Mental health and Loss depression
TO SPECIFICALLY tailor and implement psychosocial interventions to meet the mental health needs of spouses caring for a partner with Alzheimer’s disease (AD) or a related disorder, health care professionals must first have the knowledge and understanding of the elements of the caregiver, care-receiver dyadic relationship, and the complexities that often result from the 10, 15, or even 20 years of “living” the role of a caregiving spouse. Research has consistently found that the adverse effects on the mental health of AD caregiving spouses, especially in the form of depression, has been much higher than either age- or gender-based population norms or demographically matched non-caregiving control groups [Haley et al 1995, Russo et al 1995 and Schulz et al 1995]. AD caregivers reporting symptoms of depression have ranged from 28% to 55% [Schulz et al 1995], with female caregivers more likely to experience depression than male caregivers [Chappell and Penning 1996 and Stuckey et al 1996]. Marital relational losses or relational deprivation reported by AD spousal caregivers have been found to be directly related to their mental health, specifically increased depressive symptoms [Pearlin et al 1990 and Rankin et al 2001]. Furthermore, the caregiving role can result in a loss of self by the caregiver, thus experiencing a loss of his or her own identity as the patient’s persona becomes fragmented and blurred. This is especially exacerbated when the identity of the caregiver is closely tied to that of the patient [Pearlin et al 1990].
Although a number of background and demographic factors associated with caregiver depression have been identified in previous research, investigation into the psychologic and social predictors of depressive symptomatology has been minimal [Lebowitz et al 1997]. The etiology of depression in AD caregivers, especially spouses, is still not clear. Loneliness as a factor in the development of depression in the AD spousal caregivers has been given little attention, even though researchers have found moderate to high correlations between loneliness and depression for many years [Mullins and Dugan 1990 and Shaver and Brennan 1991]. This study addressed the following two research questions: (1) Do AD spousal caregivers report higher levels of loneliness and depression than non-caregiving spouses? (2) Is there a relationship between relational deprivation, loss of self, and loneliness in predicting depression for AD spousal caregivers?
Literature review
Theoretical framework
The theoretical framework for this study was adapted from [Pearlin et al 1990] model of Alzheimer’s caregivers’ stress, which depicts the dynamic complexity of caregiving within a stress process framework. Modifications were made to the conceptual model for this research. Loneliness, defined as a subjective emotional experience of dissatisfaction with the quality or quantity of personal social relationships with others, was included as a variable.
Gender/spousal relationship
Research has found that the demands of the caregiver role are experienced differently by husbands and wives [Barber and Pasley 1995, Ory et al 1999 and Rankin et al 2001]. Investigators have predominantly found that caregiving wives were more depressed than caregiving husbands [Alspaugh et al 1999, Beeson et al 2000, Neundorfer et al 2001 and Rose-Rego et al 1998]. Only a few studies found that female caregivers were not more depressed than male caregivers [Hinrichsen and Niederehe 1994].
Research on gender differences in loneliness has produced many inconsistent findings. Elderly female residents have been reported to experience loneliness more than elderly male residents in both Florida [Mullins et al 1989] and The Netherlands [de Jong Gierveld et al 1987 and Holmen et al 1992]. [Mullins et al 1996] study of 1,071 older persons and [Mullins and Mushel 1992. L.C. Mullins and M. Mushel, The existence and emotional closeness of relationships with children, friends and spouses. Research on Aging 14 (1992), pp. 448–470. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (18)Mullins and Mushel 1992] study of 950 elderly found men were lonelier than women. However, more often research has reported that in the elderly population gender is not correlated to loneliness [Hector-Taylor and Adams 1996 and Mullins et al 1991]. [Beeson et al 2000] found that caregiving wives reported significantly greater loneliness than caregiving husbands, but not caregiving daughters, indicating that the relationship of caregiver to care receiver might be more important to the demands of the caregiver role than gender.
Relational deprivation
Relational deprivation, or the negative restructuring of the caregiver-patient relationship, can develop from the caregivers’ feelings of being deprived of a relationship with a significant companion or the loss of an affectional exchange as the AD illness progresses [Pearlin et al 1990]. Research has found that the loss of companionship, loss of the reciprocal exchange of affection between spouses, and the loss of a confidant, especially in the marital dyad, can affect the quality of life for both the caregiver and the care recipient, as well as the continuity and quality of care for the AD spouse [Hays et al 1998, Kramer and Lambert 1999, Siriopoulos et al 1999 and Yates et al 1999]. Furthermore, studies have found that the loss of emotional attachment between a married couple resulting from the cognitive changes in one spouse often led to depression in the caregiving spouse [Beeson et al 2000 and Blatt and Zuroff 1992]. In a sample of 96 AD spousal caregivers, [Rankin et al 2001] found that losses associated with emotional rather than instrumental support were more notable in understanding depressive reactions in AD spouse caregivers.
Tags: mental health