The important role of sense of coherence in relation to depressive symptoms for Taiwanese family caregivers of cancer patients at the end of life

Objective: To determine whether the strength of personal coping capability, the sense of coherence (SOC), makes a unique contribution in explaining the extent of depressive symptoms experienced by family caregivers of terminally ill cancer patients. Methods: A total of 253 Taiwanese family caregivers of terminally ill cancer patients participated in this survey. Caregiver depressive symptoms were assessed using the CES-D. Potential correlates of depressive symptoms were categorized as: (1) characteristics of the caregivers; (2) demographics and disease-related characteristics of the patients; (3) objective caregiving loads; (4) confidence in end-of-life caregiving; (5) subjective caregiving burden; and (6) SOC. Results: Family caregivers scored high on the CES-D [mean (S.D.)=22.24 (11.36)]. Results from the R² change in the hierarchical multiple regression model indicated that the incremental variance explained by each block of variables for (1) the characteristics of family caregivers, (2) the characteristics of cancer patients, (3) objective caregiving loads, (4) confidence in caregiving, and (5) subjective caregiving burden was 20.5%, 6.8%, 1.5%, 3.7%, and 11.9%, respectively. In the final step of regression, SOC of caregivers increases the explained variation in depressive symptoms by 21.5%. Conclusions: This study confirms that, among the independent variables examined in this study, variations in SOC are comparatively important in explaining the variation of depressive symptoms experienced by Taiwanese family caregivers. Developments and evaluations of the effectiveness of clinical interventions aimed at augmenting caregivers' coping capability (such as SOC) to facilitate positive appraisal and finding meaning, to improve understanding of the demands and challenges of caregiving, and to mobilize resources available to manage caregiving tasks are highly recommended.