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Factors Influencing Levels of Depression Among Surrogate Caregivers

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Factors influencing levels of depression among surrogate caregivers.

The prospective study examined the factors influencing levels of depression among surrogate caregivers. A sample of 177 male and 244 female American patients was used. A multiple regression was carried out to analyse the data. It found that both the patients optimism score, and the patient-surrogate relationship quality had a significant effect on the level of surrogate's depression. It would prove beneficial to replicate this study to ensure reliability and validity of the result.


Due to increases in life expectancy among the species, the ageing population are becoming debilitated and require assistance during their day to day lives. Archetypally this will result in surrogate caregivers being selected to look after them and make decisions when they are themselves unable to do so. This is an inordinate responsibility to be given and can lead to detrimental effects on the surrogate caregiver's well-being, leading to negative effects on their own health. This paper aims to clarify the different factors that can influence levels of depression among surrogate caregivers.

Emotional distress is commonplace among caregivers (Schulz et al., 2008). It has been theorised that on average, caregivers demonstrate more symptoms of depression than those of non-caregivers (Bookwala, Yee & Schulz, 2000; Pinquart & Sörensen, 2005, 2007). The interactive nature of caregiving proposes that features of the relationship may impact care provision. Caregiver depression has been found to have a significant effect on the quality of care given (Cooney, Howard, & Lawlor, 2006; Wolf, 1988); this creates great cause for concern.

Empathy is defined as "the capacity for participation in or a vicarious experiencing of another's feelings, volitions, or ideas and sometimes another's movements to the point of executing bodily movements resembling this" (Odegaard, 1996). Ferguson (2010) suggests a reciprocal relationship between the empathizer and the empathy receiver, which amounts to greater capacity to receive empathy in times of distress, such as during times of heightened depression.

Relationship attributes have been correlated to greater caregiver depression, feelings of being burdened, and providing problematic care (Cicirelli, 1993; Martin, Gilber, McEwan, & Irons, 2006). Taking into consideration caregiver and recipient relationships is important in understanding positive and negative caregiver responses (Morse, Shaffer, Williamson, & Schulz, 2012).

Given, Stommel, Given, Osuch, Kurtz and Kurts (1993) found that depression levels among family surrogate caregivers positively correlated with those of the patients. Along with this, it was found that optimism was a significant predictor of their mental health.

It has been recognised that religion can contribute to a person's sense of well-being (Myers, 2000). Studies have shown that there is a correlation between those who attend worship frequently and lower levels of depression (Idler, 1987; Idler & Kasl, 1992; Koenig, 1995). This has been said to be due to social support available (McIntosh, Silver & Wortman, 1993). Theories of depression have described hopelessness as one of its major characteristics (Beck, 1967; Beck, Rush, Shaw, & Emery, 1979).

This paper will address the effects of surrogate's level of empathetic concern and patient-surrogate relationship quality on levels of depression found among surrogate caregivers. It will also address the effect of patient's levels of optimism and surrogates views of the importance of religious beliefs on levels of surrogate depression. The current research will aim to provide answers to the following questions; "Will more empathetic surrogates with patients that have higher levels of relationship quality have higher levels of depression?" and "Will surrogates who view religion as being important and patients with higher scores of optimism lead to surrogates being more depressed?".

Taking into consideration previous research, it is hypothesised that patients and surrogates with higher levels of relationship quality will lead to higher levels of depression among surrogates than those surrogates who have higher empathetic concern. It is also hypothesised that surrogates with a higher optimism score will lead to higher depression among surrogates than those who find religious beliefs to be important.


The study consisted of 401 patients who were recruited from a doctor's office during a physical examination at an American hospital. The 401 participants were comprised of 177 (44.1%) male patients and 244 (55.9%) female patients. Of the 401 patients, 370 (92.3%) where white, and 31 (7.7%) were black. The patients age ranged from 65 to 94 years (M=72.98, SD=5.40). The data was initially attained by means of a phone interview, followed by 3 interviews (Time 1, Time 2, Time 3) conducted in-person and a concluding interview which took place at a hospital over a period of 3 years. During Time 1 an in-person interview was executed, personal sociodemographic items (age, race, gender, marital status) were attained. During Time 2 and Time 3, the sociodemographic items were again addressed by means of a self-administered questionnaire. The importance of religion to the surrogates was addressed within the interviews carried out during Time 1, 2 and 3.

The surrogates were asked to rate the importance of religious beliefs on a five point scale from 1='Not at all important' to 5= 'Extremely important', with an option for 'Not applicable'. The Interpersonal Reactivity Index (Davis, 1980, 1983) was used to approach individual differences in empathy. The IRI is a measure of dispositional empathy that believes that empathy is as a result of a combination of cognitive and affective components which have influence on each other. The IRI was composed of four subscales which were derived using factor analysis, each tapping into a separate facet of empathy. The subscale that was focused on during this paper was empathetic concern, which assesses the tendency to experience feelings of warmth, compassion, and concern for others undergoing negative experiences.

A five point scale was administered to patients to obtain data regarding relationship quality. This was administered to both patients and surrogates at Time 1. Nine items were chosen from the Dyadic Relationship Scale (DRS) component of the Family Assessment Measure (FAM; Skinner, Steinhauer, & Santa-Barbara, 1983). DRS measures negative and positive dyadic interactions from the perspective of both the patient and the surrogate (Sebern &



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