Is sertraline treatment or depression remission in depressed Alzheimer patients associated with improved caregiver well being? Depression in Alzheimer's Disease Study 2.

OBJECTIVE: We wanted to assess if sertraline treatment (versus placebo) or remission of depression at 12 weeks (versus nonremission) in Alzheimer patients is associated with improved caregiver well being. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial of the efficacy and safety of sertraline for the treatment of depression in individuals with Alzheimer disease in five clinical research sites across the United States. Participants were caregivers of patients enrolled in the Depression in Alzheimer's Disease Study 2 (N = 131). All caregivers received standardized psychosocial support throughout the study. Caregiver outcome measures included depression (Beck Depression Inventory), distress (Neuropsychiatric Inventory), burden (Zarit Burden Interview), and quality of life (Medical Outcomes Study Short Form Health Survey). RESULTS: Fifty-nine percent of caregivers were spouses, 63.4% were women, and 64.1% were white. Caregivers of patients in both treatment groups had significant reductions in distress scores over the 24-week study period, but there was not a greater benefit for caregivers of patients taking sertraline. However, caregivers of patients whose depression was in remission at week 12 had greater declines in distress scores over the 24 weeks than caregivers of patients whose depression did not remit by week 12. CONCLUSION: Patient treatment with sertraline was not associated with significantly greater reductions in caregiver distress than placebo treatment. Distress but not level of depression or burden lessened for all caregivers regardless of remission status and even more so for those who cared for patients whose depression remitted. Results imply an interrelationship between caregiver distress and patient psychiatric outcomes.

Confirmatory factor analysis of the Center for Epidemiologic Studies-Depression Scale in black and white dementia caregivers.

OBJECTIVES: In order to better understand if measurement problems underlie the inconsistent findings that exist regarding differences in depression levels between Black and White caregivers, this study examined the factor structure and invariance of the Center for Epidemiologic Studies-Depression (CES-D) Scale. METHOD: A confirmatory factor analysis of the 20-item CES-D was performed on a sample of 167 Black and 214 White family caregivers of older adults with dementia from Los Angeles County. RESULTS: The relationships between the 20 items and the four factors, as well as the relationships among each of the factors, were equivalent across both caregiver groups, indicating that the four-factor model fit the data for both the racial groups. CONCLUSION: These findings offer further evidence that the standard four-factor model is the best fitting model for the CES-D and is invariant across racial groups.

Confirmatory factor analysis of a brief version of the Zarit Burden Interview in Black and White dementia caregivers.

PURPOSE OF THE STUDY: Although the Zarit Burden Interview (ZBI) is one of the most extensively used measures in research for caregiver burden, few researchers have examined its factor structure. Furthermore, though the ZBI has also been used in cross-group comparisons of burden, there have not been studies of whether or not it measures burden equally across various groups. Therefore, this study considers the psychometric properties of a brief version of the ZBI with particular attention to its factor structure and metric equivalence across two racial groups. DESIGN AND METHODS: Distribution, reliability, and confirmatory factor analyses were performed with a 14-item three-factor ZBI factor model in a sample of 175 Black and 225 White caregivers of family members with dementia. RESULTS: The 14 ZBI items were reliable and fairly normally distributed for both groups. The three-factor model fits the data and was invariant across the Black and White caregivers for number of factors, factor loadings, and factor covariances. IMPLICATIONS: These findings contribute to the literature on the factor structure of the ZBI and provide new data on the invariance of the ZBI across two racial/ethnic groups of caregivers. This study provides support for the validity of findings that compare the burden scores of Black and White caregivers in studies utilizing the ZBI. The 14-item version also offers a more parsimonious way to measure burden in clinical settings, potentially increasing screening opportunities when caregiver contact time is limited.