Predictors of Depression Among Caregivers of Older Adults with Severe Mental Illness

Background and Purpose: Approximately one million older persons have a severe mental illness (SMI).  This number will double by the year 2030 (Cohen, 2003). Family support and care is critical to enhance older SMI individuals ability to continue living in the community. One third to one half of persons with SMI live with family members on an ongoing basis (Lefley, 2003) and many family members provide on-going support and assistance. Due to the chronic nature of these disorders, family members are often called on to provide long-term assistance to their disabled relatives. Numerous studies indicate that family members providing care to those with SMI often experience substantial stress, burden and psychological distress. Little research, however, has focused on those who provide care for SMI elders.  These family caregivers confront challenges related to not only to psychiatric problems but, also, aging-related concerns.  This study sought to investigate psychological distress among older SMI caregivers and factors associated with this distress. 

Methods: A cross-sectional research design was employed with caregivers of older clients (55 years+) who had a diagnosis of a SMI (schizophrenia, schizoaffective disorder, bipolar disorder, or major recurrent depression) and were being treated in community-based mental health clinics. Permission of older SMI clients was sought to contact the family member from whom they received the most support. Of 118 caregivers approached, 96 participated.  Surveys were conducted via telephone by trained research assistants. Tessler and colleagues’ (1992) family caregiver scales were used to collect data on subjective and objective caregiver burden, client symptoms, and social support.  Psychological distress was operationalized as depression using the Brief Symptom Inventory-18 (Derogatis, 2001).  A scale derived from The Caregiver Health Effects Study (Schulz et al., 1997) was used to measure caregiver rewards. Descriptive, bivariate and hierarchical linear regression analyses were conducted.

Findings: Most caregivers were white women. The vast majority (85%) had contact with their older SMI family member at least several times per week.  Almost 40% of caregivers were adult children, with the next largest group of respondents being siblings.

Over half of the respondents indicated total annual family incomes of less than $30,000.  All caregivers reported assisting their older family members with some aspects of daily functioning.  Caregivers reported low to moderate subjective burden and moderate rewards.  Although overall rate of depression was low, a substantial portion (25%) of the caregivers scored in the clinical range for depression.  Care recipient gender (male) and number of symptoms, and caregiver health, income, employment, marital status, relationship to care recipient, subjective burden and rewards were significantly associated with caregiver depression at the bivariate level.   Results of regression analysis indicated that lower income, poorer caregiver health and higher subjective burden were predictive of caregiver depression, F(3,81) = 10.8, p < .001; R² = .26. 

Implications:  Assessment of caregivers of older SMI clients is critical to maintain the functioning of both clients and caregivers. Additional research is required to clarify the emotional and practical needs of those providing care for the growing population of older persons with SMI.