OBJECTIVES: To examine differences between depressed and non-depressed family caregivers during the initial year of the caregiver role for family members who have incurred a spinal cord injury.
DESIGN: Correlational and longitudinal.
POPULATION, SAMPLE, SETTING: A sample of 128 individuals assuming family caregiving roles for a person with a recent-onset spinal cord injury agreed to participate in a study of family caregiver adjustment. Family members were recruited while their family member was receiving inpatient rehabilitation services for recent-onset spinal cord injury. The sample was predominately Caucasian (57%) and African-American (36%). Women were more likely to be in the caregiver role (80%). Caregivers were typically either a wife or a mother of the care recipient.
VARIABLES: The Center for Epidemiological Studies Depression Scale was used to obtain an index of depressive behavior at each assessment. A cut-off of 16 was used to determine depression status; those scoring higher than 16 at any assessment were classified as depressed for our purposes. Other measures included reports of caregiver overload, competence, role captivity, loss of self, management of meaning, use of medications to calm down, and hours in caregiving activities. Measures of health complaints, expressed social support, exercise, negative affectivity, positive affectivity, and of negative attitudes toward and from the care recipient were also administered.
METHODS: Following each consecutive admission to the inpatient rehabilitation program, a trained research assistant reviewed each case to determine potential eligibility for inclusion in the study. Individuals were eligible for the study if a family member would be involved in providing some level of care and assistance in ongoing caregiving activities to the person with SCI upon return to the community (e.g., assistance with activities of daily living, adherence to self-care regimens, and other supportive care). The research assistant then approached prospective family caregivers and informed them of the study. Informed consent was obtained from those who agreed to participate. The initial assessment was conducted during the hospitalization. Subsequent assessments were conducted by mail one month, six months, and one year postdischarge. Questionnaires were mailed in envelopes in no particular order and participants completed the instruments in no particular sequence. The research assistant maintained telephone contact with participants to discuss receipt of materials and to address any questions or comments about the study. Comparisons were made between the depressed and non-depressed caregivers at each assessment and throughout the year.
FINDINGS: At least 50% of the sample exceeded the cut-off score for depression at each assessment (50% were depressed at time 1, 56% were depressed at time 2, 51% were depressed at time 3, and 52% were depressed at time 4). Depressed caregivers were significantly more likely to experience more health problems, more family conflict, more negative attitudes toward care recipient, more negative attitudes from the care recipient, more role captivity, greater loss of self, and more overall distress throughout the first year than nondepressed caregivers. Depressed caregivers also reported significantly less exercise, less social support, a lower sense of competence, more economic strain and greater medication use to calm down than nondepressed caregivers from the first month of caregiving throughout the year.
CONCLUSIONS: Depressed family caregivers of persons with recent-onset spinal cord injury experience an array of problems that appear to persist throughout the initial year of caregiver. These problems reflect difficulties in personal adjustment and in their relationships with a care recipient. Depressed caregivers may also become consumers of health care services as they are more likely to have problems with their emotional and physical health over time.
IMPLICATIONS: Health care services should consider interventions that strategically assist caregivers who exhibit problems with depression throughout the first year of providing care to a family member with spinal cord injury.
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