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A Stress and Coping Model of Adjustment to Caring for an Adult with Mental Illness

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Abstract

This study investigated the utility of a stress and coping framework for identifying factors associated with adjustment to informal caregiving to adults with mental illness. Relations between stress and coping predictors and negative (distress) and positive (positive affect, life satisfaction, benefit finding, health) carer adjustment outcomes were examined. A total of 114 caregivers completed questionnaires. Predictors included relevant background variables (carer and care recipient characteristics and caregiving context), coping resources (optimism, social support, carer-care recipient relationship quality), appraisal (threat, control, challenge) and coping strategies (problem-focused, avoidance, acceptance, meaning-focused). Results indicated that after controlling for relevant background variables (burden, caregiving frequency, care recipient symptom unpredictability), better caregiver adjustment was related to higher social support and optimism, better quality of carer-care recipient relationship, lower threat and higher challenge appraisals, and less reliance on avoidance coping, as hypothesised. Coping resources emerged as the most consistent predictor of adjustment. Findings support the utility of stress and coping theory in identifying risk and protective factors associated with adaptation to caring for an adult with mental illness.

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References

  • Aitenza, A., Stephens, M. A. P., & Townsend, A. L. (2002). Dispositional optimism, role-specific stress, and the well being of adult daughter caregivers. Research on Aging, 24, 193–217.

    Article  Google Scholar 

  • Armeli, S., Gunthert, K. C., & Cohen, L. H. (2001). Stressor appraisals, coping and post-event outcomes: The dimensionality and antecedents of stress-related growth. Journal of Social & Clinical Psychology, 20, 366–395.

    Article  Google Scholar 

  • Australian Bureau of Statistics. (2004). Disability, ageing and carers: Summary of findings, Australia, 2003, cat. no. 4430.0. Canberra: Australian Bureau of Statistics.

    Google Scholar 

  • Baronet, A. M. (2003). The impact of family relations on caregivers’ positive and negative appraisal of their caretaking activities. Family Relations, 52, 137–142.

    Article  Google Scholar 

  • Billings, A. R., & Moos, R. H. (1982). Psychosocial theory and research on depression: An integrative framework and review. Clinical Psychology Review, 2, 213–237.

    Article  Google Scholar 

  • Cannuscio, C. C., Colditz, G. A., Rimm, E. R., Berkman, L., Jones, C. P., & Kawachi, I. (2004). Employment status, social ties, and caregivers’ mental health. Social Science and Medicine, 58, 1247–1256.

    Article  PubMed  Google Scholar 

  • Cannuscio, C. C., Jones, C., Kawachi, I., Colditz, G. A., Berkman, L., & Rimm, E. (2002). Reverberations of family illness: A longitudinal assessment of informal caregiving and mental health status in the nurses’ health survey. American Journal of Public Health, 92, 1305–1311.

    Article  PubMed  Google Scholar 

  • Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4, 92–100.

    Article  PubMed  CAS  Google Scholar 

  • Caserta, M., Lund, D., Utz, R., & de Vries, B. (2009). Stress related growth among the recently bereaved. Aging & Mental Health, 13, 463–476.

    Article  Google Scholar 

  • Chang, K. H., & Horrocks, S. (2006). Lived experiences of family caregivers of mentally ill relatives. Journal of Advanced Nursing, 53, 435–443.

    Article  PubMed  Google Scholar 

  • Chen, F.-P., & Greenberg, J. S. (2004). A positive aspect of care giving: The influence of social support on care giving gains for family members of relatives with schizophrenia. Community Mental Health Journal, 40, 423–435.

    Article  PubMed  Google Scholar 

  • Chien, W.-T., Chan, S. W. C., & Morrisey, J. (2005). The perceived burden among Chinese family caregivers of people with schizophrenia. Journal of Clinical Health Nursing, 16, 1151–1161.

    Article  Google Scholar 

  • Coles, A. R., Pakenham, K. I., & Leech, C. (2007). Evaluation of an intensive psychosocial intervention for children of parents with Multiple Sclerosis. Rehabilitation Psychology, 52(2), 133–142.

    Article  Google Scholar 

  • Cooper, C., Katona, C., Orrell, M., & Livinston, G. (2008). Coping strategies, anxiety and depression in caregivers of people living with Alzheimer’s Disease. International Journal of Geriatric Psychiatry, 23, 929–936.

    Article  PubMed  Google Scholar 

  • Crawford, J. R., & Henry, J. D. (2003). The depression anxiety and stress scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111–131.

