The dementia caregiving literature is reviewed with the goals of (a) assessing the prevalence and magnitude of psychiatric and physical morbidity effects among caregivers, (b) identifying individual and contextual correlates of reported health effects and their underlying causes, and (c) examining the policy relevance of observed findings. Virtually all studies report elevated levels of depressive symptomatology among caregivers, and those using diagnostic interviews report high rates of clinical depression and anxiety. The evidence is more equivocal and generally weaker for the association between caregiving and physical morbidity, such as self-rated health, number of illnesses, symptomatology, health care utilization, preventive health behaviors, and cardiovascular functioning. Across studies, psychiatric morbidity in caregivers was linked to patient problem behaviors, income, self-rated health, perceived stress, and life satisfaction. Physical morbidity was associated with patient problem behaviors and cognitive impairment, and with caregiver depression, anxiety, and perceived social support. Possible causes of reported effects and policy implications are discussed.

A bstract M ost deaths in the US are preceded by an extended period of time during which one or more fam ily members provide health and support services to their disabled relative. The high prevalence and signi® cance of disability and death have generated two large but separate empirical literatures: studies of family caregiving and research on the effects of bereavement. The purpose of this review is to facilitate the convergence of these two content areas. First, we describe and evaluate separately the theoretical perspectives used to explain caregiving and bereavem ent outcomes and consider how these frameworks can be applied to the bereavem ent process for family caregivers. Second, existing ® ndings on caregiving and bereavem ent are summarized. Third, m ethodological strengths and weaknesses of the current research are identi® ed and recommendations for future research are made. Examination of the existing literature shows few negative consequences and several positive outcomes associated with the death of the care recipient. Predictive analyses suggest that the availability of support during caregiving and the quality of the caregiving experience facilitate adaptation to bereavement among form er caregivers.M ore than tw o m illion persons d ie in the U S each year. T he larg e m ajority of these d eaths occu r am ong older persons suffering from one or m ore d isablin g con dition s w hich com prom ise their ability to function in depend ently. As a resu lt, a typical d eath is preced ed by an extend ed perio d of tim e d uring w hich one or m o re fa m ily m em bers provid e health and support services to their d isab led relative. C urren t estim ates are that betw een ® ve and n in e m illion person s serve as fa m ily caregivers to sick an d disab led elderly relatives (S chulz & O ' B rien, 1994). Becau se of the high prevalen ce and signi® can ce of both fam ily caregivin g and d eath, larg e bu t separate literatures have evolved on each of these topics.Previous review s have docum ented the rapid growth of research exam ining adjustm ent to caregiving (Pearlin et al., 1990;Schulz et al., 1990;Schulz et al., 1995; T oseland et al., 1990;Zarit, 1989), but few have considered the psychological and physical health effects observed am ong fam ily caregivers after the patient dies. The in¯uence of caregiving on post-loss health and adjustm ent should also be of interest to researchers studying bereavem ent. Just as m odels of caregiving need to be extended to include an exam ination of caregiver outcom es after the carerecipient has died, existing bereavem ent m odels are likely to be incom plete without incorporating current knowledge about the dynam ics of caregiving prior to the death.Research on caregivin g and studies of bereavem ent have evolved as tw o distin ct areas of inquiry, but w e think it is im portan t to brin g these literatures together. T he pu rpose of this review is to fa cilitate and prom ote the convergence of these tw o content areas. F irst, w e d escribe and evaluate separate...

The vital roles that women play in keeping households afloat in economic crises have been largely ignored. This study of 152 women in a region that experienced catastrophic unemployment found that women are the pillars of family support. Beyond maintaining their households and supplementing their families' income whenever pos sible, the women helped to mend their demoralized families and find necessary resources for comfort and aid. When unemployment strikes families, it affects all family members. The strength of the women in this study in dealing with the needs of their husbands and children had demonstrable effects.