Response to "Wives, Husbands, and Daughters of Dementia Patients: Predictors of Caregivers' Mental and Physical Health"
Stewart, Barbara J. PhD, Archbold, Patricia G. Rn, DNSc, Faan, Scholarly Inquiry for Nursing Practice
Understanding the health effects of family caregiving is clearly an important area for research. Sparks and colleagues' paper addresses predictors of the mental and physical health in wives, husbands, and daughters caring for relatives with dementia. In our response to their study, we have highlighted some of the findings we found most interesting and have raised issues with respect to current research in caregiving.
Despite relatively large differences in the mean ages of the three groups included in the Sparks study-65 years for wives, 71 years for husbands, and 51 years for daughters-the three groups are remarkably similar in physical and mental health. Likewise, the three groups are similar in social position, years of caregiving, and the dementia severity of the care receiver. These similarities in health and other variables coexist with relatively large differences in how the three groups appraise caregiving: daughters (M = 17.4) and wives (M - 14.6) reported higher burden than did husbands (M = 6.6), and wives reported greater worry (M = 30.2) than did husbands (M= 22.3) and daughters (M = 22.7). These statistically significant differences correspond to effect sizes in the .60 to .80 range.
What do the three groups' similarities in health mean in the presence of moderate to large differences in cognitive appraisal? Is there a sample selection factor operating that affects these similarities and differences, or are they accurately portraying wives, husbands and daughters who are caregivers? We do not know the answer. Results of numerous studies of health and aging conclude that higher socioeconomic status, or SES (social position in the Sparks study) is a powerful predictor of health (Maddox, 1987). Thus the relatively high SES of the sample in the Sparks study may contribute to the similarities in health across groups. This restriction of range in SES may contribute to the lack of a significant association between social position and health in the correlation and regression analyses.
Although not stated as a purpose of the study, a question that seems to underlie it is: Does caregiving cause health problems in caregivers? Although quite a bit of research in the past has focused on this topic, results are conflicting. In their meta-analysis, Schulz, O'Brien, Bookwala, and Fleissner (1995) concluded that dementia caregivers had elevated levels of depressive symptoms compared to noncaregivers but that the evidence for physical health effects was less clear. Contrary to the conclusions by Schulz and associates, Sparks and colleagues found that mean scores of caregiving wives, husbands and daughters on the Brief Symptom Inventory were not significantly higher than normative data for elderly nonpatient adults. In another study of caregiver health that also used the Brief Symptom Inventory, Neundorfer (1991) found results similar to those of Sparks and associates; although depression and anxiety scores of dementia caregivers were slightly higher than age norms, they were not significantly different. If caregiving has deleterious effects on mental health of caregivers, it may be that the Brief Symptom Inventory is not sensitive enough to detect them.
One indirect approach to examining health effects of caregiving is to examine the correlation between years of caregiving and health. In the Sparks study, although there is no clear link between years spent in caregiving and mental health based on the simple correlations in Table 2 (r= -.12, .11, and .00 for wives, husbands, and daughters, respectively), it appears that years spent in caregiving may be associated with poorer physical health, as shown in Table 3. Using a one-tailed alpha for r, there is some suggestion that more years of caregiving is related to poorer physical health for daughters (r = .44, p < .01), and less so for wives (r = .24, p = .05). In the multiple regression analysis, the ability of years caregiving to predict the physical health of daughters remains, even after controlling for five other predictors including age. …