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Depression and complicated grief in bereaved caregivers in cardiovascular diseases: prevalence and determinants
  1. Keitaro Shinada1,
  2. Takashi Kohno1,2,
  3. Keiichi Fukuda1,
  4. Michiaki Higashitani3,
  5. Naoto Kawamatsu4,
  6. Takeshi Kitai5,6,
  7. Tatsuhiro Shibata7,
  8. Makoto Takei8,
  9. Kotaro Nochioka9,
  10. Gaku Nakazawa10,11,
  11. Hiroki Shiomi12,
  12. Mitsunori Miyashita13 and
  13. Atsushi Mizuno14,15
  1. 1Division of Cardiology, School of Medicine, Keio University, Tokyo, Japan
  2. 2Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
  3. 3Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
  4. 4Department of Cardiology, Mito Saiseikai General Hospital, Ibaraki, Japan
  5. 5Departments of Cardiovascular Medicine and Clinical Research Support, Kobe City Medical Center General Hospital, Hyogo, Japan
  6. 6Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  7. 7Division of Cardiovascular Medicine, Department Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
  8. 8Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
  9. 9Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
  10. 10Department of Cardiology, School of Medicine, Tokai University, Kanagawa, Japan
  11. 11Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
  12. 12Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
  13. 13Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
  14. 14Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  15. 15Department of Cardiovascular Medicine, St Luke's International University, Chuo-ku, Japan
  1. Correspondence to Dr Takashi Kohno, Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, 6-20-2, Shinkawa, Mitaka Tokyo 181-8611, Japan; kohno-ta{at}ks.kyorin-u.ac.jp

Abstract

Objectives Despite the recommendation that patients with cardiovascular disease (CVD) receive bereavement care, few studies have examined the psychological disturbances in bereaved caregivers. We examined the prevalence and determinants of depression and complicated grief among bereaved caregivers of patients with CVD.

Methods We conducted a cross-sectional survey using a self-administered questionnaire for bereaved caregivers of patients with CVD who had died in the cardiology departments of nine Japanese tertiary care centres. We assessed caregiver depression and grief using the Patient Health Questionnaire-9 (PHQ-9) and Brief Grief Questionnaire (BGQ), respectively. The questionnaire also covered caregivers’ perspectives toward end-of-life care and the quality of the deceased patient’s death.

Results A total of 269 bereaved caregivers (mean age: 66 (57–73) years; 37.5% male) of patients with CVD were enrolled. Overall, 13.4% of the bereaved caregivers had depression (PHQ-9 ≥10) and 14.1% had complicated grief (BGQ ≥8). Depression and complicated grief’s determinants were similar (ie, spousal relationship, unpreparedness for the death, financial and decision-making burden and poor communication among medical staff). Patients and caregivers’ positive attitudes toward life-prolonging treatment were associated with complicated grief. Notably, in caregivers with complicated grief, there was less discussion with physicians about end-of-life care. Caregivers who felt that the patients did not receive sufficient treatment suffered more frequently from depression and complicated grief.

Conclusions Approximately 15% of bereaved caregivers of patients with CVD suffered from depression and complicated grief. Cardiologists should pay particular attention to caregivers with high-risk factors to identify those likely to develop depression or complicated grief.

  • depression
  • terminal care
  • bereavement
  • end of life care
  • family management
  • heart failure

Data availability statement

Data are available upon reasonable request. Data that support the findings of this study are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data that support the findings of this study are available from the corresponding author upon reasonable request.

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Footnotes

  • Twitter @dragonsbt

  • Contributors TKo contributed to the conceptualisation, data curation, formal analysis, investigation, methodology, supervision, validation writing (review and editing) and guarantor. KS contributed to formal analysis and writing (original draft). KF contributed to supervision. NK, TKi, TS, MT, KN, GN and HS contributed to data curation. MM contributed to conceptualisation, investigation, methodology and supervision. AM contributed to conceptualisation, data curation, investigation, methodology, resources, supervision and validation. TKo is responsible for the overall content as guarantor.

  • Funding This research was supported by the ‘Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus’ from the Japan Agency for Medical Research and Development (AMED, 18ek0210072h0003) and Grant-in-Aid for Scientific Research (JPSS KAKENHI, 17K09526, 20K08408).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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