 107 (30.5)
received Chemotherapy 23 (6.6)
  Radiation therapy 2 (1.4)
  Surgery + chemotherapy 141 (40.2)
  Surgery + radiation 7 (2.0)
  Surgery + radiation 27 (7.7)
  + chemotherapy 27 (7.7)
  Radiation + chemotherapy 22 (2.3)
  Hormone 5 (1.4)
  None 19 (5.4)
Stage of the cancer Stage I 100 (29.0)
at diagnosis Stage II 96 (27.8)
  Stage III 91 (26.4)
  Stage IV 58 (16.8)

Values are presented as N (%) or mean±SD unless otherwise indicated.

Depressive tendency of a caregivers according to treatment period of cancer patients (n=110)

Stressor, moderator and depression with correlation

Moderator effect between Stressor and depression of cancer caregivera: step 1, 2

  Step 1 Step 2
  B β P B β P
Controls            
Genderb 0.452 0.040 0.397 –0.023 –0.002 0.966
Age –.0037 –0.096 0.052 –0.032 –0.082 0.267
Education 1.990 0.365 <0.001 1.167 0.214 <0.001
Self-rated health –0.355 –0.078 0.107 –0.073 –0.016 0.726
Subjective economic status –1.347 –0.245 <0.001 –0.827 –0.150 0.002
Primary objective stress            
Relationships with patientsc – – – 1.108 0.102 0.206
Nursing periodd       –0.002 –0.013 0.761
Physical function of patientse       0.012 0.058 0.360
Emotional function of patientse       –0.046 –0.190 0.001
Role function of patientse       –0.002 –0.011 0.864
Cognitive function of patientse       –0.003 –0.011 0.839
Social function of patientse       –0.015 –0.080 0.168
Secondary stress            
Role overload       1.432 0.186 0.001
Caregiving competence       –0.429 –0.051 0.233
Relational change       1.306 0.143 0.006
Moderators            
Optimism – – – – – –
Family support – – – – – –
Moderation effect            
Emotional function∗optimism – – – – – –
Emotional function∗family support – – – – – –
Role overload∗optimism – – – – – –
Role overload∗family support – – – – – –
F   26.989 (P<0.001)     16.964 (P<0.001)  
R2   0.283     0.434  
△R2   –     0.151  
△F   –     8.853 (P<0.001)  

Hierarchical regression analysis: step1, step2 after conducting the mean centered for each variable were subjected to Hierarchical regression analysis.

Gender: male=1, female=0.

Relationships with patients: spouse=1, children=0.

Nursing period: from the patient's cancer diagnosis date to the survey date.

Patient function rating by family caregiver: The function score is an aggregate score of the 15 functioning measures of EORTC QLQ-C30. The higher the score, the better functional status.

Moderator effect between Stressor and depression of cancer caregivera: step 3, 4

  Step 3 Step 4
  B β P B β P
Control            
Genderb 0.013 0.001 0.979 0.048 0.004 0.923
Age –0.048 –0.122 0.084 –0.046 –0.117 0.090
Education 0.974 0.178 <0.001 0.903 0.165 0.001
Self-rated health 0.193 0.042 0.349 0.207 0.045 0.306
Subjective economic status –0.708 –0.129 0.006 –0.659 –0.120 0.009
Primary objective stress            
Relationships with patientsc 1.246 0.114 0.132 1.273 0.117 0.117
Nursing periodd –0.002 –0.011 0.787 –0.003 –0.020 0.601
Physical function of patientse 0.017 0.077 0.193 0.014 0.065 0.271
Emotional function of patientse –0.039 –0.162 0.004 –0.031 –0.127 0.023
Role function of patientse –0.005 –0.025 0.688 –0.005 –0.026 0.670
Cognitive function of patientse –0.004 –0.015 0.774 –0.011 –0.044 0.380
Social function of patientse –0.015 –0.076 0.169 –0.011 –0.056 0.311
Secondary stress            
Role overload 1.254 0.162 0.003 1.291 0.167 0.002
Caregiving competence –0.058 –0.007 0.869 –0.296 –0.035 0.398
Relationship changes 0.666 0.073 0.161 0.440 0.048 0.350
Moderators            
Optimism –1.540 –0.221 <0.001 –4.350 –0.623 <0.001
Family support –1.217 –0.179 0.001 0.791 0.116 0.431
Moderation effect            
Emotional function∗optimism – – – 0.035 0.397 0.019
Emotional function∗family support – – – –0.026 –0.259 0.058
Role overload∗optimism – – – –0.413 –0.042 0.368
Role overload∗family support – – – –1.364 –0.167 0.002
F 1 19.422 (P<0.001) ) 1 17.393 (P<0.001) )
R2   0.500     0.528  
△R2   0.066     0.028  
△F 2 21.862 (P<0.001) )   4.884 (P<0.001)  

Hierarchical regression analysis: step3, step4 after conducting the mean centered for each variable were subjected to Hierarchical regression analysis.

Gender: male=1, female=0.

Relationships with patients: spouse=1, children=0.

Nursing period: from the patient's cancer diagnosis date to the survey date.

Patient function rating by family caregiver: the Function score is an aggregate score of the 15 functioning measures of EORTC QLQ-C30. The higher the score, the better functional status.