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Epidemiol Health > Volume 42; 2020 > Article
Park, Lee, Jeong, Hong, Bae, and Yim: Characteristics of depressive symptoms in middle-aged family members of dementia patients: 2017 Korea Community Health Survey

Abstract

OBJECTIVES

The characteristics of depressive symptoms in the family members of home-dwelling patients with dementia have not been clearly reported. This study aimed to investigate the characteristics of depressive symptoms in middle-aged family members living with a patient with dementia.

METHODS

This study used the data from the nationwide 2017 Korea Community Health Survey. Among the 228,381 survey participants, 77,276 participants in their 40s and 50s were finally selected for this study. The participants consisted of 760 family members of home-dwelling dementia patients and 76,516 general family members comprising a control group.

RESULTS

The positive rate of Patient Health Questionnaire-9 (PHQ-9)-measured depressive symptoms was significantly higher in the family members of home-dwelling dementia patients (4.4%; control group: 1.9%). After adjusting for potential confounders, the prevalence of PHQ-measured depressive symptoms was 1.72 times (95% confidence interval [CI], 1.03 to 2.85) higher in the family members of home-dwelling dementia patients compared to the control group. The positive rate of depressive symptoms was 2.26 times higher (95% CI, 1.26 to 4.05) in the female middle-aged family members of home-dwelling dementia patients compared to the control group. In addition, those who reported having symptoms almost every day in the PHQ-9 questions had significantly higher positive rates on questions about loss of interest, depression, sleep disturbance, fatigue, poor appetite, and suicidal ideation, and not on questions regarding feelings of worthlessness and psychomotor agitation, compared to the control group.

CONCLUSIONS

Active interventions are needed to relieve depression in the family members of home-dwelling dementia patients.

INTRODUCTION

Dementia is a fatal disease that affects over 46.8 million people worldwide. This figure is expected to double every 20 years, reaching 75 million by 2030 and approximately 130 million by 2050 [1]. Looking at the domestic status, the estimated number of patients with dementia in Korea in 2017 was 702,436 out of the total 7,066,201 elderly people across the country, and the number of family members of patients with dementia, including spouses, children, and grandchildren was approximately 3.5 million [2].
As a dementia-related policy in Korea, the National Responsibility System for Dementia was implemented in 2017, and started providing various services for patients with dementia and their family members. Although various programs such as self-help groups and vocational programs for family caregivers of patients with dementia are being implemented, their effect on alleviating care burden among family caregivers is insignificant [3].
Among the family members of home-dwelling patients with dementia, sons and their wives (patients’ daughters-in-law) often care for home-dwelling patients with dementia, and 50-60% of family members living together are middle-aged, in their 40s and 50s, who are engaged in economic activities and bearing the care burden of the patients with dementia [4]. Consequently, they experience economic burden due to limited economic activities and dementia-related medical expenses [5].
The family members of patients with dementia have been reported to play a central role in caring for the patients, and as patients’ cognitive impairment deteriorates, family caregivers’ physical and mental efforts required for continuous care increase, thereby increasing the risk of stress and depression [6]. In addition, caregiver burden for caring for elderly persons with dementia was reported to be higher than for caring for elderly persons with chronic diseases or stroke [7].
Depressive symptoms are the most common psychiatric symptoms experienced by the caregivers of patients with dementia, and 75% of caregivers of elderly persons with dementia were reported to experience depressive symptoms [8]. In addition, approximately 60% of family caregivers of patient with dementia were found to have sleep disturbance [9], and 16% had contemplated suicide more than once [10]. Furthermore, they had poor health status [5,11] and were at a high risk of stroke [12]. Although it has been reported that family members of patients with dementia have various mental burdens including depression as well as physical burdens, the characteristics of depressive symptoms have not been clearly reported. Therefore, this study aims to compare the prevalence of Patient Health Questionnaire-9 (PHQ-9)-measured depressive symptoms and the characteristics of depressive symptoms for each PHQ-9 question, and to determine the characteristics of depressive symptoms in family members of home-dwelling patients with dementia using the data from the nationally representative 2017 Korea Community Health Survey (KCHS).

MATERIALS AND METHODS

Study design

This is a cross-sectional study aimed to determine the prevalence of depression and the characteristics of depressive symptoms for each PHQ-9 question in middle-aged families of patients with dementia using the data from the KCHS that was conducted nationwide in 2017.

