Moderating Effects of Optimism and Family Support on the Depression of Family Caregivers of Cancer Patients

Kyoungwon Choi; Dae Ro Choi; Dae Young Zang; Young Suk Park; Seok Yun Kang; Hyunsook Yoon; Yeon Ok Lim; Yojin Kim; Ilsung Nam; Hyen Joo Lee

doi:10.15384/kjhp.2016.16.3.192

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Choi, Choi, Zang, Park, Kang, Yoon, Lim, Kim, Nam, and Lee: Moderating Effects of Optimism and Family Support on the Depression of Family Caregivers of Cancer Patients

Original Article

Korean J Health Promot 2016;16(3):192-202.

Published online: 20 January 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.3.192

Moderating Effects of Optimism and Family Support on the Depression of Family Caregivers of Cancer Patients

Kyoungwon Choi¹, Dae Ro Choi^2,, Dae Young Zang³, Young Suk Park⁴, Seok Yun Kang⁵, Hyunsook Yoon¹, Yeon Ok Lim⁶, Yojin Kim¹, Ilsung Nam⁷, Hyen Joo Lee⁸

¹Department of Social Welfare, Hallym University, Chuncheon, Korea

²Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea

³Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea

⁴Divisions of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁵Division of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea

⁶Institute of Aging, Hallym University, Chuncheon, Korea

⁷Department of Family Welfare, Daegu University, Gyeongsan, Korea

⁸Department 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

Received 7 January 2016 Accepted 10 May 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.

Abstract

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.

Keywords: Caregivers, Depression, Optimism, Social support, Cancer

References

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Table 1.

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	6 (1.7)
	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	82 (23.2)

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

Table 2.

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.

Table 3.

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

Table 4.

Stressor, moderator and depression with correlation

Table 5.

Moderator effect between Stressor and depression of cancer caregiver^a: step 1, 2

	Step 1			Step 2
	B	β	P	B	β	P
Controls
Gender^b	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 patients^c	–	–	–	1.108	0.102	0.206
Nursing period^d				–0.002	–0.013	0.761
Physical function of patients^e				0.012	0.058	0.360
Emotional function of patients^e				–0.046	–0.190	0.001
Role function of patients^e				–0.002	–0.011	0.864
Cognitive function of patients^e				–0.003	–0.011	0.839
Social function of patients^e				–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)

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

^b Gender: male=1, female=0.

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

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

^e 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.

Table 6.

Moderator effect between Stressor and depression of cancer caregiver^a: step 3, 4

	Step 3			Step 4
	B	β	P	B	β	P
Control
Gender^b	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 patients^c	1.246	0.114	0.132	1.273	0.117	0.117
Nursing period^d	–0.002	–0.011	0.787	–0.003	–0.020	0.601
Physical function of patients^e	0.017	0.077	0.193	0.014	0.065	0.271
Emotional function of patients^e	–0.039	–0.162	0.004	–0.031	–0.127	0.023
Role function of patients^e	–0.005	–0.025	0.688	–0.005	–0.026	0.670
Cognitive function of patients^e	–0.004	–0.015	0.774	–0.011	–0.044	0.380
Social function of patients^e	–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)

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

^b Gender: male=1, female=0.

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

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

^e 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.

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