The goal of this two-year research project is to examine the efficacy of the
presence of pets as a protective factor supporting the psychosocial well being
of cancer patients and their family members, through both secondary analyses of
previously collected data and analyses of data on human-animal interaction to be
newly collected over the two-year study period. Specifically, the research aims
are:
To examine the association of the presence of pets-dogs, cats and other
household animals-with psychosocial well-being (as measured, e.g., by
depression, anxiety, self-esteem and, for children, peer-relationships, social
competence and school performance) of cancer patients and their family
members.
To examine the efficacy of the presence of pets in mediating the impact of
stressful life situations (i.e., serious illness and/or death) on the
psychological well-being of cancer patients and their family members.
To assess the importance of various aspects (i.e., extent and quality) of
human-animal interactions in contributing to the psychosocial well-being of
cancer patients and their family members.
To compare the effect of human-animal interactions on the psychosocial
well-being of patients and their family members at different stages of the
illness course (i.e., diagnosis, active treatment, terminal period); in
different types of households (i.e., intact families with young children,
families with grown children, single parent households, and adults living
alone); and in varying age-groups (i.e., latency-aged children, adolescents,
young adults, middle-aged and older adults).
We will accomplish these research aims through conducting secondary analyses of
data from two studies we have recently completed which focused on seriously-ill
or terminally-ill cancer patients and their families as well as collecting
additional information on human-animal interactions as part of a third cancer
study which is still ongoing. The first recently completed study was a
multi-site, longitudinal investigation of adult cancer patients' needs for
illness-related assistance and the impact on the family of providing this
assistance. The second recently completed study examined the psychosocial
adjustment of children who experienced recent parental death from cancer. The
third study, which is still ongoing, is a longitudinal investigation of children
experiencing the terminal illness and subsequent death of a parent to cancer. We
have now added an extensive pet history questionnaire to the well parent and
child interview schedules to enable us to examine the role of companion pets in
human adjustment to loss in greater detail.
Secondary analyses conducted during Year 1 focused on addressing Aims 1 and 2.
These findings suggest that having a pet in the household may well be associated
with better psychological adjustment for caregivers whose spouse is
seriously-ill. While the current findings pertain only to spousal caregivers,
they suggest that the presence of companion animals, specifically, cats and
dogs, may have an beneficial impact in situations of stress and burden, such as
experienced when caring for a spouse who is seriously-ill.
Theoretical Framework
The Research Unit of the Department of Social Work at Memorial Sloan-Kettering
Cancer Center (MSKCC) has conducted a number of studies designed with the
objective of learning more about problems and issues which confront seriously
ill cancer patients and their family members or caregivers. In our work, we have
become increasingly aware of the broad range of resources that people use to
cope with stress in their lives and the importance of less commonly recognized
sources of emotional support, such as companion animals, particularly dogs and
cats.
In clinical work with patients and their families we have observed that the
companionship of pets can facilitate a child's healthy adaptation to a parent's
serious illness and death, by providing unconditional love and continuity at a
time when children's needs for love, affection and support are enormous.
Furthermore, children need to talk about their painful and conflicted feelings
regarding parental loss, and often they are able to confide these feelings more
readily to their pets than to humans. Taking care of a pet can also enhance
children's adjustment by providing environmental consistency and maintaining the
structure of their daily routines, so important in the face of the vast
disruption that occurs during the parent's terminal illness and in the
post-death period (Siegel, Mesagno & Christ, 1990). Children's feelings of
competence and control are also enhanced by their fulfilling a necessary family
role as the pet's caretaker. Their self-esteem can be enhanced by experiencing a
feeling of being needed by the pet. In our interviews, children frequently list
their pets as family members and both children and their surviving parents
report that their companionship has been enormously comforting.
In our work with other patient populations, we have also observed that household
pets are frequently spontaneously mentioned by AIDS patients as important in
helping them cope when they feel distressed. These patients have remarked on the
unconditional love and affection they receive from their pets and the
consistency with which this affection is expressed. Some have acquired a pet
since becoming ill because they find that they have more time to themselves. For
them, the pet is a source of companionship and a means of overcoming the
loneliness they are experiencing. These patients have also remarked that having
a pet provides them with a reason to remain active and life-focused (e.g., to
take care of the pet, interact with the pet).
The contribution of companion animals to human psychological well-being and
interpersonal development has received increasing attention in recent years.