Participants and data collection

Since 2008, the KCHS is conducted annually in accordance with the Community Health Act, with the target population of adults aged 19 years or older as of July 1st of the respective year [13].
One-person households that had no possibility of caring for a patient with dementia were excluded. In addition, considering the fact that those in their 20s and 30s are unlikely to be family caregivers of patients with dementia, and that dementia is predominant in the elderly population (i.e., persons aged 65 years or older), middle-aged persons (or those in 40s and 50s) were selected as the children generation of dementia patients for this study.
Therefore, among 228,381 survey participants in 2017, excluding single-person households, and selecting those in their 40s and 50s, and further excluding three who did not respond to the question regarding whether or not they were living with a patient with dementia, and 157 who did not respond to the PHQ-9 questions, a total of 77,276 participants were finally selected. Families who were currently living with a patient diagnosed with dementia by a physician were defined as family members of home-dwelling patients with dementia, and families not living with a patient with dementia were defined as general families comprising the control group. The sample consisted of 760 family members of home-dwelling dementia patients, and 76,516 general family members in the control group (Figure 1).

Instruments

General characteristics

The information of gender, age, household type, household income, employment status, education level, residential area, current smokers, drinking alcohol, physical activity (PA), and body mass index (BMI) were collected from the survey. Age was divided into those in their 40s (40-49 years old), and those in their 50s (50-59 years old); employment was divided into employed (those with a job), student/repeater, housewife, and unemployed (those without a job/vocation); the household type was classified as one, two, and three generational households; practicing moderate PA for more than 30 minutes a day for more than five days per week, or practicing vigorous PA for more than 20 minutes a day for more than three days per week during the one week preceding data collection was considered as moderate or high PA.

Depressive symptoms and depressive mood

Depressive symptoms were assessed using the PHQ-9. The PHQ-9 is widely used as a screening tool for major depressive disorders, and is known to have high sensitivity (88%) and specificity (88%) [14]. The PHQ-9 consists of nine questions. Each question is scored from 0 to 3, and the total score ranges from 0 to 27. In this study, the criteria for major depressive disorder, that is, a PHQ-9 score of ≥ 10 points was used as the cut-off point. To identify the characteristics of depression, a score of 0-2 points for each question in the PHQ-9 was reclassified as negative, and a score of 3 points was reclassified as positive to determine the response rate. The Cronbach’s alpha reliability of the scale was 0.78 in this study.
Those who felt sadness or hopelessness interfering with their daily lives for more than two consecutive weeks in the one year preceding data collection were considered as experiencing depressive mood.

Statistical analysis

The statistical analysis was performed using the SAS version 9.4 (SAS Institute Inc., Cary, NC, USA), and the data were analyzed using the complex sample design method considering the weight. The statistical significance level was set at p-value < 0.05.
In order to compare the characteristics of the participants in the two groups according to households with or without homed-welling patients with dementia, the participants’ characteristics were presented as frequencies and percentages, and the means and standard errors for the continuous variables were presented.
The comparison of the differences between the two groups was performed for categorical variables using the Rao-Scott chi-square test, and for continuous variables using the t-test.
The differences between the prevalence of PHQ-9 measured depressive symptoms and the positive rate of depressive symptoms for each PHQ-9 question was determined using the RaoScott chi-square test.
Confounding variables included demographic variables, and income level and economic activity variables, which are known as burden factors [15] in the family members of home-dwelling patients with dementia. Monthly alcohol drinking with a p-value of ≤ 0.25 found in the univariate analysis, and current smoking were used as adjustment variables. Multivariable logistic regression analysis was performed to determine the relationship between the presence or absence of home-dwelling dementia patient and depressive symptoms in family members of patients with dementia.

Ethics statement

This study was approved by the Institutional Review Board of The Catholic University of Korea (approval No. MC19ZESI0051).

