Presentation on theme: "SARAH DIHMES, M.A. MEHRAN HABIBI, M.D. Male Caregivers of Breast Cancer Patients."— Presentation transcript:
SARAH DIHMES, M.A. MEHRAN HABIBI, M.D. Male Caregivers of Breast Cancer Patients
Increase in Male Caregivers The number of cancer patients receiving informal care at home is at an all-time high. 66 million Americans (3 out of 10 homes) have a family member delivering informal care to a loved one National Center on Caregiving At least 50% of the 1.3 million cancer diagnoses will be cared for by someone in the patient’s immediate family. National Alliance for Caregiving & American Association of Retired Persons, 2009). 99% of cancer patients were receiving informal care Yabroff and Kim, % of married women diagnosed with breast cancer report receiving copious support from their spouse. Ciambrone & Allen, 2005 Husbands comprise 30-50% of spousal caregivers Campbell & Carrol, 2007
A Rise in Male Caregivers Kim, Loscalzo, Wellisch, & Spillers, 2006
Why are there more male caregivers now? Human life span is increasing. Advances in medicine Expensive healthcare costs Limit feasibility o formal caregiving Evolution of Gender Roles Paradigm shift in traditional male and female gender roles.
Limited Research on Male Caregivers Men as control subjects Focus is on elderly husbands caring for wives with Alzheimer’s disease. Lack of explanatory framework about men’s experiences.
Men are LESS likely to: Men are MORE likely to: Seek support for their own physical and mental health needs. Report exacerbated physical ailments associated with giving care. Practice health promoting behaviors Ask for help Emotionally cope Identify themselves as caregivers. Provide physical care. Perform more tasks related to hygiene, communication, mobility, dressing and feeding. Sacrifice gendered roles in the family. Work outside the home while being a caregiver. Accept caregiving as an extension of their marital vows. Use a stoic approach. Gender Differences in Caregiving Who copes better?
Adherence to Traditional Masculine Norms Traditional masculine norms commend: Self-reliance Physical Strength Emotional Control Hegemonic masculine beliefs, often thought of as societal ideals, prohibit some men from demonstrating typical DSM-IV symptoms of depression and caregiver burden. Emotional Expression Men who adhere to traditional masculine roles have more difficulty: Judging the non-verbal expressions of others Find expressing their emotions more stressful
DSM-IV Depressive Symptoms Male Specific Symptoms of Stress Non-Typical Depressive Symptoms Male Specific Symptoms of Stress Non-Typical Depressive Symptoms Crying* Sadness* Guilt * Worthlessness * Anhedonia Appetite/ weight change Sleep change Concentration difficulties Fatigue Psychomotor retardation/ agitation *Not supported by traditional masculine beliefs. Drugs & alcohol Aggression & irritability Interpersonal conflict Preoccupation with work Measurement Issues Men who adhere to traditional masculine norms often experience stress through more masculine congruent behaviors and emotions Magovcevic & Addis, 2008
Analyses Compliance Will compliance differ between those who completed the survey in the clinic compared to those who completed the survey online? Stage of Cancer Does the stage of breast cancer influence male caregivers’ experiences of stress? Types of Treatment Will the types of treatment impact male caregivers’ experience of stress?
APPLICATION OF THE STRESS PROCESS MODEL IN HUSBAND CAREGIVERS OF BREAST CANCER PATIENTS This Study
The Stress Process Model 2006: Family Caregiver Alliance held a national conference to bring together researchers, policymakers, and practitioners. They produced a report: Caregiver Assessment: Voices and Views from the Field Established national standards for all caregiving research and clinical practice. Originally created from and for CGs with dementia
Conceptualized Model of Pearlin’s Cancer Caregiver Burden Model Mediators Coping & Social Support Primary Stressors Objective Indicators: - Activities of Daily Living - Instrumental Activities of Daily Living - Type of cancer - Treatments Subjective Indicators: - Patient’s level of pain - Patient’s mental health Secondary Stressors Roles Strains: - Family Conflicts - Occupational Strain - Economic Strain - Social Strain Intrapsychic Strains: - Self-Esteem - Mastery - Loss of Self - Role Captivity - Competence - Gain Outcomes - Depression - Anxiety - Physical Health Problems - Irascibility - Giving up Caring Role Background and Context Demographics: - Age - Gender - Culture - SES - Education - Personal history Caregiving History: - Caregiver’s relationship to patient - Length of time delivering care - Specific health problems of cancer patient - Marital quality pre-illness - Medical resource availability