    Article  PubMed  Google Scholar 

  • Cuijpers, P. (1999). The effects of family interventions on relative’s burden: A meta-analysis. Journal of Mental Health, 8, 275–285.

    Article  Google Scholar 

  • DeLongis, A., & O’Brien, T. (1990). An interpersonal framework for stress and coping: An application to the families of Alzheimer’s patients. In M. A. P. Stephens, J. H. Crowther, S. E. Hobfoll, & D. L. Tennenbaum (Eds.), Stress and coping in later-life families. Series in applied psychology (pp. 221–239). Washington, DC: Hemisphere Publishing Corporation.

    Google Scholar 

  • Diener, E., Emmons, R., Larsen, J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71–75.

    Article  PubMed  CAS  Google Scholar 

  • Dyck, D. G., Short, R., & Vitaliano, P. P. (1999). Predictors of burden and infectious illness in schizophrenia caregivers. Psychosomatic Medicine, 61, 411–419.

    PubMed  CAS  Google Scholar 

  • Ferriter, M., & Hubband, N. (2003). Experiences of a parent with a son or daughter suffering from schizophrenia. Journal of Psychiatric and Mental Health Nursing, 10, 552–560.

    Article  PubMed  CAS  Google Scholar 

  • Fitzell, A., & Pakenham, K. I. (2010). Application of a stress and coping model to positive and negative adjustment outcomes in colorectal cancer caregivers. Psycho-Oncology, 19, 1171–1178.

    Article  PubMed  Google Scholar 

  • Fraser, E., & Pakenham, K. I. (2008). Evaluation of a resilience-based intervention for children of parents with mental illness. Australian and New Zealand Journal of Psychiatry, 42, 1041–1050.

    Article  PubMed  Google Scholar 

  • Gallagher, S. K., & Mechanic, D. (1996). Living with the mentally ill: Effects on the health and functioning of other household members. Social Science and Medicine, 42, 1691–1701.

    Article  PubMed  CAS  Google Scholar 

  • Ganzach, Y. (1998). Nonlinearity, multicollinearity and the probability of a type II error in detecting interaction. Journal of Management, 24, 615–622.

    Google Scholar 

  • Given, C. W., Stommel, M., Given, B., Osuch, J., Kurtz, M. E., & Kurtz, J. C. (1993). The impact of cancer patients’ symptoms and functional states on patients’ depression and family caregivers’ reaction and depression. Health Psychology, 12, 277–285.

    Article  PubMed  CAS  Google Scholar 

  • Goossens, P. J., Van Wijngaarden, B., Knoppert-Van-Der-Klein, E. A., & Van Achtberg, T. (2008). Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress. The International Journal of Social Psychiatry, 54, 303–316.

    Article  PubMed  CAS  Google Scholar 

  • Grant, J. S., Elliott, T. R., Giger, J. N., & Bartolucci, A. A. (2001). Social problem-solving abilities, social support and adjustment among family caregivers of individuals with a stroke. Rehabilitation Psychology, 46, 44–57.

    Article  Google Scholar 

  • Hooley, J. M. (2007). Expressed emotion and relapse in psychopathology. Annual Review of Clinical Psychology, 3, 329–352.

    Article  PubMed  Google Scholar 

  • Jardim, C., & Pakenham, K. I. (2009). A pilot investigation of the effectiveness of respite care for carers of an adult with mental illness. Clinical Psychologist, 13, 87–93.

    Article  Google Scholar 

  • Jardim, C., & Pakenham, K. I. (2010a). Respite care for carers of adults with mental disorders: A qualitative investigation. Advances in Mental Health, 9, 84–97.

    Article  Google Scholar 

  • Jardim, C., & Pakenham, K. I. (2010b). Carers of adults with mental illness: A comparison of respite care users and non-users. Australian Psychologist, 45(1), 50–58.

    Article  Google Scholar 

  • Jeon, Y.-H., & Madjar, I. (1998). Caring for a family member with a mental illness. Qualitative Health Research, 8, 694–706.

    Article  PubMed  CAS  Google Scholar 

  • Johnson, E. D. (2000). Differences among families coping with serious mental illness: A qualitative analysis. American Journal of Orthopsychiatry, 70, 126–134.

    Article  PubMed  CAS  Google Scholar 

  • Joyce, J., Leese, M., Kuipers, E., Schmukler, E., Harris, T., & Staples, E. (2003). Evaluating a model of caregiving for people with psychosis. Social Psychiatry and Psychiatric Epidemiology, 38, 189–195.

