Psychological aspects of lay caregiving

Impact of multiple caregiving roles on elevated depressed mood in early-stage breast cancer patients and same-age controls

The effect of caregiving roles on risk of elevated depressed mood over 12 months was examined in early-stage (0-IIA) breast cancer patients and same-aged women without breast cancer. Women were interviewed 4-6 weeks, 6 months, and 12 months following definitive surgical treatment (patients) or routine screening mammogram (controls). The Center for Epidemiologic Studies-Depression Scale was administered at each interview and dichotomized for analysis (<16 [little/no depressed mood] vs. >or=16 [elevated depressed mood]). Participants were categorized as having no caregiving responsibilities, caregiving for children or other persons, or caregiving for both children and others (multiple caregiving roles). Two multivariable marginal logistic regression models with repeated measures were fit (one each for patients and controls) to examine the effect of caregiving roles on elevated depressed mood, using generalized estimating equations to account for intra-individual correlations. Of 1096 participants (mean age 58; 76% white), 1019 with caregiving data were included in the analysis. Compared with baseline, patients with multiple caregiving roles (23/521 patients) were at increased risk of elevated depressed mood at 6 months (adjusted odds ratio [aOR], 7.20; 95% confidence interval [CI], 1.17-44.46; P = 0.034), and controls with multiple caregiving roles (15/498 controls) were at decreased risk of elevated depressed mood at 12-month follow-up (aOR, 0.12; 95% CI, 0.02-0.97; P = 0.047). Patients with multiple caregiving roles were more likely while controls were less likely to report elevated depressed mood over time, suggesting a need to identify patients with multiple caregiving roles early during their treatment.

Family cancer caregiving and negative outcomes: the direct and mediational effects of psychosocial resources

This study tested the hypothesis that various components of the stress process model were related to negative outcomes (depression, guilt, negative health) in cancer caregivers. This study also tested the hypothesis that psychosocial resources (mastery, socioemotional support) mediated the relationship between the various domains of the stress process model and negative outcomes. A total of 238 cancer caregivers were recruited from radiation medicine clinics at the University of Maryland Greenebaum Cancer Center (n = 186) and the University of Minnesota Cancer Center (n = 52). A comprehensive interview battery was administered. A multivariate regression found that primary subjective stressors were the strongest predictors of depression and negative health impact. A path analysis indicated that mastery mediated the relationship between role captivity and negative health impact. These results emphasize the importance of multidimensional assessment in cancer caregiving. The findings also suggest refinements to the stress process model when examining family cancer care.

An exploratory qualitative analysis of the emotional impact of breast cancer and caregiving among older women

Using in-depth qualitative interviews, this exploratory analysis evaluated the emotional impact of breast cancer on seven older women caring for others at the time of their breast cancer diagnosis. Stress--not depression as hypothesized--was identified as a primary issue for the women in their struggle to balance caregiving responsibilities and health needs. Modified by the caregiver-care recipient relationship and the type and amount of care provided, participants' experience with stress was influenced by a host ofphysical emotional, economic, and environmental factors. Life course pattern similarities represented another compelling emergent theme in the study. Participants shared similar characteristics and experiences during their lives, leading them through common pathways to the dual status of caregiver and breast cancer patient. Findings from this preliminary analysis support the need for more extensive research in this area as well as heightened awareness among social workers and care managers of the unique stressors experienced by older women breast cancer patients caring for others.

Older women with breast cancer: caregiving and the risk of depression--an exploratory analysis

OBJECTIVES

The primary objective of this exploratory analysis was to assess the prevalence of caregiving among older (60+) newly diagnosed female breast cancer patients and to examine the risk of depression associated with breast cancer, caregiving, and age, at 3 months and 12 months after diagnosis.

METHODS

Data from interviews conducted for the case-control study, Health and Functioning in Women with Breast Cancer (HFW), were used for this analysis. Interviews were conducted at 3 months and 12 months post-diagnosis. Participants for this analysis were restricted to those who completed both interviews (cases n = 904; controls n = 966). Risk of depression was assessed using a self-reported depression question from the HFW instrument.

RESULTS

The multivariate analysis showed that stage of breast cancer was significantly related to depression among older women with breast cancer while controlling for various socio-demographic factors; however, caregiving did not significantly increase the risk for depression for this population.

DISCUSSION

A breast cancer diagnosis for women, regardless of age or caregiving status, presented an increased risk of depression at 3 and 12 months post-diagnosis. These and other findings and their implications for social work practice are discussed.

Family caregiver expectations and management of the stroke trajectory

Less than 20% of stroke survivors enter rehabilitation or long-term care facilities after their stroke. Stroke recovery is extremely variable and the resulting uncertainty places a heavy burden on the survivors' family caregivers. According to the trajectory framework, chronic conditions have a defined course that can be shaped and managed. This grounded theory study, part of a larger research project, explored the expectations of family caregivers of the stroke trajectory and their management strategies. Thirteen family caregivers of stroke patients in a sparsely populated area participated in semi-structured interviews. The caregivers were without ideas about what the recovery of their loved ones would be like and had difficulty making projections about the trajectory. They used several strategies, however, in attempts to manage the stroke trajectory. They constructed a positive recovery, reconstituted family life, maintained family routines, created a safety net, and redoubled self-reliance. The findings have implications for how nurses support family caregivers of stroke survivors.

Mood and blood pressure responses in black female caregivers and noncaregivers

BACKGROUND

Substantial interaction between mood and blood pressure, especially in the context of caregiving for a dependent elder, could increase the risk in the already at-risk population of black women for either higher blood pressure or the onset of hypertension.

OBJECTIVES

To examine the relationship between mood symptoms and daytime ambulatory blood pressures during a 12-hour period in Black female caregivers and noncaregivers.

METHOD

A prospective cohort design was employed to study black females 18 years of age or older identified by randomly selected elders as the provider or potential provider of 5 or more hours of care per week to the elder. Mood symptoms were measured on visual analogue scales by the subjects in a diary attached to a retractable clip key ring worn by the subject. Blood pressure responses were measured with automated portable blood pressure monitors every 30 minutes. Additional risk and treatment factors were considered for descriptive purposes.

RESULTS

The two groups were equivalent on all hypertension risk and treatment factors except alcohol use (more noncaregivers consumed alcohol). Among caregivers, anger and mean diastolic blood pressure (DBP) were negatively related (parameter = -0.64, SE = .23, p = .01) and the negative relationship between anger and systolic blood pressure approached significance (parameter = -0.81, SE = 0.65, p = 0.10). Anxiety and sadness were not significant predictors.

CONCLUSION

Among black caregivers, elevated anger was associated with significant decreases in DBP, while lowered anger was associated with significant increases in DBP. Whether lower anger scores reflect a low level of perceived anger or suppressed anger among black caregivers should be explored in future studies.