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Thesis (DPhil (Environmental Health))--Cape Peninsula University of Technology, 2016. / Informal caregivers play an important role in the well-being of dependent members in a household. The burdens of these caregivers are multiple and pervasive and may contribute to mental health epidemiology as a result of worry, grief, anxiety and stress. The literature review revealed that studies in caregiving and its various facets began from a pragmatically applied interest rather than from theoretical and intellectual curiosity. The majority of the research on caregiver burden involves meta-analysis of qualitative studies with little quantitative research. Also, many of these studies are concentrated on caregivers of chronically ill patients, such as those suffering from dementia, Alzheimer’s disease, and heart disease, without much attention to care burden resulting from caring for those who are not necessarily ill. Similar studies by other researchers did not consider the impact of the physical health of the care recipients or the environmental factors that are critical in the study of female caregiver burden in low-income settings. In addition, existing studies did not adequately evaluate the many potential factors that may vary and influence the lives of the caregivers, especially in a single, comprehensive model. This study attempted to provide a more complete picture of these relationships in low-income and culturally diverse settings. The study population consisted of black/African and coloured populations living in subsidised or low-cost housing settlements. In each of the two different cultural communities, 100 black/African and 100 coloured female caregivers were selected through a systematic random sampling procedure. In addition, data were also collected from caregivers in Tamale, Ghana to assess differences between the socio-demographic profiles of the caregivers in Cape Town, South Africa and Tamale, Ghana. The theoretical paradigm used in this study is the Stress Process Model by Pearlin et al., (1990). The study instrument assessed caregiver burden with both objective and subjective measures through the use of a fully structured questionnaire. The information that was collected according to the constructs of the Stress Process Model included personal and role strains and incorporated the physical health of the care recipients and environmental factors such as kitchen and toilet hygiene. Inclusion criteria for the respondents in both Cape Town and Tamale were the principal female caregivers who were present, willing, and able to give informed consent. The Statistical Package for Social Sciences (SPSS Version 22) was used for the analyses. The Chi-square test was used to assess the relationships between environmental health, the socio-demographics of the female caregivers and the health status of the care recipients. The hierarchical regression analysis in the form of a General Linear Model was used to model caregiving burden. iv The results showed that the majority of the female caregivers were in the age group 40 – 49 years and in both Cape Town and Tamale, a large proportion was in the low-income group. Also, the majority of the informal caregivers in the two samples were in care tasks as a full-time job, providing more than 40 hours of care per week. Regarding the length of time in caregiving, a large proportion of the caregivers in both Cape Town and Tamale had been in the care role for more than three years preceding the survey, and almost all the caregivers in the Cape Town sample (98.4%) did not use any form of caregiving programme to ameliorate the negative effects of caregiving. Further, the results showed statistically significant relationships between the socio-demographic characteristics of female caregivers (age, education, population group and income status) and the diarrhoea status of the care recipients. Also, a significant relationship was shown between environmental health variables of the home (kitchen hygiene and toilet hygiene) and the physical health of the care recipients. The major predictors of female caregiver burden in the samples were the physical health of the care recipients and access to social grants. On the basis of the analyses, it was recommended that the government should recognise the importance of the physical health of the care recipients and increase the amounts of social grants to the caregivers since this could improve the circumstances of both the caregivers and the care recipients. In addition, this could aid in improving the standard of living of caregivers in these households. Future research in similar settings should disaggregate the data to compare the burden of caring for caregivers of physically strong care recipients with physically ill care recipients.

