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In vulnerable populations research, a relationship is proposed among resource availability, relative risk and health status. Female informal caregivers may be considered a social group, vulnerable to adverse health outcomes because of limited resources and increased exposure to conditions (risks) that contribute to poor health. A lack of socioeconomic and environmental resources contributes to the vulnerability of women. Poverty, unemployment and lower levels of educational attainment represent a lack of socioeconomic resources that are consistently linked to poor health (Adler et al. 1994, Link & Phelan 1996). Often women live in poverty with low social status and jobs paying salaries averaging 30-40% less than men's salaries (Bureau of the Census 1997, 30 September, Thomas 1997). Furthermore, ethnic women of colour compared with whites, experience more than twice as much poverty and unemployment (Bureau of the Census 1997, Department of Labor 1997). Other social resources that are often unavailable to women are social status, connection and power (Schiller 1993, Sher 1993, Amaro 1995). There is social inequality in role relationships with partners, employers and service agencies (Thomas 1997). Additionally, female-headed households (22% of family households in the USA) have fewer social connections, economic resources and limited access to community resources (Aday 1993, Bureau of the Census 1997). Ethnic women of colour are heads of households twice as often as white women (Bureau of the Census 1997).
This group of informal caregivers experienced both physical and mental health problems. Other investigators have found poor physical health and depressive symptoms among AIDS and ARD caregivers (Lieberman & Fisher 1995, Leblanc et al. 1997, Meshefedjian et al. 1998). However, the use of a vulnerable populations' framework offers an alternative explanation for the health status of informal caregivers. Rather than relating only individual and interpersonal characteristics to health outcomes, a vulnerable populations' framework relates resource availability and risk exposure to health outcomes, in the total sample, resource variables (income and minority ethnicity) contributed the most to the explanation of health status in this sample of caregivers. Other studies also have found low income and minority ethnicity to be significantly associated with depressive symptoms and poor physical health among caregivers (McNaughton et al. 1995, Russo et al. 1995, Cefalu et al. 1996, Leblanc et al. 1997, Turner & Catania 1997, Meshefedjian et al. 1998). Caregivers with fewer resources, less income and minority social status may have more health problems because they lack resources to obtain assistance with the objective demands of caregiving (Cox & Monk 1993, Cox 1995, Turner & Catania 1997, Meshefedjian et al. 1998). Resources (income, ethnicity) may have explanatory power for health status for these reasons.
One risk variable (anger) had explanatory power for depressive mood. Anger was more common in caregivers of PWHIV. Phillips and Thomas (1996) found anger to be common in HIV caregivers, anger directed towards both the self and the care receiver. However, other investigators have found verbal and physical aggression also against demented elderly by informal caregivers (Pot et al. 1996).
Depressive symptoms contributed to the explanation of perception of physical health problems in this study. Depressive symptoms were more common in PWHIV caregivers. Despite the fact that caregivers of PWHIV were considerably younger than those of PWARD and might be expected to perceive fewer physical health problems, both groups perceived health problems and more caregivers of PWHIV perceived their health to be poor. Younger age may be related to depressive symptoms and poorer perception of health because of the ‘untimeliness’ of the care given to receiver's illness, the multiple developmental roles and demands of younger caregivers and the low level of preparation for the caregiver role in younger persons (Turner & Catania 1997, Raveis et al. 1998).
The study was limited by sample size and use of a convenience sample. Several other variables may have had a significant relationship with the dependent variables with a larger sample size. Sample size and setting also limit generalizability of the findings. The sample of caregivers of PWARD lacked ethnic diversity, however, caregivers of PWHIV were ethnically diverse and represent an understudied group of female caregivers. Several variables that were not studied may have explanatory value for health status. Other explanations for the mental and physical health problems experienced by caregivers may be related to social and resource variables that were not addressed in this study. These include the stigma of AIDS and ARD, and the availability of resources such as health insurance, access and availability of care, and quality of care. These variables may have added to the explanation of health status and should be considered in future studies.
Reflection Exercise #3
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