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**
|
**p＜0.01
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**
|
**p＜0.01
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.
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