Page 131 - GHES-2-3

Global Health Economics and
Sustainability
Positive and negative aspects of caregiving

and enhancing their well-being (Fredrickson, 2004; support and therapeutic interventions can significantly
Fredrickson et al., 2003; Tennen & Affleck, 2002). With benefit the mental health of caregivers. On the other hand,
regard to quality of life, there was a significant difference objective burden, measured as hours of care per day for
between caregivers providing ≤10 h of care per day and PWAD, can be modulated to maintain a balance between
those providing ≥11 h of care per day, with a negative positive and negative aspects of caregiving could maintain
relationship indicating that providing a higher number of sustaining caregivers’ mental health at an adequate level.
hours of care resulted in lower quality of life. This result Our results suggest that an adequate level of happiness,
confirms the qualitative study by Vellone et al. (2008), gain in caregiving, and quality of life can be achieved
which explored the quality of life in relation to the time when the objective burden is around 10 h of care per day.
dedicated to caregiving in caregivers of PWAD. Caregivers At this level, perceived burden and psychological distress
expressed a need for respite care to reduce the time they are at moderate levels, not the perfect situation. However,
dedicated to the task. The respite care provided by the day- it should be noted that psychological distress has a mean
care services had a direct impact on the mental health of score of 14.35, just above the threshold of 14 proposed by
caregivers of relatives with dementia (Gaugler et al., 2003). Lundin et al. (2017) as the cut-point to distinguish between
caregivers with a higher likelihood of experiencing
Regression analysis results showed that both positive depression, anxiety, and adjustment symptoms, using the
and negative aspects of caring play an important predictive GHQ-12’s Likert response scale. Although a dedication of
role in the mental health of caregivers. Although age and 10 h of care per day may be considered high, it is important
gender are related to mental health, with women and older to note that in our sample, 44.3% of caregivers dedicated
caregivers presenting poorer mental health than men and over 15 h of care per day, and 57.2% provided 11 h of
younger caregivers, their importance diminishes when care daily. This level of commitment makes it difficult for
perceived burden is introduced into the regression model. PWAD caregivers to maintain a full-time job. Caring for a
Furthermore, age and gender lose their significance entirely relative with dementia is costly. In 1998, the annual cost of
when positive aspects of caregiving, such as happiness, informal care was $17,000 (Moore et al., 2001). A systematic
gain, and quality of life, are considered. The most salient review by Schaller et al. (2014) estimated the cost of caring
predictor of psychological distress is perceived burden when for PWAD at home varied with the stage of Alzheimer’s
no positive aspects are considered, confirming numerous disease: $15,478 for mild dementia, $31,104 for moderate
studies that have associated these variables (Campbell et al., dementia, and $38,403 for severe dementia. A more recent
2008; del Pino-Casado et al., 2021; Geng et al., 2018; Grano study reported the medium total lifetime cost of caring
et al., 2017; Liu et al., 2020; Loh et al., 2017; Sallim et al., for a person with dementia as $225,140, considering the
2015). However, the introduction of positive aspects of time of diagnosis as 83 years old (Jutkowitz et al., 2017).
caregiving in the regression equation makes low happiness Given these costs, financial support is necessary to provide
the most relevant predictor of psychological distress. This respite care for PWAD caregivers. Governments have a
finding is consistent with the studies performed by Argyle responsibility to provide this support, whether through
(2001) and de Camargos et al. (2020), which associate high daycare services or financial aid, as an investment that
levels of happiness with good mental health in caregivers. will, in the long term, result in savings in mental health
In the present study, both low quality of life and low gain treatment that these caregivers might otherwise require.
in caregiving also played a predictive role in psychological
distress. These findings converge with and expand on This study is not without limitations. One limitation is the
existing literature concerning the relationship between use of self-report measures to assess the variables studied, which
positive aspects of caregiving and mental health and the are subjected to biases such as memory distortions or social
potential role they could play in mitigating the impact of desirability bias. Another limitation is the generalizability of
stressors on mental health (Kulhara et al., 2012). the results, which is restricted by the convenience sample used
and the cross-sectional design. The results of this research
The relationship between burden and psychological were obtained from a sample with specific characteristics: half
distress, and the role of positive aspects, depends on of the caregivers reported having a high school education,
how we define burden. Subjective burden, understood as most were women, married, and primarily the children of the
the burden perceived by the caregiver, showed a strong care recipients. Therefore, generalizing these results should
positive relationship with psychological distress and had be done with caution and limited to samples with similar
high predictive power, whereas positive aspects presented characteristics. Using larger, randomly selected probabilistic
negative relationships with psychological stress. Promoting samples in longitudinal studies could enhance our knowledge
positive aspects of caregiving and reducing perceived about the variations and causal relationships between the
burdens can improve caregivers’ mental health. Therefore, variables studied. In addition, employing different assessment

Volume 2 Issue 3 (2024) 9 https://doi.org/10.36922/ghes.3145