Abstract
The present study investigated how stressors experienced by caregivers of people with personality disorders relate to each other and psychological distress, using the Stress Process Model (Pearlin et al. in Gerontologist 30(5):583–594, https://doi.org/10.1093/geront/30.5.583, 1990). A community sample of caregivers (N = 106) completed an online survey. Partial Least Squares Path Modelling revealed that caregivers who were male, younger, or residing with their loved one were more likely to experience stressors. Salient primary stressors included the caregivers' worry and care-receivers' levels of instrumental demands and interpersonal problems. Important secondary stressors included strains in the caregivers' schedules, family relationships, and health, as well as reduced mastery and caregiving esteem. The model provided preliminary support for a pathway from demographic and relationship characteristics, through primary and secondary stressors, to heightened psychological distress. The present study clarifies the way caregiving stressors give rise to psychological distress; directions for future research are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders fifth edition DSM-5. Washington DC: American Psychiatric Publishing.
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler psychological distress scale (K10). Australian and New Zealand Journal of Public Health, 25(6), 494–497. https://doi.org/10.1111/j.1467-842X.2001.tb00310.x.
Bailey, R. C., & Grenyer, B. F. (2013). Burden and support needs of carers of persons with borderline personality disorder: A systematic review. Harvard Review of Psychiatry, 21(5), 248–258. https://doi.org/10.1097/HRP.0b013e3182a75c2c.
Bailey, R. C., & Grenyer, B. F. S. (2014). Supporting a person with personality disorder: A study of carer burden and well-being. Journal of Personality Disorders, 28(6), 796–809.
Bailey, R. C., & Grenyer, B. F. S. (2015). The relationship between expressed emotion and wellbeing for families and carers of a relative with borderline personality disorder. Personality and Mental Health, 9, 21–32. https://doi.org/10.1002/pmh.1273.
Bauer, R., Döring, A., Schmidt, T., & Spießl, H. (2012). “Mad or bad?”: Burden on caregivers of patients with personality disorders. Journal of Personality Disorders, 26(6), 956–971. https://doi.org/10.1521/pedi.2012.26.6.956.
Bradford, D., & Palmer, A. F. (2016). In strong hands: Ehealth support for mental health carers. San Jose, CA: Poster session presented at the meeting of Computing and Mental Health.
Buteau, E., Dawkins, K., & Hoffman, P. (2008). In their own words: Improving services and hopefulness for families dealing with BPD. Social Work in Mental Health, 6(1–2), 203–214. https://doi.org/10.1300/J200v06n01_16.
Cairney, J., Veldhuizen, S., Wade, T. J., Kurdyak, P., & Streiner, D. L. (2007). Evaluation of 2 measures of psychological distress as screeners for depression in the general population. Canadian Journal of Psychiatry, 52(2), 111–120. https://doi.org/10.1177/070674370705200209.
Chin, W. W. (1998). The partial least squares approach to structural equation modeling. In G. A. Marcoulides (Ed.), Modern methods for business research (pp. 295–336). Mahwah, NJ: Lawrence Erlbaum Associates.
Chin, W. W. (2010). How to write up and report PLS analyses. In V. E. Vinzi, W. W. Chin, J. Hensler, & H. Wang (Eds.), Handbook of partial least squares: Concepts, methods and applications (pp. 655–690). New York, NY: Springer.
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., et al. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129.
Clifton, A., Turkheimer, E., & Oltmanns, T. F. (2005). Self-and peer perspectives on pathological personality traits and interpersonal problems. Psychological Assessment, 17(2), 123–131. https://doi.org/10.1037/1040-3590.17.2.123.
Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). New York, NY: Routledge.
Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2001). Suicidal ideation and help-negation: Not just hopelessness or prior help. Journal of Clinical Psychology, 57(7), 901–914. https://doi.org/10.1002/jclp.1058.
Dunne, E., & Rogers, B. (2013). “It’s us that have to deal with it seven days a week”: Carers and borderline personality disorder. Community Mental Health Journal, 49(6), 643–648. https://doi.org/10.1007/s10597-012-9556-4.
Ferriter, M., & Huband, N. (2003). Experiences of parents with a son or daughter suffering from schizophrenia. Journal of Psychiatric and Mental Health Nursing, 10(5), 552–560. https://doi.org/10.1046/j.1365-2850.2003.00624.x.
Given, C. W., Given, B., Stommel, M., Collins, C., King, S., & Franklin, S. (1992). The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairment. Research in Nursing and Health, 15, 271–283. https://doi.org/10.1002/nur.4770150406.
Goodman, M., Patil, U., Triebwasser, J., Hoffman, P., & Weinstein, Z. A. (2011). Parental burden associated with borderline personality disorder in female offspring. Journal of Personality Disorders, 25(1), 59–74. https://doi.org/10.1521/pedi.2011.25.1.59.
Haley, W. E., LaMonde, L. A., Han, B., Burton, A. M., & Schonwetter, R. (2003). Predictors of depression and life satisfaction among spousal caregivers in hospice: Application of a stress process model. Journal of Palliative Medicine, 6(2), 215–224. https://doi.org/10.1089/109662103764978461.
