Cultural aspects of caregiver burden in psychiatric disorders

Abstract

Caring for a mentally ill family member is well known to be mostly a stressful, distressing and burdensome experience. The dominant model for examining the process of caregiving has been the stress-appraisal-coping paradigm, in which interactions between stressors, appraisals, coping, and various mediators produce the eventual outcomes in terms of distress or well-being among caregivers. Ethnic and cultural factors have traditionally received the least research attention as mediators of the caregiving process. However, a large body of accumulated research evidence has clearly demonstrated that culturally-defined values, norms, and roles are among the major determinants of the caregiving experience. This research is based mainly on cross-cultural comparisons between caregivers of minority ethnic groups residing in the West and the native Caucasian population. It has been supplemented, to a limited extent, by research carried out among caregivers belonging to different cultures and residing in their countries of origin. Most of this research has been carried out among caregivers of elderly people with dementia; other psychiatric disorders such as schizophrenia have received much less attention. Results of this research have documented important differences in caregiving experiences and outcomes across cultural and ethnic groups. Cultural factors which could mediate these differences have been identified, and theories, which could provide a coherent framework to understand these differences, proposed. Though limited by methodological difficulties, this research has provided important insights into the impact of cultural and ethnic factors on the whole spectrum of the caregiving experiences. An improved understanding of the area is, nevertheless, required because it will eventually help in devising appropriate ways to reduce burden and distress among caregivers from diverse ethnic and cultural groups.

Keywords: Culture, Ethnicity, Caregiving, Caregiver-burden, Psychiatric disorders

Core tip: The cultural context shapes the entirety of the caregiving experience and its outcomes. Important differences have been identified in the extent of caregiving, caregiver burden and distress, attitudes and norms influencing caregiving, appraisal, coping, help-seeking, and social support, between caregivers belonging to diverse ethnic and cultural groups. Familial-cultural factors seem to be the principal determinants of caregiving outcomes, though they appear to influence burden and distress in complicated, and yet unclear ways. Since an understanding of the role of culture in caregiving is an essential first step towards helping lower burden among caregivers from different cultural and ethnic groups, more research is required in this area.