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Sense of coherence, burden, and affective symptoms in family carers of people with dementia

  • Vasiliki Orgeta (a1) and Elena Lo Sterzo (a1)

Abstract

Background: Caring for a relative with dementia has been associated with high levels of psychological morbidity in carers. Sense of coherence is an important resource of successful coping with caregiving. The purpose of the present study was to examine the relationship between stress associated with caregiving, sense of coherence, and self-reported depression and anxiety in family carers of people with dementia. We hypothesized that carers reporting high levels of anxiety and depression will report low levels of coherence, and that the relationship between caregiver stress and affective symptoms will be mediated by sense of coherence.

Methods: A total of 170 carers of people with dementia took part in the present study. Family carers completed the Sense of Coherence Scale, the Relative Stress Scale, and the Hospital Anxiety and Depression Scale. A series of multiple linear regressions were conducted to examine the relationship between stress related to caregiving, caregiver anxiety and depression, and whether sense of coherence mediated this relationship.

Results: Self-reported anxiety and depression were associated with low levels of sense of coherence. Sense of coherence mediated the relationship between burden and self-reported depressive effect and anxiety symptoms.

Conclusions: Carers reporting high levels of anxiety and depression are more likely to report low levels of sense of coherence. The relationship between stress related to caregiving and depressive symptoms is mediated by carers’ self-reported sense of coherence. Future psychotherapeutic intervention studies in family carers of people with dementia may incorporate strategies that specifically target sense of coherence.

Copyright

Corresponding author

Correspondence should be addressed to: Dr. Vasiliki Orgeta, Mental Health Sciences Unit, University College London, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London, W1W 7EJ, UK. Phone: +0044-020-7679-9294; Fax: +0044-020-7679-9426. Email: v.orgeta@ucl.ac.uk.

