치매노인을 돌보는 가족부양자의 우울과 삶의 만족 예측요인 = Predictors of Depression and Life Satisfaction among Family Caregivers for Demented Elderly

다국어 초록 (Multilingual Abstract)

The purposes of this study were to examine depression and life satisfaction of family caregivers for demented elderly, and to identify predictors of family caregivers' depression and life satisfaction. Data were collected from 189 daughter and daughter-in-law caregivers using structured questionnaire. Most caregivers were daughters-in-law(74.6%) and most demented elderly were female(84.7%). Seventy-five percent of caregivers reported depressive symptoms and reported low life satisfaction. In the final analysis, caregiver's depression was predicted by poor health status of caregivers and frequent use of avoidance coping. Moreover, lower life satisfaction was predicted by lower family income, poor health status of caregivers, frequent use of avoidance coping, and less use of approach coping, and lower satisfaction of social support. Interventions to increase psychological well-being of caregivers such as health promotion program, education program for coping strategies are need to be developed and applied. Further caregiving studies are necessary to understand a very complex phenomenon of caregiving in sociocultural context in Korea.

국문 초록 (Abstract)

본 연구의 목적은 치매노인을 가정에서 부양하고 있는 가족부양자의 우울 및 삶의 만족 정도를 조사하고, 부양자의 우울과 삶의 만족의 예측요인을 파악하여, 부양자의 안녕을 증진시키기 위한 중재를 개발하기 위한 기초자료로 사용하고자 함이다. 자료수집은 65세 이상의 치매노인을 가정에서 돌보고 있는 189명의 딸과 며느리 부양자를 대상으로 구조화된 설문지를 이용한 면담 또는 자기기입식 설문을 통해 이루어졌다. 부양자의 74.6%가 며느리였으며, 치매노인의 84.7%가 여자였다. 부양자의 75%가 우울증상을 경험하고 있었으며, 삶의 만족 정도도 낮았다. 위계적 회귀분석을 통한 최종분석 결과, 부양자의 건강상태가 좋지 않을수록, 그리고 회피적 대처유형을 많이 사용할수록 부양자의 우울정도가 높았고, 부양자의 가족수입이 적을수록, 건강상태가 안 좋을수록, 접근적 대처유형을 적게 사용할수록, 회피적 접근유형을 많이 사용할수록, 그리고 사회적 지지에 대한 만족도가 낮을수록 부양자의 삶의 만족이 낮았다. 부양자를 위한 건강증진 프로그램 및 대처전략 교육 등과 같은 가족부양의 부정적인 영향을 최소화하고 부양자의 안녕을 증진시키기 위한 중재의 개발과 적용이 요구된다. 복잡한 부양현상을 이해하기 위해 한국의 사회문화적인 배경에서의 더 많은 부양연구가 필요하다.

참고문헌 (Reference)

1 최혜경, "한국 치매노인 부양상황에서의 스트레스 과정" 17 (17): 35-50, 1997

2 권중돈, "한국 치매가족 연구 부양부담사정도구 및 결정모형 개발" 홍익제 1995

3 조남옥, "치매환자 가족의 경험과 간호요구에 관한 연구" 1996

4 김윤정, "치매노인의 장애기간과 부양자의 대처자원이 부양자의 부담 및 부양만족에 미치는 영향" 13 (13): 63-86, 1993

5 이경자, "치매노인의 간호문제와 돌보는 가족원의 부담감에 관한 연구" 15 (15): 30-51, 1995

6 이해정, "치매노인을 돌보는 주가족간호제공자의 스트레스원과 우울 간의 관계에서 사회적 지지의 역할" 33 (33): 713-721, 2003

7 이해정, "치매노인을 돌보는 가족간호제공자의 우울 예측요인" 한국간호과학회 33 (33): 936-944, 2003

8 한국보건사회연구원, "치매노인실태 조사 및 관리대책" 한국보건사회연구원 1998

9 문혜리, "치매노인 및 가족간호인의 삶의 질과 사회복지 지원대책에 관한 경로분석" 1 : 181-201, 1998

10 김수영, "치매노인 가족보호자의 생활만족과 우울에 미치는 영향요인 한국과 미국의 비교연구" 23 (23): 193-221, 2003

11 통계청, "장래인구추계" 2001

12 김진선, "우리나라 치매노인 가족간호제공에 관한 연구의 현황과 전망" 29 (29): 1419-1433, 1999

13 이해정, "노인대상자를 돌보는 비전문 간호제공자의 대응기전과 건강반응 예측요인" 30 (30): 893-904, 2000

14 Gonzalez-Salvador, M. T.,, "The stress and psychological morbidity of the Alzheimer patient caregiver" 14 (14): 701-710, 1999

15 Baumgarten, "The psychological and physical health of family members caring for an elderly person with dementia Journal of Clinical Epidemiology" 61-70, 1992

