5 Factors that Contribute to Depression in Caregivers, Part II

crutches in a handicapped parking spaceIn Part I of this series, we discussed the rate of depression among caregivers. The Family Caregiver Alliance reports that 40% to 70% of family caregivers have clinically significant symptoms of depression, with about 25% to 50% meeting the criteria for major depression. This statistic is more alarming when compared to the general population, where the depression rate is 6.7%.

We also addressed the first five of 10 factors that contribute to depression: isolation, role conflict, change in identity, guilt and shame, and empathy overload. The following are five other issues that contribute to the depression rate among caregivers.

Financial Concerns

The financial stress of caregiving affects many families. It is not uncommon for the income of families to decrease when one of the primary contributors is unable to work due to injury or illness. This often occurs at a time when medical expenses increase, further stretching the budget. For those who are caring for aging parents (or spouses), there are often costs associated with assisted-living facilities or in-home care. Some of these costs are covered by insurance, but many are not.

The stress associated with financial constraints can be all-consuming. In fact, many families experience “medical bankruptcy.” According to a Harvard study, 62% of bankruptcies filed in the United States are due in part to medical bills or job loss because of injury or illness; in 78% of these cases, the families had insurance.

The best way to avoid this pitfall seems to be planning for long-term medical expenses early in life. Long-term care insurance can be very expensive if purchased at mid-life or after one has medical complications or risk factors. Short- and long-term disability policies provided by employers are often reasonably priced and well worth the investment. Health insurance is simply not enough to cover ongoing medical care for chronic illness or injuries resulting in disability. Consider an investment in long-term care and/or other supplemental policies when possible.

Loss of Autonomy

There’s no question that caregivers often give up much of their independence to care for their loved ones. This loss of autonomy is related to loss of identity, as people generally give up those “extracurricular” activities that involve socializing with others and engaging in hobbies and interests that nourish our souls. Simply being unable to go for a walk or step out for groceries at will can lead to feelings of frustration and helplessness. When possible, share the caregiving responsibilities with others so that you can maintain as much autonomy as possible.

Challenges at Work

Caregivers who are still working often find they face role conflict when caregiving interferes with work responsibilities. They frequently experience work-related stress and may face problems on the job. This is known as family responsibilities discrimination (FRD) or caregiver discrimination (CD) in the legal arena.

The Equal Employment Opportunities Commission (EEOC) issued guidelines in 2007 to help employers understand and prevent FRD and CD. These guidelines are based on legal protections provided by the Americans with Disabilities Act (ADA), Family Medical Leave Act (FMLA), Civil Rights Act, Equal Pay Act, and others. If you find that your caregiving responsibilities conflict with your work schedule or duties, talk to your supervisor or human resources representative to determine if you are eligible for FMLA or other protections.

Sense of Helplessness

One of the primary contributors to depression is a feeling of helplessness. Those who find they have limited options or the inability to change their circumstances, especially with no end in sight, often experience feelings of helplessness. In short, helplessness may lead to feeling overwhelmed by things that seem out of our control.

If you experience a sense of helplessness, it might be useful to focus on what you can control. Talk to others who are struggling with these feelings and learn from each other. A counselor may be able to help you brainstorm ideas you haven’t considered, or offer guidance in coping with these feelings. You might find a caregiver support group in your area, or check out online caregiver support groups.

Decline in Physical and Emotional Health

Many caregivers find their physical and emotional health begins to suffer as they continue to care for loved ones. In addition to depression, caregivers frequently report anxiety and grief. Exhaustion from sleep deprivation, injuries from lifting and helping with transfers, etc., take a toll on the body and mind. The literature is filled with studies and reports of physical and psychological issues experienced by caregivers. Many of these are stress-related.

It is important for caregivers to maintain their own health and mental health. Keeping regular appointments for physical, dental, and mental well-being are critical. Your ability to provide care to another human being is dependent on your own health and well-being.

It is important to recognize that caregiving also has a positive impact on psychological health for many. About a third of caregivers report no adverse effects from caregiving. In fact, many report that caregiving has a positive effect on them. Feeling good about helping another in need, learning new skills, and strengthening relationships are a few of the positive effects cited by caregivers. Even those who experience health and mental health issues often recognize the positive impact caregiving has on their lives.

How about you? What positive effects do you experience as a caregiver?


