미국 치매노인 부양자의 우울증에 영향을 미치는 요소 : 배우자 부양자와 딸 부양자 비교 연구 = The Impact of Family Caregiving for the Elderly with Dementia on Depression in the United States: Does the Relationship of Caregivers to Care Recipients Matter?

다국어 초록 (Multilingual Abstract)

Adult child caregivers and spousal caregivers might deal with differential challenges. Studies about caregivers’ psychological outcomes, however, tended to investigate associations between caregiving and its outcomes by pooling adult child caregivers and spousal caregivers together. By using a U. S. sample of family caregivers who assisted a relative with dementia, this study examined whether the relationship of caregivers to care receivers (daughter caregivers or spousal caregivers) made a difference in levels of depressive symptoms. The result showed that wife caregivers were more likely to be depressed than daughter caregivers. For daughter caregivers, role overload, role captivity, and behavior problems significantly influenced on depression. Besides these variables, the level of education was a significant predictor for wife caregivers. Role captivity and behavior problems significantly impacted on depression for husband caregivers. Thus, role captivity and behavioral problems were common predictors for all the caregivers. Specifically, higher levels of role captivity and behavioral problems were likely to make caregivers more depressed. The implication of these results were discussed.

국문 초록 (Abstract)

본 연구는 미국의 치매노인 부양자들을 대상으로 하여 치매환자가 배우자인 경우와 부모인 경우를 분리하여 이들 두 집단의 우울증이 어떠한 차이를 보이는지 또 우울증에 영향을 미치는 요소가 어떻게 다른지를 회귀모형을 통해 분석해보았다. 분석결과에 의하면, 치매에 걸린 남편을 돌보는 아내 부양자가 치매에 걸린 부모를 돌보는 딸 부양자보다 우울증 점수가 더 높은 경향성을 보여주었다. 한편, 배우자 부양자와 딸 부양자 집단의 우울증 점수에 영향을 미치는 요소들에 어떠한 공통점과 차이점을 갖고 있는지 알아보기 위해 각각의 회귀분석을 실시한 결과는 다음과 같다. 먼저, 딸 부양자의 경우 역할부담감, 역할구속감, 그리고 문제행동이 그들의 우울증에 유의미한 영향을 주었고, 아내 부양자의 경우에는 역할부담감, 역할구속감, 문제행동, 그리고 교육수준이 우울증에 유의미한 영향을 주는 변수였으며, 마지막으로 남편 부양자에게는 오직 역할구속감과 문제행동만이 그들의 우울감에 유의미한 영향을 미치는 변수로 나타났다. 따라서 모든 부양자 집단의 우울증에 공통적으로 영향을 주는 유의미한 예측변수는 역할구속감과 문제행동이었다. 즉 부양자의 역할구속감이 클수록, 그리고 피부양자인 치매환자의 문제행동 수준이 높아질수록 부양자의 우울증 점수는 높아지는 경향성을 보였다.

참고문헌 (Reference)

1 Moen, P., "Women's Work and Caregiving Roles: A life Course Approach" 49 (49): S176-S186, 1994

2 Brody, E.M., "Women in the Middle and Family Help to Older People" 21 (21): 471-480, 1981

3 Stephens, M.A.P., "Where Two Roles Intersect: Spillover between Parent Care and Employment" 12 : 30-37, 1997

4 Hendershott, A.B., "The Reluctant Caregivers: Learning to Care for a Loved One with Alzheimers(Chapter 1-2)" Bergin & Garvey 2000

5 Morris, L., "The Relationship between Marital Intimacy, Perceived Strain and Depression in Spouse Caregivers of Dementia Sufferers" 61 : 231-236, 1993

6 Lewis, R.D.H., "The Impact of the Marital Relationship on the Experience of Caring for an Elderly Spouse with Dementia" 18 : 209-231, 1998

7 Zarit, S.H., "Subjective Burden of Husbands and Wives as Caregivers: A Longitudinal Study" 26 (26): 260-265, 1986

8 Stephens, M.A.P., "Stress of Parent Care: Positive and Negative Effects of Women's Other Roles" 12 (12): 376-386, 1997

9 Zarit, S.H., "Stress Reduction for Family Caregivers: Effects of Adult Day Care Use" 53B : S267-S278, 1998

10 Cantor, M., "Strain among Caregivers: A study of experience in the United States" 23 : 597-604, 1983

11 Franks, M.M., "Social Support in the Context of Caregiving: Husbands Provision of Support to Wives Involved in Parent Care" 51 (51): 43-52, 1996