16 Burns, N.,, "The practice of nursing research: Conduct, critique, and utilization" W.B. Saunders 2001

17 Cattanach, "The nature of elder impairment and its impact on family caregivers' health and psychological function- ing" 246-255, 1991

18 Neugarten,B.L, "The measurement of life satisfaction" 16 : 134-143, 1961

19 Lawton, "The dynamics of caregiving for a demented elder among Black and White families Journal of Gerontology" 1992

20 Radloff,L.S, "The CES-D Scale:A self-report depression scale for research in the general population" 1 : 385-401, 1977

21 Katz, "Studies of illness in the aged The index of ADL a standardized measure of biological and psychological function Journal of the American Medical Association" 914-919, 1963

22 Zarit, S. H.,, "Stress reduction for family caregivers: Effects of adult day care use" 53 (53): 267-277, 1998

23 Lee, H. S.,, "Relationship of empathy to appraisal, depression, life satisfaction, and physical health in informal caregivers of older adults" 24 (24): 44-56, 2001

24 Williamson, "Quality of prior relationship and distress among caregivers of Alzheimer's patients" 502-509, 1990

25 Haley, W. E.,, "Psychological, social, health impact of caregiving: A comparison of black and white dementia family caregivers and noncare- givers" 10 (10): 540-552, 1995

26 Schulz, R.,, "Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes" 35 : 771-791, 1995

27 Haley, W. E.,, "Predictors of depression and life satisfaction among spousal caregivers in hospice Application of a stress process model" 6 (6): 215-224, 2003

28 Covinsky, K. E.,, "Patient and caregiver characteristics associated with depression in caregivers of patients with dementia" 18 (18): 1006-1014, 2003

29 Horowitz, "Past influences on current caregiving Journal of Gerontological Social Work" 5-20, 1983

30 Park, "Modification of the Mini-Mental State Examination for use in the elderly in a non-western society Development of Korean version of Mini-Mental State Examination International Journal of Geriatric Psychiatry" 381-387, 1990

31 Lee, H.,, "Learning from other lands Caring for elderly demented Koreans" 23 : 21-31, 1997

32 Strawbridge,W.J, "Impact of family conflict on adult child caregivers" 31 : 770-777, 1991

33 Acton,G.J, "Health-promoting self-care in family caregivers" 24 (24): 73-86, 2002

34 LaRue, "Health in old age How do physicians' ratings and self-ratings compare? Journal of Gerontology" 687-691, 1979

35 Wright, "Health consequences of caregiver stress" 1993181-195

36 Yee, J. L.,, "Gender differences in psychiatric morbidity among family caregivers" 40 (40): 147-164, 2000

37 Clark,L.M, "Effects of hardiness and appraisal on the psychological distress and physical health of caregivers to elderly relatives" 18 : 379-401, 1996

38 Youn, G.,, "Differences in familism values and caregiving outcomes among Korean, Korean American, and White American dementia caregivers" 14 (14): 355-364, 1999

39 O'Rourke, N.,, "Depressive symptoms and physical health of caregivers of persons with cognitive impairment Analysis of reciprocal effects over time" 15 (15): 688-712, 2003

40 Noh, "Depressive symptoms among Korean immigrants Assessment of a translation of the Center for Epidemiologic Studies- Depression Scale" 84-91, 1992

41 Merrill D, "Daughters-in-law as caregivers to the elderly Research on Aging" 70-91, 1993

42 Kim,J.S, "Daughter-in-law in Korean caregiving families" 36 (36): 399-408, 2001

43 Rankin,E.D, "Clinical assessment of family caregivers in dementia" 32 : 813-821, 1992

44 Peters-Davis,N.D, "Children-in-law in caregiving families" 39 : 66-75, 1999

45 Ingersoll-Dayton, B.,, "Caregiving for parents and parents-in-law: Is gender important?" 36 : 483-491, 1996

46 Sisk,R.J, "Caregiver burden and health promotion" 37 (37): 37-43, 2000

47 Shin, S. Y, "Burden and depression in caregivers of senile dementia patients in Korea" Unpublished doctoral dissertation Columbia University 1995

48 Lawton, "Assessment of older people Self-maintenance instrumental activities of daily living" 179-186, 1969

49 Haley, W. E.,, "Appraisal, coping, and social support as mediators of well-being in black and white family caregivers of patients with alzheimer's disease." 64 (64): 121-129, 1996

50 Pohl, J. M.,, "Analysis of the input of mother- daughter relationships on the commitment to caregiving" 44 : 68-75, 1995

51 Wood, "An analysis of short self-report measure of life satisfaction Correlation with rater judgements Journal of Gerontology" 465-460, 1969

52 Mossey, "A predictor of mortality among the elderly American Journal of Public Health" 800-808, 1982

53 I, "A brief measure of social support Journal of Social and Personal Relationships" 497-510, 1987

54 Schulz, "A 2-year longitudinal study of depression among Alzheimer caregivers" 569-578, 1991