Health of Spouse Caregivers of Dementia Patients: The Role of Personality and Social Support
Monahan, Deborah J., Hooker, Karen, Social Work
Providing care to a spouse with dementia is a challenging activity, even under the best of circumstances. Why one spouse caregiver copes effectively whereas another becomes demoralized and unable to cope is not well understood. There is an extensive literature on the stresses of caregiving (George & Gwyther, 1986; Haley, Levine, Brown, & Bartolucci, 1987; Horowitz, 1985; Pruchno & Resch, 1989) and evidence that the strains of caregiving can affect a caregiver's physical and mental health (Kiecolt-Glaser et al., 1987; Kiecolt-Glaser, Dura, Speicher, Trask, & Glaser, 1991; Moritz, Kasl, & Berkman, 1989; Vitaliano, Maiuro, Ochs, & Russo, 1989). Dementia-related caregiving is particularly demanding for spouses because the caregiver's stress arises not only from the heavy and often relentless responsibilities but also may involve bearing witness to and being victimized by the inevitable intellectual and psychological deterioration of one with whom the caregiver has had close and longstanding social and emotional ties.
That individual differences are associated with the effects of caregiving through the subjective appraisal of the stressor is a recent line of inquiry in caregiving research (Hooker, Monahan, Shifren, & Hutchinson, 1992), as is the relationship between individual differences and the appraisal of social support resources (Sarason et al., 1991). In this article, we examine relationships among social support, personality, and health. We explore the extent to which social support, gender, and personality (specifically neuroticism) independently predict caregivers' health. Whether personality plays a role in bolstering social support has important implications for understanding how spouses of dementia patients deal with the daily strains of caregiving and for reducing negative health outcomes for these caregivers.
Social support, a multidimensional construct, encompasses a multitude of relationships, behaviors, and consequences (Streeter & Franklin, 1991) and has been studied widely as a coping resource that might mitigate the adverse psychological effects of stress (Cohen & Syme, 1985). Although the nature, meaning, and measurement of social support are still being debated in the literature, investigators remain challenged by the need for more systematic and precise conceptualizations of the construct (Kessler, Price, & Wortman, 1985). Although the concept has been operationalized in diverse ways, there is evidence that an individual's perception of social support is most crucial in predicting the buffering effect of social support on stress (Sarason et al., 1991). For a person in a caregiving role, perceived amount and adequacy of social support seem to be important variables for understanding how that individual copes with stress.
Under some types of chronic stress, the buffering effects of social support are short lived, because the stressor eventually erodes the support (Lepore, Evans, & Schneider, 1991). Antecedents of support, such as environmental and genetic factors, seem to buffer the effect of stress on mood (Kessler, Kendler, Heath, Neale, & Evans, 1992). Another possible antecedent of social support that has not been examined in the context of caregiving is personality. Whether personality plays an autonomous role in the need for and development, maintenance, and mobilization of social support is a question that requires further exploration (Cohen & Wills, 1985). Sarason et al. (1991) concluded that the association between self-perceptions and perceived social support makes intuitive sense because individuals who do not feel good about themselves have little reason to believe that others will take an interest in them.
Dementia caregiving is an arena in which these questions can be explored, because the stress of such caregiving is usually long term, and caregivers need concrete as well as emotional assistance (Clipp & George, 1990). …