The International Journal of Psychosocial Rehabilitation

Quality of Life and Social Support
 in Spouses of Patients With Depression



Jikun Wang, MD

PhD candidate
Institute of Psychosomatic Medicine
 Shanghai East Hospital
 Tongji University
 School Medicine
Shanghai, China

Xudong Zhao, MD
Chief of the Psychiatry Department
Institute of Psychosomatic Medicine
Shanghai East Hospital
Tongji University
School of Medicine
Shanghai, China




Citation:
Wang J. & Zhao X. (2012) Quality of Life and Social Support in Spouses of Patients With 
Depression
 International Journal of Psychosocial Rehabilitation. Vol 16(2) 28-35

Correspondence: Jikun Wang, liwangjk@gmail.com
244 P.O. Box, Tongji University
1239 Siping Road, Shanghai 200092
China


Abstract
Background: There was strong association between depression and caregiver burden. However, there are few studies about the quality of life and social support in the spouses of depressed patients in China. The aim of the present study was to explore the quality of life and social support perceived by the partners of depressed patients in China.
Methods: Using a cross-sectional design, fifty-nine participants with a depressed partner according to a DSM-Ⅳ diagnosis of major depressive disorder and fifty-nine married normal controls participated in the study. All participants completed MSPSS and QLESQ. The data collected was analyzed to compare the quality of life and social support between the depressed patients’ spouses and married normal controls, and the relationship between social support and the quality of life in the two groups.
Results: There were significant differences in the quality of life (p<0.01 ) and perceived social support (p<0.01 ) between the two groups. The spouses of depressed patients, who were younger than fifty years, employed and role as a wife in the family reported better quality of life than those older than fifty years, unemployed and role as a husband. There was positively correlation between the quality of life and social support from friend in the spouses of depressed patients.
Conclusions: It is very important to provide the social support with a person with a depressed partner so that improving their quality of life.

Key Words:
Quality of Life, Depression, Social Support, Caregiver Burden


Introduction
Mental disorders such as depression can result in enormous economic burden (Wang., et al, 2003), and caregiver burden (Baronet, 1999) including a serious of psychological, emotional, social, physical and financial problems. Caregiver burden consists of subjective and objective burden according to the definition (Idstad., et al, 2010). For example, subjective burden refers to psychological distress such as stigma and embarrassment while objective burden includes financial problems (Idstad., et al, 2010). Family members of depression such as partners reported much burden. There was strong association between depression and marital relationship (Ayotte., et al, 2010). Additionally, having a spouse with depression also increases the risk of depression for the partner (Townsend., et al, 2001). For example, one person suffered from depression may lead to changes in his/her partner (Siegel., et al, 2004). Lessening the burden of spouses of depression may help the improvement of depressed patients (Meyler., et al, 2007).

Previous research has shown family members of a depressed patients especially living with the patients were exposed to high risk of psychological distress and suffered from marital conflict (van Wijngaarden B., et al, 2004; Scazufca., et al, 2002; Highet., et al., 2005; van Wijngaarden., et al, 2009). Some research proposed that elderly caregiver may better deal with illness due to more experience (Baronet, 1999). It is well established that women tend to be vulnerable to depression than men (Idstad., et al, 2010), so that female spouses of mentally ill husbands tend to report more caregiver burden (Dudek ., et al, 2001).

Although caregiver burden are receiving attention, it is still in strong need to study spouse’s burden of mental illness, particularly depression and anxiety (Idstad., et al, 2010). For example, there is a dearth of research about partner resemblance in mental health, such as assertive mating, effects of marital quality, and dynamic relationship between depression and mental health of partner.

The research about caregiver burden of mood disorders tended to overlap with the literature on spousal health (Idstad., et al, 2010). For instance, a recent review showed that affective contagion could be one explanation (Rehman., et al, 2008), because people tended to choose their partner whose characteristics are similar with them. Moreover, there was strong association between depression in spouses and marital distress (Rehman., et al, 2008).
Considerable research have reported family members and caregivers of persons with mental disorders seldom seek mental health services, while they may suffer from significant stress and burden (Saunders, 2003; Lua and Bakar, 2011). Depression influences family functioning, marital quality and parenting style.  Family members exhibit dysfunction and bad emotion. Some research has demonstrated that there was an association between mental disorders such as depression in one partner and subjective burden in the spouse (Idstad et al., 2010).

