Economic Hardship and the Emotional Health of Family Caregivers

Research Purposes: Multiple studies have quantified the direct and indirect costs of cancer care; however, there is little attention to how concerns about costs impact the emotional health of family caregivers. The purpose of this study, using the Pittsburgh Mind Body Center Model, was to evaluate how perceptions of economic hardship influence burden, anxiety, and depressive symptoms in caregivers of persons with a primary malignant brain tumor.Methods: Data were from an ongoing, longitudinal study (NCI R01CA118711). Caregiver (CG)/care recipient (CR) dyads (n=33) were recruited within a month of the CR's diagnosis; data were collected at the point of diagnosis and 4 months later. CRs were questioned using the Neurocognitive Status Exam (NCSE) and CGs completed questionnaires to determine perceptions of economic hardship, burden (Caregiver Reaction Assessment), anxiety (POMS), and depressive symptoms (CES-D). Linear regression was used to examine relationships among variables.Results: Perceived economic hardship had a significant effect on two CG burden subscales: feelings that providing care negatively affected one's schedule, and feelings of abandonment. Economic hardship did not predict CG burden due to schedule at baseline, but did significantly (p<.01) predict burden 4 months later. Alternately, economic hardship predicted burden due to feelings of abandonment at the time of diagnosis (p<.01), but not 4 months into the care situation. CG depression was predicted by economic hardship 4 months after diagnosis (p=.05), but not at the initial interview. Economic hardship predicted CG anxiety at both the time of diagnosis and at the second interview (p<.01).Conclusions: Results suggest that caregivers' perception of economic hardship may be an important yet variable aspect of the burden, anxiety, and depression caregivers feel at the time of diagnosis and throughout the care situation.Public Health Significance: Caregivers of persons with a chronic disease such as cancer face financial pressure that may have negative emotional consequences. Although it may not be feasible to alleviate economic hardship, interventions may be effective in decreasing associated feelings of burden and anxiety during the care situation, and preventing the escalation of depressive symptoms