RESULTS

The general characteristics of family members of home-dwelling patients with dementia and general family members in the control group

The results of a comparison of the general characteristics of the two groups showed significant differences in age, household income, economic activity, education level, household by generation, residential area, current smoking, monthly alcohol drinking, and number of diagnosed diseases (p<0.05). By age group, the proportion of family members aged 50-59 years of home-dwelling dementia patients was 60.2%, and the proportion of those aged 40-49 years was 39.8%. In the control group, the proportion of those aged 40-49 years was 51.3%, and the proportion of those aged 50-59 years was 48.7%.
The proportion of those with a household income < 1 million Korean won (KRW) was higher in the families of home-dwelling dementia patients (11.0%) than in the general families in the control group (2.9%), whereas the proportion of those with a household income ≥ 3 million KRW was higher in the control group (74.5%) than in the families of home-dwelling dementia patients (51.9%). The proportion of those who were unemployed was higher in the families of home-dwelling dementia patients (25.3%) than in the general families in the control group (20.5%). The proportion of current smokers was higher in the families of home-dwelling dementia patients (26.9%) than in the control group (22.4%). The proportion of those with monthly drinking was higher in the control group (58.0%) than in the families of home-dwelling dementia patients (63.7%) (Table 1).

Group differences on depression

The rate of experience of depression as measured with a single question was higher in the families of home-dwelling dementia patients (12.2%) than in the control group (5.6%) (Table 2). The prevalence of depressive symptoms measured by the PHQ-9 was higher in the families of home-dwelling dementia patients (4.4%) than in the control group (1.9%). In terms of gender, the prevalence of depressive symptoms in men was higher in the families of home-dwelling dementia patients (3.2%) than in the control group (1.5%), and also higher in women in the families of homed-welling dementia patients (5.9%) than in the control group (2.2%).
The prevalence of depressive symptoms was significantly higher in the family of home-dwelling dementia patients with an odds ratio (OR) of 2.46 (95% confidence interval [CI], 1.56 to 3.88) and an adjusted odds ratio (aOR) of 1.72 (95% CI, 1.03 to 2.85) compared to the control group after adjusting for potential confounders. Sensitivity analysis was performed with different selection criteria that were limited to 40s and 50s. Similar results were obtained by changing the age category into 30-69 year and 40-69 years (Supplementary Materials 1 and 2).
The crude OR and aOR were significantly higher at 2.75 (95% CI, 1.61 to 4.68) and 2.26 (95% CI, 1.26 to 4.05), respectively, in the female family members of home-dwelling dementia patients, compared to female family members in the control group. The difference was not significant in the male family members in the two groups (Table 3).

Characteristics of families of home-dwelling dementia patients and control families according to each Patient Health Questionnaire-9 question

The analysis of differences between the two groups according to each PHQ-9 question showed that the positive rates of loss of interest, depression, sleep disturbance, fatigue, and appetite problems were higher in the family members of home-dwelling dementia patients. Moreover, the positive rate of thinking about death almost every day was also higher in this group (1.5%) than in the control group (0.2%). There was no difference in two areas such as feelings of worthlessness and psychomotor (p = 0.064, p= 0.905, respectively) (Figure 2, Table 4).

