Psychological Needs of a Depressed Caregiver of Caring Patients with Dementia and the Treatment Efficacy

Published: 2021-07-12 14:53:27
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Carnegie Mellon University
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Literature review
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Introduction

Contemporary research indicates that people diagnosed with symptoms of depression rarely perceive themselves as being miserable. More often than not individuals are unable to recognize the underlying symptoms while other have a preference for denial since it is deemed as embarrassing to espouse ones depressive moods. In regards to the caregiving profession, depression has emerged as a major concern since it is seemingly the natural response when a person is subjected in a highly intense and challenging predicament. As a result, caregivers develop mild or exaggerated forms of depression. Equally important is the fact that administering care to people living with dementia often culminates in an emotional turmoil as the loss of cognitive functioning can prove to be quite problematic. The experience involved in caring for an individual suffering from dementia is inherently stressful since the observations of the caregiver, and the outcome of events has a significant role in the bodys response (Tsai et al., 2015). Consequently, in the analysis of the literature review, research on psychological needs was conducted using Internet-based peer reviewed journals and the search terms incorporated keywords including dementia, caregiver, intervention and depression. Besides, the psychological needs of a seemingly depressed caregiver were evaluated based on the use of psychotherapeutic procedures such as Cognitive Behavioural Therapy, Art Therapies, Motivational Interviewing, and the Psychoeducation of information on the burden of care and subsequent depression. Moreover, the paper also presents evidence-based approaches on the various interventions that are instrumental in addressing the psychological needs of caregivers by the DSM criteria.

Psychological Needs of Caregivers

Contemporary studies indicate that there exists the burden of care whose manifestation is prodigious particularly in instances where care is informally accorded. In a family setting, the secondary survivor undergoes the demanding task of taking the role of a sole breadwinner during the treatment and recovery of the ailing spouse. Although a loved one may not be subjected to the physical experience of dealing with dementia, the traumatic experiences inevitable during the delivery of care is bound to take a toll on the caregiver including causing a potential strain on an individuals relationship leading to depression. Additionally, this experience is viewed as a chronic stressor, which culminates in adverse physiological, psychological, and behavioural alterations, which have an impact on their daily activities as well as health. In most cases, the caregiver is preoccupied and concerned with meeting the needs of a mentally ill individual thereby disregarding her deteriorating health, which reportedly culminates in unprecedented deaths. According to De Fazio et al. (2015), different studies indicate that the problems that are paramount to a caregiver working in a dementia ward include distorted family relations owing to prolonged working hours, sleeping difficulties, physical fatigue, and pervasiveness of the feelings of professional inadequacy. Alternatively, other depressed caregivers, more intricate pathologies may ensue such as gastrointestinal diseases and arterial hypertension. The clinical discernment of this development is attributed to the influence stress creates on the brain, and it acts as a seat upon which depressive moods precipitate. Moreover, dealing with dementia-related behavior serves to compound on the depression of a caregiver, which includes dealing with instances of agitation, wandering, embarrassing conduct and non-cooperation from the patient, which makes it harder for the caregiver to catch a glimpse of rest (Bednarek et al., 2016). Seminal studies indicate that lower socioeconomic status, advanced age, developmental and physical burdens are all predictive factors of depression, which is coupled with anxiety and diminished quality of life.

According to Toepfer, Foster & Wilz (2015), a unique feature in dementia wards is the aspect of social isolation, which exacerbates the mental as well as the physical descent of a primary caregiver. These repercussions of which stem from the mental illness interfere with the social life, and expectations of the health professionals. Subsequently, the caregiver grows anxious as the patients medical condition progressively worsens which leads to cognitive challenges, the onset of maladaptive behaviour, elevated levels of anxiety and reduction in the independence of activities of daily living. Sociodemographic factors also have an impact on the caregiver's influence when attending to her clients needs. For instance, research indicates that women, who form the larger majority in the caregiving profession, experience clinical depression nearly as twice as their male counterparts do. Pundits attribute this trend to factors such as childbirth, menopause, and deficiencies in nutrients such as Omega-3, iron, and vitamin D all of which lead to depression (Joling et al., 2015). Conversely, male caregivers are less likely to be diagnosed with depression due to the adoption of the self-treatment mechanisms for irritability and depressive moods in the form of alcohol or overworking ones self. Nonetheless, men show a greater willingness in hiring outside help for their loved one who suffers from dementia but is too reluctant to confide in their close associates due to the fear of judgment and reprisal. Amongst the dominant sources of depression in caregivers is the survivorship phase where a caregiver is concerned with the fear of recurrence and the advent of family stressors owing to the hereditary connotations of mental illness (Borsje et al., 2016). Additionally, the advent of technology has facilitated the concept of genetic testing which has proven instrumental in the identification of heritable factors that lead to mental disorder. This phenomenon is exemplified in as study, which denoted increased anxiety and depression in caregivers who have spouses living with dementia.

