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Download Secondary Stressors - Male Caregivers of Breast Cancer Patients
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Male Caregivers of Breast Cancer Patients SARAH DIHMES, M.A. MEHRAN HABIBI, M.D. Increase in Male Caregivers The number of cancer patients receiving informal care at home is at an all-time high. 66 million Americans (3 out of 10 homes) have a family member delivering informal care to a loved one National Center on Caregiving At least 50% of the 1.3 million cancer diagnoses will be cared for by someone in the patient’s immediate family. National Alliance for Caregiving & American Association of Retired Persons, 2009). 99% of cancer patients were receiving informal care Yabroff and Kim, 2009 75% of married women diagnosed with breast cancer report receiving copious support from their spouse. Ciambrone & Allen, 2005 Husbands comprise 30-50% of spousal caregivers Campbell & Carrol, 2007 A Rise in Male Caregivers Kim, Loscalzo, Wellisch, & Spillers, 2006 Why are there more male caregivers now? Human life span is increasing. Advances in medicine Expensive healthcare costs Limit feasibility o formal caregiving Evolution of Gender Roles Paradigm shift in traditional male and female gender roles. Limited Research on Male Caregivers Men as control subjects Focus is on elderly husbands caring for wives with Alzheimer’s disease. Lack of explanatory framework about men’s experiences. Gender Differences in Caregiving Who copes better? Men are LESS likely to: Men are MORE likely to: Seek support for their own Provide physical care. Perform more tasks related to hygiene, communication, mobility, dressing and feeding. Sacrifice gendered roles in physical and mental health needs. Report exacerbated physical ailments associated with giving care. Practice health promoting behaviors Ask for help Emotionally cope Identify themselves as caregivers. the family. Work outside the home while being a caregiver. Accept caregiving as an extension of their marital vows. Use a stoic approach. www.mengetdepression.com Adherence to Traditional Masculine Norms Traditional masculine norms commend: Self-reliance Physical Strength Emotional Control Hegemonic masculine beliefs, often thought of as societal ideals, prohibit some men from demonstrating typical DSM-IV symptoms of depression and caregiver burden. Emotional Expression Men who adhere to traditional masculine roles have more difficulty: Judging the non-verbal expressions of others Find expressing their emotions more stressful Measurement Issues DSM-IV Depressive Symptoms Crying* Sadness* Guilt * Worthlessness * Anhedonia Appetite/ weight change Sleep change Concentration difficulties Fatigue Psychomotor retardation/ agitation Male Specific Symptoms of Stress Non-Typical Depressive Symptoms Drugs & alcohol Aggression & irritability Interpersonal conflict Preoccupation with work *Not supported by traditional masculine beliefs. Men who adhere to traditional masculine norms often experience stress through more masculine congruent behaviors and emotions Magovcevic & Addis, 2008 Analyses Compliance Will compliance differ between those who completed the survey in the clinic compared to those who completed the survey online? Stage of Cancer Does the stage of breast cancer influence male caregivers’ experiences of stress? Types of Treatment Will the types of treatment impact male caregivers’ experience of stress? This Study APPLICATION OF THE STRESS PROCESS MODEL IN HUSBAND CAREGIVERS OF BREAST CANCER PATIENTS The Stress Process Model 2006: Family Caregiver Alliance held a national conference to bring together researchers, policymakers, and practitioners. They produced a report: Caregiver Assessment: Voices and Views from the Field Established national standards for all caregiving research and clinical practice. Originally created from and for CGs with dementia Conceptualized Model of Pearlin’s Cancer Caregiver Burden Model Background and Context Demographics: -Age -Gender - Culture -SES -Education -Personal history Caregiving History: -Caregiver’s relationship to patient -Length of time delivering care -Specific health problems of cancer patient -Marital quality pre-illness -Medical resource availability Primary Stressors Objective Indicators: -Activities of Daily Living -Instrumental Activities of Daily Living -Type of cancer -Treatments Subjective Indicators: -Patient’s level of pain -Patient’s mental health Secondary Stressors Roles Strains: -Family Conflicts -Occupational Strain -Economic Strain -Social Strain Intrapsychic Strains: -Self-Esteem -Mastery -Loss of Self -Role Captivity -Competence -Gain Mediators Coping & Social Support Outcomes -Depression -Anxiety -Physical Health Problems -Irascibility -Giving up Caring Role Operationalized Male Caregiver Burden Model BACKGROUND & CONTEXT VARIABLES PRIMARY STRESSORS •Demographics: •Males •Age •SES •Education •Personal history •Caregiving History: •Relationship to patient •Length of time delivering care •Specific health problems of cancer patient •Objective Indicators: •Activities of Daily Living •Instrumental Activities