DISCUSSION

This study investigated the difference in the positive rate of the PHQ-9 measured depressive symptoms between the middle-aged family members of home-dwelling dementia patients and the middle-aged family members in the control group, and investigated the positive rate of depressive symptoms for each PHQ-9 question to identify the characteristics of the family members of home-dwelling dementia patients using the data from the 2017 KCHS.
In this study, the mean age of the middle-aged family members of home-dwelling dementia patients was 51 years, which was consistent with a previous study by Kim et al. [16] indicating that the mean age of the main caregivers of dementia patients was 52.3 years old, and that most of the main caregivers were middle-aged.
Household income and economic activity were significantly lower in the family members of home-dwelling dementia patients. A study by Choi et al. [17], reported that 27% of the caregivers of dementia patients quit their jobs after a family member developed dementia, and 51% reduced their working hours. This was because they could not maintain economic activities due to their responsibilities of caring for dementia patients. Quitting a job or reduced working hours led to decreased income levels.
In terms of residential area, the proportion of those living in ‘eup’/‘myeon’ was significantly higher, which is consistent with a study [18] reporting that a large number of dementia sufferers and family members of home-dwelling dementia patients live in rural areas.
This study investigated the positive rate of depressive symptoms using the PHQ-9. The prevalence of depressive symptoms in the 2016 Korea National Health and Nutrition Examination Survey was 5.6%, which was measured by the PHQ-9 [19], while the prevalence of depressive symptoms in the 2017 KCHS was underestimated at 3.2%. Although these surveys used the same survey scale, the Korea National Health and Nutrition Examination Survey was conducted through one-to-one interviews in independent spaces, whereas the KCHS was conducted through one-to-one interviews in open spaces (possibly where family members were in the vicinity). Such an underestimation is thus thought to be due to the survey method.
However, it is difficult to assume that this was measured differentially according to whether or not families had to care for dementia patients, and thus it is assumed to be a bias toward the null.
In addition, the prevalence of depressive symptoms measured by the PHQ-9 and the rate of experience of depression measured by a single question were working in the same direction. An underestimation is expected because the survey was conducted in open spaces. However, in view of the fact that differential measurement errors did not occur depending on caring for a dementia patient, but non-differential errors occurred, the effects might be directed toward the null. Therefore, the results of this study are considered to be justified.
The positive rate of PHQ-9-measured depressive symptoms was higher in the middle-aged family members of home-dwelling dementia patients (4.4%) than in the middle-aged family members in the control group (1.9%). A similar previous study using the KCHS data found that the prevalence of depression diagnosed by physicians who did not use a scale was higher in the family members of home-dwelling dementia patients (5.0%) compared to the control group (2.5%) [20]. In addition, a study using the data from the 2012 and 2013 National Health and Wellness Survey, an online survey, in Japan with a PHQ-9 cut-off score of 10 points found that the positive rate of depressive symptoms was higher in the family members of home-dwelling dementia patients (14.2%) compared to the non-caregivers in the control group (8.6%) [21]. It is not possible to make an absolute comparison between the aforementioned previous study and this study due to the differences in tools and study methods. Nevertheless, similarities were observed between the two studies in that the prevalence of depressive symptoms was higher in the family members of home-dwelling dementia patients, and the positive rate of depressive symptoms was also higher in the family members of home-dwelling dementia patients despite the differences in medical systems and culture between the countries.
The ORs for depressive symptoms in the female family members of home-dwelling dementia patients and the control family members show that the positive rate of depressive symptoms was 2.3 times higher after adjusting for demographic variables of monthly drinking, current smoking, and adjustment variables. Daughters-in-law (sons and their wives) often cared for home-dwelling dementia patients, which can be interpreted as similar to the results of a study reporting that females had a high prevalence of depressive disorders in caring for dementia patients [4,22].
The PHQ-9 reflects all the nine criteria for the diagnosis of major depression according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. An investigation into the characteristics of the severe depressive symptoms for each PHQ-9 question found that the positive rate on the questions, ‘Little or no interest or pleasure in doing things’, ‘Feeling tiered or having little energy’, and ‘Poor appetite or overeating,’ were higher in the family members of home-dwelling dementia patients. This is supported by the results of previous studies reporting that an increase in care-giving time is experienced as the most stressful among all the difficulties experienced by caregivers, and that the family caregivers of patients with dementia suffered from depression and loss of appetite [17,23].
The positive rate for the question, ‘Trouble falling or staying asleep, or sleeping too much’ was higher in the family members of home-dwelling dementia patients (8.3%), compared to the control group (3.6%). This result indicates that the family members of home-dwelling dementia patients tended to either lose sleep or oversleep. Sleep has commonly been reported as a risk factor for depression [24], and it is explained that dementia patients’ being awake at night is a common cause of sleep disorders in caregivers [9].
Question 8 in the PHQ-9 indicates psychomotor retardation, which is known to be biologically correlated with abnormalities in basal ganglia and dopaminergic pathways [25]. This is assessed that depression might be caused by caring for home-dwelling elderly with dementia, and biological abnormalities might not increase.
The positive rate for the question, ‘I would rather be better off dead or hurting myself’, which was related to suicide, was higher in the family members of home-dwelling dementia patients (1.5%) than in the control group (0.2%). A study by O’Dwyer et al. [10] reported that 16% of the family caregivers in the United States and Australia contemplated suicide more than once, and a fourth of those who contemplated suicide were likely to attempt suicide. The present findings are consistent with these results in that the prevalence of suicidal ideation was higher in the family members of home-dwelling dementia patients than in the control group.
Nevertheless, this study has several limitations. First, the presence or absence of home-dwelling dementia patients was based on only whether or not dementia patients diagnosed by a doctor were living at home, and the types and severity of dementia symptoms such as cognitive and mental behavior problems, and the degree of deterioration in physical function due to internal and surgical complications associated with dementia could not be identified. In addition, psychosocial factors such as dementia patients’ personality and their relationships with family members could not be considered.
Second, because there were no survey data regarding caring for home-dwelling dementia patients, such as what roles the middle-aged family members played as main caregivers, and whether or not any external caregiver visited the home and cared for the homed-welling dementia patient, it was not possible to identify the main caregivers. However, in view of the fact that the middle-aged family members, as the children generation of dementia patients, were living with dementia patients and caring for them, depression-related burden could be found in them.
Third, in order to enhance the comparison between the family members of home-dwelling dementia patients and the control group, adjustments were made for demographic variables, income level and economic activity variables, which are known as factors for burden in the family members of home-dwelling dementia patients, and monthly drinking and current smoking with p-value ≤ 0.25, found as the confounding variables in the univariate analysis. However, there were no survey data related to dementia patients, such as whether dementia patients were living in facilities, and whether caregivers were living at home, which are considered to be confounding variables. Therefore, adjustments could not be made for such variables, and they could not be compared.
Fourth, the 2017 KCHS is a cross-sectional study, and cannot clearly explain the causal relationship between depression and the presence or absence of home-dwelling dementia patients.
This study has representativeness as it used the data from the KCHS conducted in 254 areas across the country, and determined the positive rate of depressive symptoms in the middle-aged (40-59 years old) family members, who are the children of home-dwelling dementia patients. In particular, the results of this study confirmed that the positive rate of depressive symptoms was higher in the female family members of home-dwelling dementia patients, which is consistent with the results of previous studies.
Moreover, this study found that the response rate of severe depressive symptoms in most PHQ-9 questions was higher in the family members of home-dwelling dementia patients, indicating that the depressive symptoms in the family members of home-dwelling dementia patients were more serious compared to the control group. Therefore, preventive intervention approaches to the caregiver burden borne by the family members of home-dwelling dementia patients are needed in the future, and active interventions are needed to reduce depressive symptoms in the family members of home-dwelling dementia patients.

