Caregiver

No one is born as a caregiver, although it is a role that life obliges us to fulfil.

Being a caregiver means being a family member (or a paid helper) who regularly looks after a sick, elderly or disabled person (Oxford Dictionaries).

It seems that on average caregivers are women, in their mid 40s, who spend about 20 hours per week (or more) taking care of another person, usually their mother or a young family member or their own partner.

Being a caregiver implies a direct contact with different types of diseases, from dementia to physical illnesses and mental problems. Another responsibility is usually helping the person carrying out different daily tasks: from assuring the compliance to pharmacological and non-pharmacological treatments to monitoring the general health of the assisted person and helping in daily routines…

The list is potentially very long, depending on the severity and type of disability.

The sure thing is that being a caregiver can become a full-time job and it can involve great responsibilities, a considerable amount of stress and very often putting the other person’s needs first with the consequent risk of disregarding our own personal needs.

Caregivers and mental health

In particular, if the assisted person suffers from a mental health condition the scenario may get even more distressful and complexed.

Mental health problems are unfortunately still marked by stigma and prejudice and the general information about them is still not sufficient. As a consequence the emotional burden of the caregivers may be even heavier and it is not uncommon for caregivers to experience anxiety and/or depressive symptoms. Scientific research shows that family members of schizophrenic and bipolar patients are particularly affected by the issue, with between 30 to 60% experiencing depressive symptoms (NAC, 1997; Heru et al, 2005).

Given this delicate and complex background, being a caregiver or living with a person suffering from a psychiatric disorder, is doubtless a tough job that implies many challenges and that can sometimes make us feel isolated and not supported enough.

If you are a caregiver

If you find yourself in a similar situation, keep in mind that your health (also your mental health) should come first, as it allows you to better take care of the other person. Plus, a very important tool is information: getting to know the specific illness that the person you are taking care of is suffering from may give you better tools to deal with it as well as foresee any possible complication.

If you feel too burdened don’t be ashamed to ask for help and cooperation to your close family and your closest friends and use the services provided by your community; very often hospitals and clinics organise support or self-help groups specifically for caregivers. Even if often we may feel lonely and not fully understood by the people who surround us, reality is different: there are many caregivers who experience the same feelings and sharing can bring a powerful relief.

On the contrary, if you are experiencing intense symptoms of anxiety or prolonged sadness you may start thinking about seeking a more specialised help and perhaps beginning psychotherapy to better deal with the whole situation.

Remember that it is not possible to take care of everything on your own; sometimes a little help could really bring much more relief than you may think.

Seasonal Sadness

The temperature goes down, days get shorter, you wake up in the morning and outside it is already dark … you get out from work and outside it is still dark. You hope that the day will pass as fast as possible so that you can go directly back home, sleep and wait for spring to come back. You have the feeling of having become like a bear in hibernation: you have interest in doing nothing, you are only very tired, irritable and maybe more hungry than usual.

Why is this happening?

The change of season, in particular the shift from summer to autumn/winter in northern Europe, can be tough especially in countries situated far from the equator, where the amount of light is significantly different among the seasons.

Researchers have found that light has a significant impact on our circadian rhythms and on the production of some hormones; in particular, the most affected hormones seem to be melatonin, responsible for sleep patterns, and serotonin, a hormone linked to mood.

Therefore it seems normal to experience a slight effect of the lack of light on our mood, the so-called seasonal sadness, but usually this effect doesn’t have a significant impact on our daily life and it doesn’t prevent us to efficiently carry out our daily duties and activities.

On the contrary, for around the 2-3% of the adult european population autumn blues take the form of a real psychiatric disorder: the Seasonal Affective Disorder (SAD). Very often SAD symptoms show up in autumn, they worsen in January – February and tend to disappear with the arrival of spring.

SAD implies severe depressive symptoms such as a persistent low mood, loss of interest/pleasure in everyday activities, lack of energy, sleeping and eating more than usual, feelings of guilt or despair.

To diagnose SAD these symptoms must begin and end always in the same seasons and must be experienced for at least two consecutive years. Interestingly women are six times more at risk to developing SAD then men.

What to do

In general if you are experiencing a slight seasonal sadness, then taking care of yourself, your habits and your relationships can be a good start in dealing with it and feeling better.

