Skip to main content
SpringerLink
Log in

Does Caregiving Cause Psychological Distress? The Case for Familial and Genetic Vulnerabilities in Female Twins

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Informal caregiving can be deleterious to mental health, but research results are inconsistent and may reflect an interaction between caregiving and vulnerability to stress.

Methods

We examined psychological distress among 1,228 female caregiving and non-caregiving twins. By examining monozygotic and dizygotic twin pairs discordant for caregiving, we assessed the extent to which distress is directly related to caregiving or confounded by common genes and environmental exposures.

Results

Caregiving was associated with distress as measured by mental health functioning, anxiety, perceived stress, and depression. The overall association between caregiving and distress was confounded by common genes and environment for mental health functioning, anxiety, and depression. Common environment also confounded the association of caregiving and perceived stress.

Conclusions

Vulnerability to distress is a factor in predicting caregivers' psychosocial functioning. Additional research is needed to explicate the mechanisms by which common genes and environment increase the risk of distress among informal caregivers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. National Alliance for Caregiving, AARP. Caregiving in the US. Washington, DC; 2009.

  2. Rosalynn Carter Institute for Caregiving. Averting the caregiving crisis: Why we must act now. Americus, GA; 2010; 5-12.

  3. National Alliance for Caregiving, AARP. Caregiving in the US. Washington, DC; 2004.

  4. Marks NF, Lambert JD, Choi H. Transitions to caregiving, gender, and psychological well-being: A prospective US national study. J Marriage Fam. 2002; 64: 657-667.

    Article  Google Scholar 

  5. Pearlin LI, Semple S, Turner H. Stress of AIDS caregiving: A preliminary overview of the issues. Death Stud. 1988; 12: 5-6.

    Article  Google Scholar 

  6. Shahly V, Chatterji S, Gruber M, et al. Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys. Psychol Med. 2012; 9: 1-15.

    Google Scholar 

  7. Pinquart M, Sorensen S. Differences between caregivers and non-caregivers in psychological health and physical health: A meta-analysis. Psychol Aging. 2003; 18: 250-267.

    Article  PubMed  Google Scholar 

  8. Dyck DG, Short R, Vitaliano PP. Predictors of burden and infectious illness in schizophrenia caregivers. Psychosom Med. 1999; 61: 411-419.

    PubMed  CAS  Google Scholar 

  9. Lutgendorf SK, De Geest K, Bender D, et al. Social influences on clinical outcomes of patients with ovarian cancer. J Clin Oncol. 2012; 30: 2885-2890.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Mosher CE, Danoff-Burg S. Psychosocial impact of parental cancer in adulthood: A conceptual and empirical review. Clin Psychol Rev. 2005; 25: 365-382.

    Article  PubMed  Google Scholar 

  11. Molloy GJ, Johnston DW, Witham MD. Family caregiving and congestive heart failure. Review and analysis. Eur J Heart Fail. 2005; 7: 592-603.

    Article  PubMed  Google Scholar 

  12. Schieve LA, Blumberg SJ, Rice C, Visser SN, Boyle C. The relationship between autism and parenting stress. Pediatrics. 2007; 119: 114-121.

    Article  Google Scholar 

  13. Whitlatch CJ, Feinberg LF, Stevens EJ. Predictors of institutionalization for persons with Alzheimer's disease and the impact on family caregivers. J Ment Health Aging. 1999; 5: 275-288.

    Google Scholar 

  14. Miller B, Cafasso L. Gender differences in caregiving: Fact or artifact? Gerontologist. 1992; 32: 498-507.

    Article  PubMed  CAS  Google Scholar 

  15. Grad J, Sainsbury P. Mental illness and the family. Lancet. 1963; 1: 544-547.

    Article  PubMed  CAS  Google Scholar 

  16. Schulz R, Sherwood PR. Physical and mental health effects of family caregiving. Am J Nurs. 2008; 108: 23-27. quiz 27.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Vitaliano P, Echeverria D, Shelkey M, Zhang JP, Scanlan J. A cognitive psychophysiological model to predict functional decline in chronically stressed older adults. J Clin Psychol Med S. 2007; 14: 177-190.

    Article  Google Scholar 

  18. Mittelman MS. A family intervention to delay nursing home placement of patients with Alzheimer's disease. A randomized controlled trial. J Am Med Assoc. 1996; 276: 1725-1731.

    Article  CAS  Google Scholar 

  19. Zubin J, Spring B. Vulnerability—a new view of schizophrenia. J Abnorm Psychol. 1977; 86: 103-126.

    Article  PubMed  CAS  Google Scholar 

  20. Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one's physical health? A meta-analysis. Psychol Bull. 2003; 129: 946-972.

    Article  PubMed  Google Scholar 

  21. Russo J, Vitaliano PP, Brewer DD, Katon W, Becker J. Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: A diathesis-stress model of psychopathology. J Abnorm Psychol. 1995; 104: 197-204.

