How Partner Responsiveness Shapes Alzheimer’s Caregiver Well-Being

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A recent study found that greater marital distress among caregivers of spouses with Alzheimer’s disease was linked to more depressive symptoms, with the relationship being stronger when caregivers perceived their partners as less responsive. Marital distress was also associated with elevated proinflammatory cytokine production in caregivers receiving low perceived partner responsiveness.

Conversely, caregivers with more depressive symptoms reported greater marital distress, and those with higher cytokine production experienced more marital distress when partner responsiveness was moderate or high. These findings persisted regardless of dementia stage or caregiving hours.

“Caregiving for a spouse with Alzheimer's disease or a related dementia (ADRD) is an immensely stressful experience associated with drastic changes in the marital relationship,” wrote a team of investigators including Jensine Paoletti-Hatcher, PhD, assistant professor in the Department of Psychology at Portland State University. “With the onset and progression of ADRD, caregivers report disruptions in the relationship, including a lack of intimacy, difficulty feeling connected, changing roles and identities, and uncertainties surrounding the diagnosis and relationship.”

Marital distress has been linked to elevated symptoms of depression and a greater risk for mental health problems. Regarding ADRD caregivers, this distress can cause adverse effects on their psychological well-being and more significant burden, in addition to more severe depression.

Interpersonal stressors, such as receiving low social support or being in conflict-filled relationships with lower marital quality, have been associated with increased proinflammatory cytokine production. Long-term, low-grade inflammation is linked to increased mortality, chronic diseases of older adulthood and premature aging.

To assess the link between marital distress, perceived partner responsiveness, and psychological and physiological well-being indicators among caregivers, investigators recruited a cohort of 161 caregivers who completed self-reported questionnaires and gave blood samples. These patients were recruited as part of a larger study evaluating the factors that influence risk and resilience to the adverse effects of dementia caregiving on physical health. Eligible patients were those who dedicated four or more hours to caregiving per day and had been married or in a committed partnership for at least three years.

In addition to demographic information, body mass index (BMI) and inflammation-related medications, patients completed the 4-item Couple Satisfaction Index (CSI-4) to assess the caregiver’s general evaluation of their relationship, with zero defined as extremely unhappy and six defined as perfect. Patients were asked about how rewarding their relationship with their partner was as well as their perceived partner responsiveness, per the three questions derived from the positive spouse interaction questionnaire. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and proinflammatory cytokine production was assessed via whole blood cultures.

Results demonstrated that caregivers experiencing more marital distress were significantly more likely to report depressive symptoms, regardless of their partner's perceived responsiveness. However, the association between marital distress and inflammation was less clear, with no significant connection found in the model testing hypothesis 1b. Partner responsiveness did influence the severity of depressive symptoms, with higher partner support slightly reducing the impact of marital distress but not eliminating it completely.

Caregivers with low support from their partners showed higher inflammation when experiencing marital distress. However, for those with average or high partner support, marital distress did not significantly impact inflammation levels.

“Interventions facilitating supportive interpersonal behaviors within the caregiving relationship may promote caregiver well-being,” investigators concluded. “These findings contribute to our growing understanding of the interpersonal characteristics associated with the mental and physical health of dementia spousal caregivers.”