Caregiver coping strategies related to anxiety, depression, and quality of life


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November is caregiver month and timely results from a study published in Blood progress suggest that among caregivers of patients undergoing stem cell transplantation, how someone approaches coping can influence the anxiety, depression, and poor quality of life (QOL) they experience. In particular, problem-solving and coping strategies appeared more helpful.

“This study highlights that the psychological distress experienced by caregivers is real and how caregivers deal with the challenges they face in supporting their loved one affects their distress and their quality of life. We also know from previous research that caregivers’ psychological well-being. it affects patients’ well-being,” said Hermione Amonoo, MD, of the Dana-Farber Cancer Institute and Carol C. Nadelson, MD, Distinguished Chair in Psychiatry, Brigham and Women’s Hospital in Boston, and the study’s principal investigator.

Most stem cell transplant centers require people preparing for a transplant to designate a primary caregiver—someone who will support them for the first 100 days after their transplant. In addition, before undergoing a stem cell transplant for blood cancer, most patients receive induction chemotherapy, which effectively wipes out their immune system, leaving them highly vulnerable to infections and other medical complications.

Caregivers have many responsibilities, Dr. Amonoo said, including taking steps to protect patients from infection due to their highly immunocompromised state, supporting patients to take a number of medications correctly each day, helping patients prepare meals that follow post-transplant guidelines, and coordinating patient communication and their healthcare providers. .

“Our research highlights the urgent need for resources to help caregivers develop and use coping strategies that protect their mental health and quality of life and enable them to successfully perform this important role,” she said.

Previous research has shown that caregivers of cancer patients experience distress, loneliness, fatigue, sleep disturbances, financial concerns, and poor quality of life, and that fatigue among caregivers of patients undergoing stem cell transplantation is associated with slower growth of healthy new blood cells and poorer sleep quality for the patient. Dr. Amonoo took this research a step further by specifically investigating the effects of different types of coping strategies on caregivers and their loved ones.

“This is the largest study to date to look at caregiver coping strategies,” said Dr. Amonoo said. “The whole field of research on caregivers is very new,” she said.

Researchers in the field categorize caregiver coping strategies into two broad categories called “avoidant” and “approach-oriented.” Avoidant coping strategies include denial of the reality of the situation and self-blame, in which the caregiver blames themselves if the patient misses a dose of medication or is late for an appointment. In contrast, approach-based coping strategies involve active problem solving, finding sources of emotional support, and using “positive reframing” to think about their situation differently.

For this study, Dr. Amonoo and her colleagues enrolled 170 primary caregivers of people with blood cancers who were undergoing stem cell transplants. A caregiver may be a spouse, relative, or friend named by the patient as their primary caregiver. Most caregivers were female (130, or 76.5%) and white (147, or 86.5%); Their average age was 53.

Shortly after a patient’s hospitalization for stem cell transplantation, caregivers completed questionnaires asking about their use of different coping strategies, symptoms of anxiety or depression, and QOL. The researchers also looked at caregivers’ reliance on religious beliefs as a coping mechanism.

A significant number of caregivers reported high use of acceptance (55.9%), positive reframing (45.9%), and religious (44.1%) coping strategies. Caregivers who relied on approach-based coping strategies such as these (49.4%) had fewer symptoms of anxiety and depression and better quality of life compared to those who relied on avoidant coping strategies (32.9%).

“Strategies such as active problem solving and positive reframing appeared to be more helpful for caregivers than strategies such as denial and self-blame,” said Dr. Amonoo said. “In this study, we did not find an association between religiosity and caregiver distress or QOL, although some previous smaller studies have found such an association.”

“Response strategies are neither good nor bad – you have to meet people where they are,” she added.

“And caregivers can be taught to use coping strategies that may be more helpful and may allow them to feel less anxious, depressed, or overwhelmed. So if a caregiver is thinking, ‘My life will never be the same again,’ we can help they reframe it in a more positive way – for example, I know there will be a lot of uncertainty when my loved one recovers from a stem cell transplant, but I am not alone in this – I can talk to the care team when questions arise or when I feel inadequate about something I need to do.'”

Dr. Amonoo said her research group is working to develop a variety of interventions and resources for caregivers. “Our goal is to create resources that help caregivers succeed while empowering them to take care of their own mental health,” she said.

More information:
Hermione L. Amonoo et al., Coping in Caregivers of Patients with Hematologic Malignancies in Going Hematopoietic Stem Cell Transplantation, Blood progress (2022). DOI: 10.1182/bloodadvances.2022008281

Provided by the American Society of Hematology

Quotation: Caregivers Coping Strategies for Anxiety, Depression and Quality of Life (2022, November 18) Retrieved November 19, 2022 from

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