Women's unpaid caregiving and stress.

If the title of this article makes you wonder if your daughter has enough medication to last until payday or whether your father-in-law's new home-care worker will actually follow your instructions, then you are like many women in Canada today. It's no secret that women provide the vast majority of care for family and friends, (1) but the health effects of women's unpaid caregiving have not been well researched.

What little research there is on stress and caregiving typically focuses on the mental health of individuals providing care for others with a specific disease or problem. For example, one-third of women caregivers for individuals with Multiple Sclerosis are distressed to the point that they have a clinical disorder themselves. (2) A landmark study on the connections between caring for an individual with Alzheimer's disease and depression in caregivers reported that over 50 percent of female caregivers suffered from clinical depression. (3) Numerous studies have reported that more women than men are likely to suffer negative health effects of caregiving, especially in regards to mental health. (4) One explanation for these findings is that because caregiving is central to most women's identities, it is more likely to lead to distress for women than for men. (5) Another possible explanation is that not only do women shoulder the burden for the vast majority of caregiving but they are also more likely to be responsible for tasks that are stressful. Men are more likely to be involved in instrumental caregiving, such as household repairs, while women are more apt to be responsible for medical appointments and providing emotional support to the care recipient, activities which engage the caregiver themselves in emotional ways that may be stressful. (6)

The Healthy Balance Research Program (HBRP) in Nova Scotia has extensively studied the causes underlying women's disproportionate share of caregiving responsibilities and the accompanying negative health effects, especially the experience of negative stress. The HBRP was developed to investigate women's unpaid caregiving across a range of settings, from taking care of children to providing care for aging parents within Nova Scotia. Based on the results of two projects of the HBRP, it appears that Nova Scotian women experience many negative outcomes in association with their unpaid caregiving. Measuring stress is one way to evaluate the overall negative health impact of caregiving, especially because stress has been linked to a whole variety of negative health effects.

Using quantitative and qualitative methods, HBRP researchers have documented that caregiving is very stressful for many women. For example, HBRP researchers Martha MacDonald, Shelley Phipps and Lynn Lethbridge report that women are more likely to provide care and to experience stress as a result of trying to balance their work and home responsibilities. (7) MacDonald and colleagues analyzed data on Nova Scotian women from the Canadian census and the General Social Survey. They found that women, regardless of the number of hours of paid work they do outside the home, still report more hours of unpaid caregiving in the home than their male partners. They also found that women in the "sandwich" generation--those providing care for both children and aging family members--may experience more stress than any other group of caregivers. MacDonald and colleagues found that for men there is no association between stress and hours of unpaid caregiving, but that for women increased caregiving hours lead to increases in stress. (8)

Focus groups conducted as part of the HBRP gave women a forum to discuss the health effects of their caregiving. (9) These focus groups consisted of women involved in many types of caregiving from diverse backgrounds. Across caregiving types, ethnic groups and geographic location, many women reported that caregiving led to feelings of depression and helplessness. These women also discussed poor eating habits and disturbed sleep.

A few women in the focus groups described positive aspects of caregiving. They discussed how being a caregiver made them feel good about themselves and the skills they had acquired as a result of caregiving. What was interesting is that women who reported positive experiences of caregiving did not have a "lighter" caregiving load than depressed and stressed women, but for a variety of reasons--some of them still unclear--they were better able to cope with their load and not feel depressed. An analysis of the coping mechanisms used to offset caregiving-related stress indicated that these "unstressed" women could cope in a way that was appropriate to the problems they faced. (10) For example, they drew on strong personal and community support networks and knowledge of programs and services available to care recipients. Women in the focus groups who did not experience caregiving as stressful also mentioned that they believed they had had a right to support and services. If caregivers can approach caregiving this way, it may help to reduce stress.

Nova Scotia's Healthy Balance Research Program has contributed to the growing body of research that demonstrates the need for policies and programs that address the negative health consequences of caregiving and that recognize that the burden of caregiving falls disproportionately on the shoulders of women. As the HRBP moves into its final phase, our research findings and policy analysis can contribute to the growing national discussion on caregiving.

For more information about the Healthy Balance Research Program, see www.healthyb.dal.ca

NOTES

(1.) Armstrong P, Armstrong H. Thinking It Through: Women, Work and Caring in the New Millennium. In Grant KR, Amaratunga C, Armstrong P, Boscoe M, Pederson A, Willson K (Eds.). Caring For/Caring About Women, Home Care and Unpaid Caregiving. Aurora, ON: Garamond Press, 2004;5-43.

(2.) Pakenham KI. Relations between coping and positive and negative outcomes in carers of persons with Multiple Sclerosis (MS). Journal of Clinical Psychology in Medical Settings 2005;12(1):25-38.

(3.) Cohen D, Eisdorfer C. Depression in family members caring for a relative with Alzheimer's disease. Journal of the American Geriatrics Society 1988;36(10):885-89.

(4.) Feeney J, Alexander R, Noller P, Hohaus L. Attachment insecurity, depression, and the transition to parenthood. Personal Relationships 2003;10(4):475-93. Gahagan J, Loppie C, MacLellan M, Rehman L, Side K. Caregiver Resilience and the Quest for Balance: A Report on Findings from Focus Groups. Halifax: The Healthy Balance Research Program, 2004.

(5.) Haegedoorn M, Sanderman R, Buunk BP. Failing in spousal caregiving: The "identity-relevant stress" hypothesis to explain sex differences in caregiver distress. British Journal of Health Psychology 2002;7(4):481-92.

(6.) Armstrong P, Kits O. One Hundred Years of Caregiving. In Grant et al, 2004;45-73.

(7.) MacDonald M, Phipps S, Lethbridge L. Taking its toll: Implications of paid and unpaid work responsibilities for women's well-being. Feminist Economics 2005;11(1):63-94.

(8.) MacDonald et al, 2005.

(9.) Gahagan et al, 2004.

(10.) Brannen C. Caregiving and Well-being: Examining the Linkages between Controllability and Coping in Urban Women Caregivers. Halifax: The Healthy Balance Research Program, 2005.

Cyndi Brannen, Healthy Balance Research Program