Page 125 - GHES-2-3

Global Health Economics and
Sustainability
Positive and negative aspects of caregiving

of PWAD. Accordingly, these results highlight the need to (ii) Positive and negative aspects of caregiving are
combine family caregiving with paid or volunteering care negatively related.
to maintain the burden at an appropriate level compatible (iii) Caregivers’ poor mental health can be predicted
with higher happiness levels in family caregivers. by high levels of negative aspects and low levels of
On the other hand, in a general view, gain in caregiving positive aspects.
has been conceptualized as any positive result of caregiving 2. Data and methods
activity (Kramer, 1997). Sanders (2005) identified three
components of gain in caregiving: spiritual growth, 2.1. Participants
personal growth, and a sense of mastering skills. Some years A sample of 140 caregivers (96 female and 44 male) were
later, Netto et al. (2009) added the ability to develop deeper recruited from the Family of Alzheimer’s Disease Associations
relations with the care recipient and other dependent adults in the Valencian Community in Spain. The inclusion criteria
as an additional component. The perception of gain or were: (i) the relative receiving care had been diagnosed
benefits from caregiving is associated with low burden and with Alzheimer’s disease, (ii) the relative with dementia
good mental health (García-Castro et al., 2021; Liew et al., was in a community-dwelling situation, and (iii) there were
2010), and it is reported that caregivers need to provide no reading or understanding problems that would prevent
care for at least 60% of the time, or about 14 h every day, to completing the requested information. The Alzheimer’s
perceive these gains (Liew et al., 2010). disease diagnosis was performed by a neuropsychiatrist
Finally, quality of life in caregiver studies is defined as a working at the corresponding health center.
multidimensional phenomenon influenced mainly by three 2.2. Variables
types of determinants: the “clinical,” related to the form,
stage, duration, and cognitive and behavioral disorders of 2.2.1. Psychological distress
the care recipient’s disease; the “psychological” component, Mental health status was measured using the General
associated with caregivers’ coping strategies, social Health Questionnaire, GHQ-12 (Goldberg & Williams,
support, and family relations; and the “sociodemographic,” 1988), in its Spanish adaptation (Sánchez & Dresch, 2008).
encompassing variables including age, educative level, The 12-item questionnaire is a mental health screening tool
financial status, and the caregiving role (Glozman, 2004). that measures anxiety, depression, and social dysfunction. It
The prevalence of one or more of these determinants has uses a four-level response scale (0, 1, 2, 3) and the standard
centered several studies. Andreakou et al. (2016) focused GHQ score method (0-0-1-1), with higher scores indicating
on the caregivers’ mental health as a key element in their greater levels of distress. The standard GHQ score was used
quality of life, highlighting the detrimental impact of to calculate the percentages of caregivers with and without
depressive symptoms. Zuchella et al. (2015) also identified psychological distress, with a GHQ Index ≥4 as the threshold
depressive symptoms as a significant factor affecting (Lundin et al., 2017), providing better sensibility (81.7%)
the quality of life, along with the burden and behavioral and specificity (85.4%). The reliability of this variable in this
problems of the care recipient. Similarly, Gómez-Gallego study was adequate (Cronbach’s α = 0.87).
et al. (2012) highlighted burden and behavioral problems,
such as irritability in PWAD, as primary determinants. 2.2.2. Burden
Behavioral problems displayed by the care recipient and The Zarit’s Caregiver Burden Interview (Zarit et al., 1980),
perceived burden are the most frequently associated in its Spanish adaptation (Martín-Carrasco et al., 2010),
elements with caregivers’ quality of life, but other factors, was used to assess perceived burden. The 22 items have
such as time dedicated to care and economic problems, a five-level response scale, scored between 0 and 4 (“0”:
also contribute (Vellone et al., 2008). never, “1”: seldom, “2”: sometimes, “3”: often, “4”: nearly

In this context, the present study measured two groups always). Higher scores indicated higher perceived burdens.
of variables in family caregivers of PWAD: (i) the negative Mulund and McCarthy (2017) proposed four levels of
aspects of caregiving, with the variables including hours perceived burden with three cut-points (≤20: No burden;
of care per day, perceived burden, and psychological 21 – 40: Mild burden; 41 – 60: Moderate burden; ≥60:
distress; and (ii) the positive aspects of caregiving, with Severe burden). The reliability of this variable in this study
the variables including happiness, gain in caregiving, and was adequate (Cronbach’s α = 0.85).
quality of life. Considering the previous literature in the
field, three hypotheses were proposed: 2.2.3. Gain
(i) Family caregivers of PWAD present both negative and The perception of gain in caregiving was measured using
positive aspects associated with caregiving. the GAIN scale (Gain in Alzheimer Care Instrument)

Volume 2 Issue 3 (2024) 3 https://doi.org/10.36922/ghes.3145