of Daily Living •Type of cancer •Treatments •Subjective Indicators: •Patient’s level of pain •Patient’s mental health MEDIATORS •Marital Satisfaction •Shame & Guilt Secondary Stressors •Roles Strains: •Vocational environment •Domestic environment •Social environment •Sexual relationships •Extended-family relationships •Psychological distress MODERATOR •Expressed Emotion from Wife Outcomes •Depression •DSM-IV Criteria •A-typical Symptoms •Physical Health Problems Stress Process Model Domains Background & Social Context Control Factors: gender & age Help identify pts at risk i.e. If gender is a risk factor, primary and secondary stressors may be different for females and males. Demographics Most common: gender, age, ethnicity, marital quality Background & Social Context •Demographics: •Males •Age •SES •Education •Personal history •Caregiving History: •Relationship to patient •Length of time delivering care •Specific health problems of cancer patient Primary Stressors Caregiving History Family relationship to patient (i.e. husband) Length of time being a caregiver Quality of the relationship Specific health problems of the cancer patient. Secondary Stressors Stress Outcomes Primary Stressors Background & Social Context Secondary Stressors Secondary Stressors Primary Stressors • Factors that relate directly from the cancer and caregiving role. • Disease Specific: • Original Model: memory impairment & disruptive behavior Objective Indicators: •Activities of Daily Living •Instrumental Activities of Daily Living •Type of cancer •Treatments Subjective Indicators: •Patient’s level of pain •Patient’s mental health Stress Outcomes Subsequent stressors that may occur from primary. • Caregiver’s experience of primary ongoing demands • Vocational/ occupational strain is especially difficult for men. Roles Strains: •Vocational environment •Domestic environment •Social environment •Sexual relationships •Extended-family relationships •Psychological distress Primary Stressors Background & Social Context Stress Outcomes Secondary Stressors Stress Outcomes •Depression •DSM-IV Criteria •A-typical Symptoms •Physical Health Problems • 61% of caregivers suffered from depression • National Family Caregivers Association, 2000 • Men & women caring for their ill spouses experience an increase in depression and decline in happiness • National Survey of Families and Households, 2009 • 31% of caregivers report that their role causes emotional stress • National Alliance for Caregiving & AARP, 2009 Mediators Independent variables cause the mediator, and the mediator causes the dependent variable Intermediary factor of the causal pathway Marital Satisfaction Psychological adjustment the marriage must undergo after a diagnosis of cancer. Can exacerbate or strengthen emotional bonds. Pre-illness quality of the relationship is also important. Shame & Guilt Correlate with onset and maintenance of psychopathology. Individuals who are shame prone are at increased risk for MH disorders. Moderator Interactions between the independent and dependent variables that can strengthen, weaken, or account for the relationships between the two – MacKinnon, 2008 Expressed Emotion from Wife Definition: the extent to which a family member of a distressed individual expressed critical, hostile, or emotionally overinvolved statements towards their distressed family member. Higher EE in a spouse predicts higher depression symptoms in the depressed patient Butzlaff & Hooley, 1998; Forin et al., 1992 Depressed patients living with Type of Variable Variables Measures/ Instruments Source of Report Independent Variables: Background Factors Primary Stressors Secondary Stressors Demographics Patient’s Overall Well-Being Caregiver Duties Caregiver Tasks of Daily Living Role Strains Potential Mediator Marital Satisfaction Potential Moderators Expressed Emotion Shame & Guilt Demographic Form1 FACT-B 2 Male Caregiver Male Caregiver Activities of Daily Living Instrumental Activities Male Caregiver Male Caregiver Psychological Adjustment to Illness Scale Revised Dyadic Adjustment Scale Five Minute Speech Sample Personal Feeling Questionnaire-2 Male Caregiver Male Caregiver Female Patient Male Caregiver Dependent Variables: Outcome Variables Caregiver Depression Beck Depression Inventory-II Masculine Depression Masculine Depression Scale Symptoms Physical Health Problems SF-12 Male Caregiver Male Caregiver Male Caregiver Note. 1Caregivers demographics: age, culture, SES, education, medical information, mental illness history, and length of time delivering care. 2 Functional Assessment of Cancer Therapy- Breast (FACT-B) subscales: physical, emotional, functional well-being, social/ family, and additional concerns. Men Against Breast Cancer Do educational resources help? Do male caregivers who attend workshops and educational seminars experience less stress than men who do not? Medical Setting Is there a difference between medical settings? Do the male caregivers whose wives are receiving treatment at Johns Hopkins University experience stress differently than male caregivers whose wives are being treated at private oncologists’ offices?
