Table 3.

Summary of the Evidence

Article	Purpose/sample size	Funding	Prevalence of Depression	Measure	Findings	Grade
Bradley et al. (2004)	To assess the impact of length of hospice enrollment on caregiver major depressive disorder N=174	Foundation and NIMH	25.9%	SCID	Baseline prevalence was 25.9% and follow-up was 11.5%. Caregivers of patients enrolled in hospice within 3 or fewer days of their death were more likely to be depressed follow-up than those who enrolled earlier.	11
Buck & McMillan (2008)	To identify the spiritual needs of the informal caregivers of cancer patients using a standardized instrument and explore the relationships among the patient’s global symptom distress, caregivers unmet spiritual needs, and depressive symptomatology in the caregiver N=110	Not reported	Not reported	CES-D	The caregivers’ depression score was related to unmet needs. As the number of unmet needs increased, so did the CES-D score.	11
Burton et al. (2008)	To assess the extent to which stressors, appraisals, social support, and well-being while caregiving predict well-being during bereavement N=50	University funded	Not reported	CES-D	Being non-White, having fewer months caregiving, and having lower levels of social resources were significant predictors of depression. Pre-loss depression was not very highly correlated with post- loss depression.	11
Chentsova- Dutton et al. (2000)	To examine emotional and physical adjustment and social and occupational functioning of hospice caregivers; also compares the effects of caregiving on spouses and adult children and male and female caregivers of hospice patients N=181	Foundation	Feeling lonely 19% Feeling blue 34% Sleep problems 22% Suicidal thoughts 14%	HPRSD BDI	Caregivers had significantly higher levels of depression than controls. Caregiver spouses were more depressed than adult children. Women had higher levels of depression than men.	10
Cherlin et al. (2007)	To assess the degree to which bereavement services are used by surviving family caregivers of hospice patients, identify the predictors of service use and potential barriers to the use of hospice bereavement services N=161	Foundation and NIMH	26.1 % at baseline	SCID	Among depressed caregivers at baseline, 19.6% did not use services when they became bereaved. Many caregivers with baseline depression believed that bereavement services would not be beneficial to them.	7
Fenix et al. (2006)	To examine the association between religiousness and depression among bereaved hospice caregivers N=175	Foundation, NIMH, and NCI	Not reported	SCID	Although pre-bereavement depression measured it was not reported- no findings reported were applicable to this review.	9 Quant 8 Qual
Haley, LaMonde, Han, Burton, & Schonwetter (2003)	To examine the applicability of a stress process model for spousal caregivers of the terminally ill N=80	University	Mean CES-D score = 17.73a	CES-D	Wives and those with behavioral problems, poor health, and/or negative social interactions had higher depression levels.	12
Haley, LaMonde, Han, Narramore, & Schonwetter (2001)	1) To assess the impact of caregiving stress on psychological and health functioning in spousal caregivers 2) To compare the caregiving stressors faced by spousal caregivers of patients with lung cancer versus dementia 3) To assess whether psychological and physical health functioning differs in spousal caregivers of hospice patients with dementia versus lung cancer N=120	University	50% for both dementia and lung cancer caregivers; 57% of wives and 29% of husbands	CES-D	Hospice family caregivers are at high risk for both psychological and physical health disorders; caregiver depression and health problems should be systematically assessed and treated by the hospice team.	12
Kilbourn et al. (2011)	To examine the feasibility of the Caregiver Life Line intervention for caregivers of home-based hospice patients to inform the design of a future randomized clinical trial (RCT) N=19	Foundation	Mean baseline CES-D = 15.3a	CES-D	Depression scores decreased with intervention; intervention was feasible.	9
Kris et al. (2006)	To examine the association between patient length of hospice enrollment and major depressive disorder among the surviving primary family caregivers 13 months after the patient’s death. N=175	Foundation, NIMH, NCI	28% at baseline	SCID	Baseline depression did not differ significantly based on hospice lengths of enrollment. The effect of very short hospice length of enrollment was significantly associated with elevated risk of caregiver depression 13 months post- loss.	9
Ladner & Cuellar (2003)	To determine if hospice caregivers in rural settings were depressed and, if so, if they accessed treatments N=30	Not reported	40%	CES-D	40% of caregivers were depressed, yet only 17% were being treated for depression. Married caregivers were more depressed than single caregivers. Male caregivers were more depressed than female caregivers.	0
McMillan, Small, & Haley (2011)	To determine the efficacy of providing systematic feedback from standardized assessment tools for hospice patients and caregivers N=709	NINR	Not reported	CES-D	Providing team with feedback from instruments did not result in any significant differences in caregiver-related depression, support, and spiritual needs.	17
Mickey, Pargament, Brant, & Hipp (1998)	1) To describe both religious and nonreligious appraisals of hospice caregiving 2) To explore the relationship between these appraisals with situational, mental health, and spiritual health outcomes N=92	University	Not reported	CES-D	Religious appraisals did not have a significant effect on caregiver depression.	8
Prigerson et al. (2003)	1) To use the SCARED scale to examine the frequency of specific caregiver exposures involving patient distress and the fear and helplessness they evoke, and 2) To examine the extent to which these experiences are associated with depression and quality-of-life impairments N=76	Not reported	30.3%	SCID	The SCARED scale total and event frequency scores were significantly associated with increased odds of depression and increased impairment in several quality of life domains.	7
Rivera & McMillan (2010)	To examine caregiver and patient factors as predictors of depression symptoms and level of depression symptoms in caregivers of hospice cancer patients N=578	Not reported	37.5% had a score predictive of depression	CES-D	Wives who were caregivers were more depressed than husbands who were caregivers. Better health was associated with lower depression and high life satisfaction. Caregivers who reported that self-care and behavioral problems in the patient were subjectively upsetting had higher depression.	10
Walsh & Schmidt (2003)	1) To evaluate recruitment and intervention protocols for the Tele-Care II intervention 2) To test the feasibility of a pre-post test assessment package 3) To measure the results of the intervention N=6	University	Not reported	CES-D	Caregiver depression scores decreased after the intervention.	8