Zarit, S. (2006). Assessment of Family Caregivers: A Research Perspective in Family Caregiver Alliance (Eds.), Caregiver Assessment: Voices and Views from the Field. Report from a National Consensus Development Conference (Vol. II) (pp. 12-37). San Francisco: Family Caregiver Alliance.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by LuAnn Pierce, LCSW

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Makenna

    March 18th, 2014 at 3:45 PM

    I watched my mother go through this with my grandmother. I think that she felt this deep sense of isolation as she was the only girl in a family of all boys and the bulk of the work fell to her. She wanted to be there for my grandmother because she loved her and felt this heavy sense nof responsibility but at the same time she very much lost her family life and anytime she had for herself because of all the time she had to then spend caring for her too. So it was very much a time for her where she felt alone and overworked, with no help from others even when we tried to give it to her there was no real sense that we could give her what she really needed. She declined a lot herself during this time.

  • abbie

    March 19th, 2014 at 3:54 AM

    While it is all well and good to suggest that we plan ahead of time, you know that most of us are nowhere near doing this and then when something like this hits then naturally we are all very concerned about money and the impact that long term care will have on us and the family from a financial point of view.
    My in laws are ging through this very thing right now. My father in law went in for surgery thinking that he would be down for maybe two weeks and now he has been down for more than two months and still no signs that he is getting any better. My mother in law was close to retiring but not quite ready so that has put a kink in all of that so now I know that both of them are very worried about what all of this mean for them in the long term.

  • Jamie R

    March 19th, 2014 at 11:39 AM

    You know how you feel when you think that no one understands what you are going through or what you are feeling? I imagine that this must be what many people who care for other family members must feel like. It has to be a lonely time, knowing that there is no othetr person who has the same sort of experience that you are having and you come to feel like you are very alone in your journey.
    There are support groups, but it would be easier if there was another family member, someone with whom you were already close, who could help or take a little time out to talk or listen.

  • MariAnne

    March 20th, 2014 at 3:54 AM

    You lose even the ability to go to the drugstore if even for a minute! Your day becomes so tied up in the needs of someone else that it is easy to see how you can quickly lose yourself.

  • bryn

    March 21st, 2014 at 4:03 AM

    can you imagine having to care for someone full time and then having a full time job on top of your own family responsibilities at home too?

    how could anyone juggle so much

    and yet I know that there are people who do this every day, how they do it without pulling out all their hair I am not sure!

  • Amelia

    March 22nd, 2014 at 6:22 AM

    Bad hours, bad pay, little respect. Yep, I think that this just about sums it up

  • carrie h

    March 22nd, 2014 at 2:06 PM

    Does anyone know if you can apply for FMLA leave if you are having to take extended time off to be with a sick family member?

  • Caroline

    March 24th, 2014 at 10:36 AM

    I would be so scared about losing my paycheck from work and having to be afraid of losing my job from all of the time that I had to be away from work. There are still some employers who understand that family has to come first but there are far more who don’t understand that at all and for them it is all about the bottom line. How are you supposed to have to make a decisison in a case like that? You need to pay but at the same time you need to be able to spend this time caring for a sick relative. It really is a sad choice that many families have to go through every day.

  • LuAnn

    March 24th, 2014 at 11:16 AM

    Carrie – Most companies are required to follow the federal guidelines for FMLA, and caring for a family member is allowable under FMLA. Talk to your supervisor or HR representative to find out the details. LuAnn Pierce

  • carrie h

    March 24th, 2014 at 5:39 PM

    Thanks for the advice- I work for a very small business so I wasn’t sure what the guidelines there were regarding this issue or if there were diffeernt rules that they got to follow

  • LuAnn

    March 25th, 2014 at 12:04 PM

    Carrie and others re: FMLA:

    The FMLA only applies to employers that meet certain criteria. A covered employer is a:
    Private-sector employer, with 50 or more employees in 20 or more workweeks in the current or preceding calendar year, including a joint employer or successor in interest to a covered employer;
    Public agency, including a local, state, or Federal government agency, regardless of the number of employees it employs; or
    Public or private elementary or secondary school, regardless of the number of employees it employs.


    Only eligible employees are entitled to take FMLA leave. An eligible employee is one who:
    Works for a covered employer;
    Has worked for the employer for at least 12 months;
    Has at least 1,250 hours of service for the employer during the 12 month period immediately preceding the leave*; and
    Works at a location where the employer has at least 50 employees within 75 miles.

    Eligible employees may take up to 12 workweeks of leave in a 12-month period for one or more of the following reasons:
    The birth of a son or daughter or placement of a son or daughter with the employee for adoption or foster care;
    To care for a spouse, son, daughter, or parent who has a serious health condition;
    For a serious health condition that makes the employee unable to perform the essential functions of his or her job; or
    For any qualifying exigency arising out of the fact that a spouse, son, daughter, or parent is a military member on covered active duty or call to covered active duty status.

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