Levinson's (1969, 1972, 1978) groundbreaking work on the role of pets in human
development heightened behavioral scientists' awareness of the varied beneficial
consequences of animal-human interaction. While much of the earlier work in this
area relied on anecdotal reports and clinical experiences, recent work
represents efforts to more systematically explore the role of companion animals.
The work of Katcher, Beck and colleagues (e.g., Beck & Katcher, 1983; Friedmann,
et al., 1983; Katcher & Beck, 1986; Katcher et al., 1983; Katcher, Beck &
Levine, 1988) has provided evidence that contact and interaction with animal
companions increases relaxation and reduces arousal in both children and adults,
especially in stressful situations (Katcher, Segal & Beck, 1984). Others (Baun
et al., 1984; Grossberg & Alt, 1984) have noted similar findings. In a one-year
follow-up study of coronary heart disease patients, patients with a household
pet had a better survival rate than those without pets (Friedmann et al., 1980).
Current investigations have primarily focused on the beneficial health aspects
of animal companions to the elderly and, to a lesser extent, on the role of pets
in childhood development. Kidd and Feldmann (1981) reported that pet owners
scored higher than non-owners on measures of responsibility, dependability,
nurturance, helpfulness, benevolence and lack of egotism or self-centeredness.
Mugford and M'Comisky (1975) reported longer survival among elderly retirees who
were given pet birds. In a study of widowers, Akiyama et al. (1987) observed
that pet owners had significantly fewer psychosomatic symptoms than those who
did not have a pet. Others have not been able to demonstrate statistically
significant effects of pet ownership on health outcomes (e.g., Ory & Goldberg,
1983; Lago, Knight & Connell, 1983; Lawton, Moss & Moles, 1984; and Robb &
Stegman, 1983); however, their findings do suggest that the influence of animal
companionship is complex and may be influenced by other elements, such as
personality characteristics or situational factors.
In a longitudinal investigation of health outcomes among the elderly, Lago et
al. (1989) posited that the effect of pets on health was indirect, that is, pets
improved morale, which more directly influenced the respondents' self-reported
health and functioning levels. Garrity et al. (1989) observed that pet ownership
in an elderly sample of community respondents was not related to depression when
one or more confidants were available, but among a subgroup of recently bereaved
elderly with minimal confidant support, pet ownership was associated with less
depression. Additionally, for the sample as a whole, strong attachment to a pet
was associated with less depression. Siegel (1990) has observed that the
presence of pets served as a moderator of the effect of stressful life events on
the health of the elderly.
In other empirical work, children have been found to develop strong affective
ties with their pets, especially dogs and cats. In a survey of 300 children
between the ages of 3 and 13, which explored differences in children's attitudes
by age, sex, and type of pet, Kidd and Kidd (1985) found that children defined
their pets as playmates and companions. Children without siblings may be
particularly motivated to keep pets for play and care (Siegmund & Biermann,
1988). Children regularly engage in mutual activities with pets, and, although
predominantly recreational, even preadolescent children assume significant
caretaking tasks (Davis, 1987a). There is some evidence that children's pet
ownership is associated with their increased self-esteem and sociability (Covert
et al., 1985; Siegmund & Biermann, 1988). Levinson (1972) has further argued
that through interaction with pets, children can achieve a balance between
independence and dependence with his/her family. Covert et al. (1985), however,
focusing on the role of adolescent pet ownership on the family system, did not
find pet owners and nonowners to differ significantly on the quality of the
parent-child relationship. Finally, childhood experience with pets has been
found to influence individuals' likelihood to own pets as adults (Serpell,
1981). Poresky et al. (1988) similarly found adults' retrospective reports of
pet bonding during childhood to predict contemporary attitudes toward pets and
that this relationship was affected by the age at which earliest bonding had
occurred.
In summary, although the existing research provides some support for concluding
that companion animals make an important contribution to human well-being
throughout the life cycle, the results also indicate that this relationship is
complex and requires further investigation. Clearly, additional research needs
to be done in which various aspects of pet ownership are examined, such as type
of pet, and the nature and strength of the pet-human relationship. Moreover, an
area which has not been as systematically examined is the role of companion
animals in mediating the impact of stressful situations, such as being seriously
ill, having a seriously ill family member, or experiencing the death of a family
member.
Methodology
We will conduct secondary analyses of data from two studies we have recently
completed, which focused on seriously-ill or terminally-ill cancer patients and
their families. In addition, during the two-year project period we will collect
additional information on human-animal interactions as part of a third cancer
study, which is still ongoing to examine this issue in greater detail. All three
research studies are described below.
