Page 130 - GHES-2-3

Global Health Economics and
Sustainability
Positive and negative aspects of caregiving

and positive aspects of caregiving, confirming our first García-Castro et al. (2021) on caregivers’ gain; and
hypothesis. Regarding the negative aspects, most caregivers Gómez-Gallego et al. (2012), Zuchella et al. (2015), and
in our sample dedicate more than 15 h of care per day and Andreakou et al. (2016) on caregivers’ quality of life. In
reported a moderate perceived burden. This observation all these cases, mental health or perceived burden was
indicates a high objective and subjective burden, confirming negatively associated with happiness, gain, or quality of
results reported in other studies (Grano et al., 2017; Liu life. However, the relationship between positive aspects
et al., 2020). In the other negative aspects of caregiving, of caregiving and objective burden, measured as hours of
psychological distress plays a key role as it can indicate the care per day, is less clear compared to subjective burden
initial symptoms of mental health problems. Considering and psychological distress. Happiness showed minimal
the cut-point of four suggested by Lundin et al. (2017) to variation when caregivers provided <15 h of care per day,
identify individuals with a higher probability of presenting with significant decreases in happiness only observed
a non-specific affective disorder, half of our sample falls when providing more than 15 h of care per day. Our
into this category. These caregivers exhibit behaviors results suggest a higher level of happiness in caregivers of
associated with the three components of psychological PWAD compared to the results reported by van Campen
distress: depression, anxiety, and social dysfunction. Our et al. (2013). The study used a threshold of 11 h of care
results confirm those reported previously, where high levels per week, whereas our study used a threshold of 15 h
of psychological distress increase the risk of psychiatric of care per day. This substantial difference in the study
disorders, significantly affecting the caregivers’ mental setting can hardly explain the discrepancy in the findings,
health (Campbell et al., 2008; del Pino-Casado et al., 2021; considering that both studies were conducted in European
Geng et al., 2018; Loh et al., 2017; Sallim et al., 2015). The countries (van Campen et al. [2013] in Holland and ours
high burden experienced by these caregivers, coupled with in Spain). The discrepancy could be due to the fact that
the close relationship between burden and psychological our study did not include a comparison with a sample of
distress and other factors such as behavior problems in non-caregivers and only examined caregivers of relatives
the care recipient and anticipated grief, differentiates them with Alzheimer’s disease. In contrast, van Campen et al.
from caregivers of other dependent individuals (Brodaty & (2013) compared caregivers and non-caregivers and used
Donkin, 2009; Campbell et al., 2008). Despite the negative a broader definition of “caregiver” that included those
aspects of caring for PWAD, positive aspects of caregiving providing one or more hours per week of free help to sick
are also evident in the studied sample. The mean scores or disabled family members, acquaintances, or friends. In
for the three variables associated with positive aspects of addition, van Campen et al. (2013) used a single question
caregiving – happiness, gain, and quality of life – are high, to assess happiness (“To what extent do you regard yourself
consistently above the medium response level for each as a happy person?”), while the Lyubomirsky & Lepper
scale. This finding indicates that the sample experiences (1999) scale used in this study contains four questions.
happiness, gain, and quality of life above the medium Therefore, differences in the types of caregivers studied
point. Therefore, these results confirm that both positive and the tools used to measure happiness likely account for
and negative responses to caregiving activities are present the discrepancies in results.
(Andren & Elmstahl, 2005; Schulz et al., 2003; Wang et al., In the case of gain and quality of life, the number of
2018; Wennberg et al., 2022; Yap et al., 2010). hours of care for PWAD showed significant differences
The second hypothesis of this work focused on the between caregivers providing ≤10 h of care per day and
relationships between the positive and negative aspects those providing ≥11 h. Gain did not follow the general
of caregiving. Several studies have related high burdens expectation that providing a higher number of hours of
with a lower likelihood of experiencing positive aspects of care per day would result in lower perceived gain. Instead,
caregiving (Chappell & Reid, 2002; Pinquart & Sörenem, the opposite was observed: PWAD caregivers providing
2006). Examining the correlations between the variables a higher number of hours of care per day, particularly
associated with positive and negative aspects of caregiving, those providing 11 h or more, reported higher levels of
this hypothesis is partially confirmed. Perceived burden perceived gain. This result aligns with the findings of
and psychological distress showed negative relationships Liew et al. (2010), who reported that primary caregivers
with happiness, gain, and quality of life. Furthermore, of relatives with dementia perceived higher levels of
levels of happiness, gain, and quality of life decrease as perceived gain and benefits when they provided care in at
perceived levels of burden and psychological distress levels least 60% of their time (14 h a day), similar to the 11 h or
increase. Our results are consistent with previous studies: more observed in this study. This suggests that gain may
Chappell and Reid (2002) on caregivers’ happiness; require time for caregiver adaptation, allowing caregivers
Kramer (1997), Sanders (2005), Liew et al. (2010), and to develop resources where positive emotions can flourish

Volume 2 Issue 3 (2024) 8 https://doi.org/10.36922/ghes.3145