Litzelman Kristin, Skinner Halcyon G, Gangnon Ronald E, Nieto F Javier, Malecki Kristen, Witt Whitney P
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA,
Qual Life Res. 2014 Jun;23(5):1569-78. doi: 10.1007/s11136-013-0598-z. Epub 2013 Dec 10.
Informal caregivers play a critical role in the care of individuals who are aging or have disabilities and are at increased risk for poor health outcomes. This study sought to determine whether and to what extent: (1) global stress and health-related quality of life (HRQoL) differed between caregivers and non-caregivers; (2) global stress mediated the relationship between caregiving status and HRQoL; and (3) caregiver strain (i.e., stress attributable to caregiving) was associated with worse HRQoL after accounting for global stress.
Cross-sectional data were from the 2008-2010 Survey of the Health of Wisconsin, a representative sample of adults aged 21-74 years. Participants (n = 1,364) completed questionnaires about caregiving status, sociodemographics, global stress, and HRQoL. Staged generalized additive models assessed the impact of caregiving on HRQoL and the role of caregiver strain and global stress in this relationship.
In the last 12 months, 17.2% of the sample reported caregiving. Caregivers reported worse mental HRQoL than non-caregivers (β -1.88, p = 0.02); global stress mediated this relationship (p < 0.01). Caregivers with the highest levels of strain reported worse mental and physical HRQoL (β -7.12, p < 0.01), and caregivers with the lowest levels of strain reported better mental HRQoL (β 2.06, p = 0.01) than non-caregivers; these associations were attenuated by global stress (p < 0.01).
Global stress, rather than caregiving per se, contributes to poor HRQoL among caregivers, above and beyond the effect of caregiving strain. Screening, monitoring, and reducing stress in multiple life domains presents an opportunity to improve HRQoL outcomes for caregivers.
非正式照料者在照顾老年人或残疾人士方面发挥着关键作用，而这些人健康状况不佳的风险更高。本研究旨在确定：（1）照料者与非照料者之间的总体压力和健康相关生活质量（HRQoL）是否存在差异以及差异程度如何；（2）总体压力是否介导了照料状态与HRQoL之间的关系；（3）在考虑总体压力后，照料者压力（即归因于照料的压力）是否与较差的HRQoL相关。
横断面数据来自2008 - 2010年威斯康星州健康调查，这是一个年龄在21 - 74岁的成年人代表性样本。参与者（n = 1364）完成了关于照料状态、社会人口统计学、总体压力和HRQoL的问卷。分阶段广义相加模型评估了照料对HRQoL的影响以及照料者压力和总体压力在此关系中的作用。
在过去12个月中，17.2%的样本报告有照料行为。照料者报告的心理HRQoL比非照料者差（β -1.88，p = 0.02）；总体压力介导了这种关系（p < 0.01）。压力水平最高的照料者报告的心理和生理HRQoL较差（β -7.12，p < 0.01），而压力水平最低的照料者报告的心理HRQoL比非照料者好（β 2.06，p = 0.01）；这些关联因总体压力而减弱（p < 0.01）。
总体压力而非照料本身，在照料者压力的影响之上，导致了照料者较差的HRQoL。在多个生活领域进行压力筛查、监测和减轻，为改善照料者的HRQoL结果提供了机会。
