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Research has demonstrated that taking care of a patient with schizophrenia has serious mental health costs to caregivers including high levels of burden and poorer overall mental health. Research also indicates that caregivers from certain ethnic/racial groups may fare better in this process. Specifically, prior research indicates that African American and Hispanic caregivers often exhibit better mental health than their Caucasian counterparts. Using a sample of 176 caregivers of patients with schizophrenia, the present study was specifically aimed at examining whether three variables (caregiver burden, family cohesion and interdependence) may account for part of the formerly observed ethnic/racial differences in psychological outcomes. Study hypotheses pertaining to ethnicity/race and family cohesion were not supported. For the most part, minorities in this study did not demonstrate better mental health outcomes than Caucasians and family cohesion did not predict mental health outcomes. However, in line with study hypotheses, we did find that subjective burden mediated the relationship between objective burden and mental health. In other words, subjective appraisals of caregiving appear to partially underlie the association between concrete costs of caregiving and psychological outcomes in schizophrenia caregivers. Also as expected, we found that interdependence moderated the relationship between objective burden and subjective burden. This finding suggests that helping caregivers to value harmony and connection with others over individual self-interests may reduce the likelihood that objective stressors (which are often inevitable in schizophrenia) will result in subjective distress.

Cognitive impairment in Parkinson’s disease (PD) can impact negatively on caregivers and is associated with carer distress and feelings of burden. To investigate this relationship we examined level of burden, coping strategies, depression, anxiety and potential positive aspects of caregiving in the caregivers of 104 PD patients. The PD patients were classified as either showing normal cognition (PD-N; n=57), with mild cognitive impairment (PD-MCI; n=31) or with dementia (PD-D; n=16). The key finding was that mean Zarit burden score increased between carers of PD-N (M=14.1, SD=12.0) through to PD-MCI (M=21.1, SD=9.86) and PD-D (M=27.8, SD=10.61); F (2,101) =9.96, p<0.001. Post hoc tests (Newman-Keuls) identified significantly higher Zarit burden scores in PD-D caregivers compared to both PD-N (p<.001) and PD-MCI patients (p<.05), but carers of PD-MCI patients also showed increased burden scores relative to those of PD-N patients (p<.05). The proportion of carers showing significant levels of burden (Zarit burden score ≥21) also increased as cognition declined (21% for PD-N; 58% for PD-MCI; and 81% for PD-D). Time spent providing care and problem-focused, emotion-focused and dysfunctional coping strategies also increased with worsening cognition. While caregiver use of problem-focused coping mediated the association between patient cognitive status and caregiver burden, we could not be confident about this relationship as the inverse model was also significant. Caregiver Zarit burden was independent of caregiver depression, anxiety and positive attributions of caregiving. The study highlights the impact of Parkinson’s disease on those providing care when the patients’ cognition is poor, including those with MCI. Caregiver well-being has important implications for nursing home placement and disease course.

Individuals who live with depressed partners have increased rates of anxiety, depression, and difficult coping. They experience greater burdens of parenting and financial responsibilities, and often feel isolated and restricted. Much of this is similar to what has been termed caregiver burden in the context of other illnesses. This study used qualitative interviews to explore the day-to-day experience of what it is like to live with a depressed partner, as well as to test the fit of the term `caregiver burden' in the context of depression. Participants were seven individuals who were in long-term relationships with depressed partners. Analysis of the interviews identified four stages of a helping process that individuals go through as they care for their depressed partners and transition from partners to caregivers. These individuals are experts on their partners and have important perspective and essential support to offer when their depressed partners are seeking care. Findings underline the importance of advanced nursing and medical care that recognizes the significant burden that nondepressed partners experience and the important ways that they can help their depressed partners seek and stay with treatment.

The purpose of this research was to explore the gender differences in caregiver burden in Alzheimer’s patients in the Inland Empire. Currently, there are more than half a million Californians who live with Alzheimer’s disease (Ross, Brennan, Nazareno, & Fox, 2009) and this number is expected to double over the next few years. Due to an increase in the older population and the rise of informal caregivers, the study provided insight as to how males and females perceive caregiver burden and how each gender responds to caregiver burden. This exploratory study utilized a quantitative research design through the use of questionnaires which measured caregiver burden through the use of the Zarit Burden Interview. A total of 38 participants were recruited through support groups at the Inland Caregiver Resource Center. Though findings did not suggest a gender difference in caregiver burden, they did indicate that there was a relationship between ethnicity and gender in relation to the caregiver and care receiver relationship. Implications for social work practice include assessment for and aid in the development of gender appropriate resources for informal caregivers of Alzheimer’s patients.

Caring for an individual with Alzheimer’s disease is especially challenging and impacts every aspect of the lives of the informal caregivers. Informal caregiving is defined as unpaid care provided by family or friends to people with a chronic illness or disability (Young & Newman, 2002). Caregiver burden involves the physical, psychological, social and emotional problems experienced by a caregiver of an impaired loved one (Gwyther & George, 2006). Alzheimer’s disease caregivers report more depression than their caregiving and non-caregiving peers, experience increased physical decline, and often experience financial challenges. Evidence suggests Alzheimer’s disease caregiver burden is a result of both care recipient and caregiver factors. Pearlin et al’s Stress Process model (1990) is widely used to examine triggers in caregiver burden. The model consists of antecedents, stressors, and outcomes. Few studies have examined moderators in the burden process in Alzheimer’s disease caregiving. Whether resilience accounts for variance in outcomes associated with caregiver burden is not addressed in the literature. Data from a convenience sample of Alzheimer’s disease caregivers (N=111) were examined for the purpose of exploring the moderating effect of resilience on the relationship between stressors and caregiver burden predictors. RESULTS: Resilience did not moderate the relationship between the caregiver stressors and caregiver burden. However, results indicated a relationship between resilience and caregiver burden. Specifically, as resilience increases, caregiver burden decreased. This finding highlights the importance of Alzheimer’s caregivers and implementing support and interventions that will increase their resilience.

