No votes yet

Caregivers' Descriptions of Sleep Changes and Depressive Symptoms

Patricia A. Carter
ONF 2002, 29(9), 1277-1283 DOI: 10.1188/02.ONF.1277-1283

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.


Aneshensel, C., Pearlin, L., Mullan, J., Zarit, S., & Whitlatch, C. (1995). <i>Profiles in caregiving: The unexpected career.</i> New York: Academic Press.

Bramwell, L., MacKenzie, J., Laschinger, H., & Cameron, N. (1995). Need for overnight respite for primary caregivers of hospice clients. <i>Cancer Nursing</i>, <i>18</i>, 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. <i>Gerontologist</i>, <i>35</i>, 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. <i>Psychiatry Research</i>, <i>28</i>, 193-213.

Carter, P. (2000). Cancer caregiver's depression and sleep disturbances. <i>Dissertation Abstracts International: Section B: The Sciences and Engineering</i>, <i>60</i>(1 -B), 3199.

Carter, P., & Chang, B. (2000). Cancer caregiver depression and sleep disturbances. <i>Cancer Nursing</i>, <i>23</i>, 410-415.

Douglass, L.G. (1997). Reciprocal support in the context of cancer: Perspectives of the patient and spouse. <i>Oncology Nursing Forum</i>, <i>24</i>, 1529-1536.

Dura, J., Stukenburg, K., & Kiecolt-Glaser, J. (1990). Chronic stress and depressive disorders in older adults. <i>Journal of Abnormal Psychology</i>, <i>99</i>, 284-290.

Given, B., & Given, C.W. (1992). Patient and family caregiver reaction to new and recurrent breast cancer. <i>Journal of the American Medical Women's Association</i>, <i>47</i>, 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. <i>Gerontologist</i>, <i>39</i>, 76-85.

Jepson, C., McCorkle, R., Adler, D., Nuamah, I., & Lusk, E. (1999). Effects of home care on caregivers' psychosocial status. <i>Image: Journal of Nursing Scholarship</i>, <i>31</i>, 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. <i>Lancet</i>, <i>346</i>, 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. <i>Journal of Psychosocial Nursing</i>, <i>36</i>(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. <i>Cancer</i>, <i>74</i>, 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. <i>Social Science and Medicine</i>, <i>40</i>, 837-846.

Lawton, M., Moss, M., Kleban, M., Glicksman, A., & Rovme, M. (1991). A two-factor model of caregiving appraisal and psychological well-being. <i>Journal of Gerontology: Psychological Sciences</i>, <i>46</i>, P181-P189.

Lazarus, R., & Folkman, S. (1984). <i>Stress, appraisal, and coping.</i> New York: Springer.

Li, L., Seltzer, M., & Greenberg, J. (1999). Change in depressive symptoms among daughter caregivers: An 18-month longitudinal study. <i>Psychology and Aging</i>, <i>14</i>, 206-219.

McClenahan, R., & Weinman, J. (1998). Determinants of carer distress in non-acute stroke. <i>International Journal of Language and Communication Disorders</i>, <i>33</i>, 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. <i>Journal of Gerontology: Series B, Psychological and Sociological Sciences</i>, <i>52</i>, P122-P129.

McCurry, S.M., & Ten, L. (1995). Sleep disturbance in elderly caregivers of dementia patients. <i>Clinical Gerontologist</i>, <i>16</i>, 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. <i>Cancer</i>, <i>86</i>, 577-588.

Pearlin, L., & McKean, S.M. (1996). Stress and the life course: A paradigmatic alliance. <i>Gerontologist</i>, <i>36</i>, 239-247.

Pearlin, L., Mullan, J., Semple, S., & Skaff, M. (1990). Caregiving and the stress process: An overview of concepts and their measures. <i>Gerontologist</i>, <i>30</i>, 583-594.

Radloff, L., & Teri, T. (1986). Use of the Center for Epidemiological Studies-Depression Scale with older adults. <i>Clinical Gerontologist</i>, <i>5</i>, 119-136.

Raveis, V., Karus, D., & Siegel, K. (1998). Correlations of depressive symptomatology among adult daughter caregivers of a parent with cancer. <i>Cancer</i>, <i>83</i>, 1652-1663.

Sandelowski, M. (1986). The problem of rigor in qualitative research. <i>Advances in Nursing Science</i>, <i>8</i>(3), 27-37.

Schwarz, K. (1999). A study of the relationship of caregiving appraisal to depressive symptomatology and home care utilization. <i>Journal of Community Health Nursing</i>, <i>16</i>, 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. <i>Gerontologist</i>, <i>32</i>, 656-664.

Strauss, A., & Corbin, J. (1990). <i>Basics of qualitative research: Grounded theory procedures and techniques.</i> Newbury Park, CA: Sage.

Tennstedt, S., Cafferata, G., & Sullivan, L. (1992). Depression among caregivers of impaired elders. <i>Journal of Aging and Health</i>, <i>4</i>(1), 58-76.

Turner, H., Pearlin, L., & Mullan, J. (1998). Sources and determinants of social support for caregivers of persons with AIDS. <i>Journal of Health and Social Behavior</i>, <i>39</i>, 137-151.

Vitaliano, P.P., Scanlan, J.M., Krenz, C., Schwartz, R.S., & Marcovina, S.M. (1996). Psychological distress, caregiving, and metabolic variables. <i>Journal of Gerontology: Series B, Psychological Science and Social Sciences</i>, <i>51</i>, P290-P299.

Wilcox, S., & King, A.C. (1999). Sleep complaints in older women who are family caregivers. <i>Journal of Gerontology: Series B, Psychological Science and Social Sciences</i>, <i>54</i>, P189-P198.

Wyatt, G., Friedman, L., Given, C., & Given, B. (1999). A profile of bereaved caregivers following provision of terminal care. <i>Journal of Palliative Care</i>, <i>15</i>(1), 13-25.

Yates, M.E., Tennstedt, S., & Chang, B.H. (1999). Contributors to and mediators of psychological well-being for informal caregivers. <i>Journal of Gerontology: Series B, Psychological Science and Social Sciences</i>, <i>54</i>, P12-P22.

Yee, J.L., & Schulz, R. (2000). Gender differences in psychiatric morbidity among family caregivers: A review and analysis. <i>Gerontologist</i>, <i>40</i>, 147-164.