Research Studies for the Secondary Data Analyses
Study 1: Cancer patients and their familial caregivers
The first recently completed study was a longitudinal investigation of adult
cancer outpatients and their familial caregivers, conducted in collaboration
with Brown University and Hershey Medical Center and supported by a grant from
the National Cancer Institute. Dr. Raveis was the Project Director at the
Memorial Hospital site. Data were gathered from patients from three geographic
locations: New York, Rhode Island and Pennsylvania. The principal objectives of
this study were to:
identify the home care needs of patients initiating outpatient chemotherapy
and radiation treatment,
determine how these needs change over time, and
determine the kinds of burdens experienced by cancer patients' informal
caregivers.
Enrolled patients were asked to identify the principal person who provided or
would provide informal (unpaid) assistance to them when necessary. The person
they nominated was then approached to become part of the caregiver sample.
Patients and their caregivers were interviewed twice. The initial patient
interview was conducted shortly after the patient began a new or initial
treatment regimen of chemotherapy or radiation. Their informal caregiver was
also interviewed at the same time. Half of the patient sample and their
caregivers were randomly selected to be re-interviewed 3 months after the
initial interview; the remainder were re-interviewed after 6 months. Structured
questionnaires were used to collect information from the patients and their
caregivers. The interviews were generally administered over the telephone. The
patient interview schedule contained basic socio-demographic data, information
on needs for assistance, source and extent of care received, symptom status,
healthcare utilization and psychological distress. The caregiver interview
schedule included demographic items, measures of burden in various domains
(social, financial, physical, time, and employment), substance abuse,
availability of social resources, psychological well-being, physical health, and
the presence and type of pet in the household. A total of 629 adult cancer
outpatients and 483 informal caregivers participated in the interviews.
Early in Year 1 of the study, as part of preparing the data files for the
secondary data analyses, we went back to the original questionnaires and coded
additional information concerning pet ownership that was obtained during the
interview, but not coded into the data files. Specifically, during the interview
with the patient's informal familial caregiver, the caregiver was asked if there
was a pet in the household. If they reported having a pet, the interviewer then
asked what type of pet they had. If more than one type of pet was in the
household, i.e., "cat and dog" or "dog, fish and horse", the information was
written down in the interview schedule but only the fact that it was a multiple
pet household was coded into the data file. The exact composition of the pets in
the household was not coded into the computer data files. We felt that it was
important to the analyses we planned to carry out to determine not only if pet
ownership, per se, was important for psychological well-being, but whether
specific types of pets were more strongly associated with reduced distress than
other pets, we decided to go back to the original questionnaires and code this
missing information. Since the data for this study was obtained from a
multi-site project, we contacted the investigators at the other research sites
and arranged for them to provide us with the detailed data concerning the exact
composition of the pets in a household as well. We then merged this extra
information with the data in our existing data files
Study 2: The psychosocial adjustment of bereaved children
The second recently completed study examined the psychosocial adjustment of
children who experienced recent parental death from cancer. Dr. Mesagno was the
Co-Principal Investigator and Project Director of this study, supported by a
grant from the American Cancer Society. It was undertaken to describe the
nature, intensity, and determinants of psychological symptomatology in normal
bereaved children, aged 6-16 years, during the 16 months following a parent's
death and to identify determinants of healthy adaptation to the loss. The
study's quasi-longitudinal design, assessing children at various points
post-parental death, allows us to document the natural history of childhood
bereavement including both the acute and chronic phases of mourning. Data were
collected from the children themselves and their surviving parents and teachers,
using self-administered instruments and in-depth, face-to-face interviews by
experienced clinicians. We assessed children's psychosocial adaptation in a
number of domains including their psychiatric symptomatology, competencies, peer
relationships and school performance. The study also examined factors, which
have been associated with children's psychosocial adjustment, including
background characteristics (e.g., child's age, sex, and birth order, parent's
sex, socioeconomic status); illness-related factors (e.g., length of parent's
illness, number and length of hospitalizations); and characteristics of the
family environment (e.g., quality of the parent-child relationship, the
surviving parent's depressive symptomatology). The data include the parent's
reports of the acquisition or death of a pet since the patient's death and
children's reports of what kinds and for how long they have had their current
pets. Post-death data are available on 65 families, consisting of an intensive
interview with the surviving parent and a randomly-selected index child per
family.