Caregiving for a close family member with Alzheimer’s disease is a stressful situation to be in, that often leads to high levels of caregiver burden and subsequent stress and depressive symptoms, and while there are numerous community and government resources available to caregivers, there are aspects of Hispanic cultures that may lead Hispanic caregivers to have higher levels of caregiver burden and depressive symptoms than White caregivers. 80 Hispanic caregivers and 80 White caregivers, with 40 males and 40 females within each group, will be recruited to participate in this study. Scales will be administered to both Hispanic and White caregivers in order to assess levels of caregiver burden, depressive symptoms, familism values, gender role beliefs, acculturation levels, and knowledge, comfort, and use of community resources. Hispanic caregivers will have higher levels of caregiver burden and depressive symptom scores than White caregivers, while women will have higher scores overall than men overall. Hispanic caregivers will have less knowledge, comfort, and use of community resources than White caregivers, while gender role views, familism values, and acculturation levels will be mediating factors of these relationships. Cultural differences in caregiver burden need to be assessed further, so that clinical and practical implications for community and government resources can be discussed.

This thesis investigated the longitudinal role of defeat and entrapment in populations where these factors were expected to be particularly relevant (a sample of individuals from areas of socioeconomic deprivation and a sample of formal caregivers). The thesis then considered whether defeat and entrapment influenced reward sensitivity on a gambling task and lastly, designed a short scale measuring defeat and entrapment suitable for use in clinical populations. The research incorporated a review of the literature, two longitudinal studies, a behavioural study and the development of a scale. The literature review presented in Chapter 1 provided evidence of a well-established link between defeat, entrapment and poor mental health, suggesting that defeat and entrapment may act as a transdiagnostic process; contributing to the development and maintenance of a range of mental disorders. However, the review also demonstrated that defeat and entrapment relate to the same experiences, suggesting that logically these constructs may equally co-occur, although the structure of the constructs is currently debated. The studies presented in Chapters 3 and 4 demonstrated that perceptions of defeat and entrapment predicted poor mental health (depression and anxiety, and depression and caregiver burden) at a second time point, 12 months later. These chapters presented the first longitudinal evidence for samples recruited from the general population and occupational settings. Furthermore, these chapters provided evidence that the relationship between defeat, entrapment and poor mental health operates in a bidirectional way within a sample recruited from community settings, but a linear way within a sample of formal caregivers, suggesting that further research is needed to confirm the direction of this relationship. The research presented in Chapter 5 found a non-significant relationship between defeat and entrapment and reward sensitivity among a sample of undergraduate students. This may have arisen due to the generally low levels of defeat and entrapment within the sample despite highly varied performance on the task. Replication of this research within a sample where a wider range of defeat and entrapment experiences would be expected might be beneficial. Additionally, this thesis aimed to confirm the factor structure of defeat and entrapment amongst various populations. Exploratory and confirmatory factor analysis demonstrated that defeat and entrapment are best conceptualised as a single psychological construct (Chapters 3 and 6), supporting one-factor theories of defeat and entrapment (e.g. Taylor et al., 2011a). During the course of conducting research for this thesis, it became apparent that the length of existing scales used to measure defeat and entrapment were not suitable for use with clinical populations. Despite evidence that defeat and entrapment may reduce symptoms of mental health problems, their measurement has not yet translated to clinical practice. Although several reasons underlie this, a lack of short measurement tool is a major factor. To address this, an eight-item scale was developed, which demonstrated good psychometric properties across four samples from clinical and non-clinical settings. The current research was supported by a discussion of the clinical implications of the work, specifically identifying how defeat and entrapment could be implemented within therapeutic interventions for mental health problems. The current thesis represents a significant contribution to original research considering defeat and entrapment as predictors of mental health problems. The thesis presents the first longitudinal evidence that defeat and entrapment impact on mental health problems for individuals recruited from community and occupational settings and first application of defeat and entrapment to a behavioural task. Through development of a short scale, the thesis also presents a potential avenue to increase the measurement of defeat and entrapment in clinical settings.

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Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the goal of early communication to the interdisciplinary team. The project aims are as follows: a) to integrate the “Preparing for Caring” screening tool into the electronic health record, b) for nursing to provide education to the caregiver and assist with identification of needs during the inpatient stay, c) for nursing and the interdisciplinary team to collaborate with the caregiver during the inpatient stay to prepare for discharge, d) to provide education of resources available within the community upon discharge, and e) to include discussion of caregiver presence during the daily interdisciplinary team meeting. Program outcome measures will include use of aggregate data reports to determine the percentage of compliance for screening conduction, case review of identified caregivers, discharge education, and provision of a resource list upon discharge. Specified outcomes are being measured weekly during the implementation phase. As a result of the above, it will be determined if identification and subsequent intervention for informal family caregivers reduces readmission rate to an inpatient facility and the caregiver’s overall sense of burden in providing care upon discharge. Expected outcomes will be reduction in 30-day readmission to the inpatient geropsychiatry unit due to caregiver distress.