Relationship between social support and mental health status

Relationship between social support and mental health status among caregivers of AD and MCI Huali Wang, MD, Ph. D Dementia Care & Research Center Peking University Institute of Mental Health Board of Directors International Psychogeriatric Association (IPA) Vice President Alzheimer’s Disease Chinese (ADC)

Conflict of Interest Disclosure Huali Wang, MD, Ph. D Has no real or apparent conflicts of interest to report. Research funding from National Institute on Aging and the Fogarty International Center (R 21 AG 028180 -01 A 2), and Alzheimer’s Association (NIRG-04 -1184). The case registry of cognitive impairment was supported by Natural Science Foundation of China (30500178, 30971044) and Ministry of Science and Technology (2007 AA 02 Z 421).

BACKGROUND • It is estimated that there were around 5 million people of AD in China. • Family members are still the major source of caregiving in China. Dementia caregiving may have great effect on the mental health status of family caregivers. • Social support and social network may play an important role in mediating the outcome of caregiving. Zhang ZX, et al. Arch Neurol, 2005, 62: 447 -453 Wang H, et al. Ageing International, 2010, 35: 72 -84.

OBJECTIVE • To explore the relationship between mental health status, effects of caregiving and social support among caregivers of AD and MCI in China.

RESEARCH PARTICIPANTS • A sample was drawn from memory clinics in Beijing and Wuhan, China. • 48 caregivers – 24 MCI informants/caregivers – 24 caregivers for people with mild/moderate dementia.

METHODS • A mixed-method approach – quantitative questionnaire • mental health status: SAS, SDS • effects of caregiving: CBS • social support: SSS – qualitative semi-structured interviews to explore their views on potential social stigma.

RESULTS AD (n=24) MCI (n=24) 68. 2± 9. 0 70. 3± 10. 1 13/11 12/12 Married (N) 23 23 Retirement (N) 20 20 Spouse (N) 19 19 Education (high school or above) 21 20 SDS 32. 0± 9. 9 33. 8± 8. 2 SAS 28. 6± 7. 5 29. 2± 5. 3 CBS 24. 8± 7. 5 23. 7± 7. 3 SSS 57. 8± 9. 7 58. 5± 9. 9 Age (years) Gender (M/F)

Comparisons between sites Beijing (n=24) Wuhan (n=24) 17/7 7/17* 69. 5± 9. 2 69. 0± 10. 1 14/10 11/13 Married (N) 23 23 Retirement (N) 18 22 Spouse (N) 20 18 Education (high school or above) 23 18 SDS 28. 8± 6. 5 35. 8± 9. 5* SAS 27. 8± 6. 3 30. 0± 6. 5 CBS 25. 5± 7. 6 23. 0± 7. 0 SSS 55. 3± 9. 3 61. 3± 9. 5 Diagnosis (AD/MCI, N) Age (years) Gender (M/F)

Relationship of caregiving effects and social support with mental health status AD CBS MCI SSS CBS SSS SDS 0. 43 -0. 10 0. 09 -0. 27 SAS 0. 53** -0. 04 0. 27 -0. 26

Relationship of caregiving effects and social support with mental health status Beijing site AD (n=17) CBS SSS MCI (n=7) CBS SSS SDS 0. 62* -0. 51 0. 53 -0. 62 SAS 0. 50* -0. 13 0. 63 -0. 31

Relationship of caregiving effects and social support with mental health status Wuhan site AD (n=7) CBS SSS MCI (n=17) CBS SSS SDS 0. 91** 0. 08 -0. 10 -0. 41 SAS 0. 82* 0. 02 0. 06 -0. 40

DISCUSSION • Mental health status of caregivers – AD vs MCI: similar, mostly within normal range – Beijing vs Wuhan: slightly better in Beijing, partly due to • accessibility of dementia care service • knowledge of cognitive impairment • perception of cognitive impairment Xue HB, et al. J Clin Psychol Med 2006; 16(1): 11 -13 Fu Y, et al. Chinese Mental Health Journal 2007 Dai BZ, et al. submitted

• Relationship between CBS and mental health status – Significant in AD group, independent of sites – Higher perceived burden of caregiving, poorer of emotional feelings, though within normal range • A trend, though not significant, that better social support was associated with better emotional feelings. – Ceiling effects of emotional feelings – Sample size concerns

CONCLUSION • There was geographic variation in mental health status of caregivers for people with cognitive impairment. • Perceived caregiver burden may impact the emotional feelings of caregivers for people with AD. • The findings suggest that raising awareness and disseminating knowledge of cognitive impairment and dementia is important in improving mental health status of caregivers.

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