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Puneet Singh Braich, Matthew Jackson, David RP Almeida, Vikram Brar; Burden and Depression among Caregivers of Blind Patients: A Meta-analysis & Systematic Review. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):507.
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Burden and depression among caregivers of patients with debilitating neurologic conditions (e.g. dementia and stroke) has been studied for several decades. However, studies examining this relationship pertaining to blind patients have only emerged recently. Our aim was to perform a meta-analysis and review of the literature describing the degree of burden and the prevalence of depression among caregivers of legally blind patients.
We performed a systematic literature search of Medline, Embase, and PsycINFO databases. We identified 6 studies, totaling 1432 caregivers of patients with visual acuities from 20/200 OU to no light perception (NLP) OU. All studies were cross-sectional questionnaires. The scales used to measure burden were the Burden Index of Caregivers (BIC), the Zarit burden scale, the short form 8 (SF-8) and disability adjusted life years (DALYs). The Center for Epidemiologic Studies Depression (CES-D) scale determine those at risk for depression. Study results were statistically combined in a meta-analysis to generate an overall pooled summary statistic with a 95% confidence interval.
The proportion of caregivers at risk for depression increased with degree of visual impairment from 13% in the 20/200 group to 49% in the NLP group (P<0.01). This proportion decreased when accounting for lower socioeconomic status: 8% in 20/200 group to 28% NLP group (P<0.01). Factors associated with caregiver depression included being the male spouse of a blind patient (OR 3.45, 95% CI 2.43-5.82) or being the male child of a blind patient (OR 6.82, 95% CI 3.87-9.52). Lower DALYs but higher BIC & SF-8 scores were strongly correlated with daily hours spent on care (OR 5.26, 95% CI 2.86-8.54) and caregivers with ≥ 3 comorbidities (OR 2.56, 95% CI 1.87-3.67).
Caregivers of patients with the worst vision were at the highest risk of being depressed. This risk was compounded when socioeconomic status is unfavorable. Male spouses or children of blind patients were at higher risk for depression. Burden was highest amongst caregivers with multiple comorbidities and those providing care for several hours per day. Awareness of which caregivers are at highest risk of depression is required to implement effective interventions.
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