Group-based trajectory analysis is an innovative statistical method to identify distinct populations over time. We used this approach to characterize patterns of change in distress using shortened scales (depressive symptoms (CESD), anxiety (POMS), and caregiver burden (CRA)) in caregivers (CG) of persons with primary malignant brain tumors. In an ongoing longitudinal study, 98 CGs were interviewed within a month of their care recipients diagnosis and at 4, 8, and 12- months afterwards. We used SAS Proc Traj to select models based on clinical criteria and statistical judgment. We identified 2 trajectories for depressive symptoms, 2 for anxiety, and 3 for caregiver burden. An estimated 61.2% of CGs had low CESD (range: 0-30) scores at baseline (mean (M)=5.3, standard deviation (SD) = 3.6) and remained low (M=2.7, SD=2.8) at 12-months (p=0.06 for trajectory slope); the remaining CGs (38.8%) had high scores at baseline (M=14.4, SD=5.3) that significantly decreased by 12-months (M=9.1, SD=4.6; p=0.01). An estimated 20.4% of CGs had low POMS (range: 3-18) scores at baseline (M=6.0, SD=2.2) that decreased significantly (M=4.0, SD=1.1) at 12-months (p=0.002); the remaining CGs (79.6%) had high scores at baseline (M=10.2, SD=2.1) that decreased significantly by 12-months (M=7.8, SD=1.5; p=0.001). An estimated 20.4% of CGs had low CRA (range: 5-25) scores at baseline (M=10.5, SD=2.7) that decreased significantly (M=6.4, SD=1.3) at 12-months (p<0.001); the moderate trajectory included 26.5% of CGs with consistent scores at baseline (M=14.2, SD=2.0) and 12 months (M=11.0, SD=1.4; p=0.51); the majority of CGs (53.1%) had consistently high scores at baseline (M=19.7, SD=2.1) and (M=20.0, SD=2.4) at 12 months (p=0.85). Logistic and multinomial regression results revealed that CGs with low emotional stability were more likely to belong to the high depressive symptoms (p=0.007) and anxiety (p=0.002) trajectory groups. CGs were more likely to belong to the moderate to high caregiver burden trajectory group if their care recipients had more aggressive tumor types (p=0.004) or lower constructional ability (p=0.05). The public health significance of this work is that trajectory analysis provides a way to identify CGs at risk of increasing psychological distress so that suitable interventions can be developed and targeted.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12042009-010411 |
| Date | 28 January 2010 |
| Creators | Kuo, Chien-Wen Jean |
| Contributors | Dianxu Ren, Paula Sherwood, Roslyn Stone, Kevin Kim |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12042009-010411/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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