In 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.
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.
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