Consequently, paying attention to spouses of depression may improve quality of life and social support in depression. The quality of life includes physical health, psychological health, social relationship and so on proposed by the World Organization Quality of Life (WHOQOL) Group (Sales, 2003). Past research has demonstrated lower quality of life for depressive patients were associated with the caregivers’ reduced quality of life.

There is growing awareness on quality of life for depressive patients.  However, not so much emphasis has been put on the research about the quality of life and social support for spouses of depressed patients.  Previous studies about family members of depressed patients have shown improvement the quality of life for caregivers help depressed patients recover. This is very important in depression because depression is related with family functioning.  Hence, assessing the quality of life and social support for caregivers is significant in the treatment of depression. By measuring and understanding the quality of life and social support of caregivers, clinicians can provide proper interventions with family caregivers and improve their quality of life and reduce their burden. The present study focused on the quality of life and perceived social support including from family, friend and significant others by the spouses of depressed patients.

Methods
Subjects
This was a cross-sectional study. The sample consists of 59 spouses of depressed married outpatients from the Psychiatry Department, Shanghai East Hospital of Tongji University in Shanghai, China, and the married normal controls recruited from the neighbor community. Participants completed written consent form after a careful explanation of the study. The study was approved by the institutional review board (IRB) of Tongji University School of Medicine.

Sociodemographic characteristics
Participants completed a sociodemographic survey form including gender, age, marital status, relationship with the patient and level of education. These items were selected based on the literature associated with family caregivers (Lua and Bakar, 2011).

Quality of Life
The quality of life was measured by Quality of Life-Enjoyment and Satisfaction Questionnaire (Q-LES-Q) (Endicott et al, 1993).The QLESQ consists of 14 items which is a self-reported questionnaire assessing subjective satisfaction and enjoyment (Hope, Page, and Hooke, 2009).  High scores mean high quality of life ranging from 0 (very poor satisfaction) to 4 (very good satisfaction).  The version of 14 items QLESQ has been demonstrated to possess good psychological properties, including high test-retest reliability (interclass correlation coefficient = 0.86) and high internal consistency (Cronbach’s α= 0.90) (Rapaport, Clary, Fayyad, and Endicott, 2005).

Social Support
The social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet et al., 1990) which is a 12item self-reported measure assessing social support from three aspects including family, friends and significant others.  Each item is rated between 1 (very strongly agree) and 7 (very strong disagree), high scores suggesting lower perceived social support. The psychometric properties of the MSPSS were previously investigated in a Chinese sample in Hongkong (Chou, 2000).

Data analysis
Data were analyzed using the statistical package, SPSS 16.0.  Sociodemographic data were presented using descriptive statistics. The QLESQ scores and MSPSS scores were presented as median and mean for each dimensions.  The value of P<0.05 was considered statistically significant for group differences.

Results
Sociodemographic characteristics of participants
The sample consisted of 59 depressed patients’ spouses and 59 community controls. The overall mean age of spouses for depressed patients was 47.2 years (SD=14.4), and the range was from 18 to 70 years; the mean educational years was 10.8 years (SD=2.9); the mean marital years was 19.5 years (SD=12.9). The overall mean age of spouses for community controls was 43.9 years (SD=11.5), and the range was from 22 to 71 years; the mean educational years was 11.8 years (SD=3.3); the mean marital years was 16.0 years (SD=12.2). Table 1 shows there were no significant differences of age, education and marital years between the two groups.

