Do positive aspects of caregiving lessen burden and depression, or the other way round? A mixed-methods study

Positive aspects of caregiving (PAC) are assumed to protect against caregiver suffering, but evidence is lacking. Two studies examined this assumption through testing the reciprocal causality between PAC and burden/depression, and exploring the mechanisms linking these constructs.

MethodsIn Study One, 99 dementia caregivers were interviewed six months apart. In Study Two, 45 caregivers provided 620 diaries across eight weeks.

In Study One, baseline burden predicted increased depressive symptoms, whereas baseline depressive symptoms predicted less PAC. Although burden was unrelated to PAC concurrently, burden was found to strengthen PAC after depression was controlled for (statistical suppression). Contrary to prevailing assumption, PAC predicted neither burden nor depression. In Study Two, 213 of the 620 diaries contained narratives linking burden to PAC. Supporting the PAC-enhancing role of burden, four mechanisms were extracted using thematic analysis, describing unrelenting caregiving stress enriching the significance of their work and pressuring them to learn, to push beyond boundaries, and to transform thinking.

Chronic hardship may be a breeding ground for positive meanings, yet also increasing depression, undermining positivity. Consequently, burden has a direct positive effect, but an indirect negative effect via depression, on PAC. A conceptual model depicting such complex dynamics is proposed.