SUPPLEMENTARY MATERIALS

Supplementary materials are available at http://www.e-epih.org/.
epih-42-e2020031-suppl1.pdf
Korean version is available at http://www.e-epih.org/.
epih-42-e2020031-suppl2.pdf

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare for this study

NOTES

FUNDING
None.

NOTES

AUTHOR CONTRIBUTIONS
Data curation: JP, WCL, HWY. Formal analysis: JP, BB, NH. Funding acquisition: None. Methodology: JP, WCL, HJ, HWY. Project administration: JP, WCL, HJ, NH, BB, HWY. Visualization: JP, WCL, HJ, HWY. Writing – original draft: JP, HWY. Writing – review & editing: JP, WCL, HJ, NH, BB, HWY.

ACKNOWLEDGEMENTS

We are grateful to the Korea Centers for Disease Control and Prevention (KCDC) that conducted the Community Health Survey which is the primary source of our study.

Figure 1.
Flow chart of this study. PHQ-9, Patient Health Questionnaire-9.
epih-42-e2020031f1.jpg
Figure 2.
Proportion of severe answered Patient Health Questionnaire-9 item between family with dementia patients at home and control family. *p<0.05, ***p<0.001.
epih-42-e2020031f2.jpg
Table 1.
General characteristics of the subjects
Characteristics Family with dementia (n=760) Control family (n=76,516) p-value
Age, mean±SE (yr) 51.0±0.3 49.5±0.0 <0.001
40-49 260 (39.8) 36,442 (51.3) <0.001
50-59 500 (60.2) 40,074 (48.7)
Gender Men 371 (53.4) 34,892 (50.0) 0.176
Women 389 (46.6) 41,624 (50.0)
Household monthly income (10,000 Korean won) <100 94 (11.0) 3,538 (2.9) <0.001
100-299 300 (37.2) 21,558 (22.6)
≥300 356 (51.9) 50,646 (74.5)
Employment Yes 591 (74.7) 61,284 (79.5) 0.014
No 168 (25.3) 15,142 (20.5)
Education level ≤ Elementary 92 (6.1) 5,047 (3.9) <0.001
Middle/high school 440 (57.3) 42,838 (51.2)
≥ College 227 (36.6) 28,537 (44.8)
Household by generation 1 39 (3.9) 18,919 (17.4) <0.001
2 397 (50.9) 51,513 (75.2)
3 324 (45.2) 6,084 (7.4)
Location Urban 360 (72.7) 47,087 (83.0) <0.001
Rural 400 (27.3) 29,429 (17.0)
Current smoker Yes 176 (26.9) 16,096 (22.4) 0.027
No 584 (73.1) 60,418 (77.6)
Monthly alcohol drinking Yes 434 (58.0) 46,373 (63.7) 0.016
No 326 (42.0) 30,137 (36.3)
Vigorous or moderate physical activity Yes 545 (76.1) 57,393 (76.5) 0.837
No 212 (23.9) 19,096 (23.5)
Body mass index (kg/m2) < 25 507 (68.1) 53,169 (70.5) 0.256
≥25 244 (31.9) 22,546 (29.5)

Values are presented as number (%).