Research Study in Which Additional Data Will Be Collected
Study 3: Facilitating bereaved children's adaptation to the terminal illness and
death of a parent
The ongoing study, in which we propose to examine the role of companion pets in
human adjustment to loss, is a true longitudinal study of children's adjustment
to parental serious illness and death to cancer, and a comprehensive evaluation
of the relative efficacy of two preventive interventions designed to facilitate
children's healthy adaptation to their loss. Dr. Mesagno is the Co-Principal
Investigator and Project Director for this 5-year study supported by a grant
from the National Institute of Mental Health. Efficacy of the intervention is
assessed in terms of children's ability to maintain competence as demonstrated
by their levels of school performance, social competence, self-esteem,
psychiatric symptomatology, and behavior problems. Study participation is
offered to intact, English-speaking families in which there is at least one
child between 7 and 16 years of age and a parent with advanced cancer and an
expected survival time of 4-6 months. This study employs a true experimental
design with a target sample of 110 families assigned to Treatment Group 1 who
are offered participation in an intensive clinical intervention program, and 110
families assigned to Treatment Group 2 who receive enhanced social work
services. Baseline (T1) data are collected during the parent's terminal illness,
at the time of accrual into the study, prior to the initiation of any
intervention. Group differences in children's functioning are also assessed at 7
and 14 months (T2 and T3) following the death of the parent.
Face-to-face research interviews are conducted with the well parents and all
eligible children at T1, T2, and T3. The data include self-report,
parental-report, and teacher-report measures. Comprehensive assessment of
children's psychosocial adaptation is made with standardized measures of their
depression, anxiety, behavior problems, competencies, peer relationships, and
school performance. In addition, several parent and child report measures have
been developed to evaluate family environment and quality of the parent-child
relationship, particularly the extent of open parent-child communication, the
child's perception of the adequacy of his/her support, and the degree of
consistency in his/her environment. We also assess several risk factors expected
to be associated with a child's adjustment to parental death (e.g., his/her
awareness of the severity of illness, experience of other stressful life events,
and number and length of separations from the family). Finally, we assess the
psychological adjustment of the well/surviving spouses who must now raise the
children as single parents.
During Year 1 we developed an expanded set of pet history questions to be
administered to the families participating in the study. In designing the pet
history questionnaire we utilized, whenever possible, pre-existing scales and
inventories. Specifically, the pet history questionnaire collects information on
the history of pet ownership, change in pet ownership over time, strength of the
human-animal bond, mutual pet-human activities, and attitudes toward pets.
In developing this questionnaire we incorporated the pet history section from
the Pet Attitude Inventory [PAI] (Wilson, Netting & New, 1987) and the pet
attachment scale and pet interaction checklist utilized by Albert and Bulcroft
(1987). We also included several additional items drawn from measures developed
by Poresky et al. (1987), Davis (1987) and Templer et al. (1981), revising the
wording in these additional items to make them compatible with the format and
metric of the other questionnaire items. We also included extra items that
tapped areas of pet relationships which we know from our work and research in
bereavement and chronic illness that might be especially important to children
experiencing stressful life changes.
In constructing the questionnaire it was necessary to make slight modifications
in the pet measures. In some instances we revised the response categories to
make them compatible with the format and metric of the Childhood Bereavement
Interview Schedule. We also altered the question stems of some items so that
they could be answered about any type of pet, not just dogs or cats. Because the
pet questions will be asked as part of a face-to-face interview, we opted for
obtaining a more comprehensive or precise response to some of the questions
rather than giving the response a forced choice alternative. For example, for
duration questions, the exact length of time would be recorded rather than
coding the answer into a category which spanned a range of time (e.g., 1-5
years, 6-10 years). Also, questions which asked the respondent to give one or
more reasons for an attitude or behavior were left open-ended to obtain a more
comprehensive answer before being coded into broad categories.
Both an adult version and a child version of the pet questionnaire were
constructed. Skip instructions for follow-up interviews were developed so that
the pet history questions would be administered to each parent and child only
once. Other skip instructions ensure that the appropriate items to be asked of
current pet owners (parent/child), former pet owners (parent/child), and non-
pet owners (parent/child).