Taking care of ourselves implies caring for our body as well: having a good and healthy diet and physical exercise are recommended. At the same time taking care of our relationships is important: researchers showed that perceiving a good social support is a protective factor for many psychological difficulties.

Another good way of taking care of our seasonal sadness is stimulating emotions that are opposite to the problematic ones; if you feel down you may try to work on your everyday life to improve the amount of positive events that can foster a better mood. A way of tracking this exercise is keeping a diary of pleasurable activities so that you can monitor your progress and the impact that these activities have on your mood.

If you think that you may be suffering from SAD then seeking help to your GP is recommended. Psychotherapy can help you out as well in dealing with these seasonal sadness. Cognitive behavioural psychotherapy is indeed very recommended by NICE for the treatment of mild and moderate depressive states.

Women and Depression

Depression is a severe condition characterised by a significant change in mood, pleasure and motivation regarding our usual activities. Researchers have highlighted that women and depression are particularly linked: women are from two to three times more at risk to developing a depressive disorder during adolescence and adult life then men.

This data highlights the importance of spreading information and knowledge of this problem and promoting access to effective treatments.

Why are women more at risk? 

Many factors seem to contribute in increasing this risk.

First of all, biology plays an important role: there is a huge hormonal difference between men and women.

Sexual hormones have a direct impact on our psychological life and in particular on our emotions and motivational systems. Women experience very different fluctuations of these hormones during their life; specifically there are three periods in women’s life that involve intense hormonal fluctuations (and therefore a higher risk): puberty, puerperium and menopause. Indeed in pre-puberty and post-menopause, the risk for depression seems to be equal between genders.

Another important role is played by cultural and social factors.

Different specific social factors have been identified as contributing to an increased risk, such as taking on multiple roles, being mother of two or more kids under 14, experiencing a lack of social support, having a poor relationship with the partner, retirement, having experienced bereavement during infancy and being a caregiver.

In particular, the caregiver role is culturally more linked to women than men; interestingly, it seems that in Scandinavian countries, where gender equality is more acknowledged, the incidence of depression in women is lower.

Risky moments in a woman’s life

As written above, puberty, puerperium and menopause involve deep hormonal fluctuations in women and at the same time significant changes in roles and identities. These changes might not be so easy for every woman to adapt to; some of them, because of personal and genetical predisposition, may experience some difficulties and stress in dealing with these changes, thus bringing an impact on an already particular biological substrate.

Specifically, puberty implies deep biological, physical and psychological changes, with the girl experiencing more and more autonomy and responsibilities for the first time. Furthermore, a specific kind of depression is linked to the menstrual cycle, called premenstrual dysphoric disorder.

Puerperium and the first year of motherhood are also very delicate moments in a woman’s life.
Indeed pregnancy can be associated with physical and psychological stress, and becoming a mother for some of them may bring not only joy and happiness but also feelings of loss of independence, extreme responsibilities and sometimes very high expectations about themselves.

In these instances, experiencing depressive symptoms is normal and transient (the so-called baby blues); but for about 10% of women these symptoms may turn into a postpartum depression. This kind of depression has a particular importance, as it might prevent the new mom to fully fulfil her new role and it might impact on the quality of the attachment bonding with the baby.

Menopause is also a very risky moment, in particular the pre-menopause period. This life moment is characterised by an irregular cycle, muscle and articular pains, sleep problems and endocrine changes. Furthermore, beyond these physical changes, menopause may be difficult to deal with because of its own personal meaning and other significant events may contribute in a negative way, as not having satisfactory working activities, friendships or relationships.

How to use this information

The recognition of the link among women and depression represents an important tool. Knowing that women have a higher risk of developing a depressive disorder and that there are defined moments in a woman’s life that specifically raise this risk, should allow us to keep an eye particularly open and to promptly react if depressive signs show up in order to receive appropriate treatment.

At the same time, if you have a previous history of depression and you are about to go through one of these delicate moments mentioned above, keeping both eyes open is important.

In either circumstance, depression can be faced and managed with an appropriate support. Depending on the symptom’s severity, psychotherapy and/or psychiatric support are highly recommended.