12 Ward, R., "Sandwiched Marriages: The Implications of Child and Parent Relations for Marital Quality in Midlife" 77 (77): 647-666, 1998

13 Williamson, G., "Relationship Orientation, Quality of Prior Relationship, and Distress among Caregivers of Alzheimer's Patients" 5 : 502-509, 1990

14 Townsend, A.L., "Quality of the Relationship between Elderly Spouse: Influence on Spouse Caregivers Subjective Effectiveness" 46 : 33-39, 1997

15 Schulz, R., "Psychiatric and PhysicalMorbidity Effects of Alzheimer's Disease Caregiving: Prevalence, Correlation, and Causes" 35 : 771-791, 1995

16 Aneshensel, C.S., "Profiles in Caregiving: The Unexpected Career (Chapter 1-7)" Academic Press 1995

17 Tennstedt, S., "Predictors of Informal Care for Frail Elders: the Role of Secondary Caregivers" 29 (29): 677-683, 1989

18 Zarit, S.H., "Parent-Child Relationships in Adulthood and Later Years. In Handbook of Parenting" Erlbaum 135-161, 2002

19 Treas, J., "Older Americans in the 1990s and Beyond" 50 (50): 1-48, 1995

20 Kramer, B.J., "Marital History and the Prior Relationship as Predictors of Positive and Negative Outcomes among Wife Caregivers" 42 : 367-375, 1993

21 Martire, L.M., "Juggling Parent Care and Employment Responsibilities: The Dilemmas of Adult Daughter Caregivers" 48 (48): 167-173, 2003

22 Wright, L.K., "Health Consequences of Caregiver Stress" 2 : 181-195, 1993

23 Dwyer, J.W., "Gender, Family, and Long-Term Care of. In Gender, Families, and Elder Care" Sage 3-17, 1992

24 Stoller, E.P, "Gender Differences in the Experiences of Caregiving Spouses. In Gender, Families, and Elder Care" Sage 49-64, 1992

25 Miller, B., "Gender Differences in Spouse Caregiver Strain: Socialization and Role Expectation" 52 : 311-321, 1990

26 Allen, S.M., "Gender Differences in Spousal Caregivign and Unmet Need for Care" 49 (49): S187-S195, 1994

27 Miller, B., "Gender Differences in Caregiving: Fact or Artifact?" 32 : 498-507, 1992

28 Suitor, J.J., "Family Caregiving and Marital Satisfaction: Findings form 1-year Panel Study of Women Caring for Parents with Dementia" 56 : 691-690, 1994

29 Horowitz, A., "Family Caregivers to the Frail Elderly. In Annual Reviewof Gerontology andGeriatrics" Springer 1985

30 Adamson, D., "Factors Affecting Marital Happiness of Caregivers of the Elderly in Multigenerational Families" 20 (20): 62-70, 1992

31 Spaid, W.M., "Emotional Closeness and Caregiver Burden in the Marital Relationship" 21 : 197-211, 1994

32 Whitlatch, C.J., "Efficacy of Interventions with Caregivers: A Reanalysis" 31 (31): 9-14, 1991

33 Youn, G., "Differences in Familism Values and Caregiving Out comes among Korean, Korean American, and White American Dementia Caregivers" 14 (14): 355-364, 1999

34 Kim, J. S., "Daughter-in-law in Korean Caregiving Families" 36 (36): 399-408, 2001

35 Kasper, J.D., "Cognitive Impairment and Problem Behaviors as Risk Factors for Institutionalization" 13 (13): 371-385, 1994

36 Pearlin, L.I., "Caregiving and the Stress Process: An Overview of Concepts and Their Measures" 30 : 583-594, 1990

37 Stone, R., "Caregivers of the Frail Elderly: A National Profile" 27 : 616-626, 1987

38 McFall, S., "Caregiver Burden and Nursing Home Admission of Frail Elderly Persons" 47 : S73-S79, 1992

39 Johnson, C., "A longitudinal Study of Family Supports to Impaired Elderly" 23 (23): 612-618, 1983