Whitehouse, Lisa; (2000) Attachment, caregiving and coping in daughters caring for their mothers with dementia. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Caring for a relative with dementia is thought to be one of the most stressful and disruptive life events in the family life cycle (Zarit and Edwards, 1996). The effects of caring for a relative with dementia are well documented, with some caregivers coping well and others developing psychological difficulties (Zarit and Edwards, 1996). However, little is known about the risk and protective factors involved for individual caregivers. Caring for a mother with dementia is a task primarily undertaken by daughters (Stone and Kemper, 1989). Past research has shown that the kin relationship between caregiver and care recipient affects the experience of family caregiving (Li, Seltzer and Greenberg, 1999). This study set out to investigate whether the quality of the relationship between daughters and mothers throughout the life span influences how daughters cope with caring for their mothers when they develop dementia. As part of a larger study, thirty one daughters were interviewed using the Adult Attachment Interview (AAI: George, Kaplan and Main, 1996). The interviews were rated according to Main and Goldwyn's (1994) standardized classification system. Daughters' reflective functioning was also rated using the Reflective Functioning Scale (Fonagy, Target, Steele, and Steele, 1998). The participants completed a series of self report questionnaire measures including the Clinical Dementia Rating Scale (Hughes Berg, Danziger, Coben, and Martin, 1982), the Relative Stress Scale (RSS: Greene, Smith and Timbury, 1982), the General Health Questionnaire (GHQ-28: Goldberg, 1978) and the Social Support Questionnaire (SSQ: Sarason, Sarason, Shearin and Pierce, 1987). Additionally, some of the daughter caregivers were asked how they understood their relationship with their mother to have influenced their caring role and data from the responses to these questions was analysed qualitatively. It was predicted that daughters with secure attachment histories would be less psychologically distressed as measured by the RSS and GHQ-28 than daughter caregivers with insecure attachment histories. Using overall coherence as an indicator of attachment security, a relationship between overall coherence and psychological distress was not found. It was also predicted that high reflective functioning would serve as a protective factor from psychological distress. Conversely, it was found that daughters with higher reflective functioning scores were more psychologically distressed than daughter caregivers with lower reflective functioning scores. The qualitative analysis revealed four clusters of themes. These were change and loss, motivational influences, coping and support and caring within the context of the wider care system. The limitations of the research design, the clinical implications of the findings and future research directions are discussed.

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