Coping with Caregiver Depression & Anxiety

The prevalence of depression, anxiety, and/or chronic stress in caregivers of individuals with traumatic brain injury has been found to fairly high. Often caregivers, desiring to provide the best care possible for their loved one, will sacrifice their own physical and emotional needs. The emotional and physical experiences involved in caregiving can be very straining for even the most capable individuals. Feelings of anger, anxiety, sadness, isolation, exhaustion, and then guilt for having these feelings are not uncommon. Ignoring these feelings will not make them go away and can lead to more serious emotional distress and physical illness.

A study conducted in 1994, looking at the emotional experiences of 62 caregivers of outpatient individuals with brain injury, found that approximately ½ of the caregivers reported serious emotional distress. This finding was greater than the incidence of such emotional distress found in the general population or for the caregivers of individuals with other diagnoses. Approximately 1/3 of the caregivers reported significant levels of anxiety; approximately ¼ of the caregivers reported clinical depression; and a large amount of the caregivers reported feelings of burden and alienation (Kreutzer, Gervasio, and Camplair, 1994).

What are the consequences of depression and anxiety?

Again and again, studies have consistently found a direct link between depression and health. It has been found to increase the risk of high blood pressure, atherosclerosis, and other factors leading to heart attack or stroke, as well as lowered immune functioning which leads to a whole host of disorders and diseases. Anxiety or chronic stress has been found, over the course of 50 years of research, to lead to damage of almost every system of the body. It has been linked to hypertension, migraine headaches, ulcers, suppression of the reproductive system in both men and women, asthma and other respiratory conditions, diabetes, osteoporosis, immune and inflammatory diseases, susceptibility to colds, flu, and exacerbation of immune diseases such as cancer and AIDS, worsening of conditions, such as arthritis, chronic pain, and diabetes. In addition, there is evidence that chronic stress and anxiety can contribute to the onset of depression (Davis, Eshelman, and McKay, 1995; Hamby and Sacher, 2004).

Here are some of the common symptoms of stress or anxiety:

• Increased heart rate (fast pounding heart)
• Increased respiration rate (shortness of breath, shallow breathing, hyperventilation)
• Increased blood pressure
• Increased muscle activity (tight muscles, headaches, grinding teeth, tight jaw, tight stomach)
• Decreased blood flow (cold extremities)
• Increased sweating (especially hands)
• Increased brain activity (unable to focus attention or concentrate, irritable, worried, decreased sleep)
• Increased gastric activity (upset stomach, “butterflies”)

Do you know when you are depressed?

Here is a list of the most common symptoms of depression, put together by the Depression Alliance (2003). Many people experience these feelings at one time or another. If you have been experiencing any of these symptoms for a period of two weeks or longer, then it is very important to seek help from a professional (such as, your doctor; a psychologist, a psychiatrist, a social worker, a mental health counselor; a community mental health center; clergy; employee assistance program).

• Feelings of helplessness or hopelessness.
• Feeling useless, inadequate, or bad.
• Self-hatred, constant questioning of thoughts or actions, an overwhelming need for reassurance.
• Being vulnerable and “over-sensitive.”
• Feeling guilty.
• A loss of energy and motivation, that makes even the simplest tasks or decisions seem difficult.
• Engaging in self-harming behaviors.
• Loss or gain in weight.
• Difficulty with getting off to sleep or an excessive desire to sleep.
• Agitation and restlessness.
• Loss of sex drive.
• Finding it impossible to concentrate for any length of time.
• Forgetfulness.
• A sense of unreality.
• Physical aches and pains, sometimes with the fear that you are seriously ill.

In severe depression, these symptoms may also include:

• Suicidal thoughts.
• Failure to eat or drink.
• Delusions and/or hallucinations.

* Note: Do not wait two weeks to bring any of these symptoms to the attention of a medical or mental health professional.

Use of stress reduction techniques can, not only reduce the symptoms of stress and anxiety, but can decrease the risk of developing depression. Here are a few stress reducing ideas for the caregiver:

• Find all related information about care giving.
• Be practical with the goals you set for your loved one and yourself.
• Understand that care giving is often a stressful activity and do not be critical of yourself in moments of stress or irritation.
• Stay in touch with your friends as much as possible, do not give up being involved in activities that you enjoy.
• Take advantage of respite services available for you and your loved one.
• Keep a caregiver journal.
• Join a support group.
• Accept that there are events that you cannot control.
• Exercise regularly.
• Eat well-balanced meals.
• Rest and sleep.
• Don’t rely on alcohol or drugs to reduce stress.
• Learn to relax (see tips for relaxation below).
• Allow yourself the chance to laugh everyday.

* A few words about humor: Researchers at Loma Linda University in California have found that laughter appears to activate important elements of the immune system, such as T lymphocytes, gamma interferon, and immunoglobin A, which defend us from illness ranging from colds to cancer. Laugher also appears to help protect us from the dangers of stress by reducing the hormone related to stress, epinephrine, which can elevate the heart rate and blood pressure while also suppressing immune activity. In addition, scientists from the University of Michigan at Ann Arbor found that pessimists tend to suffer from more health problems than optimists (Shimer, 2002).

Quick relaxation tips:

• Just stop wherever you are. Take a deep breath . . . let the air out very slowly. Imagine that you are breathing in energy and breathing out tension, letting all the tension go. Repeat several times.
• Lie on your back with support, if needed. Let your body sink down until it is completely supported by the floor. Close your eyes and sink back in total relaxation, letting your mind and body be perfectly still. Feel yourself breathing deeply and easily.
• Assume a comfortable position. Close your eyes. Deeply relax all of your muscles, beginning at your feet and progressing up to your face. Keep the relaxed feeling. Breathe through your nose and become aware of your breathing. After each exhalation, think the word “one” silently to yourself. Breathe easily and naturally.

If you feel guilty about taking this time to take care of yourself as a caregiver, ask yourself this question, if you were to lose your health, who else would have the compassion and courage to step in and take care of both you and your loved one?

References

Barg, G. (2001). The Fearless Caregiver: How to get the best care for your loved one and still have a life of your own. Capital Books, Inc: Herndon, VA.

Chwalisz, K. (1992). Perceived stress and caregiver burden after brain injury: A theoretical integration. Rehabilitation Psychology, 37 (3), 189-203.

Davis, M., Robbins-Eshelman, E., & McKay, M. (1995). The Relaxation and StressReduction Workbook. New Harbinger Publications, Inc.: Oakland, CA.

Family Caregiver Alliance, Fact Sheet: Care giving and Depression.

Hamby, R. I. & Sacher, M. (2004). Effects of Depression on the Body. Heart Center Online.

Kreutzer, J. S., Gervasio, A. H., & Camplair, P. S. (1994). Primary caregivers’ psychological status and family functioning after TBI. Brain Injury, 8 (3), 197-210.

Shimer, P. (2002). New Hope for People With Alzheimer’s and Their Caregivers. Prima Publishing: Roseville, CA.