Operationalized Male Caregiver Burden Model MEDIATORS Marital Satisfaction Shame & Guilt PRIMARY STRESSORS Objective Indicators: Activities of Daily Living Instrumental Activities of Daily Living Type of cancer Treatments Subjective Indicators: Patient’s level of pain Patient’s mental health Secondary Stressors Roles Strains: Vocational environment Domestic environment Social environment Sexual relationships Extended-family relationships Psychological distress Outcomes Depression DSM-IV Criteria A-typical Symptoms Physical Health Problems BACKGROUND & CONTEXT VARIABLES Demographics: Males Age SES Education Personal history Caregiving History: Relationship to patient Length of time delivering care Specific health problems of cancer patient MODERATOR Expressed Emotion from Wife
Stress Process Model Domains Background & Social Context Control Factors: gender & age Help identify pts at risk i.e. If gender is a risk factor, primary and secondary stressors may be different for females and males. Demographics Most common: gender, age, ethnicity, marital quality Caregiving History Family relationship to patient (i.e. husband) Length of time being a caregiver Quality of the relationship Specific health problems of the cancer patient. Background & Social Context Primary Stressors Secondary Stressors Stress Outcomes Demographics: Males Age SES Education Personal history Caregiving History: Relationship to patient Length of time delivering care Specific health problems of cancer patient
Objective Indicators: Activities of Daily Living Instrumental Activities of Daily Living Type of cancer Treatments Subjective Indicators: Patient’s level of pain Patient’s mental health Roles Strains: Vocational environment Domestic environment Social environment Sexual relationships Extended-family relationships Psychological distress Primary Stressors Factors that relate directly from the cancer and caregiving role. Disease Specific: Original Model: memory impairment & disruptive behavior Secondary Stressors Subsequent stressors that may occur from primary. Caregiver’s experience of primary ongoing demands Vocational/ occupational strain is especially difficult for men. Background & Social Context Primary Stressors Secondary Stressors Stress Outcomes
61% of caregivers suffered from depression National Family Caregivers Association, 2000 Men & women caring for their ill spouses experience an increase in depression and decline in happiness National Survey of Families and Households, % of caregivers report that their role causes emotional stress National Alliance for Caregiving & AARP, 2009 Background & Social Context Primary Stressors Secondary Stressors Stress Outcomes Depression DSM-IV Criteria A-typical Symptoms Physical Health Problems
Mediators Independent variables cause the mediator, and the mediator causes the dependent variable Intermediary factor of the causal pathway Marital Satisfaction Psychological adjustment the marriage must undergo after a diagnosis of cancer. Can exacerbate or strengthen emotional bonds. Pre-illness quality of the relationship is also important. Shame & Guilt Correlate with onset and maintenance of psychopathology. Individuals who are shame prone are at increased risk for MH disorders.
Moderator Interactions between the independent and dependent variables that can strengthen, weaken, or account for the relationships between the two – MacKinnon, 2008 Expressed Emotion from Wife Definition: the extent to which a family member of a distressed individual expressed critical, hostile, or emotionally overinvolved statements towards their distressed family member. Higher EE in a spouse predicts higher depression symptoms in the depressed patient Butzlaff & Hooley, 1998; Forin et al., 1992 Depressed patients living with
Type of Variable VariablesMeasures/ InstrumentsSource of Report Background FactorsDemographicsDemographic Form 1 Male Caregiver Primary StressorsPatient’s Overall FACT-B 2 Male Caregiver Well-Being Caregiver DutiesActivities of Daily LivingMale Caregiver Caregiver TasksInstrumental Activities Male Caregiver of Daily Living Secondary StressorsRole StrainsPsychological Adjustment Male Caregiver to Illness Scale Potential MediatorMarital SatisfactionRevised Dyadic Male Caregiver Adjustment Scale Expressed EmotionFive Minute Speech SampleFemale Patient Potential ModeratorsShame & GuiltPersonal Feeling Male Caregiver Questionnaire-2 Outcome VariablesCaregiver DepressionBeck Depression Inventory-IIMale Caregiver Masculine DepressionMasculine Depression ScaleMale Caregiver Symptoms Physical Health ProblemsSF-12Male Caregiver Note. 1 Caregivers demographics: age, culture, SES, education, medical information, mental illness history, and length of time delivering care. 2 Functional Assessment of Cancer Therapy- Breast (FACT-B) subscales: physical, emotional, functional well-being, social/ family, and additional concerns. Independent Variables: Dependent Variables:
Men Against Breast Cancer Do educational resources help? Do male caregivers who attend workshops and educational seminars experience less stress than men who do not?
Medical Setting Is there a difference between medical settings? Do the male caregivers whose wives are receiving treatment at Johns Hopkins University experience stress differently than male caregivers whose wives are being treated at private oncologists’ offices?