AAD  Vol.7 No.4 , December 2018
Structure of Personality at Intrapsychic and Interpersonal Levels and Depression of Caregivers of Patients Affected by Alzheimer’s Disease: Which Psychotherapeutic Approach?
Abstract: Background: Many studies have underlined as caregiving for people with Alzheimers disease (AD) is highly stressful and has significant negative consequences. Objectives: The study of the structure of personality, can help to understand the association between depression, intrapsychic and interpersonal processes of caregivers of Alzheimer’s disease patients and what kind of intervention can be planned to favor the stress burden management. Methods: Case group: Caregivers (CG) (n = 75); control group, Subjects not Caregivers (nCG) (n. 104). Tests: SASB questionnaire (Structural Analysis of Interpersonal Behavior) describing intrapsychic and interpersonal processes of the structure of personality validated on the basis of DSMIV; CDQ questionnaires—depression. Results: Intrapsychic level: From the results it emerged that CGs had lower autonomy in their choices, and lower acceptance of their own feelings, and exercised greater self-control exhausting themselves toward predetermined goals, and more depression compared to the control group. They may be not able to achieve psychic equilibrium in the presence of stress: they may likely become disoriented and engage in behaviors that may be self-defeating. SASB-Cl = Autonomy (p < 0.001); SASB-Cl2-Autonomy and Love (p < 0.001), SASB-CL3-Love (p < 0.001); SASB-Cl4 Love and control (p < 0.001), SASB-CL5-Control (p = 0.015), SASB-Cl6-Control and hate (p < 0.001), SASB-Cl7-Hate (p < 0.001). Conclusions: Intrapsychic characteristics such as tendency to depression, inability to being in contact with their own feelings, excessive self-control may be linked to difficulties in facing burden of care and indicate serious difficulties to adaptation to burden condition. The knowledge of these modalities could allow to plan a psychotherapeutic and multidisciplinary intervention aimed at facing and overcoming the psychological distress of the caregiver.
Cite this paper: Velia, G. , Vespa, A. , Berti, S. , Gori, G. , Ottaviani, M. , Meloni, C. , Fabbietti, P. , Pelliccioni, G. , Paciaroni, L. and Spatuzzi, R. (2018) Structure of Personality at Intrapsychic and Interpersonal Levels and Depression of Caregivers of Patients Affected by Alzheimer’s Disease: Which Psychotherapeutic Approach?. Advances in Alzheimer's Disease, 7, 103-118. doi: 10.4236/aad.2018.74008.

[1]   Berger, G., Bernhardt, T., Weimer, E., et al. (2005) Longitudinal Study on the Relationship between Symptomatology of Dementia and Levels of Subjective Burden and Depression among Family Caregivers in Memory Clinic Patients. Journal of Geriatric Psychiatry and Neurology, 18, 119-128.

[2]   Papastavrou, E., Kalokerinou, A., Papacostas, S.S., et al. (2007) Caring for a Relative with Dementia: Family Caregiver Burden. JAN, 58, 446-457.

[3]   Mohamed, S., Rosenheck, R., Lyketsos, C.G., et al. (2010) Caregiver Burden in Alzheimer Disease: Cross-Sectional and Longitudinal Patient Correlates. The American Journal of Geriatric Psychiatry, 18, 917-927.

[4]   Schulz, R., McGinnis, K.A., Zhang, S., et al. (2008) Dementia Patient Suffering and Caregiver Depression. Alzheimer Disease & Associated Disorders, 22, 170-176.

[5]   Mausbach, B.T., Chattillion, E., Roepke S.K., et al. (2012) A Longitudinal Analysis of the Relations among Stress, Depressive Symptoms, Leisure Satisfaction, and Endothelial Function in Caregivers. Health Psychology, 31, 433-440.

[6]   García-Alberca, J.M., Cruz, B., Lara, J.P., et al. (2013) The Experience of Caregiving: The Influence of Coping Strategies on Behavioral and Psychological Symptoms in Patients with Alzheimer’s Disease. Aging & Mental Health, 17, 615-622.

[7]   Rocca, P., Leotta, D, Liffredo, C., et al. (2010) Neuropsychiatric Symptoms Underlying Caregiver Stress and Insight in Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders, 30, 57-63.

[8]   García-Alberca, J.M., Cruz, B., Lara, J.P., et al. (2012) Disengagement Coping Partially Mediates the Relationship between Caregiver Burden and Anxiety and Depression in Caregivers of People with Alzheimer’s Disease. Results from the MáLAGA-AD Study. Journal of Affective Disorders, 136, 848-856.

[9]   Papastavrou, E., Charalambous, A., Tsangari, H., et al. (2012)The Burdensome and Depressive Experience of Caring: What Cancer, Schizophrenia, and Alzheimer’s Disease Caregivers Have in Common. Cancer Nursing, 35, 187-194.

[10]   Epstein-Lubow, G., Gaudiano, B., Darling, E., et al. (2012) Differences in Depression Severity in Family Caregivers of Hospitalized Individuals with Dementia and Family Caregivers of Outpatients with Dementia. The American Journal of Geriatric Psychiatry, 20, 815-819.

[11]   Engelborghs, S., Maertens, K., Nagels, G., et al. (2005) Neuropsychiatric Symptoms of Dementia: Cross-Sectional Analysis from a Prospective, Longitudinal Belgian Study. International Journal of Geriatric Psychiatry, 20, 1028-1037.

[12]   Campbell, P., Wright, J., Oyebode, J., et al. (2008) Determinants of Burden in Those Who Care for Someone with Dementia. International Journal of Geriatric Psychiatry, 23, 1078-1085.

