Sarah Dihmes, M.A.

1
Male Caregivers of Breast Cancer Patients

• Sarah Dihmes, M.A.
• Mehran Habibi, M.D.

2
Increase in Male Caregivers

• The number of cancer patients receiving informal
  care at home is at an all-time high.
• 66 million Americans (3 out of 10 homes) have a
  family member delivering informal care to a loved
  one
• National Center on Caregiving
• At least 50 of the 1.3 million cancer diagnoses
  will be cared for by someone in the patients
  immediate family.
• National Alliance for Caregiving American
  Association of Retired Persons, 2009).
• 99 of cancer patients were receiving informal
  care
• Yabroff and Kim, 2009
• 75 of married women diagnosed with breast cancer
  report receiving copious support from their
  spouse.
• Ciambrone Allen, 2005
• Husbands comprise 30-50 of spousal caregivers
• Campbell Carrol, 2007

3
A Rise in Male Caregivers
Kim, Loscalzo, Wellisch, Spillers, 2006
4
Why are there more male caregivers now?

• Human life span is increasing.
• Advances in medicine
• Expensive healthcare costs
• Limit feasibility o formal caregiving
• Evolution of Gender Roles
• Paradigm shift in traditional male and female
  gender roles.

5
Limited Research on Male Caregivers

• Men as control subjects
• Focus is on elderly husbands caring for wives
  with Alzheimers disease.
• Lack of explanatory framework about mens
  experiences.

6
Gender Differences in CaregivingWho copes better?

• Men are LESS likely to

• Men are MORE likely to

• Seek support for their own physical and mental
  health needs.
• Report exacerbated physical ailments associated
  with giving care.
• Practice health promoting behaviors
• Ask for help
• Emotionally cope
• Identify themselves as caregivers.

• Provide physical care.
• Perform more tasks related to hygiene,
  communication, mobility, dressing and feeding.
• Sacrifice gendered roles in the family.
• Work outside the home while being a caregiver.
• Accept caregiving as an extension of their
  marital vows.
• Use a stoic approach.

7
www.mengetdepression.com
8
Adherence to Traditional Masculine Norms

• Traditional masculine norms commend
• Self-reliance
• Physical Strength
• Emotional Control
• Hegemonic masculine beliefs, often thought of as
  societal ideals, prohibit some men from
  demonstrating typical DSM-IV symptoms of
  depression and caregiver burden.
• Emotional Expression
• Men who adhere to traditional masculine roles
  have more difficulty
• Judging the non-verbal expressions of others
• Find expressing their emotions more stressful

9
Measurement Issues

• DSM-IV Depressive Symptoms

• Male Specific Symptoms of Stress
• Non-Typical Depressive Symptoms

• Crying
• Sadness
• Guilt
• Worthlessness
• Anhedonia
• Appetite/ weight change
• Sleep change
• Concentration difficulties
• Fatigue
• Psychomotor retardation/ agitation
• Not supported by traditional masculine beliefs.

• Drugs alcohol
• Aggression irritability
• Interpersonal conflict
• Preoccupation with work

Men who adhere to traditional masculine norms
often experience stress through more masculine
congruent behaviors and emotions Magovcevic
Addis, 2008
10
Analyses

• Compliance
• Will compliance differ between those who
  completed the survey in the clinic compared to
  those who completed the survey online?
• Stage of Cancer
• Does the stage of breast cancer influence male
  caregivers experiences of stress?
• Types of Treatment
• Will the types of treatment impact male
  caregivers experience of stress?

11
This Study

• Application of the stress process model in
  husband caregivers of breast cancer patients

12
The Stress Process Model

• 2006 Family Caregiver Alliance held a national
  conference to bring together researchers,
  policymakers, and practitioners.
• They produced a report Caregiver Assessment
  Voices and Views from the Field
• Established national standards for all caregiving
  research and clinical practice.
• Originally created from and for CGs with dementia

13
Conceptualized Model of Pearlins Cancer
Caregiver Burden Model
14
Operationalized Male Caregiver Burden Model
15
Stress Process Model DomainsBackground Social
Context

• Control Factors gender age
• Help identify pts at risk
• i.e. If gender is a risk factor, primary and
  secondary stressors may be different for females
  and males.
• Demographics
• Most common gender, age, ethnicity, marital
  quality

• Caregiving History
• Family relationship to patient (i.e. husband)
• Length of time being a caregiver
• Quality of the relationship
• Specific health problems of the cancer patient.