Because of the age range of the population being surveyed (i.e., children aged
7-16 as well as adults), we pre-tested the various versions of the pet
questionnaire on different age-groups of children and adults, checking for
question flow and sequencing, clarity of wording, comprehension and
age-appropriateness before using it with the families in the study. Once we
finalized the pet questionnaire items we then incorporated it into the Childhood
Bereavement Interview Schedule (Adult and Child versions) and began
administering the questionnaire in Year 1 as a family came due for an initial or
follow-up interview. Data collection will continue throughout Year 2 of the
project. All well/surviving parents and children between 7-16 years old who are
accrued into the study, regardless of the type of intervention they receive, are
asked to participate in the research interviews. We are estimating that by the
completion of the data collection in Year 2 approximately 200 families will have
completed individual interviews containing the detailed pet questions (i.e.,
individual interviews with the well parent and each age-eligible child).
Description of Year 1 Secondary Data Analyses
The secondary analyses that were conducted during Year 1 focused on research
aims 1 and 2. Specifically, we examined the association of the presence of a
household pet with the psychological well-being of adults who were providing
informal caregiving to a family member seriously-ill with cancer. We also
examined the efficacy of the presence of a household pet in mediating the
stressful consequences of the provision of informal caregiving to cancer
patients.
For many years treatment for patients with cancer involved long and frequent
hospitalizations. More recently, however, care has increasingly been
administered on an outpatient basis (Mor, Guadagnoli and Wool, 1987). This has
resulted in family members performing a growing variety of complex
time-consuming and stressful tasks to meet the outpatients needs for assistance
(Siegel, Raveis, Mor and Hoots, 1991). While the practical and emotional
benefits that accrue to the recipients of familial support and care are well
recognized (Shanas, 1979), there is substantial evidence that the burdens of
providing informal practical and emotional support are far-reaching and diverse,
negatively impacting on numerous aspects of caregiver's lives (see Siegel,
Raveis, Mor and Hoots, 1991, for review).
The data for these analyses was drawn from the recently completed collaborative
study conducted by MSKCC, Brown University and Pennsylvania State University
College of Medicine. The research, a longitudinal investigation of the
caregiving needs of cancer patients and their family members (see Study 1).
In the analyses presented below, we examine the contribution of the presence of
a pet (specifically a cat or a dog) in the household to caregiver psychological
well-being in association with caregiver burden and other aspects of the
caregiving situation. The sample is restricted to the 243 spousal dyads for
which all the data were available. Among married patients, the spouse is almost
always the primary provider of emotional support and personal care (Shanas,
1979; Stone et al., 1987). Spousal caregivers also appear to be particularly at
risk for caregiver burden; typically providing the most extensive and
comprehensive care, they maintain the role longer, tolerate greater levels of
disability than other caregiver groups, experience more severe lifestyle
adjustments and exhibit lower levels of well-being than other caregiver groups
(Cantor, 1983; Soldo and Myllyluoma, 1983; George and Gwyther, 1986).
A comparison of households containing a dog or cat with those that do not
Before a multivariate analysis of the effect of the presence of a pet in the
household on caregiver depression, it was important to look for ways in which
pet owners and non-pet owners differed. Forty percent of the households included
in the analysis contained at least one pet. Thirty-seven percent of all
households contained either a dog or a cat (with or without another pet). Of the
eight households which had a pet, but did not contain either a dog or a cat,
three contained only a bird(s); three contained only fish and/or turtles; and
two contained a pet(s) of some other unspecified species. For all subsequent
analyses, the measure of pet ownership used was whether or not a cat and/or a
dog was present in the household. Given the wide variety of species included in
respondent households it is important to provide at least some control for the
type of pet(s) included in the household. This restricted definition of pet
ownership provides an important control in that any effect associated with the
measure can be said to apply only households known to contain at least one or
more mammals (all households containing rabbits or horses also contain a cat or
dog). The analysis of whether different pets are associated with different
effects on adjustment will be conducted during Year 2. Cats and dogs are the
only two species of pets residing in a sufficient number of respondent
households to analyze separately and are therefore the only two species for
which these analyses will be run.
