Guilt, dysfunctional thought processes and depression in caregivers of people with dementia
Roach, Louise Victoria
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Background: Leading researchers have called for more sophisticated research designs in caregiver intervention research; by using theoretically grounded interventions, considering the likely mechanism of action and using appropriate outcome measures. This thesis comprises a systematic review which evaluates the match between psychosocial interventions for dementia caregiver burden and the burden measure used to evaluate them and an empirical study which tests the psychometric properties of two caregiving outcome measures developed in Spain (Caregiver Guilt Questionnaire - CGQ and Dysfunctional Thoughts about Caregiving Questionnaire - DTACQ). The empirical study also considers the role of guilt and cognition (conceptualized as dysfunctional thoughts in Cognitive Behavioural Therapy and cognitive fusion in Acceptance and Commitment Therapy) in predicting depression in dementia caregivers. Systematic review: Results for the effectiveness of psychosocial interventions to reduce dementia caregiver burden are mixed. Caregiver burden is inconsistently defined and measured, which may contribute to the mixed results. This review sought to systematically evaluate the match between psychosocial interventions for dementia caregiver burden and the burden measure used to evaluate them. A systematic search identified 15 studies using the 22 item Zarit Burden Interview as an outcome measure. A systematic review using specified quality criteria indicated a low level of congruence between the content of the psychosocial interventions and the content of the Zarit Burden Interview used to evaluate the interventions in the majority of studies. Methods: 221 informal familial dementia caregivers completed a cross sectional postal questionnaire survey. Results: Using exploratory factor analysis, the factor structures of the CGQ and DTACQ identified in the Spanish development studies were replicated in this study. Adequate internal consistencies were found for both scales. Convergent validity was established for the CGQ with the measures of guilt and depression. The DTACQ correlated positively with general dysfunctional attitudes and negatively with amount of support received as predicted, but did not correlate significantly with depression. A multiple regression analysis identified caregiver guilt and cognitive fusion, but not dysfunctional attitudes as significant predictors of depression in dementia caregivers. Conclusion: The CGQ appears to be a reliable and valid measure of caregiver guilt in a British population of dementia caregivers, although further research is recommended to develop the DTACQ. The relative strength of cognitive fusion as a predictor of caregiver depression suggests that the way in which an individual relates to their thoughts should be tested as a mechanism of change in dementia caregiver interventions.