Table 1.  Sociodemographic Characteristics of Participants (n=59)

Characteristics

Spouses of patients

Mean(SD)

Spouses of controls

Mean(SD)

t

Mean age

47.2(14.4)

43.9(11.5)

1.388

Mean educational years

10.8(2.9)

11.8(3.3)

1.838

Mean marital years

19.5(12.9)

16.0(12.2)

1.520

 

Quality of life and social support
There were significant differences of social support and quality of life between the spouses of depressed patients and community controls (Table 2). Community controls reported better perceived social support including family, friend and significant others than the spouses of depressed patients. Also, the spouses of depressed patients reported poorer quality of life than the community controls.

Table 2.  Quality of life and social support of Participants (n=59)

Characteristics

Spouses of patients

Mean(SD)

Spouses of controls

Mean(SD)

t

MSPSS

45.8(11.5)

27.2(10.8)

8.982**

Family

13.2(4.3)

8.5(4.0)

6.031**

Friend

20.1(5.2)

10.1(4.3)

11.284*

Significant others

12.5(5.1)

8.5(3.3)

4.987**

QLESQ-14

25.5(7.4)

38.1(5.1)

10.707**

**p0.01


Quality of life and social support: Univariate sociodemographic comparisons
Older people, not employed reported poorer quality of life than people younger than 50 years. Women reported higher quality of life than men.

Table 3.  Quality of life and social support: Univariate sociodemographic comparisons

Socioldemographic

Characteristics

MSPSS

 

Family

Friend

 

Significant others

QLESQ-14

50 years  Mean(SD)

46.6(12.0)

14.0(4.3)

19.5(5.7)

12.8(4.9)

28.3(6.8)

50years  Mean(SD)

44.5(10.8)

12.7(4.7)

20.3(4.8)

11.6(5.1)

24.0(6.5)

P

0.49

0.28

0.60

0.38

0.01

Employed  Mean(SD)

46.5(12.2)

13.5(4.7)

20.4(5.1)

12.3(4.8)

28.3(6.3)

Not employed  Mean(SD)

44.0(10.1)

13.2(4.1)

18.9(5.5)

12.2(5.4)

23.0(1.5)

P

0.42

0.80

0.29

0.93

0.003

Husband  Mean(SD)

45.1(12.0)

12.9(4.7)

20.3(5.4)

12.0(5.3)

25.0(6.1)

Wife     Mean(SD)

46.4(10.6)

14.2(3.9)

19.1(5.0)

12.6(4.5)

28.7(7.8)

P

0.67

0.29

0.42

0.65

0.03

 

Correlation between quality of life and social support in two groups
Table 4 shows that the quality of life for the spouses of depressed patients was negatively associated with the perceived social support from their friends, but not their family and significant others. While the quality of life for the community controls was negatively associated with the perceived social support from their friends, their family and significant others.

Table 4.  Correlation between Quality of life and social support in two groups

Correlation

(r)

Spouses of patients

Quality of life

Spouses of controls

Quality of life

MSPSS

-0.226

-0.454**

Family

-0.057

-0.506**

Friend

-0.322*

-0.373**

Significant others

-0.179

-0.404**

**p0.01

Discussion
In general, the spouses living with depressed patients encounter enormous emotional burden when their spouses suffer from depression. Some research has shown the quality of life for the family members and caregivers was influenced by mental disorders such as depression and schizophrenia (Lua and Bakar, 2011) and the quality of life for the partner could play a significant role in the prognosis of depression (Lua and Bakar, 2011). Considerable research has demonstrated there was strong association between depression and marital relationship. When one family member suffers from depression, the quality of life for the spouses was influenced. Our results showed the quality of life and social support for the spouses of depressed patients were poorer than the married community controls, consistent with previous study in mood disorders (Heru., et al, 2004). Obviously, when one family member suffered from depression, the spouse of depressed patients needed to take care of the patient and bear more emotional and economic burden, less social support especially from the family.

Additionally, our findings also showed the quality of life for spouses of depressed patients was positively associated with the social support from their friends, not from their family and significant others, which suggests when one person suffered from depression, the major supportive sources of the family caregiver is from their friends. While the quality of life for the community controls was positively with social support from their family, friend and significant others, which suggests they have enough supportive sources.