Although caregivers who were also pet owners of cats or dogs were more likely to
be males-46% of the caregivers who were also pet owners were male compared to
66% of the non-owners, this difference was not statistically significant. Pet
owners were significantly more likely to be white-100% of the pet owners were
white compared to 93% of non-pet owners (p. =.021). Pet owners, as a group, were
significantly younger than non-owners (mean age 56.0 vs. 61.0, p<.001). They
were also more likely to be employed (49% vs. 39%), although this difference was
not statistically significant. Both pet owners and non-owners were fairly
well-educated (40% and 38%, respectively, had attended college, with 20% and 27%
having graduated college). The distribution of household incomes was similar for
both groups even though the median household income was higher for those
households containing a cat or dog than those that did not ($32,239 and $27,500,
respectively). There was no significant difference between pet owners and
non-pet owners in terms of any measure of the patient's health status, type of
cancer, or stage of illness at the time of the interview.
Measurement of variables used in the regression analyses
A variety of measures, based on a review of the literature on informal
caregiving, have been shown to be associated with caregiver psychological
distress (see Siegel, Raveis, Mor and Hoots, 1991 for a review) and were
selected for inclusion in the regression analysis in addition to the presence of
a cat or dog in the household. These groups of variables include demands and
characteristics of the caregiving situation, caregiving burdens, and various
sociodemographic characteristics.
Demands and characteristics of the caregiving situation
The patient's need for illness-related assistance with each of the following
activities was identified: personal care (bathing, dressing, or getting around);
instrumental activities (cooking and shopping, light and heavy housekeeping);
transportation (to doctor or for other purposes), home health care, child care,
and administrative tasks. The total number of domains of activities for which
they required assistance because of their illness was then summed to form a
count of the total number of patient needs. Patients were also asked the total
number of days during the prior two weeks that they spent entirely or most in
bed or had to curtail their activities because of their illness or
illness-related treatment. The responses were summed (with a cap of 14 days) and
trichotomized as 0 days, 1 to 13 days, and 14 days, representing a measure of
reduced patient activity days. Familial caregivers were asked to assess the
extent to which the patient's illness made it difficult to establish a daily
routine or plan activities. Caregivers also reported how confident they felt
that they could personally provide the patient with additional care should the
need arise.
Caregiver burden
Based on the literature, caregiver burden was conceptualized as falling into
five principal domains: employment, financial, physical, social and time. Using
items contained in the caregiver interview, separate measures were constructed
of objective (i.e., empirically verifiable or observable consequences of
caregiving) and subjective (i.e., perceived or felt consequences of caregiving)
burden for each domain. A separate summary measure of global objective and
global subjective burden was constructed for each domain (see Siegel, Raveis,
Mor and Hoots, 1991), consistent with other caregiver investigations (Raveis,
Seigel and Sudit, 1990).
Presence of a cat or dog in the household
The measure of pet ownership used in the regression analyses was whether or not
a cat and/or a dog was present in the household as discussed above.
Description of the sample and distribution of variables used in the regression
analyses
In 62% of these dyads the husband was the patient, while in the remainder the
wife was the patient. The majority of patients and their spouses were 45 and
older, with a sizable proportion 65 and older, 37% and 35%, respectively. Nearly
all respondents (patients and caregivers) were white (96% and 95% respectively).
About one quarter of the patients and 43% of the spousal caregivers were
currently employed. Median household income was $29,149. As stated earlier, in
37% of the households a cat or dog was present. All patients reported needing
assistance with tasks in at least one domain of activity, with most needing help
with three or more domains. While none of the patients reported needing
assistance with all six domains of activities this is due to the fact (given the
age distribution) that only 7% of the households contained a child under 12
years of age, rather than indicating a lack of need. Thirty-nine percent of the
patients had had to curtail their activities everyday during the past two weeks
while 29% reported not having to curtail their activities at all. Over
three-fifths (62%) of the caregivers reported their caregiving activities had
disrupted their daily routines at least "a little." Most were "quite" or "very"
confident they would be able to provide more care if the patient needed it in
the future, but one-fourth were only "somewhat" or "not at all" confident they
would be able to do so. A sizable proportion (30%) of the spousal caregiver
sample scored at or above the cutoff for clinical caseness for depression on the
CES-D scale. The mean CES-D for the entire spousal caregiver sample was 11.4
(S.D.-9.8).
The predictors of depression included in these analyses fall into four major
domains: sociodemographic characteristics, measures of the ill spouse's level of
need and current health status, measures of caregiver burden (global objective
and subjective, and the spousal caregiver's assessment of ability to provide
additional assistance if needed), and whether there is a cat and/or dog in the
household.
