Caregivers' Descriptions of Sleep Changes and Depressive Symptoms
Purpose/Objectives: To describe caregiver sleep and depression using caregiver narratives. To compare qualitative descriptions with quantitative scores.
Design: Descriptive, one-time, open-ended interview followed by structured sleep and depression questions.
Setting: Interview conducted in person or via telephone at caregiver's preference.
Sample: 47 caregivers of patients with advanced stage cancer. Caregivers had a mean age of 54 years, and most were female (81%), Caucasian (82%), and spouses (61%). They provided care for a mean of 24 months. Patients' diagnoses were lung cancer (36%), colorectal cancer (13%), or recurrences (51%).
Methods: Two cancer care sites in southern California provided participants. After consent, the researcher conducted interviews. The Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiological Studies-Depression (CES-D) instruments were administered following interviews.
Main Research Variables: Sleep pattern changes and depression levels over time as defined by caregivers.
Findings: Caregivers described severe fluctuations in sleep patterns overtime and how these changes affected caregiver depressive symptoms. PSQI and CES-D scores matched narrative comments.
Conclusions: Caregivers' narratives suggest they suffer progressive sleep deprivation that affects their emotions and ability to continue as caregivers.
Implications for Nursing: Nurses must recognize the severe sleep problems experienced by caregivers and respond with interventions to increase sleep quality and decrease depression.
Jump to a section
References
Aneshensel, C., Pearlin, L., Mullan, J., Zarit, S., & Whitlatch, C. (1995). Profiles in caregiving: The unexpected career. New York: Academic Press.
Bramwell, L., MacKenzie, J., Laschinger, H., & Cameron, N. (1995). Need for overnight respite for primary caregivers of hospice clients. Cancer Nursing, 18, 337-343.
Brody, E.M., Litvin, S.J., Hoffman, C., & Kleban, M.H. (1995). Marital status of caregiving daughters and co-residence with dependent parents. Gerontologist, 35, 75-85.
Buysse, D., Reynolds, C., Monk, T., Berman, S., & Kupfer, D. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193-213.
Carter, P. (2000). Cancer caregiver's depression and sleep disturbances. Dissertation Abstracts International: Section B: The Sciences and Engineering, 60(1 -B), 3199.
Carter, P., & Chang, B. (2000). Cancer caregiver depression and sleep disturbances. Cancer Nursing, 23, 410-415.
Douglass, L.G. (1997). Reciprocal support in the context of cancer: Perspectives of the patient and spouse. Oncology Nursing Forum, 24, 1529-1536.
Dura, J., Stukenburg, K., & Kiecolt-Glaser, J. (1990). Chronic stress and depressive disorders in older adults. Journal of Abnormal Psychology, 99, 284-290.
Given, B., & Given, C.W. (1992). Patient and family caregiver reaction to new and recurrent breast cancer. Journal of the American Medical Women's Association, 47, 201-212.
Given, C.W., Given, B.A., Stommel, M., & Azzouz, F. (1999). The impact of new demands for assistance on caregiver depression: Test using an inception cohort. Gerontologist, 39, 76-85.
Jepson, C., McCorkle, R., Adler, D., Nuamah, I., & Lusk, E. (1999). Effects of home care on caregivers' psychosocial status. Image: Journal of Nursing Scholarship, 31, 115-120.
Kiecolt-Glaser, J.K., Marucha, P.T., Malarkey, W.B., Mercado, A.M., & Glaser, R. (1995). Slowing of wound healing by psychological stress. Lancet, 346, 1194-1196.
Knop, D.S., Bergman-Evans, B., & McCabe, B.W. (1998). In sickness and in health: An exploration of the perceived quality of the marital relationship, coping, and depression in caregivers of spouses with Alzheimer's disease. Journal of Psychosocial Nursing, 36(1), 16-21.
Kurtz, M., Given, B., Kurtz, J., & Given, C. (1994). The interaction of age, symptoms and survival status on physical and mental health of patients with cancer and their families. Cancer, 74, 2071-2087.
