16 June 2009

Australia research into caregiver burden

Chinese and Australian caregivers’ psychological health
Dementia News (Alzheimer’s Australia): 11 June 2009
Caregiver burden is complex and multidimensional, and caregivers have been known to develop depression, anxiety, and poorer physical health as a result of the stress of the care-giving role.

A team of researchers, led by Dr Helen Zong Ying Wu, recently published the results of its research examining the effects of cultural background on the psychological wellbeing or otherwise of informal caregivers of people with dementia in residential care.

The team recruited caregivers and residents from a dementia hospital in Shanghai (56 residents joined the study) and seven nursing homes in Sydney. Three of the nursing homes are specifically for Chinese-Australians; the 42 residents who took part in the study were from Hong Kong, China, and Taiwan. The remaining four nursing homes were mainstream Australian; 51 residents from these homes participated in the study. Residents from non–English-speaking backgrounds were excluded from the study.

The researchers gathered data, via interview and questionnaire, from caregivers, and held clinical interviews with residents when possible. All interviews were conducted in the language of choice of interviewees.

Analysis of the data indicated a number of differences between groups. A significantly greater proportion of mainstream Australian caregivers described being very upset upon the admission of their loved ones than did either the Shanghainese or Chinese-Australian caregivers; fewer mainstream Australian caregivers felt relieved than caregivers in the other groups; and a greater number of Chinese-Australian caregivers felt that admission had positive effects than did caregivers in the other groups.

The data also revealed that there were no significant differences between groups in levels of guilt felt by caregivers, but that there were differences in incidence of depression. Depression in the Shanghainese caregiver group was more common than in the Chinese-Australian group, which, in turn, was commoner than in the mainstream Australian group.

The researchers suggest that the greater levels of depression experienced by Shanghainese caregivers may be due to the stressors affecting members of this group, who had mostly stated that it was their inability to care adequately for their loved ones that had led to hospital admission. It is worth noting that in China there aren’t the support services that are available in Australia and that, due to the one-child policy, there is a lack of extended family to share the burden of care-giving. Also, in China there is significant stigma associated with dementia: families may lose face, feel deep shame, and lose social status because dementia is considered the product of past or present failure to fulfill filial obligations.

The lower incidence of depression seen in the Chinese-Australian caregivers may reflect acculturation and a diminishing of stigma, although the incidence in this group was still higher than in the mainstream Australian group. Part of the explanation for this may be that members of this group use fewer community services and delay in accessing them at all.

Dr Wu and her team concluded that culture, ethnicity, differences in social environments, and access to support services may have a bearing on the health of carers. They recommend further research to identify the best approaches to minimising ill health in caregivers after admission of loved ones into institutionalised care.

Reference: Helen Zong Ying Wu, Lee-Fay Low, Shifu Xiao, and Henry Brodaty (2009). Differences in psychological morbidity among Australian and Chinese caregivers of persons with dementia in residential care. International Journal of Geriatric Psychiatry. DOI:10.1002/gps.2264 online 24 April 2009.

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