Since the analysis is restricted to spousal dyads, caregiver and patient
demographics are highly correlated. As a result only the spousal caregiver
demographic characteristics [i.e., sex, age, employment status, and health
status-spousal caregiver has a health condition(s) which make it difficult to
provide care] are being included in multivariate analyses. Spousal caregiver's
depression score is significantly correlated (p<.05) with all but two of the
independent measures-spousal caregiver's employment status and the presence of a
cat or dog in the household. The spousal caregiver's depression score is most
strongly correlated with all measures of caregiver burden (all p<.001),
especially the global measure of subjective burden). Spousal caregiver
depression is also significantly correlated with patient's illness-related need
for assistance and reduced activity days.
As one would expect, based on the prior research on informal caregiving and
caregiver burden, higher levels of spousal caregiver burden and patient need for
assistance are associated with higher levels of caregiver depression. In
addition, consistent with the epidemiological research on gender an age
differences in depression, the caregiving husbands reported lower levels of
depression and younger spousal caregivers had higher levels of depression. Those
spousal caregivers who reported having a limiting health condition also tended
to have higher depression scores. Although the zero-order correlation between
spousal caregiver depression and the presence of a cat or dog in the household
was not significant, there was a trend towards lower levels of depression among
those caregivers with a cat or dog in their household (r=-.08, p=.l0).
Correlations between the independent variables are also as expected with
measures in each domain (for the most part) significantly correlated to each
other. The measures of patient need are significantly and positively correlated
with higher levels of burden. There are only scattered correlations between the
measures of caregiver characteristics and the burden measures. The presence of a
cat and/or dog in the household is significantly correlated with caregiver sex
(pets are more likely in households where the husband is the caregiver) and
caregiver age (pets are more likely in younger households.
To test the relative strength of the univariate relationships between predictors
and to determine which relationships remained significant once control for the
other measures was made, a hierarchiecal linear regression model was tested.
Even though spousal caregivers' employment status was not significantly
correlated with spousal caregivers' depression score, it was retained because it
was strongly correlated to other independent measures and because it was
conceptually and theoretically important to retain. After the model was
estimated, including all variables but the presence of a cat or dog in the
household, it was reestimated with this variable included to see if its
inclusion:
added to the explanatory power of the model, and
impacted on spousal caregivers' depression level once the patient's level of
need, caregiver characteristics, and the caregiver's level of burden and
ability to do more, were controlled for.
Results and discussion of the regression analyses
Model 1 showed that global subjective burden which also had the strongest
zero-order correlation with caregiver depression is also its strongest
predictor. The fact that no other measure of burden or patient need retains a
significant relationship with caregiver depression once global subjective burden
is controlled for suggests the effect of these measures on caregiver depression
may be indirect - i.e. the patient's level of need, the caregiver's ability to
provide help, and the amount of burden the caregiver is already doing impact the
patient's level of depression through global subjective burden rather than
directly. The main predictor of caregiver depression is not so much the status
of the patient or the patient's ability to perform various activities, but
caregivers' perception of the situation. These findings suggest the use of
LISREL or path analysis to determine which aspects of subjective burden are most
closely associated with depression, and the nature of indirect effects patient
need and other measures of burden have on caregiver depression. Ironically, the
only other significant predictor of caregiver depression in Model 1, after all
other independent measures have been controlled for is caregiver employment
status, which did not have a significant zero-order correlation with caregiver
depression.
Model 2 reestimated the equation predicting spousal caregiver depression with
the presence of a cat or dog in the household included. As was the case with
caregiver employment status, even though the presence of a cat or dog in the
household had a weak zero-order relationship with caregiver depression its
relationship is significant once the other independent measures have been
controlled for (beta = - .111; p=. 041). The inclusion of the presence of a cat
or dog in the household to Model 1 did little to change the betas between any of
the other independent measures, but did significantly increase R2 (F
change=4.206;p=. 041). As was the case in Model 1, global subjective burden
(beta = - .454; p=. 000) and caregiver employment status (beta =- .148; p =.
O21) were the only two of the original ten independent variables to have a
significant direct effect on caregiver depression. These findings suggest that
all other things being equal, the predicted level of depression for a cat and/or
dog owner is 2.239 points lower than that of a similar person who does not own a
pet.
These findings suggest that having a pet in the household may well be associated
with better psychological adjustment for caregivers whose spouse is seriously
ill. While the current findings pertain only to spousal caregivers, they suggest
that the presence of companion animals, specifically, cats and dogs, may have a
beneficial impact in situations of stress and burden, such as experienced when
caring for a spouse who is seriously ill.
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