Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment

Objective: This study investigated depressive symptomatology in lung cancer patients and their identified caregiver. Methods: We conducted semi-structured interviews and administered measures of family environment, depressive symptomatology, and the extent to which the caregiver blamed the cancer on the patient not having taken better care of him/herself to 190 patient-caregiver dyads. Multivariate two-level models were used to estimate the unique effects for each dyad member and cross-partner effects while controlling for interdependencies in the data. Results: More than half the patients (55%) were male, whereas 74% of caregivers were female. The majority (57.4%) were spouses, followed by offspring, and other family or friends. The baseline model with covariates showed that younger caregivers, spouse caregivers, and caregivers who blamed the patient for the cancer had higher depressive symptom scores. When examining the unique effect for each dyad member, with the exception of patient report of familial conflict, patient and caregiver reports of lower familial cohesion and expressiveness and higher conflict were associated with higher depression scores for patient and caregiver, respectively. When examining cross-partner effects, patient reports of lower cohesion, lower expressiveness, and greater conflict were associated with higher caregiver depression scores. Offspring caregivers reported less depression than non-offspring caregivers. Conclusion: The family environment and blaming the patient during times of illness can affect both patient and caregiver depression. Findings suggest that quality of the family dynamic is important for patients, but may be particularly influential for caregivers. Future research should aid clinicians' assessment of family environment when making treatment plans.