The impact of decreased environmental reward in predicting depression severity in caregivers

  • Fernando Lino Vázquez González Universidad de Santiago de Compostela
  • Lara López Universidad de Santiago de Compostela
  • Vanessa Blanco Universidad de Santiago de Compostela
  • Patricia Otero Universidad de A Coruña
  • Ángela J. Torres Universidad de Santiago de Compostela
  • María José Ferraces Universidad de Santiago de Compostela
Keywords: environmental reward, subclinical depression, major depression, non-professional caregivers


Reward has not been examined as a predictor of depression in the caregiver population despite the high prevalence of depression. The aim of this study was to analyze reward as a predictor of the level of depression (without depression, subclinical depression, major depressive episode) in caregivers. Independent evaluators evaluated the socio-demographic variables of the caregiver, the person receiving care, the situation of care, reward and depressive symptomatology through self-reports. Expert clinicians evaluated the prevalence of major depressive episodes using the SCID-5-CV in 592 caregivers (87.2% women, average age = 55.4 years). The average reward score was 28.1. Reward was lower in caregivers younger than 55 years old who belonged to a low/low-middle social class. Reward was higher in caregivers without depression than in those with subclinical depression and a major depressive episode. Reward was also higher in caregivers with subclinical depression versus those with a major depressive episode. Caregivers with higher reward had a lower probability of subclinical depression (adjusted OR = 0.78, 95% CI 0.75-0.83) and a major depressive episode (adjusted OR = 0.67, 95% CI 0.62-0.72). Reward was a protective factor against subclinical depression and a major depressive episode in caregivers.


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Author Biographies

Fernando Lino Vázquez González, Universidad de Santiago de Compostela

Prof Titular del Área de Personalidad, Evaluación y Tratamiento Psicológico del Dep. Psicología Clínica y Psicobiología

Lara López, Universidad de Santiago de Compostela

Department of Clinical Psychiatry and Psychobiology, Universidad de Santiago de Compostela

Vanessa Blanco, Universidad de Santiago de Compostela

Department of Evolutionary and Educational Psychology, Universidad de Santiago de Compostela

Patricia Otero, Universidad de A Coruña

Department of Psychology, Universidad de A Coruña

Ángela J. Torres, Universidad de Santiago de Compostela

Department of Psychiatry, Radiology, Public Health, Nursing, and Medicine, Universidad de Santiago de Compostela

María José Ferraces, Universidad de Santiago de Compostela

Department of Social and Basic Psychology and Methodology, Universidad de Santiago de Compostela


Alzheimer's Association and National Alliance for Caregiving (2004). Families Care: Alzheimer's Caregiving in the United States. Chicago: Alzheimer's Association and National Alliance for Caregiving.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association.

Armento, M. E. y Hopko, D. R. (2007). The Environmental Reward Observation Scale (EROS): Development, validity, and reliability. Behavior Therapy, 38, 107-119. doi: 10.1016/j.beth.2006.05.003.

Barraca, J. y Pérez-Álvarez, M. (2010). Adaptación española del Environmental Reward Observation Scale (EROS). Ansiedad y Estrés, 16, 95-107.

Backenstrass, M., Frank, A., Joest, K., Hingmann, S., Mundt, C. y Kronmüller, K. T. (2006). A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care. Comprehensive Psychiatry, 47, 35–41. doi:10.1016/j.comppsych.2005.04.007.

Clark, M. S. y Bond, M. J. (2000). The effect on lifestyle activities of caring for a person with dementia. Psychology, Health & Medicine, 5, 13–27. doi:10.1080/135485000105972.

Cuijpers, P. y Smit, F. (2004). Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavica, 109, 325–331. doi:10.1111/j.1600-0447.2004.00301.x.

Cuijpers, P., van Straten, A. y Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27, 318-326. doi:10.1016/j.cpr.2006.11.001.

First, M. B., Williams, J. B. W., Karg, R. S. y Spitzer, R. L. (2015). Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA, American Psychiatric Association.

Hulley, S. B., Cummings, S. R. y Newman T. B. (2013). Designing cross-sectional and cohort studies. En S. B. Hulley, S. R. Cummings, W. S. Browner, D. G. Grady y T. B. Newman (Eds.), Designing Clinical Research (4ª ed., pp. 85-96). Philadelphia: Lippincott Williams & Wilkins.

Instituto de Mayores y Servicios Sociales (2005). Cuidados a las personas mayores en los hogares españoles. El entorno familiar. Madrid: Ministerio de Trabajo y Asuntos Sociales.

Joling, K. J., van Marwijk, H. W. J., Veldhuijzen, A. E., van der Horst, H. E., Scheltens, P., Smit, F., y van Hout, H. P. J. (2015). The two-year incidence of depression and anxiety disorders in spousal caregivers of persons with dementia: Who is at the greatest risk? The American Journal of Geriatric Psychiatry, 23, 293-303. doi:10.1016/j.jagp.2014.05.005.

Lewinsohn, P. M. (1974). A behavioral approach to depression. En R. J. Friedman y M. M. Katz (Eds.), The Psychology of Depression: Contemporary Theory and Research (pp. 157-185). New York: Wiley.

Losada, A., Pérez-Peñaranda, A., Rodriguez-Sanchez, E., Gomez-Marcos, M. A., Ballesteros-Rios, C., Ramos-Carrera, I. R., …. Garcia-Ortiz, L. (2010). Leisure and distress in caregivers for elderly patients. Archives of Gerontology and Geriatrics, 50, 347-350. doi:10.1016/j.archger.2009.06.001.

