Purpose: In order to learn more about the service needs of families where mothers with substance abuse histories are absent due to criminal justice involvement, relative caregivers of their children were interviewed regarding support needs, coping, stigma and future plans. The purpose included how the experience of this caregiving relates to the mental health of caregivers. The interview addressed the caregiver's emotional response to the care situation assessing depression as well as narrative reports of stressors and related emotions.

Method: We interviewed 25 female kin caregivers using a semi-structured questionnaire that asked about demographic characteristics, caregiving situation, their health issue and the health of other family members, their social support and service needs, their substance use as well as substance use by other family and how HIV, substance use and criminal justice issues affect the families. We used the Center for Epidemiological Studies Depression Scale (CES-D) to assess depressive symptoms, both affective and somatic. Analyses of CES-D scores were conducted to determine what structural, health and caregiver factors were associated with elevated depression symptoms. Factors such as age, illnesses, emotional–behavioral factors, finances and other supportive services were explored. Interview transcripts were coded to determine types of responses, relationships between response categories. The responses were analyzed using descriptive, open coding categories, reviewed for commonalities to derive major themes.

Results: The sample of 25 African American women caregivers ranged in age from 22-68; 56% were grandmothers of and 24% were aunts of the children in their care. Caregivers scored a mean of 16.3 (Median 14, Range 0-48) on the CES-D, just above the cut point of 16 utilized by most researchers to designate a clinically significant depression score. Caregivers reporting two or more illnesses had a mean of 21.54 (t23_df25)=-2.71, p<.05,.013). Those reporting they had their own emotional problems had CES-D scores that were significantly higher (mean of 24.88, t(21_df,23)=-2.36,p<.05,.04) than those not reporting their own emotional conditions. The 16 children with reported emotional problems were more likely to be living with a caregiver who is depressed (mean=28.19) than children who were not reported to have emotional problems (mean=14.96), t (37_df39)= 2.95, p<.01, .007. Family income was not related to depression; when we examined those with income over $15K (CES-D mean=16.92) versus under $15K (mean= 16.45), (mean= 16.45),t(22_df,24)=.096,p>.05,.924. Findings were augmented by examples from narrative analysis of stressors including parenting and child behavior issues, financial issues, and caregiver illness concerns.

Implications for practice: The findings suggest screening methods through which agencies and practitioners can use to more effectively assist those in need. Caregiving factors appear to be clearly related to higher depressive symptoms, which are even higher when there are more physical symptoms present. The findings suggest that child welfare and service providers for the aging should explore the stresses of family composition and care patterns, especially when caregivers present with multiple health conditions or are caring for children with emotional problems.