• Increased risk of depression and complicated grief during bereavement was significantly associated with pre-loss measurements of low preparedness and presence of anticipatory grief in family caregivers of terminally ill patients.

• Highest prevalence of depression was found in older female spouses and highest prevalence of complicated grief was found in older spouses. These findings are consistent with previous studies, although we hypothesized a higher prevalence of complicated grief in female caregivers.

• Health professional should be aware of pre-loss levels of preparedness and anticipatory grief among family caregivers as these constitute potential risk factors for depression and complicated grief post-loss, especially in spouses.

Do anticipatory grief and preparedness affect distress in bereaved caregivers?

Nielsen M.K.1,2,, Guldin M.-B.1,3, Neergaard M.A.3, Jensen A.B.2, Bro F.1

1Research Unit for General Practice, Aarhus University, 2Department of Oncology, Aarhus University Hospital, 3The Palliative Team, Department of Oncology, Aarhus University Hospital

Family caregivers: • Previous studies have found increased risk of

depression and complicated grief during bereavement among caregivers.

• Low preparedness for impending death and anticipatory grief seem to be risk factors for depression and complicated grief.

• Large-scale studies of family caregivers are scarce.

Aim: • To study the association of two possible risk factors,

pre-loss preparedness and anticipatory grief, with depression and complicated grief

Background

• Response rates were 38% for Q1 and 87% for Q2.• Prevalence of depression was 19% and highest in

older female spouses. Prevalence of complicated grief was 6% and highest in older spouses. (Table 1)

Association with depression post-loss:• Risk of depression post-loss increased if caregiver

had a low preparedness score (RR=1.6) or experienced anticipatory grief pre-loss (RR=3.2). (Table 1)

Association with complicated grief:• Risk of complicated grief increased if caregiver

had a low preparedness score (RR=2.3) or experienced anticipatory grief pre-loss (RR=6.0). (Table 1)

Results

• Terminally ill patients eligible for drug reimbursement* in 2012 received a request to pass on a questionnaire to closest

caregiver (Q1). • Responding caregivers of patients who died within six

months received a follow-up questionnaire six months post-

loss (Q2).• Inclusion and exclusion criteria are displayed in Figure

1.• Presented results are based on data ready for analysis

from 1,093 caregivers who completed both Q1 and Q2.

Method

Conclusion

Scales Groups Associations

Measure-ment

Preva-lence

Highest sumscore* found

in:

With depressio

n#

With complicated grief#

Low prepared-ness

Single ItemPreparedness Question

13% Spouses RR = 1.6 RD = 11%

RR = 2.3RD = 7%

Anticipa-tory grief

Pre-PG-13 12% SpousesAge>70

RR = 3.2 RD = 33%

RR = 6.0 RD = 18%

Depres-sion

BDI>20 19% SpousesAge>70Females

- -

Compli-cated grief

PG-13 6% SpousesAge>70 - -

Letters to terminally ill patients:

9,512

Non-respondents:4,468 (47%)

Q1 from caregivers: 3,636 (38%)

Patients still alive: 1,032 (28%)

Caregiver refused: 152 (4%)Caregiver died + other: 32 (1%) Non-respondents: 266 (8%)

Q2 from bereaved caregivers:2,108 (87%)

Pt. refused: 379 (4%) Pt. died:

284 (3%) No close relative: 117 (1%) Other reasons: 208 (2%)

Caregiver refused to participate:

420 (4%)

Figure 1: Flow chart of respondees and non-respondees

Table 1: Measurements, prevalence and results

*Reported by doctor to the Danish Health and Medicines Authority

*p-value<0.05 using Wilcoxon-Mann-Whitney ranksum-test#p-value<0.05 using Chi-2 test

For further information, please contact: Mette.nielsen@alm.au.dk