Mausbach, B. T., Patterson, T. L. y Grant, I. (2008). Is depression in Alzheimer's caregivers really due to activity restriction? A preliminary mediational test of the activity restriction model. Journal of Behavior Therapy and Experimental Psychiatry, 39, 459-466. doi:10.1016/j.jbtep.2007.12.001.

Mausbach, B. T., Roepke, S. K., Depp, C. A., Moore, R., Patterson, T. L. y Grant, I. (2011). Integration of the pleasant events and activity restriction models: Development and validation of a “PEAR” model of negative outcomes in alzheimer's caregivers. Behavior Therapy, 42, 78-88. doi: 10.1016/j.beth.2009.11.006.

Mausbach, B. T., Roepke, S. K., Depp, C. A., Patterson, T. L. y Grant, I. (2009). Specificity of cognitive and behavioral variables to positive and negative affect. Behaviour Research and Therapy, 47, 608-615. doi: 10.1016/j.brat.2009.04.006.

National Collaborating Centre for Mental Health (2010). Depression: The NICE guideline on the treatment and management of depression in adults. Updated Edition. London: British Psychological Society and Royal College of Psychiatrists.

Nieboer, A. P., Schulz, R., Matthews, K. A., Scheier, M. F., Ormel, J. y Lindenberg, S. M. (1998). Spousal caregivers' activity restriction and depression: A model for changes over time. Social Science & Medicine, 47, 1361-1371. doi: 10.1016/S0277-9536(98)00214-7.

Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. doi:10.1177/ 014662167700100306.

Read, A., Mazzucchelli, T. G. y Kane, R. T. (2016). A preliminary evaluation of a single session behavioural activation intervention to improve well‐being and prevent depression in carers. Clinical Psychologist, 20, 36-45. doi: 10.1111/cp.12084.

Rodríguez, B., Ortiz, A., Palao, A., Avedillo, C., Sánchez-Cabezudo, A. y Chinchilla, C. (2002). Síntomas de ansiedad y depresión de pacientes oncológicos y en sus cuidadores. European Journal of Psychiatry (Ed. Española), 16, 27-38.

Romero-Moreno, R., Losada, A., Márquez-González, M. y Mausbach, B. T. (2014). Effects of the frequency and satisfaction with leisure profile on dementia caregivers distress. Anales de Psicología, 30, 878-886. doi: 10.6018/analesps.30.3.148381.

Schoenmakers, B., Buntinx, F. y Delepeleire, J. (2010). Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas, 66, 191-200. doi: 10.1016/j.maturitas.2010.02.009.

Trew, J. L. (2011). Exploring the roles of approach and avoidance in depression: An integrative model. Clinical Psychology Review, 31, 1156-1168. doi:10.1016/j.cpr.2011.07.007.

Torres, Á., Blanco, V., Vázquez, F. L., Díaz, O., Otero, P. y Hermida, E. (2015). Prevalence of major depressive disorders in non-professional caregivers. Psychiatry Research, 226, 333-339. doi: 10.1016/j.psychres.2014.12.066.

Vázquez, F. L., Blanco, V. y López, M. (2007). An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations. Psychiatry Research, 149, 247- 252. doi:10.1016/j.psychres.2006.03.004.

Vázquez, F.L., Otero, P., López, L., Blanco, V., Torres, A. y Díaz, O. (2018). La prevención de la depresión en cuidadores a través de multiconferencia telefónica. Clínica y Salud, 29, 14-20. doi: 10.5093/clysa2018a2.

Vázquez, F. L., Otero, P., Torres, A., Hermida, E., Blanco, V. y Díaz, O. (2013). A brief problem-solving indicated-prevention intervention for prevention of depression in nonprofessional caregivers. Psicothema, 25, 87-92. doi:10.7334/psicothema2012.89.

Vázquez, F. L., Torres, A., Blanco, V., Otero, P., Díaz, O., Ferraces, M. J. (2016). Long-term follow-up of a randomized clinical trial assessing the efficacy of a brief cognitive-behavioral depression prevention intervention for caregivers with elevated depressive symptoms. American Journal of Geriatric Psychiatry, 24, 421-432. doi:10.1016/j.jagp.2016.02.050.

Vázquez, F. L., Torres, A., Otero, P., Blanco, V., Díaz, O. y Estévez, L. E. (2017). Analysis of the components of a cognitive-behavioral intervention administered via conference call for preventing depression among non-professional caregivers: A pilot study. Aging & Mental Health, 21, 938-946. doi:10.1080/13607863.2016.1181714.

Williamson, G. M. y Shaffer, D. R. (2000). The activity restriction model of depressed affect: Antecedents and consequences of restricted normal activities. En G. M. Williamson, D. R. Shaffer y P. A. Parmelee (Eds.), Physical Illness and depression in older adults: A handbook of theory, research, and practice (pp. 173-200). New York: Kluwer Academic/Plenium.

How to Cite
Vázquez González, F. L., López, L., Blanco, V., Otero, P., Torres, Ángela J., & Ferraces, M. J. (2019). The impact of decreased environmental reward in predicting depression severity in caregivers. Anales De Psicología / Annals of Psychology, 35(3), 357-363.
Clinical and Health Psychology