Caregivers and Depression
From: Caregiver Depression Screening Toolkit,
in Partnership with Advocates, Inc. and Tufts Health Plan Foundation)
According to the Family Caregiver Alliance (www.familycaregiver.org) 40-70% of family caregivers have clinically significant symptoms of depression.
Clinical depression is different from "the blues" or passing sadness and is a treatable disease. The following will help you recognize the risk factors and symptoms of depression in caregivers and recognize the factors which impact caregivers in their ability to access support and treatment.
Depression is treatable
Depression can be treated with medications, therapy or a combination of the two. Each caregiver is different and unique with his or her own presentation of depression. By educating ourselves of the risk factors, symptoms of depression and the resources to obtaining help, we can reassure ourselves and other caregivers that we are not alone and there are options available to make their and our situation better.
Risk Factors for Depression
Genetics and Family History
An individual has a higher chance of becoming depressed if he or she has a mother, father or sibling who had suffered from depression.
Females typically suffer from depression at a higher rate than males. Women provide the majority of caregiving. Consequently, caregiving may be considered a "normal" activity for adult women. Therefore, women may be embarrassed about their depressed feelings. They may feel they are not being able to "meet expectations".
Males are generally less likely to admit to depression and more likely to "self-medicate" with alcohol or overwork. The number of male caregivers is increasing and they often do not feel acknowledged or empowered since they are in the minority.
Role/Relationship of Caregiver to Care-Recipient
The type of relationship that exists between the caregiver and care recipient has an impact on which issues are raised.
If the caregiver is a spouse, there is the chance that he or she may lose "the element of reciprocity that is the basis of a marital relationship" (Rose Beeson, D.N. Sc, RN 12/20/10)
An adult child has issues around role reversal when caring for a parent, and might have to balance this care with their own spouse or partner and/or children’s needs.
Someone caring for a disabled child has other issues, especially if he or she is a grandparent and the child is younger than 18 years old.
Many caregivers also make sacrifices, economic and social, in their other roles and relationships (as a spouse, partner, parent, worker, community member) and then feel torn and isolated as a result. Prior conflicts in the relationship can be exaggerated when the relationship changes to a caregiving one.
Witnessing the suffering of a relative or loved one can lead to distress, dread, sadness and depression.
Caregivers and Aging
As longevity increases in the US, caregivers themselves tend to be older "it is more common for older individuals to be a caregiver to an ill or impaired parent" (Lynn Martire, PhD and Rich Schulz, PhD)
A 2004 survey showed that 43% of caregivers are over 50 themselves. "…of those caring for someone aged 65 or older, the average age of the caregiver is 63, with 1/3 of these caregivers in fair to poor health themselves" (Administration on Aging 2004)
Caregiving can be physically demanding and caregivers often ignore their own health issues. Lack of sleep, which is a common problem for caregivers, increases the risk of depression and sleep disturbance. It is both a symptom and a contributing cause of depression.
Caregivers; maybe due to stress, exhaustion and self-neglect; are more likely to get infectious disease and slower to heal; with an increased risk of heart disease, arthritis, diabetes and a greatly increased risk of anxiety and depression. There is also a temptation to self-medicate with alcohol and this exacerbates health and mental health problems in caregivers. (Miller, Mark, MD)
Care-Recipient with Mental Illness or Dementia
Multiple studies show that caregiving for a person with behavioral and/or memory problems increase the rates of depression in the caregiver (Miller, Mark, April, 2010, Aging and Mental Health in Massachusetts).
Thirty to fifty-five percent of Alzheimer’s patients’ caregivers have clinically significant depression (Schultz et. al., 1995, Haley et. al., 1995). Caregiving for someone who may be wandering, agitated or engaging in embarrassing conduct can be more time-consuming and stressful; leaving caregivers with less time and energy for other family members, outlets, and supports.
There is often little financial assistance for in-home elder care. This increases the strain on low-income caregivers who may have to make sacrifices in their own employment to accommodate care requirements of their loved ones.
Women who are caregivers are 2.5 times more likely to live in poverty than non-caregivers
(www. the familycaregiver.org). Forty-four percent live in households under twice the federal poverty level, compared to only a third of non-caregivers (The Commonwealth Fund 2005, APA briefcase)
Cultural and Ethnicity Factors
Research by geriatric psychiatrist Rita Hargrave ,MD (University of California at Davis) shows that African-Americans and Hispanics are "less likely to admit being stressed or depressed by caring for loved ones when asked... but if you evaluate their physical symptoms of depression and stress, you’ll find high levels of both conditions."
Different cultural practices impact feelings about caregiving. There can be conflict in immigrant families, between the cultural expectations of the care recipient and the realities and expectations of American-raised caregivers.
Caregivers who are themselves elderly are also less likely to admit to depression because they were raised not to talk about problems.
Long Distance Caregiving
Even if the caregiver is not living with the care recipient, there are stresses which can lead to depression. There can be guilt, loneliness and the continued demands of monitoring care in a new location. Studies show that depression can persist even after the care recipient is placed in a long term care facility. (National Institute on Aging, June 2007)
The signs and symptoms of depression
Depression red flags include:
- Abandoning or losing interest in hobbies or other pleasurable pastimes;
- Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home);
- Change in eating habits resulting in unwanted weight gain or loss;
- Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness
- Loss of self-worth ( self-loathing, nothing you do is good enough);
- Increased use of alcohol or other drugs;
- Unexplained aches and pains which do not respond to treatment;
- Hopelessness or helplessness;
- Lack of interest in personal care; and
- Fixation on death; suicidal thoughts or attempts.