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Activity patterns related to depression symptoms in stressed dementia caregivers

Published online by Cambridge University Press:  29 October 2019

Stephen F. Smagula ,
Brant P. Hasler ,
Richard Schulz ,
Jessica L. Graves ,
Charles F. Reynolds III ,
Howard J. Aizenstein ,
Daniel J. Buysse ,
Robert T. Krafty  and
Martica H. Hall
Stephen F. Smagula*
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Brant P. Hasler
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Richard Schulz
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Jessica L. Graves
Affiliation:
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Charles F. Reynolds III
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Howard J. Aizenstein
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Daniel J. Buysse
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
Robert T. Krafty
Affiliation:
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Martica H. Hall
Affiliation:
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
*
Correspondence should be addressed to: Stephen F. Smagula, Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh PA, 15213, USA. Email: smagulasf@upmc.edu.
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Abstract

Objectives:

Self-reported activity restriction is an established correlate of depression in dementia caregivers (dCGs). It is plausible that the daily distribution of objectively measured activity is also altered in dCGs with depression symptoms; if so, such activity characteristics could provide a passively measurable marker of depression or specific times to target preventive interventions. We therefore investigated how levels of activity throughout the day differed in dCGs with and without depression symptoms, then tested whether any such differences predicted changes in symptoms 6 months later.

Design, setting, participants, and measurements:

We examined 56 dCGs (mean age = 71, standard deviation (SD) = 6.7; 68% female) and used clustering to identify subgroups which had distinct depression symptom levels, leveraging baseline Center for Epidemiologic Studies of Depression Scale–Revised Edition and Patient Health Questionnaire-9 (PHQ-9) measures, as well as a PHQ-9 score from 6 months later. Using wrist activity (mean recording length = 12.9 days, minimum = 6 days), we calculated average hourly activity levels and then assessed when activity levels relate to depression symptoms and changes in symptoms 6 months later.

Results:

Clustering identified subgroups characterized by: (1) no/minimal symptoms (36%) and (2) depression symptoms (64%). After multiple comparison correction, the group of dCGs with depression symptoms was less active from 8 to 10 AM (Cohen’s d ≤ −0.9). These morning activity levels predicted the degree of symptom change on the PHQ-9 6 months later (per SD unit β = −0.8, 95% confidence interval: −1.6, −0.1, p = 0.03) independent of self-reported activity restriction and other key factors.

Conclusions:

These novel findings suggest that morning activity may protect dCGs from depression symptoms. Future studies should test whether helping dCGs get active in the morning influences the other features of depression in this population (i.e. insomnia, intrusive thoughts, and perceived activity restriction).

Keywords

Dementia caregivingdepression symptomssleepactivity restrictionphysical activity
Type
Original Research Article
Information
International Psychogeriatrics , Volume 35 , Special Issue 7: Issue Theme: Neurocognitive Disorders: Predictors, Mood, and Care , July 2023 , pp. 373 - 380
Copyright
© International Psychogeriatric Association 2019

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