References

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Andren, S. and Elmstahl, S. (2008a). Effective psychosocial intervention for family caregivers lengthens time elapsed before nursing home placement of individuals with dementia: a five-year follow-up study. International Psychogeriatrics, 20, 11771192. doi:10.1017/S1041610208007503.
Andren, S. and Elmstahl, S. (2008b). The relationship between caregiver burden, caregivers’ perceived health and their sense of coherence in caring for elders with dementia. Journal of Clinical Nursing, 17, 790799. doi:10.1111/j.1365-2702.2007.02066.
Aneshensel, C. S., Pearlin, L. I., Mullam, J. T., Zarit, S. H. and Whitlatch, C. J. (1995). Profiles in Caregiving: The Unexpected Career. New York: Academic Press.
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science & Medicine, 36, 725733.
Baron, R. M. and Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 11731182.
Bjelland, I., Dahl, A. A., Tangen Haug, T. and Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52, 6977.
Bodnar, J. C. and Kiecolt-Glaser, J. K. (1994). Caregiver depression after bereavement: chronic stress isn't over when it's over. Psychology and Aging, 9, 372380.
Butcher, H. K., Holkup, P. A. and Buckwalter, K. C. (2001). The experience of caring for a family member with Alzheimer's disease. Western Journal of Nursing Research, 23, 3355.
Clyburn, L. D., Stones, M. J., Hadjistavropoulos, T. and Tuokko, H. (2000). Predicting caregiver burden and depression in Alzheimer's disease. The Journals of Gerontology: Psychological Sciences and Social Sciences, 55, S2S13.
Covinsky, K. E.et al. (2003). Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18, 10061014.
Draper, B. M., Poulos, C. J., Cole, A. M., Poulos, R. G. and Ehrlich, F. (1992). A comparison of caregivers for elderly stroke and dementia victims. Journal of the American Geriatrics Society, 40, 896901.
Ekwall, A. K., Sivberg, B. and Hallberg, I. R. (2007). Older caregivers’ coping strategies and sense of coherence in relation to quality of life. Journal of Advanced Nursing, 57, 584596. doi:10.1111/j.1365-2648.2006.03994.
Eriksson, M. and Lindstrom, B. (2005). Validity of Antonovsky's sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health, 59, 460466. doi:10.1136/jech.2003.018085.
Eriksson, M. and Lindstrom, B. (2007). Antonovsky's sense of coherence scale and its relation with quality of life: a systematic review. Journal of Epidemiology and Community Health, 61, 938944. doi:10.1136/jech.2006.056028.
EuroQoL (1990). EuroQol – a new facility for the measurement of health-related quality of life. Health Policy, 16, 199208.
Gallagher-Thompson, D., Dal Canto, P. G., Jacob, T. and Thompson, L. W. (2001). A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's disease. Journals of Gerontology, Series B-Psychological Sciences and Social Sciences, 56, S140S150.
Gallant, M. P. and Connell, C. M. (1997). Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. Journal of Aging and Health, 9, 373395.
Gallicchio, L., Siddiqi, N., Langenberg, P. and Baumgarten, M. (2002). Gender differences in burden and depression among informal caregivers of demented elders in the community. International Journal of Geriatric Psychiatry, 17, 154163.
Gaugler, J. E., Roth, D. L., Haley, W. E. and Mittelman, M. S. (2008). Can counseling and support reduce burden and depressive symptoms in caregivers of people with Alzheimer's disease during the transition to institutionalization? Results from the New York University caregiver intervention study. Journal of the American Geriatrics Society, 56, 421428. doi:10.1111/j.1532-5415.2007.01593.
Given, C. W., Stommel, M., Given, B., Osuch, J., Kurtz, M. E. and Kurtz, J. C. (1993). The influence of cancer patients’ symptoms and functional states on patients’ depression and family caregivers’ reaction and depression. Health Psychology, 12, 277285.
Greene, J. G., Smith, R., Gardiner, M. and Timbury, G. C. (1982). Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study. Age and Ageing, 11, 121126.
Hanaken, J., Feldt, T. and Leskinen, E. (2007). Change and stability of sense of coherence in adulthood: longitudinal evidence from the Healthy Child Study. Journal of Research in Personality, 41, 602617.
Hooker, K., Monahan, D., Shifren, K. and Hutchinson, C. (1992). Mental and physical health of spouse caregivers: the role of personality. Psychology and Aging, 7, 367375.
Hulme, C., Long, A. F., Kneafsey, R. and Reid, G. (2004). Using the EQ-5D to assess health-related quality of life in older people. Age and Ageing, 33, 504507. doi:10.1093/ageing/afh178.
Joling, K. J., van Hout, H. P., Schellevis, F. G., Knol, D. L. and van Marwijk, H. W. (2010). Incidence of depression and anxiety in the spouses of patients with dementia: a naturalistic cohort study of recorded morbidity with a 6-year follow-up. American Journal of Geriatric Psychiatry, 18, 146153.
Kiecolt-Glaser, J. K., Dura, J. R., Speicher, C. E., Trask, O. J. and Glaser, R. (1991). Spousal caregivers of dementia victims: longitudinal changes in immunity and health. Psychosomatic Medicine, 53, 345362.
Kivimaki, M.et al. (2002). Sense of coherence as a mediator between hostility and health: seven-year prospective study on female employees. Journal of Psychosomatic Research, 52, 239247.