Hoffman, P. D., Fruzzetti, A. E., & Buteau, E. (2007). Understanding and engaging families: An education, skills and support program for relatives impacted by borderline personality disorder. Journal of Mental Health, 16(1), 69–82. https://doi.org/10.1080/09638230601182052.
IBM Corp. (2011). IBM SPSS statistics for windows, version 20.0. Armonk, NY: IBM Corp.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(06), 959–976. https://doi.org/10.1017/S0033291702006074.
Lawn, S., & McMahon, J. (2015). Experiences of family carers of people diagnosed with borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 22(4), 234–243. https://doi.org/10.1111/jpm.12193.
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553–564. https://doi.org/10.1016/j.biopsych.2006.09.019.
MacLeod, A., Skinner, M. W., & Low, E. (2012). Supporting hospice volunteers and caregivers through community-based participatory research. Health & Social Care in the Community, 20(2), 190–198. https://doi.org/10.1111/j.1365-2524.2011.01030.x.
McIntosh, C. N., Edwards, J. R., & Antonakis, J. (2014). Reflections on partial least squares path modeling. Organizational Research Methods, 17(2), 210–251. https://doi.org/10.1177/1094428114529165.
Ohaeri, J. U. (2003). The burden of caregiving in families with a mental illness: a review of 2002. Current Opinion in Psychiatry, 16(4), 457–465. https://doi.org/10.1097/01.yco.0000079212.36371.c0.
Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594. https://doi.org/10.1093/geront/30.5.583.
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21. https://doi.org/10.2307/2136319.
Pickard, J. G., Inoue, M., Chadiha, L. A., & Johnson, S. (2011). The relationship of social support to African American caregivers’ help-seeking for emotional problems. Social Service Review, 85(2), 247–266. https://doi.org/10.1086/660068.
Pilkonis, P. A., Kim, Y., Proietti, J. M., & Barkham, M. (1996). Scales for personality disorders developed from the Inventory of Interpersonal Problems. Journal of Personality Disorders, 10(4), 355–369. https://doi.org/10.1521/pedi.1996.10.4.355.
Provencher, H. L., Perreault, M., St. Onge, M., & Rousseau, M. (2003). Predictors of psychological distress in family caregivers of persons with psychiatric disabilities. Journal of Psychiatric and Mental Health Nursing, 10(5), 592–607. https://doi.org/10.1046/j.1365-2850.2003.00623.x.
Roelands, M., van Oost, P., & Depoorter, A. (2008). Service use in family caregivers of persons with dementia in Belgium: Psychological and social factors. Health and Social Care in the Community, 16(1), 42–53. https://doi.org/10.1111/j.1365-2524.2007.00730.x.
RStudio Team. (2015). RStudio: Integrated development for R. Boston, MA: RStudio Inc.
Sanchez, G., Trinchera, L., & Russolillo, G. (2015). plspm: Tools for Partial Least Squares Path Modeling (PLS-PM). R package version 0.4.7. Retrieved from: https://CRAN.R-project.org/package=plspm
Scheirs, J. G. M., & Bok, S. (2007). Psychological distress in caretakers or relatives of patients with borderline personality disorder. International Journal of Social Psychiatry, 53(3), 195–203. https://doi.org/10.1177/0020764006074554.
Skodol, A. E., Gunderson, J. G., McGlashan, T. H., Dyck, I. R., Stout, R. L., Bender, D. S., et al. (2002). Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. American Journal of Psychiatry, 159, 276–283. https://doi.org/10.1176/appi.ajp.159.2.276.
Stommel, M., Given, C. W., & Given, B. (1990). Depression as an overriding variable explaining caregiver burdens. Journal of Aging and Health, 2(1), 81–102. https://doi.org/10.1177/089826439000200106.
Szmukler, G. I., Burgess, P., Herrman, H., Benson, A., Colusa, S., & Bloch, S. (1996). Caring for relatives with serious mental illness: The development of the Experience of Caregiving Inventory. Social Psychiatry and Psychiatric Epidemiology, 31, 137–148. https://doi.org/10.1007/BF00785760.
Tanis, M., Das, E., & Fortgens-Sillmann, M. (2011). Finding care for the caregiver? Active participation in online health forums attenuates the negative effect of caregiver strain on wellbeing. Communications, 36(1), 51–66. https://doi.org/10.1515/comm.2011.003.
Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality disorder diagnoses: Gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24(4), 412–426. https://doi.org/10.1521/pedi.2010.24.4.412.
Turnbull, A. P., Friesen, B. J., & Ramirez, C. (1998). Participatory action research as a model for conducting family research. Journal of the Association for Persons with Severe Handicaps, 23(3), 178–188. https://doi.org/10.2511/rpsd.23.3.178.
Wilson, C. J., Deane, F. P., Ciarrochi, J., & Rickwood, D. (2005). Measuring help-seeking intentions: Properties of the general help-seeking questionnaire. Canadian Journal of Counselling, 39(1), 15–28.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Research Involving Animal Rights
This article does not contain any studies with animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lamborn, P., Cramer, K.M. Factors Associated with Distress in Caregivers of People with Personality Disorders. Community Ment Health J 56, 1298–1310 (2020). https://doi.org/10.1007/s10597-020-00640-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-020-00640-5