    Article  PubMed  CAS  Google Scholar 

  22. Little RJ, Rubin DB. Causal effects in clinical and epidemiological studies via potential outcomes: Concepts and analytical approaches. Annu Rev Publ Health. 2000; 21: 121-145.

    Article  CAS  Google Scholar 

  23. McGue M, Osler M, Christensen K. Causal inference and observational research: The utility of twins. Perspect Psychol Sci. 2010; 5: 546-556.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Rubin DB. For objective causal inference, design trumps analysis. Ann Appl Stat. 2008; 2: 808-840.

    Article  Google Scholar 

  25. Afari N, Noonan C, Goldberg J, et al. University of Washington Twin Registry: Construction and characteristics of a community-based twin registry. Twin Res Hum Genet. 2006; 9: 1023-1029.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Strachan E, Hunt C, Afari N, et al. The University of Washington Twin Registry: Poised for the next generation of twin research. Twin Res Hum Genet. 2012; 1–8.

  27. Kendler KS, Prescott CA. A population-based twin study of lifetime major depression in men and women. Arch Gen Psychiat. 1999; 56: 39-44.

    Article  PubMed  CAS  Google Scholar 

  28. Kendler KS, Kessler RC, Walters EE, et al. Stressful life events, genetic liability, and onset of an episode of major depression in women. Am J Psychiat. 1995; 152: 833-842.

    PubMed  CAS  Google Scholar 

  29. Federenko IS, Schlotz W, Kirschbaum C, Bartels M, Hellhammer DH, Wust S. The heritability of perceived stress. Psychol Med. 2006; 36: 375-385.

    Article  PubMed  Google Scholar 

  30. Reed T, Plassman BL, Tanner CM, Dick DM, Rinehart SA, Nichols WC. Verification of self-report of zygosity determined via DNA testing in a subset of the NAS-NRC Twin Registry 40 years later. Twin Res Hum Genet. 2005; 8: 362-367.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Heal Soc Behav. 1983; 24: 385-396.

    Article  CAS  Google Scholar 

  32. Mitchell AM, Crane PA, Kim Y. Perceived stress in survivors of suicide: Psychometric properties of the perceived stress scale. Res Nurs Health. 2008; 31: 576-585.

    Article  PubMed  Google Scholar 

  33. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer Publishing Company; 1984.

    Google Scholar 

  34. Leventhal H, Brown D, Shacham S, Engquist G. Effects of preparatory information about sensations, threat of pain, and attention on cold pressor distress. J Pers Soc Psychol. 1979; 37: 688-714.

    Article  PubMed  CAS  Google Scholar 

  35. Selye H. The Stress of Life. New York: McGraw-Hill; 1956.

    Google Scholar 

  36. Ware J, Kosinski M, Dewey J, Gandek B. A Manual for Users of the SF-8 Health Survey. Lincoln, RI: Quality Metrics Inc.; 2001.

    Google Scholar 

  37. Derogatis LR, Melisaratos N. The brief symptom inventory: An introductory report. Psychol Med. 1983; 13: 595-605.

    Article  PubMed  CAS  Google Scholar 

  38. De Jong MM, An K, McKinley S, Garvin BJ, Hall LA, Moser DK. Using a 0–10 scale for assessment of anxiety in patients with acute myocardial infarction. Dimens Crit Care Nurs. 2005; 24: 139-146.

    Article  PubMed  Google Scholar 

  39. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med Care. 2003; 41: 1284-1292.

    Article  PubMed  Google Scholar 

  40. Daig I, Herschbach P, Lehmann A, Knoll N, Decker O. Gender and age differences in domain-specific life satisfaction and the impact of depressive and anxiety symptoms: A general population survey from Germany. Qual Life Res. 2009; 18: 669-678.

    Article  PubMed  Google Scholar 

  41. Bergen SE, Kendler KS, Gardner CO, Aggen SH. Socioeconomic status and social support following illicit drug use: Causal pathways or common liability? Twin Res Hum Genet. 2008; 11: 266-274.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Vitaliano PP, Russo J, Young HM, Teri L, Maiuro RD. Predictors of burden in spouse caregivers of individuals with Alzheimer's disease. Psychol Aging. 1991; 6: 392-402.

    Article  PubMed  CAS  Google Scholar 

  43. Monroe SM, Simmons AD. Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychological Bulletin. 1991; 110: 406-425.

    Article  PubMed  CAS  Google Scholar 

  44. Robins LN. Sturdy childhood predictors of adult antisocial behavior: Replications from longitudinal studies. Psychol Med. 1978; 8: 611-622.

    Article  PubMed  CAS  Google Scholar 

  45. Adler NE, Coriell M. Socioeconomic status and health: Do we know what explains the association? Adv J Mind Body Health. 1995; 11: 6-9.

    Google Scholar 

  46. Adler N, Boyce T, Chesney M, et al. Socioeconomic status and health. The challenge of the gradient. Am Psychol. 1994; 49: 15-24.

