Academic journal article Health and Social Work

CAREGIVER MEANING: A Study of Caregivers of Individuals with Mental Illness

Academic journal article Health and Social Work

CAREGIVER MEANING: A Study of Caregivers of Individuals with Mental Illness

Article excerpt

The study discussed in this article examined caregiver meaning. Study participants were individuals paid and supported by the South Carolina Department of Mental Health Homeshare program to provide care in their home for an individual with severe mental illness. A structured questionnaire and interviews were used to develop categories and themes about caregiver meaning. Quantitative and qualitative analyses yielded three categories of caregiver meaning: other-directed-altruistic, self-directed-self-actualization, and existential-purpose in life. Caregivers most often referred to altruistic themes, with the most common one being "helping others." The next most common themes were "home and family" and "making a difference." Caregiving difficulties also were categorized. Social work implications are discussed.

Caregiving, like most forms of work, gives life purpose and also causes stress. For those caring for individuals with serious, persistent mental illness, stress or burden often arises from the clients' illnesses. Complications of mental illness include deficits in coping, extreme dependency, difficulties in interpersonal relationships, motivational and perceptual challenges, and vocational limitations (Liberman, 1988). Other challenges come from the clients' institutionalized behaviors, low energy and motivation, and atypical perceptions. Sometimes disability emanates from the social reactions to mental illness rather than the illness itself (Gruenberg, 1982).

The demands of taking care of an individual with mental illness stem from many and varied sources (Clark, 1994; Jones, Roth, & Jones, 1995; Kuipers, 1993; Schene, Tessler, & Gamache, 1994; Steinwachs, Kasper, & Skinner, 1992; Vaddadi, 1996). Montgomery, Gonyea, and Hooyman (1985) described caregiver burden as objective, subjective, or both. One group of researchers found that age and income of the caregiver were the best predictors of subjective burden (Biegel, Milligan, Putnam, & Song, 1994). Objective burden was associated with caregiver confinement. Solomon and Draine (1995b) examined the relationship of stress, coping and adaptation, and subjective burden of family members of individuals with mental illness.

Having a client who has mental illness live in a household presents challenges. Although caregiver burden increased when the client lived with the caregiver, different sets of issues arose when the person receiving care lived in a separate household (Jones et al., 1995; Solomon & Draine, 1995a). Those in shared households had greater activity restriction but less relationship strain (Deimling, Bass, Townsend, & Noelker, 1989). Fetterman and Chamberlain (1994) found that provider families disliked dealing with client symptoms such as mood swings and memory deficits. Morgan, Eckert, and Lyon (1995) reported that almost a third of the caregivers they questioned identified client behavior problems as the most stressful feature of their job. Poulshock and Deimling (1984) concluded that professionals who support caregivers need to consider the caregiver's interpretation of impairment of activities of daily living, cognitive incapacity, disruptive behavior, and lack of sociability. Also, Morgan et al. found that pr ivacy and interpersonal conflict caused caregivers mental or physical stress.

Most caregiver studies consider family caregiving a burden. Less is known about the benefits of caring for individuals with mental illness and agency-supported caregiving. Noonan, Tennestedt, and Rebelsky (1996) gathered qualitative data from 48 family caregivers in Massachusetts. These individuals who took care of elderly people reported benefits such as satisfaction, reciprocity, companionship, and personal growth. However, Horwitz, Reinhard, and Howell-White (1996) noted that caregiving can be viewed as a process of mutual exchange. These authors showed that the satisfaction of caregivers is strongly associated with how much support the individual with mental illness receives. …

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