Does Caregiving Cause Psychological Stress? Researchers Say It Depends

A new  study recently published in the Annals of Behavioral Medicine investigating the psychological impact of caregiving suggests that heredity and upbringing may play a stronger role in who develops stress-related problems than was previously thought.   The study examined 1,228 female twins, some of whom were caregivers while others were not.    Mental health problems such as depression seem to be strongly linked to family history of depression and type of upbringing caregivers received.  

According to lead researcher Peter Vitaliano, a professor of psychiatry and psychology at the University of Washington where the stmudy was conducted, there has never been data actually showing that caregiving causes stress directly despite more than a thousand research studies on caregiver stress published since 1953.   Given the rise in chronic health problems such as Alzheimer's disease and other conditions requiring long-term care, the shortage in trained health care workers has placed a greater demand on family members to devote much of their time and resources to provide patient care.   Based on previous research findings, Vitaliano and his colleagues argue that psychiatric problems in caregivers are a function of exposure to stress as well as vulnerability factors such as early  family environment, genetic factors, and personality disposition.  How people responds to stressors also depends on their resources, including methods of coping, social support networks, and income.

If a person had problems with depression before becoming a caregiver, "caregiving may be like putting salt on the wound," said Vitaliano.   Caregivers with no history of depression are no more likely to develop depressive symptoms than non-caregivers.   Depression and perceived mental health are largely influenced by heredity while perceived stress is often related to the kind of environment in which a person is raised.   If a person is raised to learn poor coping strategies for dealing with stress, then they will be less able to handle the stress involved with caregiving.

The  study focuses on monozygotic (identical) and dizygotic (fraternal) twins to tease out the role of genetics in determining who is at risk for developing mental health problems.   Since the twins in the study share a common upbringing, the impact of environment could also be measured.    In discussing the results of the study, Vitaliano drew on the concept of diathesis - a medical term for a hereditary or constitutional predisposition towards a disorder.   Based on previous research, stress hormones are especially high in caregivers with long-term personality factors that make them more vulnerable to mental health problems.   This includes neuroticism and disagreeableness.   Caregiver stress also appears to lead to greater problems with chronic illness such as heart disease or cancer than non-caregivers with chronic illness.

With the rising need for more caregivers in future, Vitaliano suggests that limited health care dollars should focus on identifying those caregivers who are at high risk for developing mental health problems.   With proper intervention and better support programs in place, preventing the emotional burnout often seen in long-term caregivers may be increasingly important in providing care for people in need.

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