    Article  PubMed  CAS  Google Scholar 

  • Kershaw, T., Northouse, L., Kritpracha, C., Schafenacker, A., & Mood, D. (2004). Coping strategies and quality of life in women with advanced breast cancer and their family caregivers. Psychology & Health, 19, 139–155.

    Article  Google Scholar 

  • Lawrence, R. H., Tennestedt, S. L., & Assmann, S. F. (1998). Quality of caregiver–care recipient relationship: Does it offset negative consequences for family caregivers? Psychology and Aging, 13, 150–158.

    Article  PubMed  CAS  Google Scholar 

  • Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.

    Google Scholar 

  • Lee, T. C., Yang, Y. K., Chen, P. S., Hung, N. C., Lin, S. H., Chang, F. L., et al. (2006). Different dimensions of social support for the caregivers of patients with schizophrenia: Main effect and stress-buffering models. Psychiatry and Clinical Neuropsychiatry, 60, 546–550.

    Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scale. Sydney: The Psychological Foundation of Australia.

    Google Scholar 

  • Mangen, D. J., Bengsten, V. L., & Landry, P. H. (Eds.). (1988). Measurement of intergenerational relations. Beverly Hills, CA: Sage.

    Google Scholar 

  • McClausland, J., & Pakenham, K. I. (2003). Investigation of the benefits of HIV/AIDS caregiving and relations among caregiving adjustment, benefit finding and stress and coping variables. AIDS Care, 15, 853–869.

    Article  Google Scholar 

  • Menard, S. (1995). Applied logistic regression analysis: Sage university series on quantitative applications in the social sciences. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Östman, M., & Hansson, L. (2001). The relationship between coping strategies and family burden among relatives to admitted psychiatric patients. Scandinavian Journal of Caring Sciences, 46, 191–200.

    Google Scholar 

  • Pakenham, K. I. (2001). Application of a stress and coping model to caregiving in multiple sclerosis. Psychology, Health & Medicine, 6, 13–27.

    Google Scholar 

  • Pakenham, K. I. (2002). Development of a measure of coping with multiple sclerosis caregiving. Psychology & Health, 17, 97–118.

    Article  Google Scholar 

  • Pakenham, K. I. (in press). Caregiving tasks in caring for an adult with mental illness and associations with adjustment outcomes. International Journal of Behavioral Medicine.

  • Pakenham, K. I., Bursnell, S., Chiu, J., Cannon, T., & Okochi, M. (2006). The psychosocial impact of caregiving on young people who have a parent with an illness or disability: Comparisons between young caregivers and non caregivers. Rehabilitation Psychology, 51, 113–126.

    Article  Google Scholar 

  • Pakenham, K. I., & Dadds, M. R. (1987). Family care and schizophrenia: The effects of a supportive educational program on relatives’ personal and social adjustment. Australian and New Zealand Journal of Psychiatry, 21, 580–590.

    Article  PubMed  CAS  Google Scholar 

  • Pakenham, K. I., Dadds, M. R., & Lennon, H. V. (2002). The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: A controlled treatment outcome study. AIDS Care, 14, 731–750.

    Article  PubMed  CAS  Google Scholar 

  • Pakenham, K. I., Dadds, R. M., & Terry, D. J. (1994). The relationships between adjustment to HIV and both social support and coping strategies. Journal of Consulting and Clinical Psychology, 62, 1203–1994.

    Article  Google Scholar 

  • Pakenham, K. I., & Finlayson, M. (in press). Caregiving. In M. Finlayson (Ed.), Multiple sclerosis rehabilitation: From impairment to participation. NY: Taylor & Francis Publishing.

  • Park, C. L., Cohen, L. H., & Murch, R. L. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64, 71–105.

    Article  PubMed  CAS  Google Scholar 

  • Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1, 115–144.

    Article  Google Scholar 

  • Pavot, W., & Diener, E. (1993). Review of the satisfaction with life scale. Psychological Assessment, 5, 164–172.

    Article  Google Scholar 

  • Perlick, D. A., Hohenstein, J. M., Kaczynski, R., & Rosenheck, R. A. (2005). Use of mental health and primary care services by patients with bipolar disorder: A preliminary study. Bipolar Disorders, 7, 126.

    Article  PubMed  Google Scholar 

  • Pinquart, M., & Sorensen, S. (2007). Correlates of physical health of caregivers: A meta analysis. Journal of Gerontology, 62B, 126–137.

    Google Scholar 

  • Pollio, D. E., North, C. B., Osborne, V., Kap, N., & Foster, D. A. (2001). The impact of psychiatric diagnosis and family system relationship on problems identified by families coping with a mentally ill member. Family Processes, 40, 199–209.