Sociodemographic characteristic also plays an important role in the quality of life for family caregivers of chronic disease (Haltermann., et al, 2004; Lim and Zebrack, 2004). Older family caregivers reported poorer quality of life than people younger than 50 years. The results suggest all the family members, including the spouses of depressed patients, were vulnerable because they needed to be exposed to the emotional burden of their depressive spouses. It is very important to realize that, because the treatment including the family members such as patients’ spouses could improve the prognosis of depressed patients.

In addition, employment was another significant impact factor of quality of life for people with a depressed partner. In the present study, the spouses of employment showed better quality of life that those with unemployment. One possible reason could be that employment makes them earn money and reduce the economic burden. Also, they could communicate with more people and decrease the emotional burden. Therefore, employment could satisfy their economic and emotional needs. Some research showed that the family burden was related with unemployment13, resulting in lower quality of life. Some research showed there was a strong association between the quality of life and employment for the caregiver of schizophrenic patients, because employment was strongly associated with the income of the family (Lua and Bakar, 2011; Sales, 2003). Previous studies have demonstrated that household income was negatively associated with caregiver burden of schizophrenic patients (Vaddadi., et al, 2002; Li., et al, 2007).

Additionally, women reported better quality of life than men (Pinquart and Sorensen, 2006) which suggests when wife in the family suffered from depression, their husbands were exposed to higher burden and showed lower quality of life. One possible explanation could be women tend to seek more support and more social networks. Some research (Kung, 2002) proposed that Chinese family caregivers of mental disorders such as schizophrenia are usually exposed to highly family burden, because they possess strong obligation to patients, which leads them to be vulnerable to shame, stigma, guilt and anxiety (Li., et al, 2004).

The social support from friend perceived by the spouses of depressed patients was positively associated with the quality of life of them. The quality of life for the community married controls was positively associated with the perceived social support from family, friend and significant others. Our findings suggest perceived social support is very important to the quality of life for the spouses of depressed patients, especially the support from their friends, because when one family member suffered from depression, the other family member was lack of the social support from their family.
There are some limitations in the present study. The sample size is limited. Therefore, future studies need to be replicated in a larger sample size. Further, more influencing factors of quality of life should be considered such as the health problems.

However, our results could extend the understanding the quality of life for the family members of depressed patients in China. The quality of life and social support for the spouses of depressed patients were lower than that of the community controls. Better quality of life was observed in the family caregivers with these characteristics: female, younger than 50 years and employed. These information helps clinicians to understand the family burden caused by depressed patients and improve the prognosis of depression.


 

References:

Wang, P. S., Simon, G., and Kessler, R. C.  (2003).  The economic burden of depression and the cost-effectiveness of treatment.  International Journal of Methods in Psychiatric Research, 12(1), 22-33.

Ayotte, B.J., Yang, F.M., and Jones, R.N.  (2010).  Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples. Journal of Gerontology: Psychological Sciences, 65B (4), 438–448.

Baronet, A. M.  (1999).  Factors associated with caregiver burden in mental illness: A critical review of the research literature. Clinical Psychology Review, 19(7), 819-841.

Chou, K. L.  (2000).  Assessing Chinese adolescents' social support: the multidimensional scale of perceived social support. Personality and Individual Differences, 28(2), 299-307.

Dudek, D., Zieba, A., Jawor, M., Szymaczek, M., Opila, J., Dattilio, F. M.  (2001). The impact of depressive illness on spouses of depressed patients. Journal of Cognitive Psychotherapy, 15(1), 49-57.

Endicott, J., Nee, J., Harrison, W., and Blumenthal, R.  (1993).  Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacological Bulletin, 29(2), 321-326.

Heru, A. M., Ryan, C. E., and Vlastos, K.  (2004).  Quality of life and family functioning in caregivers of relatives with mood disorders. Psychiatric Rehabilitation Journal, 28(1), 67-71.

Hope, M. L., Page, A. C., and Hooke, G. R.  (2009).  The value of adding the Quality of Life Enjoyment and Satisfaction Questionnaire to outcome assessments of psychiatric inpatients with mood and affective disorders. Quality of Life Research, 18(5), 647-655.