[13]   Lyketsos, C.G., Lopez, O., Jones, B., et al. (2002) Prevalence of Neuropsychiatric Symptoms in Dementia and Cognitive Impairment: Results from the Cardiovascular Health Study. JAMA, 25, 1475-1483.

[14]   Vugt, M.E., Stevens, F., Aalten, P., et al. (2003) Behavioural Disturbances in Dementia and Quality of the Marital Relationship. International Journal of Geriatric Psychiatry, 18, 149-154.

[15]   Mausbach, B.T., Roepke, S.K., Chattillion, E.A., et al. (2012) Multiple Mediators of the Relations between Caregiving Stress and Depressive Symptoms. Aging & Mental Health, 16, 27-38.

[16]   Boutoleau-Bretonnière, C. and Vercelletto, M. (2009) Caregiver Burden in Dementia: Relationships with the Activities of Daily Living, Behavioral, and Psychological Symptoms. Psychologie & NeuroPsychiatrie du Vieillissement, 7, 15-20.

[17]   Hooker, K., Frazier, L.D. and Monahan, D.J. (1994) Personality and Coping among Caregivers of Spouses with Dementia. Gerontologist, 34, 386-392.

[18]   Hooker, K., Monahan, D.J., Bowman, S.R., et al. (1998) Personality Counts a Lot: Predictors of Mental and Physical Health of Spouses Caregivers in Two Disease Groups. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 2, 73-85.

[19]   Jang, Y., Clay, O.J. and Roth, D.L. (2004) Neuroticism and Longitudinal Change in Caregiver Depression: Impact of a Spouse-Caregiver Intervention Program. Gerontologist, 44, 311-317.

[20]   Shurgot, G.R. and Knight, B.G. (2005) Influence of Neuroticism, Ethnicity, Familism, and Social Support on Perceived Burden in Dementia Caregivers: Pilot Test of Transactional Stress and Social Support Model. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60, 331-334.

[21]   Sink, K.M., Covinsky, K.E., Barnes, D.E., et al. (2006) Caregiver Characteristics Are Associated with Neuropsychiatric Symptoms of Dementia. Journal of the American Geriatrics Society, 54, 796-803.

[22]   García-Alberca, J.M., Cruz, B., Lara, J.P., et al. (2012) Anxiety and Depression Are Associated with Coping Strategies in Caregivers of Alzheimer’s Disease Patients: Results from the MALAGA-AD Study. International Psychogeriatrics, 24, 1325-1334.

[23]   Watson, L.C., Lewis, C.L., Moore, C.G., et al. (2011) Perceptions of Depression among Dementia Caregivers: Findings from the CATIE-AD Trial. International Journal of Geriatric Psychiatry, 26, 397-402.

[24]   Sherwood, P., Given, C., Given, B. and Von Eye, A. (2005) Caregiver Burden and Depressive Symptoms: Analyses of Common Outcomes in Caregivers of Elderly Patients. Journal of Aging and Health, 17, 125-147.

[25]   Roth, D.L., Mittelman, M.S., Clay, O.J., et al. (2005) Changes in Social Supports as Mediators of the Impact of a Psychosocial Intervention for Spouse Caregivers of Persons with Alzheimer’s Disease. Psychology and Aging, 20, 634-644.

[26]   Thomas, P., Lalloué, F., Preux, P.M., et al. (2006) Dementia Patients Caregivers Quality of Life: The PIXEL Study. International Journal of Geriatric Psychiatry, 21, 50-56.

[27]   De Rotrou, J., Cantegreil, I., Faucounau, V., et al. (2011) Do Patients Diagnosed with Alzheimer’s Disease Benefit from a Psycho-Educational Programme for Family Caregivers? A Randomised Controlled Study. International Journal of Geriatric Psychiatry, 26, 833-842.

[28]   Ducharme, F.C., Lévesque, L.L., Lachance, L.M., et al. (2011) Learning to Become a Family Caregiver Efficacy of an Intervention Program for Caregivers Following Diagnosis of Dementia in a Relative. Gerontologist, 51, 484-494.

[29]   Nápoles, A.M., Chadiha, L., Eversley, R., et al. (2010) Developing Culturally Sensitive Dementia Caregiver Interventions: Are We There Yet? American Journal of Alzheimer’s Disease & Other Dementias, 25, 389-406.

[30]   Sorensen, S., Pinquart, M. and Duberstein, P. (2002) How Effective Are Interventions with Caregivers? An Updated Meta-Analysis. Gerontologist, 42, 356-372.

[31]   Negovanska, V., Hergueta, T., Guichart-Gomez, E., et al. (2011) Beneficial Effect of a Cognitive Behavioral and Multidisciplinary Program in Alzheimer Disease on Spouse Caregiver Anxiety. Revista de Neurología, 167, 114-122.

[32]   Varma, A.R., Snowden, J.S., Lloyd, J.J., et al. (1999) Evaluation of the Nincds-Adrda Criteria in the Differentiation of Alzheimer’s Disease and Frontotemporal Dementia. Journal of Neurology, Neurosurgery, and Psychiatry, 66, 184-188.

[33]   Benjamin, L.S., Rothweiler, J.C. and Critchfield, K.L. (2006) The Use of Structural Analysis of Social Behavior (SASB) as an Assessment Tool. Annual Review of Clinical Psychology, 2, 83-109.

[34]   Critchfield, K.L. and Benjamin, L.S. (2010) Assessment of Repeated Relational Patterns for Individual Cases Using the SASB-Based Intrex Questionnaire. Journal of Personality Assessment, 92, 480-489.

[35]   Krug, S.E. and Laughlin, J.E. (1978) Questionario di autovalutazione CDQ (IPAT Depression Scale): Manuale. Adattamento italiano a cura di Marcello Novaga e Arrigo Pedon (ed.). Organizzazioni speciali, Firenze.