The Effects of Informal Social Support on Depressive Symptoms and Life Satisfaction in Dementia Caregivers in Hong Kong
Au, A., Lau, K. M., Koo, S., Cheung, G., Pan, P. C., Wong, M. K., Hong Kong Journal of Psychiatry
Objective: To explore the relative contributions of different types of informal social support towards the well-being of caregivers for patients with dementia in Hong Kong.
Participants and Methods: In this cross-sectional study, 134 caregivers for patients with dementia completed questionnaires assessing the informal social support available to them and its effect on their psychological well-being in terms of depressive symptoms and general life satisfaction.
Results: Informal social support was significantly associated with the well-being of caregivers for persons with dementia. The emotional support provided by spouses and children was found to have significant correlation with enhanced life satisfaction and decreased depressive symptoms in the caregivers.
Conclusions: Informal social support correlates strongly with psychological well-being in caregivers managing patients with dementia. Different sources and types of informal support can have differential effects on well-being.
Key words: Caregivers; Depressive disorder; Personal satisfaction; Social support; Stress, psychological
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Alzheimer's disease (AD) involves progressive degeneration of the brain, leading to impaired memory, thinking, behaviour, self-care and personality, and, eventually, death. In Hong Kong, approximately 60,000 people live with AD. This costs US$1,129.7 million in 2005, including US$260.6 million spent on home-based informal care.1 The ecological theory was developed by Urie Bronfenbrenner2 in the 1970s and has had a significant impact on the investigation of individual behaviour through multiple factors. According to this theory, every single person embeds into 4 layers: (1) the micro-system, the innermost layer; (2) the meso-system, the second layer; (3) the exo-system, the outer layer; (4) the macro-system, the outermost layer. In brief, the microsystem contains the structures with which the individual has direct contact, such as the family and school. The mesosystem refers to the connections between two or more micro-systems such as the family. The exo-system, which is a larger environmental system, exerts an indirect impact on the individual, and includes the social security and medical care systems. Lastly, the macro-system comprises the culture, the customs, and the legal, political, and economic systems, which in turn impact on all other systems. The ecological theory emphasises person-environmental exchanges across the lifespan. Through understanding the connections between caregivers and their different systems, professionals can better utilise the strengths of the systems and thereby choose the best possible interventions across the layers.
In the ecological theory, social support and its influence originate from different systems to exert impact on the individual. Social support has the potential to help us understand the dynamic interactions between the individual and the social environment.3 Albee4 argued for the prominent role of social support in his analyses linking prevention to the epidemiology of psychopathology. A negative correlation has been found between social support and depression in older adults and the caregivers of patients with dementia.5,6 It has been shown that the survival and quality of life of people with dementia is related to the well-being of their caregivers.7 Caregivers may experience adverse psychological, physical, social, and financial consequences. Many caregivers become socially isolated soon after adopting the caregiver role, leading to lower levels of psychological well-being.8,9
The caregiver role is crucial to community care of patients with dementia. Social support may relieve the burden on caregivers and help them adapt better to the caregiving role.10-12 A recent meta-analysis of the dementia caregiver literature has established 2 major domains with important empirical influences on caregivers' adjustment in terms of burden and depression: firstly, the care demands posed by the care recipients' characteristics, and secondly the resources available to the caregivers. …