Uncovering an invisible network of direct caregivers at the end of life: a population study.

BACKGROUND: Most palliative care research about caregivers relies on reports from spouses or adult children. Some recent clinical reports have noted the assistance provided by other family members and friends. AIM: This population study aims to define the people who actually provide care at the end of life. SETTING/PARTICIPANTS: A South Australian study conducted an annual randomized health population survey (n=23,706) over a 7 year period. A sample was obtained of self-identifying people who had someone close to them die and 'expected' death in the last 5 years (n=7915). Data were standardised to population norms for gender, 10-year age group, socioeconomic status, and region of residence. RESULTS: People of all ages indicated they provided 'hands on' care at the end of life. Extended family members (not first degree relatives) and friends accounted for more than half (n=1133/2028; 55.9%) of identified hands-on caregivers. These people came from the entire age range of the adult community. The period of time for which care was provided was shorter for this group of caregivers. People with extended family or friends providing care, were much more likely to be supported to die at home compared to having a spousal carer. CONCLUSION: This substantial network of caregivers who are mainly invisible to the health team provide the majority of care. Hospice and palliative care services need to create specific ways of identifying and engaging this cohort in order to ensure they are receiving adequate support in the role. Relying on 'next-of-kin' status in research will not identify them.

Relationships between body mass index, mental health, and suicidal ideation: population perspective using two methods.

OBJECTIVE: The aim of the present study was to examine the relationship between body mass index (BMI), mental health, and suicidal ideation in a general population. METHOD: Two random and representative samples were drawn from the South Australian population. The interview techniques differed, as did the measures of depression and suicidality. One involved 3034 people in face-to-face interviews, and the other involved 30 214 persons providing information via a computer-assisted telephone interviewing (CATI) system. BMI was classified according to World Health Organization criteria. In face-to-face interviews, major depression was defined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) and suicidal ideation by direct enquiry. In the CATI data, psychological distress was assessed on the Kessler 10 instrument and suicidal ideation by four items on the General Health Questionnaire (GHQ). Data analysis controlled for demographic and physical health variables. RESULTS: In the face-to-face interviews, the combined obese and morbidly obese men were significantly less likely to have major depression or suicidal ideation than those of a healthy weight. For the telephone interview-derived data, the only significant finding was for overweight women to report less psychological distress than those of a healthy weight. CONCLUSIONS: It is no longer tenable to assume that increased BMI is necessarily associated with major depression, psychological distress, or suicidal ideation. Indeed, it appears protective for some people.