Factors associated with adjustment in mental health carers.

Family members or friends caring for a loved one with a serious mental illness are known as mental health carers. There are approximately 110,000 Australian mental health carers (Australian Bureau of Statistics, 2004), all of whom play an important and necessary role in supporting their care recipient and in easing the burden of care on society at large. This demanding role has been shown to have a detrimental impact on carer wellbeing, including increased psychological distress and physical health problems and decreased life satisfaction. The research programme investigated the utility of a stress and coping model of adaptation to mental health caregiving derived from Lazarus and Folkman’s (1984) stress and coping theory in predicting adjustment in Australian mental health carers over two time points. Study 1 applied the model to 114 Australian mental health carers recruited through carer support agencies and two local hospitals using a questionnaire. This cross-sectional study tested the relationships between positive (positive affect, life satisfaction, benefit finding and physical health) and negative (psychological distress) adjustment outcomes and stress and coping predictors (coping resources, cognitive appraisal and coping strategies). As hypothesised, hierarchical multiple regression analyses indicated that after controlling for the effects of relevant background variables, better caregiver adjustment was related to higher satisfaction with social support and optimism, better carer-care recipient relationship quality, lower threat and higher challenge appraisals, and less reliance on avoidance coping strategies. In the main, the model was supported by the cross-sectional data. Study 2 investigated the relationships between the abovementioned stress and coping predictors and adjustment variables over a one year period using a follow-up questionnaire survey, generated descriptive data regarding the adjustment outcomes, and assessed change in adjustment variables over a one year interval. Of the 107 participants eligible for inclusion in Study 2, 87 returned completed follow-up questionnaire packages. This constituted a high response rate of 81.31%. When controlling for time one adjustment and relevant background variables in hierarchical multiple regression analyses, better adjustment at time two was predicted by higher optimism, challenge appraisals and use of meaning-making coping strategies and lower use of avoidance and acceptance coping strategies at time one. The strongest and most consistent predictor of better adjustment was higher optimism. When controlling for time one adjustment, threat appraisals, control appraisals and both external coping resources (satisfaction with social support and carer-care recipient relationship quality) failed to emerge as predictors of adjustment at the multivariate level. Descriptive data revealed that participants reported significantly lower positive affect and life satisfaction than carer and non-carer comparison samples, and a high proportion of participants reported severe and extremely severe depression (approximately 20%), anxiety (approximately 17%) and stress (approximately 20%). Adjustment outcomes were stable over the one year period with the exception of stress, which reduced between time one and time two. These results demonstrate the stable detrimental effects of the mental health caregiving role and underscore the need to provide services to support mental health carers. Overall, the results support the stress and coping model of adaptation to mental health caregiving, showing that internal coping resources, primary appraisal and coping strategies were the strongest predictors of adjustment over time when controlling for T1 adjustment and relevant background variables, with weak support for external coping resources and threat appraisal. Secondary appraisal’s inclusion in the model was not supported by the results of either study. The research programme identified a number of background risk factors for poorer adjustment in mental health carers, as well as modifiable targets for psychological intervention in promoting better adjustment in mental health carers. Practice recommendations include provision of cognitive behavioural interventions to mental health carers targeting modifiable factors identified by the research, and greater consideration of the needs of mental health carers by service providers