Highet, N., Thompson, M., and McNair, B.  (2005).  Identifying depression in a family member: The carers’ experience. Journal of Affective Disorders, 87(1), 25-33.

Idstad, M., Ask, H., and Tambs, K.  (2010).  Mental disorder and caregiver burden in spouses: the Nord-Trøndelag health study. BMC Public Health, 10, 516-521.

Kung, W. W.  (2002).  The illness, stigma, culture, or immigration? Burdens on Chinese American caregivers of patients with schizophrenia. Families in Society, 84(4), 547-557.

Lua, P. L., and Bakar, Z. A.  (2011).  Profiles among family caregivers of patients with schizophrenia. Family and Community Health, 34(4), 331-339.

Li, L., Young, D., Xiao, S., Zhou, X., and Zhou, L.  (2004).  Psychometric properties of the WHO Quality of Life questionnaire (WHOQOl-100. in patients with chronic diseases and their caregivers in China. Bulletin of the World Health Organization, 82(7), 493-502.

Lim, J., and Zebrack, B.  (2004).  Caring for family members with chronic physical illness: a critical review of caregiver literature. Health and Quality of Life Outcomes, 2, 50.

Li, J., Lambert, C. E, and Lambert, V. A.  (2007).  Predictors of family caregivers’ burden and quality of life when providing care for a family member with schizophrenia in the People’s Republic of China. Nursing and Health Sciences, 9(3), 192-198.

Meyler, D., Stimpson, J. P, and Peek, M. K.  (2007).  Health concordance within couples: a systematic review. Social Science and Medicine, 64(11), 2297-2310.

Pinquart, M., and Sorensen, S.  (2006).  Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(1), 33-45.

Rehman, U. S., Gollan, J., and Mortimer, A. R.  (2008).  The marital context of depression: research, limitations, and new directions. Clinical Psychology Review, 28(2),179-198.

Rapaport, M. H., Clary, C., Fayyad, R., and Endicott, J.  (2005).  Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162(6), 1171-1178.
Sales, S.  (2003).  Family burden and quality of life. Quality of Life Research, 12(S1), 33-41.

Saunders, J. C.  (2003).  Families living with severe mental illness: a literature review. Issues in Mental Health Nursing, 24(2), 175-198.

Scazufca, M., Menezes, P. R., and Almeida, O. P.  (2002).  Caregiver burden in an elderly population with depression in Sao Paulo, Brazil. Social Psychiatry and Psychiatric Epidemiology, 37(9), 416-422.

Siegel, M. J., Bradley, E. H., Gallo, W. T., and Kasl, S. V.  (2004).  The effect of spousal mental and physical health on husbands’ and wives’ depressive symptoms, among older adults: longitudinal evidence from the health and retirement survey. Journal of Aging and Health, 16(3), 398.

Townsend, A. l., Miller, B., and Guo, S.  (2001).  Depressive symptomatology in middle-aged and older married couples: a dyadic analysis. The Journals of Gerontology Series B: Social Sciences, 56(6), S352–S364.

van Wijngaarden, B., Koeter, M., Knapp, M., Tansella, M., Thornicroft, G., Vazquez-Barquero, J. L, et al.  (2009).  Caring for people with depression or with schizophrenia: are the consequences different? Psychiatry Research, 169(1), 62-69.

van Wijngaarden, B., Schene, A. H., Koeter, M. W.  (2004).  Family caregiving in depression: impact on caregivers’ daily life, distress, and help seeking. Journal of Affective Disorders, 81(3), 211-222.

Vaddadi, K. S, Gilleard, C., and Fryer, H.  (2002).  Abuse of carers by relatives with severe mental illness. International Journal of Social Psychiatry, 48(2), 149-155.

Zimet, G. D, Powell, S. S, Farley, G. K, Werkman, S., and Berkoff, K. A.  (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55(3-4), 610-617.


 


Copyright © 2012  ADG, SA. All Rights Reserved.  
A Private Non-Profit Agency for the good of all, 
published in the UK & Honduras