PDF(Pubmed)
Abstract：
The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers\' wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82-0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness-in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.
摘要：
全球老龄化趋势是以与年龄相关的疾病发作加剧为代价的。痴呆是一种常见的多因素与年龄相关的神经退行性疾病，表现为认知功能和进行日常生活活动的能力逐渐下降。随着政策不鼓励机构化护理，家庭成员作为主要的照顾者，忍受更多的易受身体和心理健康问题的影响，其次是与生活常规和人际关系的护理相关变化。通过有效的简短措施在早期阶段针对临床上重大的痛苦可能会促进护理人员的健康和痴呆症护理的连续性/质量。这项研究旨在确定571名欧洲护理人员的便利样本中抑郁焦虑压力量表8项（DASS-8）的最佳截止分数（平均年龄=53±12岁，意大利语=74.4%，瑞士=25.6%）通过三种方法。K均值聚类根据DASS-8得分为19分，将样本分为高和低痛苦聚类。使用Zarit负担访谈（ZBI）和加利福尼亚大学三项研究的48和7个截止点进行的受试者操作员曲线（ROC）分析，洛杉矶,孤独量表-版本3（UCLALS3），显示了两个DASS-8截止值（12.5和14.5，曲线下面积（AUC）=0.85和0.92，p值<.001，95％CI0.82-0.88和0.89至0.94，敏感性=0.81和0.78，特异性=0.76和0.89，Youden指数分别=0.57和0.67）。决策模型产生了两个DASS-8截止值（9.5和14.5），用于预测低和高的护理负担和孤独感，分别。根据所有DASS-8截止值的中位数（14.5），精神困扰的患病率为50.8％。困扰与关键的精神问题相关，如倦怠和孤独路径分析，DASS-8分数由ZBI预测，UCLALS3，护理依赖，并接受护理帮助，尤其是老年人，女性,和配偶照顾者。应进行进一步的诊断检查，以确认DASS-8评分高于14.5的护理人员的心理致病性。在其他国家/人群中对DASS-8的调查可以证实该截止分数的有效性。