Table 2.
Depression question characteristics of the subjects
Variables Categories Family with dementia (n=760) Control family (n=76,516) p-value
PHQ-9 ≥10 35 (4.4) 1,431 (1.9) <0.001
<10 725 (95.6) 75,085 (98.1)
Experience of depressed mood1 Yes 90 (12.2) 4,084 (5.6)
No 669 (87.8) 72,418 (94.4) <0.001

Values are presented as number (%).

PHQ-9, Patient Health Questionnaire-9.

1 Experience of depressed mood were assessed by the following question: “In the last year, have you felt sadness or desperation for more than two weeks?”; Participants who answered “yes” were considered to have experience of depressed mood.

Table 3.
OR for PHQ-9 detected depressive symptom between family with dementia patients at home and control family
Depressive symptom1
Family with dementia, n (%) Control family, n (%) OR (95% CI) aOR (95% CI)
Total middle-aged family2 35 (4.4) 1,431 (1.9) 2.46 (1.56, 3.88) 1.72 (1.03, 2.85)
Male family3 13 (3.2) 491 (1.5) 2.18 (0.99, 4.82) 1.08 (0.43, 2.70)
Female family3 22 (5.9) 940 (2.2) 2.75 (1.61, 4.68) 2.26 (1.26, 4.05)

OR, odds ratio; PHQ-9, Patient Health Questionnaire-9; CI, confidence interval; aOR, adjusted odds ratio.

1 Depressive symptom was evaluated by PHQ-9; a cut-off score ≥10 is positive.

2 Adjusted for age, gender, household monthly income, employment, education, household by generation, town, current smoking, and monthly alcohol drinking.

3 Adjusted for age, household monthly income, employment, education, household by generation, town, current smoking, and monthly alcohol drinking.

Table 4.
Positive rate of Patient Health Questionnaire-9 (PHQ-9) each questions among middle-aged people between family with dementia patients at home and control family
Variables Family with dementia (n=760) Control family (n= 76,516) p-value1
Little interest or pleasure in doing things 28 (3.7) 1,445 (2.0) 0.009
Feeling down, depressed, or hopeless 23 (2.6) 727 (0.9) <0.001
Trouble falling or staying asleep, or sleeping too much 58 (8.3) 2,922 (3.6) <0.001
Feeling tired or having little energy 47 (7.2) 3,017 (4.0) 0.002
Poor appetite or overeating 18 (2.1) 805 (1.1) 0.015
Feeling bad about yourself or that you are a failure or have let yourself or you family down 12 (0.9) 380 (0.5) 0.064
Trouble concentrating on things, such as reading the newspaper or watching television 9 (1.2) 293 (0.4) 0.001
Moving or speaking so slowly that other people could have noticed; Or the opposite being so fidgety or restless that you have been moving around a lot of more than usual 3 (0.2) 167 (0.2) 0.905
Thoughts that you would be better off dead, or of hurting yourself 12 (1.5) 194 (0.2) <0.001

1 Chi-square test for PHQ-9 each question item.

REFERENCES

1. Alzheimer’s Association. 2018 Alzheimer’s disease facts and figures. Alzheimers Dement 2018;14:367-429.

2. National Institute of Dementia. 2017 National institute of dementia annual report. Seoul: National Institute of Dementia; 2017. (Korean).

