Abstract: Dyadic Analysis of Depressive Symptoms in Black Breast Cancer Patients and Informal Caregivers (Society for Social Work and Research 29th Annual Conference)

Schedule:

Thursday, January 16, 2025

University, Level 4 (Sheraton Grand Seattle)

* noted as presenting author

Tess Thompson, PhD, Assistant Professor, University of North Carolina at Chapel Hill, NC

Thomas Rodebaugh, PhD, Professor, University of North Carolina at Chapel Hill, NC

Polly Haun, MPH, Graduate Student, Washington University in Saint Louis, MO

Karin Han, MPH, Program Specialist, National Institutes of Health, MD

Naitra Ramchander, Student, Washington University in Saint Louis, MO

Krutika Chauhan, MPH, Data Coordinator, Washington University in Saint Louis, MO

Jada Meads, Student, Washington University in Saint Louis, MO

Katherine Glover-Collins, MD, Professor, Washington University in Saint Louis, MO

Julie Margenthaler, MD, Professor, Washington University in Saint Louis, MO

Graham Colditz, MD, DrPH, Professor, Washington University in Saint Louis, MO

Background and Purpose: Informal caregivers—including partners, family members, and friends—often provide breast cancer patients with tangible, emotional, decision-making, and/or social support. Prior work in (predominantly white, predominantly spousal) samples has suggested emotional distress may be interdependent in patient-caregiver dyads, but less is known about whether there are patterns of mutual influence among Black cancer patients and caregivers. We sought to determine whether Black women with breast cancer and their informal caregivers demonstrated interdependence in depressive symptoms over time.

Methods: Data were collected from breast cancer patients and informal caregivers (the patient’s “main support person”) January 2021– July 2023. Patients and caregivers each completed separate telephone surveys at baseline (within 8 weeks of the patient’s initial cancer visit), 2 months after baseline, and 4 months after baseline. Depressive symptoms were assessed using the Center for Epidemiology Studies Depression scale (CES-D). We used Actor Partner Interdependence Models (a random-intercept cross panel model with an estimator robust to nonnormality [MLR in Mplus], and a joint latent trajectory model) to analyze interdependence of depressive symptoms in patients and caregivers. We hypothesized that there would be interdependence between patient and caregiver depressive symptoms over time (i.e., that one person’s score at one time point would predict the other person’s score at the next time point).

Results: Two hundred seven participants provided CES-D scores at baseline (99 complete and 9 partial dyads; 106 patients and 101 caregivers). All patients identified as Black/African American, as did 93% of caregivers. All patients self-described as female, as did 70% of caregivers. Sixty-five percent of patients and caregivers reported they did not live together. The most common relationship of caregiver to patient was female family member. Average patient age at enrollment was 58.5 (SD = 10.9); average caregiver age was 49.9 (SD = 14.2). Mean baseline patient CES-D score was 15.0 (SD = 10.9; Cronbach’s alpha = .891) and mean caregiver score was 11.9 (SD = 9.0; Cronbach’s alpha = .869); 56% of dyads had at least one member exceed the screening cutoff for the CES-D (score ≥ 16). Actor-Partner Interdependence Models did not demonstrate interdependence of depressive symptoms between patients and caregivers cross-sectionally or prospectively. There was a significant linear trend, with both patients and caregivers decreasing in depressive symptoms over time.

Conclusions and Implications: Depressive symptoms were elevated in many patients and caregivers around the time of the patient’s diagnosis. In half of all patient-caregiver dyads, at least one member reported elevated depressive symptoms at baseline, but our hypothesis that depressive symptoms would be interdependent within dyads was not supported. This may be because most pairs did not live together and were not spouses or partners. It is also possible that emotional interdependence unfolds over a smaller timescale (over hours, days, or weeks, as opposed to months). Future collaborative research in this area may strengthen social impact by investigating different time intervals, examining additional outcomes (e.g., anxiety), and determining the best strategies for helping patients and caregivers, either as dyads or as individuals.