Klein, D. N., Kotov, R. and Bufferd, S. J. (2011). Personality and depression: explanatory models and review of the evidence. Annual Review of Clinical Psychology, 7, 269295. doi:10.1146/annurev-clinpsy-032210-104540.
Lindström, B. and Eriksson, M. (2005). Salutogenesis. Journal of Epidemiology and Community, 59, 440442.
Machnicki, G., Allegri, R. F., Dillon, C., Cerrano, C. M. and Taragano, F. E. (2009). Cognitive, functional and behavioral factors associated with the burden of caring for geriatric patients with cognitive impairment or depression: evidence from a South American sample. International Journal of Geriatric Psychiatry, 24, 382389.
Mahoney, R., Regan, C., Katona, C. and Livingston, G. (2005). Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. The American Journal of Geriatric Psychiatry, 13, 795801. doi:10.1176/appi.ajgp.13.9.795.
MaloneBeach, E. E. and Zarit, S. H. (1995). Dimensions of social support and social conflict as predictors of caregiver depression. International Psychogeriatrics, 7, 2538.
Marriott, A., Donaldson, C., Tarrier, N. and Burns, A. (2000). Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. British Journal of Psychiatry, 176, 557562.
Matsudaira, T. and Kitamura, T. (2006). Personality traits as risk factors of depression and anxiety among Japanese students. Journal of Clinical Psychology, 62, 97109. doi:10.1002/jclp.20215.
Morris, R. G., Morris, L. W. and Britton, P. G. (1988). Factors affecting the emotional well-being of the caregivers of dementia sufferers. British Journal of Psychiatry, 153, 147156.
Mykletun, A., Stordal, E. and Dahl, A. A. (2001). Hospital Anxiety and Depression (HAD) Scale: factor structure, item analyses and internal consistency in a large population. British Journal of Psychiatry, 179, 540544.
Papastavrou, E., Kalokerinou, A., Papacostas, S. S., Tsangari, H. and Sourtzi, P. (2007). Caring for a relative with dementia: family caregiver burden. Journal of Advanced Nursing, 58, 446457.
Parks, S. H. and Pilisuk, M. (1991). Caregiver burden: gender and the psychological costs of caregiving. The American Journal of Orthopsychiatry, 61, 501509.
Pinquart, M. and Sorensen, S. (2007). Correlates of physical health of informal caregivers: a meta-analysis. The Journals of Gerontology: Psychological Sciences and Social Sciences, 62, P126P137.
Proctor, R., Martin, C. and Hewison, J. (2002). When a little knowledge is a dangerous thing.: a study of carers’ knowledge about dementia, preferred coping style and psychological distress. International Journal of Geriatric Psychiatry, 17, 11331139.
Russo, J., Vitaliano, P. P., Brewer, D. D., Katon, W. and Becker, J. (1995). Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: a diathesis-stress model of psychopathology. Journal of Abnormal Psychology, 104, 197204.
Schultz, R. and Wiliamson, G. H. (1991). A 2-year longitudinal study of depression among Alzheimer's caregivers. Psychology and Aging, 6, 569578.
Schulz, R., Visintainer, P. and Williamson, G. M. (1990). Psychiatric and physical morbidity effects of caregiving. Journal of Gerontology, 45, P181P191.
Schwarzer, R. (2000). Manage stress at work through preventive and proactive coping. In Locke, E. A. (ed.), The Blackwell Handbook of Principles of Organizational Behavior (pp. 342355). Oxford, UK: Blackwell.
Snaith, R. P. and Zigmond, A. S. (1994). HADS: Hospital Anxiety and Depression Scale. Windsor, Ontario, Canada: NFER.
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. In Leinhardt, S. (ed.), Sociological Methodology (pp. 290312). Washington, DC: American Sociological Association.
Song, L. Y., Biegel, D. E. and Milligan, S. E. (1997). Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental Health Journal, 33, 269286.
Teri, L., Logsdon, R. G. and Uomoto, J. (1997). Behavioral treatment of depression in dementia patients: a controlled clinical trial. Journal of Gerontology, 52, 159166.
Valimaki, T. H., Vehvilainen-Julkunen, K. M., Pietila, A. M. and Pirttila, T. A. (2009). Caregiver depression is associated with a low sense of coherence and health-related quality of life. Aging & Mental Health, 13, 799807.
Van Den Wijngaart, M. A., Vernooij-Dassen, M. J. and Felling, A. J. (2007). The influence of stressors, appraisal and personal conditions on the burden of spousal caregivers of persons with dementia. Aging & Mental Health, 11, 626636. doi:10.1080/13607860701368463.
Vernooij-Dassen, M., Felling, A. and Persoon, J. (1997). Predictors of change and continuity in home care for dementia patients. International Journal of Geriatric Psychiatry, 12, 671677.
Volanen, S. M., Suominen, S., Lahelma, E., Koskenvuo, M. and Silventoinen, K. (2007). Negative life events and stability of sense of coherence: a five-year follow-up study of Finnish women and men. Scandinavian Journal of Psychology, 48, 433441.
Zarit, S. H. and Whitlatch, C. J. (1992). Institutional placement: phases of the transition. The Gerontologist, 32, 665672.
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychologica Scandinavica, 67, 361370.

Keywords

Sense of coherence, burden, and affective symptoms in family carers of people with dementia

  • Vasiliki Orgeta (a1) and Elena Lo Sterzo (a1)

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