Psychological Interventions

Cognitive Behavioural Therapy

According to the research conducted by Kwok et al. (2014), demonstrated that in regions that experience a proliferation of technology more specifically Hong Kong, CBT may be delivered online and has proven to be quite effective in managing depression amongst family caregivers. This was demonstrated by the decrease in severity of the symptoms of distress, and the outcome is consistent with the findings of other support programs that have developed an online mechanism for delivering therapy. The fundamental objective of the intervention was to diminish the occurrence of depression, which not only declined in family caregivers but also with their patients as well. This may be attributed to the ideology that the prevalence of depression may be because of a breakdown in communication between the caregiver and her patient. Additionally, the online CBT approach illustrated efficacy in the long term regarding improving the self-efficacy of the helping professionals where a follow-up of not less than three months indicated positive results. The principle argument for this was attributed to the fact that it requires a tremendous amount of experience and time for the institution of self-efficacy structures (Gallagher-Thompson & Steffen, 1994). Nonetheless, the above study experienced shortcomings such as access to Internet and computer literacy levels were factors more inclined towards the younger generation of caregivers who possessed higher-level education.

According to Coon & Evans (2009), another limitation was the lack of measurement of hypothetically critical outcomes such as he perceived caregiver mood and burden. Besides, cognitive restructuring has emerged as an important technique that is incorporated in CBT. This may be accredited to the cognitive outlines as the causative factors of emotional disorders, which are exemplified in negative perceptions about a persons personality, which is a frequent incidence of depression. As a result, therapy is deemed necessary to alter the prevalence of these negativities. Additionally, evidence-based practices denote that CBT offers a positive psychotherapeutic intervention, which is aimed at reducing the anxiety and depression of the caregiver in a community set up. This particular study comprised of a 9-week intervention, which was conveyed to small factions of between 4 to 8 caregivers and was compared with the wait-list as its control. Additionally, the approach incorporated a multidimensional model, which was designed to address the behavioural, cognitive, and physical facets of anxiety. A post-intervention evaluation indicated diminished levels of anxiety in both clinically administered tests and self-reports.

Motivational Interviewing

According to Pot, Blom & Willemse (2015), motivational interviewing is predominantly concerned with the activation of a caregivers motivation, which leads to the desire for change and conformity to the stipulated paradigms of treatment. Clinical trials indicate that a contrast drawn between exposure to motivational interviews and regular treatment procedures has reported a significant decline in the psychological distress and depression of the primary caregiver. Besides, the positive feelings of professional adequacy are augmented including the reinforcement of the collaborative partnership between the caregiver and her patient. Motivational interviewing has mainly been perceived as a means of addressing the particular problem of depression in caregiver by integrating a collective decision process although the caregiver may only trigger behavioural change. According to Heller, Gibbons & Fisher (2015), this introduces a paradigm shift whereby the norm of according caregivers what they lack is abandoned, and instead, the personal motivational sources for change are activated. This may involve preying on the dreams and personal life objectives of caregivers, which facilitate the comprehension of an individuals perspective. Perhaps the greatest achievement is the element of detachment from the anticipated outcomes where a caregiver is accorded the opportunity to determine the course of their lives. This implies that in as much as there may be an identification of depressed moods in an individual, a caregiver enjoys the right to autonomy in regards to the decisions made probably due to the impending resistance if viewed otherwise.

Self-help/Psychoeducation for Psychological Problems

According to Coon & Evans (2009), one aspect of evidence-based practices involves the incorporation of a psychoeducational-skill building structure. In essence, this approach is dubbed Coping with Caregiving, which denotes a 10-week educational intervention which predominantly targets an individuals behavioural skills and cognitive functioning. Further, the primary objectives included the reduction in the undesirable effect through acquiring knowledge on the ideal relaxation methodologies in the stressful situation including the appraisal of the patient's behaviour from a realistic perspective using positive communication skills. Besides, a positive mood may be spurred through the development of a mechanism of contingency between activities of daily living and the underlying attitudes. The overall outcome of this measure culminated in the lessening of depressive moods, which was coupled with augmented active coping strategies. On the other hand, a study conducted by Chan et al. (2016) scrutinized the suitability of a self-help intervention that is...

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