    Article  PubMed  CAS  Google Scholar 

  47. Regier DA. The linkage of health care reform and health services research. Am J Psychiat. 1993; 150: 1613-1615.

    PubMed  CAS  Google Scholar 

  48. Bourdon K, Rae D, Narrow W, Manderschild R, Regier D. National prevalence and treatment of mental and addictive disorders. In: Mandershild R, Sonnenschein M, eds. Mental Health, United States, 1994. Washington, DC: Center for Mental Health Services; 1994: 22-51.

    Google Scholar 

  49. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Affair. 2002; 21: 78-93.

    Article  Google Scholar 

  50. McGrath E, American Psychological Association National Task Force on Women and Depression. Women and Depression: Risk Factors and Treatment Issues: Final Report of the American Psychological Association's National Task Force on Women and Depression. Washington, DC: American Psychological Association; 1990.

    Book  Google Scholar 

  51. Conger RD, Wallace LE, Sun Y, Simons RL, McLoyd VC, Brody GH. Economic pressure in African-American families: A replication and extension of the family stress model. Dev Psychol. 2002; 38: 179-193.

    Article  PubMed  Google Scholar 

  52. Conger RD, Conger KJ, Martin MJ. Socioeconomic status, family processes, and individual development. J Marriage Fam. 2010; 72: 685-704.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997; 349: 1436-1442.

    Article  PubMed  CAS  Google Scholar 

  54. Kendler KS, Karkowski-Shuman L. Stressful life events and genetic liability to major depression: Genetic control of exposure to the environment? Psychol Med. 1997; 27: 539-547.

    Article  PubMed  CAS  Google Scholar 

  55. Saudino KJ, Pedersen NL, Lichtenstein P, McClearn GE, Plomin R. Can personality explain genetic influences on life events? J Pers Soc Psychol. 1997; 72: 196-206.

    Article  PubMed  CAS  Google Scholar 

  56. Hansell NK, Wright MJ, Medland SE, et al. Genetic comorbidity between neuroticism, anxiety/depression, and somatic distress in a population sample of adolescent and young adult twins. Psychol Med. 2012; 42: 1249-1260.

    Article  PubMed  CAS  Google Scholar 

  57. Schulz R, Beach SR. Caregiving as a risk factor for mortality—The caregiver health effects study. J Amer Med Assoc. 1999; 282: 2215-2219.

    Article  CAS  Google Scholar 

  58. Vitaliano PP, Scanlan JM, Zhang J, Savage MV, Hirsch IB, Siegler IC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002; 64: 418-435.

    PubMed  CAS  Google Scholar 

  59. Vitaliano PP, Zhang J, Young HM, Caswell LW, Scanlan JM, Echeverria D. Depressed mood mediates decline in cognitive processing speed in caregivers. Gerontologist. 2009; 49: 12-22.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Vitaliano PP, Persson R, Kiyak A, Saini H, Echeverria D. Caregiving and gingival symptom reports: Psychophysiologic mediators. Psychosom Med. 2005; 67: 930-938.

    Article  PubMed  Google Scholar 

  61. Kiecolt-Glaser JK, Glaser R, Gravenstein S, Malarkey WB, Sheridan J. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proc Natl Acad Sci U S A. 1996; 93: 3043-3047.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  62. Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado AM, Glaser R. Slowing of wound healing by psychological stress. Lancet. 1995; 346: 1194-1196.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research was supported by the National Institutes of Health grants RC2 HL103416 (D. Buchwald) and R01 AR051524 (N. Afari) and AG023629 (P. Vitaliano). We wish to thank the twins for taking part in the University of Washington Twin Registry and for their time and enthusiasm for this project.

Conflict of Interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington, PO Box 356560, Seattle, WA, 98195, USA

    Peter P. Vitaliano Ph.D. & Eric Strachan Ph.D.

  2. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Elizabeth Dansie Ph.D.

  3. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Jack Goldberg Ph.D. & Dedra Buchwald M.D.

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Dedra Buchwald M.D.

  5. The University of Washington Twin Registry, Seattle, WA, USA

    Eric Strachan Ph.D., Jack Goldberg Ph.D. & Dedra Buchwald M.D.

  6. Center for Clinical and Epidemiological Research, University of Washington, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA

    Dedra Buchwald M.D.

Authors
  1. Peter P. Vitaliano Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Strachan Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Dansie Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jack Goldberg Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dedra Buchwald M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter P. Vitaliano Ph.D..

About this article

Cite this article

Vitaliano, P.P., Strachan, E., Dansie, E. et al. Does Caregiving Cause Psychological Distress? The Case for Familial and Genetic Vulnerabilities in Female Twins. ann. behav. med. 47, 198–207 (2014). https://doi.org/10.1007/s12160-013-9538-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-013-9538-y

Keywords

Search

Navigation