Problem solving and social support patterns among family caregivers of adults with SCI
1O'Rourke K, 1Kelly E, 1January A, 2Ghaffari A, 3Harris G, 2Richardson M, 4Chen D, 5Ray L
1Shriners Hospitals for Children Chicago, Chicago, IL, USA; 2Hines Veteran Administration, Hines, IL, USA; 3Marquette University, Milwaukee, Wisconsin, United states; 4Shirley Ryan AbilityLab, Chicago, IL, USA; 5Schwab Rehabilitation Hospital, Chicago, IL, USA
Objective: Assess profiles based on social problem solving (PS) skills and social support among caregivers of adults with SCI and associations between profiles and caregiver quality of life and well-being.
Design: Mixed-methods study of 41 dyads of U.S. caregivers and adults with SCI from 3 rehabilitation hospitals and one Veterans Administration hospital.
Methods: Dyad members participated in qualitative interviews exploring caregiver quality of life and well-being and standardized surveys exploring caregiver PS, social support, quality of life, and well-being. Qualitative patterns were identified involving social support and PS, leading us to explore these constructs quantitatively using cluster analysis and MANOVA. Caregiver PS included: positive problem orientation (PPO), negative problem orientation (NPO), rational style (RS), impulsive/compulsive style (ICS), and avoidant style (AS). Adults with SCI were most commonly male (73%) and had tetraplegia (68%); mean age at injury was 22 years (range=17-37), and current age was 39 years (range=25-57); 51% reported being white; and 34% were veterans. Caregivers were most commonly female (81%), ethnic minority (56%), with post-secondary education (61%); and mean current age was 50 years (range 22-81). Just under half of caregivers were partners (46%), 39% parents, and <5% siblings, close friends, or extended relatives.
Results: Cluster analysis revealed 3 profiles distinguishing caregivers in terms of PS skills and social support (F (12,66)=10.48, p<0.01; Wilk’s lambda=0.12, eta=0.66): Profile 1 – higher social support (vs. profiles 2 and 3) higher PPO and RS (vs. profile 3); Profile 2 – higher NPO, ICS, and AS (vs. profiles 1 and 3) and lower social support (vs. profile 1); Profile 3 – lower social support and PPO (vs. profile 1) and lower RS (vs. profiles 1 and 2). The 3 profiles also distinguished dyads by caregiver quality of life and well-being. Profile 1 reported fewer challenges and higher well-being (vs. profiles 2 and 3). Specifically, caregivers in profile 1 reported higher satisfaction with leisure and social integration and fewer concerns related to depression (vs. profiles 2 and 3) as well as higher satisfaction with quality of life and lower physical complaints (vs. profile 2). Profile 2 caregivers reported more burden, depression, and anxiety (vs. profiles 1 and 3) and more physical health complaints (vs. profile 1). Profile 3 appeared to fare slightly better than those in profile 2 with fewer reported concerns relating to depression. Qualitative data further demonstrated that profile 2 caregivers experienced greater poverty and challenges with disability adjustment. Profile 1 caregivers most commonly talked about the importance of family support and active coping.
Discussion: Findings suggest that effective problem solving and strong social support may be protective factors offsetting stressors associated with caregiving and bolstering caregiver well-being. Assessing PS, social support, and caregiving challenges and triaging caregivers into supportive interventions when depicting risk may hold promise for the prevention of physical and mental health distress in caregivers.
Support: Department of Defense, Qualitative Research Award (Grant #SC130279)
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