Kurtz, M., Kurtz, J., Given, C., & Given, B. (1995). Relationship of care-giver reactions and depression to cancer patients' symptoms, functional states and depression: A longitudinal view. Social Science and Medicine, 40, 837-846.
Lawton, M., Moss, M., Kleban, M., Glicksman, A., & Rovme, M. (1991). A two-factor model of caregiving appraisal and psychological well-being. Journal of Gerontology: Psychological Sciences, 46, P181-P189.
Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
Li, L., Seltzer, M., & Greenberg, J. (1999). Change in depressive symptoms among daughter caregivers: An 18-month longitudinal study. Psychology and Aging, 14, 206-219.
McClenahan, R., & Weinman, J. (1998). Determinants of carer distress in non-acute stroke. International Journal of Language and Communication Disorders, 33, 138-143.
McCurry, S.M., Logsdon, R.G., Vitiello, M.V., & Ten, L. (1998). Successful behavioral treatment for reported sleep problems in elderly caregivers of dementia patients: A controlled study. Journal of Gerontology: Series B, Psychological and Sociological Sciences, 52, P122-P129.
McCurry, S.M., & Ten, L. (1995). Sleep disturbance in elderly caregivers of dementia patients. Clinical Gerontologist, 16, 51-66.
Nijboer, C., Triemstra, M., Tempelaar, R., Sanderman, R., & van den Bos, G. (1999). Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer, 86, 577-588.
Pearlin, L., & McKean, S.M. (1996). Stress and the life course: A paradigmatic alliance. Gerontologist, 36, 239-247.
Pearlin, L., Mullan, J., Semple, S., & Skaff, M. (1990). Caregiving and the stress process: An overview of concepts and their measures. Gerontologist, 30, 583-594.
Radloff, L., & Teri, T. (1986). Use of the Center for Epidemiological Studies-Depression Scale with older adults. Clinical Gerontologist, 5, 119-136.
Raveis, V., Karus, D., & Siegel, K. (1998). Correlations of depressive symptomatology among adult daughter caregivers of a parent with cancer. Cancer, 83, 1652-1663.
Sandelowski, M. (1986). The problem of rigor in qualitative research. Advances in Nursing Science, 8(3), 27-37.
Schwarz, K. (1999). A study of the relationship of caregiving appraisal to depressive symptomatology and home care utilization. Journal of Community Health Nursing, 16, 95-108.
Seidel, J. (1998). The Ethnograph (Version 5.0) [Computer software]. Thousand Oaks, CA: Scolari Software.
Skaff, M., & Pearlin, L. (1992). Caregiving: Role engulfment and the loss of self. Gerontologist, 32, 656-664.
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage.
Tennstedt, S., Cafferata, G., & Sullivan, L. (1992). Depression among caregivers of impaired elders. Journal of Aging and Health, 4(1), 58-76.
Turner, H., Pearlin, L., & Mullan, J. (1998). Sources and determinants of social support for caregivers of persons with AIDS. Journal of Health and Social Behavior, 39, 137-151.
Vitaliano, P.P., Scanlan, J.M., Krenz, C., Schwartz, R.S., & Marcovina, S.M. (1996). Psychological distress, caregiving, and metabolic variables. Journal of Gerontology: Series B, Psychological Science and Social Sciences, 51, P290-P299.
Wilcox, S., & King, A.C. (1999). Sleep complaints in older women who are family caregivers. Journal of Gerontology: Series B, Psychological Science and Social Sciences, 54, P189-P198.
Wyatt, G., Friedman, L., Given, C., & Given, B. (1999). A profile of bereaved caregivers following provision of terminal care. Journal of Palliative Care, 15(1), 13-25.
Yates, M.E., Tennstedt, S., & Chang, B.H. (1999). Contributors to and mediators of psychological well-being for informal caregivers. Journal of Gerontology: Series B, Psychological Science and Social Sciences, 54, P12-P22.
Yee, J.L., & Schulz, R. (2000). Gender differences in psychiatric morbidity among family caregivers: A review and analysis. Gerontologist, 40, 147-164.