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This dissertation addresses the role of welfare state/family care regimes, intersecting social locations and stress process factors in influencing the mental health and subjective well-being of informal caregivers of care recipients with age-related needs or disabilities within a European international context. Empirical analyses were conducted with secondary data from the 2012 and 2016 European Quality of Life Surveys. The study sample included informal caregivers (n=6,007) residing in seven different welfare state/family care regimes, including Denmark, Sweden, France, Germany, Italy, Greece and the United Kingdom. Ordinary least squares and ordered logit regression models revealed that welfare state/family care regime, social location (including both additive and interactive associations among gender, age group, marital status, and income), and stress process factors were independently associated with the mental health and life satisfaction of informal caregivers. Furthermore, there was some evidence to suggest that social location and stress process factors mediate some of the relationships between regime type and self-reported health and well-being and that stress process factors mediate relationships between social location factors and mental health and well-being. Overall, the results provide support for integrating welfare state/family care regime type and intersectionality factors into the SPM. Thus, future research on informal caregivers‘ mental health and well-being ought to incorporate such factors into their empirical analyses. The results also have some policy and practice implications. Residence in social democratic formal (Denmark), semi-formal (Sweden) and conservative formal (France) care regimes was the most beneficial to informal caregivers self-reported mental health. This was also the case for life satisfaction, except that residence in the liberal semi-formal (UK) was more beneficial than in the conservative formal (France) care regime. Mediating social location and stress process factors suggest that UK policy makers should address the greater social location disparities, greater role overload, and lack of coping resources that advantage Danish and Swedish informal caregivers compared to those residing in the UK. Lastly, policy makers from all the European countries assessed in the study should address the poorer mental health status of women and rural informal caregivers, those who experience role overload, secondary stressors, and lack coping resources. They should also address the the lower levels of formal education, more secondary stressors, and lack of coping resources associated with poorer subjective well-being. / Graduate

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Adults aged 50 years and older are a growing segment of the population and are more likely than their younger counterparts to experience significant stressors such as the death of a relative or friend, onset of chronic conditions, and increased health burden. The current studies use Pearlin's stress process model to evaluate the impact of these stressors on outcomes of depression. Study 1 used Wave 1 data from the ORANJ BOWL research panel of 5,688 New Jersey residents aged 50 and older to explore the relationship between relational life events, private religious practices, and depressed mood. Cross-sectional structural equation modeling was used to evaluate these relationships. Results showed that relational life events had a significant positive influence on depressive symptoms and this relationship was partially mediated by private religious practices. Findings indicate that non-personal life events are important sources of stress that may otherwise be overlooked when assessing risk factors among older adults. Study 2 used data from 640 men from the Research on Older Adults with HIV (ROAH) study to evaluate the impact of HIV-related health burden on depressed mood and to assess the mitigating effects of social support adequacy. Structural equation modeling showed that greater health burden was associated with more depressive symptoms; this relationship was significantly partially mediated by emotional support adequacy, which was a measure of unmet social need. Findings indicate that health burden has a cumulative impact on psychological health and programs and supports that target social wellness can improve this relationship. These studies point to the importance of understanding sources of risk and resilience among older people and in an attempt to improve overall health outcomes. / Ph. D. / Older adults constitute a growing portion of the population in the United States and around the world. Better understanding of challenges older adults face, including stressful life events and changes in health, could contribute to better outcomes in their later years. Two studies were designed to: (1) understand the relationship between events that affect one’s friends and family (i.e., relational life events) and feelings of depression, and explore whether religious expression is useful in reducing stress; and (2) evaluate the influence of health burden on feelings of depression in older adults with HIV and understand how social support can reduce stress from living with HIV. Data for this work come from the ORANJ BOWL research panel of interviews with 5,688 New Jersey adults and the Research on Older Adults with HIV (ROAH) study of 914 New York City residents aged 50 and older with HIV in 2005. Findings from the first study show that relational life events are associated with more depressive symptoms and more private religious expression. Thus, relational life events are an important risk factor to which family members and health service providers should pay attention. Findings from the second study demonstrate that more health difficulties in people with HIV is associated with more depressive symptoms. This is especially true when self-rated health is poorer and the number of overall chronic conditions are greater. Social support is an important resilience factor that lessens the influence of health burden on psychological health, so relatives and service providers should promote social wellness in addition to HIV treatment-specific interventions. Together, the results of these studies reveal numerous risk and resilience factors to consider when working to improve the lives of older people.