    Article  CAS  Google Scholar 

  • Qiu, Y., & Li, S. (2008). Stroke: Coping strategies and depression among Chinese caregivers of survivors during hospitalisation. Journal of Clinical Nursing, 17, 1563–1573.

    Article  PubMed  Google Scholar 

  • Reinhard, S. C., Gubman, G. D., Horwitz, A. V., & Minsky, S. (1994). Burden assessment scale for families of the seriously mentally ill. Evaluation and Program Planning, 17, 261–269.

    Article  Google Scholar 

  • Sarason, I. G., Sarason, B. R., & Shearin, K. N. (1987). A brief measure of social support: Practice and theoretical implications. Journal of Social and Personal Relationships, 4, 497–510.

    Article  Google Scholar 

  • Scazuka, M., & Kuipers, E. (1999). Coping strategies in relatives of people with schizophrenia before and after psychiatric admission. British Journal of Psychiatry, 172, 154–158.

    Article  Google Scholar 

  • Scheier, M. F., & Carver, C. S. (1985). Optimism, coping and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.

    Article  PubMed  CAS  Google Scholar 

  • Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery and self esteem): A re-evaluation of the life orientation test. Journal of Personality and Social Psychology, 67, 1063–1078.

    Article  PubMed  CAS  Google Scholar 

  • Schulze, B., & Rossler, W. (2005). Caregiver burden in mental illness: Review of measurement, findings and interventions in 2004–2005. Current Opinions in Psychiatry, 18, 684–691.

    Article  Google Scholar 

  • Segal, M. E., & Schall, R. R. (1996). Life satisfaction and caregiving stress for individuals with stroke and their primary caregivers. Rehabilitation Psychology, 41, 303–320.

    Article  Google Scholar 

  • Seligman, M. E. (1991). Learned helplessness. New York: Knopf.

    Google Scholar 

  • Singh-Manoux, A., Gueguen, A., Martikainen, P., Ferrie, J., Marmot, M., & Shipley, M. (2007). Self rated health and mortality: Short and long term associations in the Whitehall II study. Psychosomatic Medicine, 69, 138–143.

    Article  PubMed  Google Scholar 

  • Song, L., Biegel, D. E., & Milligan, S. E. (1997). Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Mental Health Journal, 33, 269–286.

    Article  PubMed  CAS  Google Scholar 

  • Song, L.-Y., & Singer, M. (2006). Life stress, social support, coping and depressive symptoms: A comparison between the general population and family caregivers. International Journal of Social Welfare, 15, 172–180.

    Article  Google Scholar 

  • Stern, S., Doolan, M., Staples, E., Szmuckler, G., & Eisler, I. (1999). Disruption and reconstruction: Narrative insights into the experience of family members caring for a relative diagnosed with serious mental illness. Family Processes, 38, 353–369.

    Article  CAS  Google Scholar 

  • Van Wijngaarden, B., Schene, A. H., & Koeter, M. W. J. (2004). Family caregiving in depression: Impact on caregivers’ daily life, distress and help seeking. Journal of Affective Disorders, 81, 211–222.

    Article  PubMed  Google Scholar 

  • Watson, D., & Clarke, A. L. (1994). Manual for the positive and negative affect schedule—Expanded form. USA: The University of Iowa.

    Google Scholar 

  • Webb, C., Pfeiffer, M., Mueser, K. T., Gladis, M., Mensch, E., DeGirolamo, J., et al. (1998). Burden and well-being of caregivers for the severely mentally ill: The role of coping style and social support. Schizophrenia Research, 34, 169–180.

    Article  PubMed  CAS  Google Scholar 

  • Winefield, H. R. (2000). Stress reduction for family caregivers in chronic mental illness: Implications from a work stress management perspective. International Journal of Stress Management, 7, 193–207.

    Article  Google Scholar 

  • Zhang, J., Vitaliano, P. P., & Lin, H.-H. (2006). Relations of caregiving stress and health depend on the health indicators used and gender. International Journal of Behavioural Medicine, 13, 173–181.

    Article  Google Scholar 

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Acknowledgments

We are grateful for the assistance with recruitment by ARAFMI (QLD), Carers Queensland and the Redlands and Gold Coast Hospitals.

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Correspondence to Kenneth I. Pakenham.

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Mackay, C., Pakenham, K.I. A Stress and Coping Model of Adjustment to Caring for an Adult with Mental Illness. Community Ment Health J 48, 450–462 (2012). https://doi.org/10.1007/s10597-011-9435-4

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