• Demographics
• Males
• Age
• SES
• Education
• Personal history
• Caregiving History
• Relationship to patient
• Length of time delivering care
• Specific health problems of cancer patient

16

• Primary Stressors

• Secondary Stressors

• Factors that relate directly from the cancer
  and caregiving role.
• Disease Specific
• Original Model memory impairment disruptive
  behavior

• Subsequent stressors that may occur from primary.
  
• Caregivers experience of primary ongoing demands
• Vocational/ occupational strain is especially
  difficult for men.

• Objective Indicators
• Activities of Daily Living
• Instrumental Activities of Daily Living
• Type of cancer
• Treatments
• Subjective Indicators
• Patients level of pain
• Patients mental health

• Roles Strains
• Vocational environment
• Domestic environment
• Social environment
• Sexual relationships
• Extended-family
• relationships
• Psychological distress

17

• Depression
• DSM-IV Criteria
• A-typical Symptoms
• Physical Health Problems

• Stress Outcomes
• 61 of caregivers suffered from depression
• National Family Caregivers Association, 2000
• Men women caring for their ill spouses
  experience an increase in depression and decline
  in happiness
• National Survey of Families and Households, 2009
• 31 of caregivers report that their role causes
  emotional stress
• National Alliance for Caregiving AARP, 2009

18
Mediators

• Independent variables cause the mediator, and the
  mediator causes the dependent variable
• Intermediary factor of the causal pathway
• Marital Satisfaction
• Psychological adjustment the marriage must
  undergo after a diagnosis of cancer.
• Can exacerbate or strengthen emotional bonds.
• Pre-illness quality of the relationship is also
  important.
• Shame Guilt
• Correlate with onset and maintenance of
  psychopathology.
• Individuals who are shame prone are at increased
  risk for MH disorders.

19
Moderator

• Interactions between the independent and
  dependent variables that can strengthen, weaken,
  or account for the relationships between the two
  MacKinnon, 2008
• Expressed Emotion from Wife
• Definition the extent to which a family member
  of a distressed individual expressed critical,
  hostile, or emotionally overinvolved statements
  towards their distressed family member.
• Higher EE in a spouse predicts higher depression
  symptoms in the depressed patient
• Butzlaff Hooley, 1998 Forin et al., 1992
• Depressed patients living with

20
Type of Variable Variables Measures/
Instruments Source of Report
Independent Variables

•  
• Background Factors Demographics Demographic
  Form1 Male Caregiver
• Primary Stressors Patients Overall FACT-B 2
  Male Caregiver
• Well-Being
• Caregiver Duties Activities of Daily
  Living Male Caregiver
• Caregiver Tasks Instrumental Activities Male
  Caregiver
• of Daily Living
• Secondary Stressors Role Strains Psychological
  Adjustment Male Caregiver
• to Illness Scale
• Potential Mediator Marital Satisfaction Revised
  Dyadic Male Caregiver
• Adjustment Scale
• Expressed Emotion Five Minute Speech
  Sample Female Patient
• Potential Moderators Shame Guilt Personal
  Feeling Male Caregiver
• Questionnaire-2
• Outcome Variables Caregiver Depression Beck
  Depression Inventory-II Male Caregiver
• Masculine Depression Masculine Depression
  Scale Male Caregiver
• Symptoms
• Physical Health Problems SF-12 Male
  Caregiver

Dependent Variables
Note. 1Caregivers demographics age, culture,
SES, education, medical information, mental
illness history, and length of time delivering
care. 2 Functional Assessment of Cancer Therapy-
Breast (FACT-B) subscales physical, emotional,
functional well-being, social/ family, and
additional concerns.
21
Men Against Breast Cancer

• Do educational resources help?
• Do male caregivers who attend workshops and
  educational seminars experience less stress than
  men who do not?

22
Medical Setting

• Is there a difference between medical settings?
• Do the male caregivers whose wives are receiving
  treatment at Johns Hopkins University experience
  stress differently than male caregivers whose
  wives are being treated at private oncologists
  offices?