Sugiura Keiko, Ito Mikiko, Kutsumi Masami, Mikami Hiroshi
Division of Health Promotion Science, Nursing Science, Course of Health Science Graduate School of Medicine, Osaka University.
Nihon Koshu Eisei Zasshi. 2010 Jan;57(1):3-16.
We examined spousal gender differences in change of caregiving experience over 2-years, focusing on care-recipient's physical and mental conditions, living arrangements, financial status, utilization of long-term care insurance (LTCI), availability of secondary caregivers, caregiver's coping strategies and psychological well-being. We also investigated causal associations between caregiving experiences and psychological well-being of the spousal caregivers.
We conducted a 2-wave survey, in Oct. 2003 and 2005. The subjects were a stratified random sample of 5,000 users of LTCI in Higashi-osaka city in Japan. Data were collected through mailed, anonymous self-report questionnaires. Totals of 212 wives and 356 husbands were longitudinally analyzed. A cross-lagged effect model by simultaneous analysis of multiple populations was made to analyze a causal association between caregiving experiences and caregivers' psychological well-being.
There were no significant changes in care-recipient's physical and mental conditions. Over the 2 years, husbands increased the amount of ADL assistance and availability as secondary caregivers, and wives increased utilization of LTCI services. We also found gender differences in the priority of coping strategies. Husbands' preferred coping strategy over 2 years was more on 'willing commitment caregiver's role 'while for wives' it was 'instrumental support seeking'. Wives demonstrated a significantly reduced positive appraisal of caregiving. Though the amount of ADL assistance and 'instrumental support seeking' reduced husband's depression, husband's positive appraisal of caregiving significantly increased strategies of 'emotional support seeking' and 'willing commitment of care role'. Wives & depression decreased with 'valuing own leisure and refreshing' strategies. Furthermore, wives' positive caregiving appraisal increased both strategies of 'keeping own pace of caregiving' and willing acceptance of care role'.
The husband's results support an interpretation of adaptation to the caregiving role over two years. Therefore husbands who do not experience increase in ADL assistance might be at risk of caregiver's depression. We should monitor their situation of caregiving continually. Though wives increased utilization of LTCI services, this service use did not improve their psychological wellbeing, and they exhibited decreased positive appraisal of caregiving.
我们研究了两年间配偶在照料经历变化方面的性别差异，重点关注受照料者的身体和精神状况、生活安排、经济状况、长期护理保险（LTCI）的使用情况、二级照料者的可获得性、照料者的应对策略和心理健康。我们还调查了照料经历与配偶照料者心理健康之间的因果关系。
我们在2003年10月和2005年进行了两波调查。研究对象是日本大阪市5000名LTCI使用者的分层随机样本。数据通过邮寄的匿名自我报告问卷收集。对212名妻子和356名丈夫进行了纵向分析。通过对多群体的同时分析建立交叉滞后效应模型，以分析照料经历与照料者心理健康之间的因果关系。
受照料者的身体和精神状况没有显著变化。在这两年中，丈夫增加了日常生活活动（ADL）协助的量和作为二级照料者的可获得性，而妻子增加了LTCI服务的使用。我们还发现了应对策略优先级上的性别差异。两年来，丈夫首选的应对策略更多是“愿意承担照料者角色”，而妻子则是“寻求工具性支持”。妻子对照料的积极评价显著降低。虽然ADL协助的量和“寻求工具性支持”减少了丈夫的抑郁，但丈夫对照料的积极评价显著增加了“寻求情感支持”和“愿意承担照料角色”的策略。妻子的抑郁随着“重视自己的休闲和放松”策略而减少。此外，妻子对照料的积极评价增加了“保持自己的照料节奏”和愿意接受照料角色这两种策略。
丈夫的结果支持了对两年间照料角色适应情况的一种解释。因此，那些在ADL协助方面没有增加的丈夫可能有患照料者抑郁的风险。我们应该持续监测他们的照料情况。虽然妻子增加了LTCI服务的使用，但这种服务的使用并没有改善她们的心理健康，而且她们对照料的积极评价有所下降。