3. Lim KC. Influencing factors on care burden among family caregivers for elders with dementia: focusing on family caregivers using a support center for dementia. J Korean Acad Soc Nurs Educ 2019;25:136-147 (Korean).
crossref pdf
4. Yoon B, Shim YS, Kim YD, Lee KO, Na SJ, Hong YJ, et al. Who takes care of patients with dementia in Korea: a study on the present state of patients with dementia living alone and primary caregivers. Dement Neurocogn Disord 2012;11:13-17 (Korean).
crossref
5. Park MH, Go YH, Jeong MR, Lee SJ, Kim SH, Kim J. Influencing factors and risk of caregiver burden of family caregivers for patient with dementia. Korean J Fam Welf 2017;22:431-448 (Korean).
crossref
6. Huang CY, Sousa VD, Perng SJ, Hwang MY, Tsai CC, Huang MH, et al. Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer’s disease. J Clin Nurs 2009;18:502-511. PMID: 19191999
crossref pmid
7. Lee HS. Caregiver burden in caring for elders before and after long-term care service in Korea. J Korean Acad Nurs 2012;42:236-247 (Korean). PMID: 22699173
crossref pmid
8. Lee SA, Kim HS. Effects of a dementia family education program for dementia recognition, burden, and depression in caregivers of elders with dementia. J Korean Acad Psychiatr Ment Health Nurs 2017;26:14-23 (Korean).
crossref pdf
9. Gehrman P, Gooneratne NS, Brewster GS, Richards KC, Karlawish J. Impact of Alzheimer disease patients’ sleep disturbances on their caregivers. Geriatr Nurs 2018;39:60-65.
crossref
10. O’Dwyer ST, Moyle W, Zimmer-Gembeck M, De Leo D. Suicidal ideation in family carers of people with dementia. Aging Ment Health 2016;20:222-230.
crossref
11. Lee HJ, Lee JW, Lee JY. Family caregiver’s burden for the elderly with dementia: moderating effects of social support. Soc Sci Res Rev 2015;26:345-367 (Korean).

12. Hong I, Han A, Reistetter TA, Simpson AN. The risk of stroke in spouses of people living with dementia in Korea. Int J Stroke 2017;12:851-857.
crossref
13. Kim YT, Choi BY, Lee KO, Kim H, Chun JH, Kim SY, et al. Overview of Korean Community Health Survey. J Korean Med Assoc 2012;55:74-83 (Korean).
crossref
14. Park SJ, Choi HR, Choi JH, Kim KW, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood 2010;6:119-124 (Korean).

15. Lee SY, Park HR, Choi SE, Lee SJ. Depression and depression relating variables for caregivers of patients with dementia in home. J Korean Acad Psychiatr Ment Health Nurs 2005;14:250-259 (Korean).

16. Kim SY, Yoon HS, Kim JS. Factors affecting life satisfaction and depression of caregivers of the elderly with dementia: a comparative study of Korean and American caregivers. J Korea Gerontol Soc 2003;23:193-221 (Korean).

17. Choi H, Yang YS, Kim HJ, Na HR, Shim YS, Park KW, et al. The survey for current state and dognition of activities of daily living in dementia patients- “Il-sang-ye-chan” campaign. Dement Neurocogn Disord 2013;12:47-51 (Korean).
crossref
18. Kim J, Ryu W, Choi Y. The effect of caregiver burden on depression of dementia family caregivers: the moderating role of perceived public support. Korean J Gerontol Soc Welf 2018;73:171-191 (Korean).
crossref
19. Korea Centers for Disease Control and Prevention. Korea health statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES VII-1). Sejong: Korea Centers for Disease Control and Prevention; 2016. p 106 (Korean).

20. Jang SI, Bae HC, Shin J, Jang SY, Hong S, Han KT, et al. Depression in the family of patients with dementia in Korea. Am J Alzheimers Dis Other Demen 2016;31:481-491.
crossref
21. Goren A, Montgomery W, Kahle-Wrobleski K, Nakamura T, Ueda K. Impact of caring for persons with Alzheimer’s disease or dementia on caregivers’ health outcomes: findings from a community based survey in Japan. BMC Geriatr 2016;16:122. PMID: 27287238
crossref pmid pmc
22. Lee AS, Kim HG. Care-givers’ attitude & determinants about the burden of the caring for senile dementia patients. Health Med Soc 2003;13:29-60 (Korean).

23. Alzheimer’s Disease International. World Alzheimer report 2009: the global prevalence of dementia. [cited 2020 May 15]. Available from: https://www.alz.co.uk/research/world-report-2009.

24. Beaudreau SA, Spira AP, Gray HL, Depp CA, Long J, Rothkopf M, et al. The relationship between objectively measured sleep disturbance and dementia family caregiver distress and burden. J Geriatr Psychiatry Neurol 2008;21:159-165.
crossref
25. Buyukdura JS, McClintock SM, Croarkin PE. Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Prog Neuropsychopharmacol Biol Psychiatry 2011;35:395-409.
crossref


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