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Study examines hospice use and depression symptoms in surviving spouses

The JAMA Network Journals

While most surviving spouses had more depression symptoms following the death of their partner regardless of hospice use, researchers found a modest reduction in depressive symptoms among some surviving spouses of hospice users compared with nonhospice users, according to an article published online by JAMA Internal Medicine.

The Institute of Medicine's report on improving the quality of care near the end of life highlights the need for supporting family caregivers. Core components of high-quality hospice care include counseling services for family members before and after the patient's death, according to study background.

Katherine A. Ornstein, Ph.D., M.P.H., of the Icahn School of Medicine at Mount Sinai, New York, and coauthors used data from a national sample to examine the effect of hospice use on depressive symptoms in surviving spouses, especially those spouses identified as primary caregivers. The authors linked data from the Health and Retirement Study to Medicare claims. Participants included 1,016 decedents and their surviving spouses. Depression scores reflecting symptom severity were measured up to two years after death.

Of the 1,016 decedents, 305 patients (30 percent) used hospice services for more than three days in the year before their deaths. Overall 51.9% of the 1016 spouses had more depressive symptoms over time. There were no significant differences across groups based on hospice use.

Study results show that 28.2 percent of spouses of hospice users had improved depression scores compared with 21.7 percent of spouses whose partners didn't use hospice, although the difference was not statistically significant. Among the 662 spouses who were primary caregivers, 27.3 percent of the spouses of hospice users had improved depression scores compared with 20.7 percent whose spouses didn't use hospice, although the difference was not statistically significant. After further adjustment based on patient and spousal characteristics, spouses of hospice users were significantly more likely than spouses of non-hospice users to have reduction in symptoms.

"Although overall depression scores increase following death in spouses regardless of hospice use, our work suggests that hospice use is associated with a modest reduction in depressive symptoms for a subgroup of surviving spouses. Because most of these spouses are themselves Medicare beneficiaries, caring for their well-being is not only important for individual health but may also be fiscally prudent. Although there has been significant attention to the current unsustainable level of spending on health care for seriously ill persons in the United States, these analyses do not even begin to factor in the downstream effects of caregiving for a seriously ill relative on spouses and other family members. Maximizing the use of hospice for appropriate patients is a high-value intervention that can benefit both the patients and their families. Attention to the quality of caregiver support and bereavement services within hospice will be necessary to increase its benefits for families," the study concludes.

(JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1722. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The authors made funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: The Antidepressant Effect of Hospice

In a related commentary, Holly G. Prigerson, Ph.D., and Kelly Trevino, Ph.D., of Cornell University and Weill Cornell Medical College, New York, write: "Is hospice the right prescription for reducing depressive symptom severity among widowed caregivers? Results from the study by Ornstein et al in this issue of JAMA Internal Medicine suggest that hospice care has a modest antidepressant effect among surviving spouses. ... Hospice care may offset the emotional costs of caregiving by creating an environment that is less depressing. ... Nevertheless, it is not surprising that hospice use was associated with only moderate improvement in bereavement-related depression in the study by Ornstein et al. As with prolonged grief disorder, major depressive disorder following the death of a spouse is likely to be rooted, perhaps deeply, in the surviving spouse's relationship to the decedent and in the intricacies and configuration of their life together," the commentary concludes.

(JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1726. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The authors made funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Media Advisory: To contact corresponding author Katherine A. Ornstein, Ph.D., M.P.H., call Renatt Brodsky at 646-605-5946 or email renatt.brodsky@mountsinai.org. To contact corresponding commentary author Holly G. Prigerson, Ph.D., call Ashley Paskalis at 646-317-7378 or email asp2011@med.cornell.edu.

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