Exploring the impact of carer stressors and psychological inflexibility on depression and anxiety in family carers of people with dementia

Abstract

This study aimed to explore the impact of carer stressors (neuropsychiatric symptoms of dementia, level of independence in activities of daily living, hours of caring per week), demographic factors (carer age, relationship with the person with dementia, dementia type, dementia severity, number of years since diagnosis and cohabitation status) and psychological inflexibility on depression and anxiety in family carers of people with dementia. Eighty-nine family carers with a mean age of 69.13 years old completed self-reported and interview-based questionnaires. Participants were primarily female family members aged 65 years or older looking after a person with severe Alzheimer's disease. Two final regression models (Depression model R 2 =.43; Anxiety model R 2 =.43) demonstrated that psychological inflexibility (β=.52) and the number of hours devoted to caregiving (β=.23) had a significant impact on carer depression, while psychological inflexibility was the only significant independent predictor of carer anxiety (β=.55). The findings demonstrated psychological inflexibility to be a common factor explaining mental health problems in this population even after controlling for other variables known to have an impact. Acceptance and Commitment Therapy (ACT) may be beneficial for concomitantly treating depression and anxiety in this population. Considering that fifty-two per cent of participants responded that they devote more than 41 hours to caregiving per week, a non-traditional face to face approach such as online ACT may have potential in future research. Future studies should also explore the suggested models in understudied subgroups of carers (e.g., carers of early-onset dementia, carers of people with early-stage dementia).

A Model of the Effects of Parental Illness on Youth Adjustment and Family Functioning: The Moderating Effects of Psychological Flexibility on Youth Caregiving and Stress

“…Evidence shows that ACT is effective in improving psychological flexibility and mental health outcomes in clinical and non-clinical youth and adult populations (see the review of meta-analyses, [ 58 ]). In other research, psychological flexibility was also associated with decreases in stress in adult carers [ 60 , 61 ]. A meta-analysis of ACT interventions for adult family carers found that ACT had moderate effects on depression and quality of life, small effects on anxiety, and small to moderate effects on stress [ 61 ].…”

“…Results from the present study suggested that the six ACT processes used to foster psychological flexibility could be tailored to help youth effectively balance their caregiving responsibilities in relation to other valued pursuits and manage their perceptions of care-giving stress [ 60 ]. Evidence shows that ACT is effective in improving psychological flexibility and mental health outcomes in clinical and non-clinical youth and adult populations (see the review of meta-analyses, [ 58 ]).…”

The role of thought suppression and psychological inflexibility in older family caregivers’ psychological symptoms and quality of life

“…Equally, Romero-Moreno et al (2016) demonstrated that psychological inflexibility as assessed by the Acceptance and Action Questionnaire (AAQ-II) was significantly correlated with higher levels of depression and anxiety, and that, experiential avoidance, rumination, and satisfaction with leisure significantly mediated the association between stressors and anxiety among family caregivers of people with dementia. Further, the findings of Kishita et al (2020) suggested that psychological inflexibility as measured by AAQ-II was the only significant predictor of anxiety in family caregivers of people with dementia. These studies, using the AAQ-II, a generic measure of psychological inflexibility, suggest that psychological inflexibility plays an important role in caregiver distress.…”

Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

“…Despite the high prevalence of depression and anxiety in family carers of people with dementia (Collins & Kishita, 2020;Kaddour & Kishita, 2020), many family carers have limited access to face-to-face psychological support due to various challenges. For example, family carers often spend long hours providing care, which can be equivalent to a full-time job (Jutkowitz et al, 2019;Kishita et al, 2020;Wolff et al, 2017) and can exceed 100 hours per week (NHS Digital, 2017) making it difficult for them to leave their house, particularly if they are unable to identify other family members or friends to provide care while they attend in-person support. Family carers living in rural areas face further difficulties due to the lack of local services, specialist providers and public transport (Alzheimer's Society, 2018;Samia et al, 2014).…”