University of Massachusets Amherst LIVING WITH A DEPRESSED PARTNER A Dissertation Presented by BRIDGET LINEHAN LOGAN Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY February, 2011 School of Nursing © Copyright by Bridget Linehan Logan 2011 All Rights Reserved LIVING WITH A DEPRESSED PARTNER A Dissertation Presented by BRIDGET LINEHAN LOGAN Approved as to style and content by: ___________________________________________________ Genevieve E. Chandler, Chair ___________________________________________________ Karen A. Kalmakis, Member ___________________________________________________ Naomi R. Gerstel, Member __________________________________________ Jean Swinney, Dean School of Nursing DEDICATION To my husband and his encouragement to undertake this project, his support and sounding-board advice throughout the process, and his energy at the end that saw me through. ACKNOWLEDGEMENTS Foremost, I would like to thank the seven individuals who participated in this study and the two who participated in the pilot study. It was a privilege to hear to their stories. I learned from their wisdom, perspective, and sense of humor. I sincerely thank them for their time and openness. I thank my advisor, Ginny Chandler, for her simplicity of guidance and support. I also thank my committee members, Karen Kalmakis and Naomi Gerstel, for their time and energy in reading along the way. Over the years that I spent at UMass, I was lucky to receive the support and encouragement of many people, and I am deeply appreciative of the entire experience. I especially thank Cynthia Jacelon, Ed Tessier, Carol Picard, Jean DeMartinis, and the late Eileen Hayes. They taught, encouraged, provided advice, served as admirable examples, and saw qualities in me that I did not see in myself, encouraging me to take on challenges that I would not have otherwise. I thank Cynthia Goss, Maureen Bailey, Liz Theroux, and Karen Ayotte for their incredibly helpful work and cheerful support over the years. I have also benefited from the support and encouragement of my family and friends at all points in this process, and I am very grateful for this. I thank: my children, Patrick, Maggie, and Brendan for cheering me on; my parents, John and Kate Linehan for reading and advising; Robin Logan for enthusiastic interest and support; and my siblings for encouragement and interest as I traveled this path. As in all of my work, and especially my writing, I have depended on the editing, listening, and unfailing support of my husband. Many thanks to you all! v ABSTRACT LIVING WITH A DEPRESSED PARTNER FEBRUARY, 2011 BRIDGET LINEHAN LOGAN, B.A., UNIVERSITY OF VERMONT B.S., UNIVERSITY OF VERMONT M.S., UNIVERSITY OF MASSACHUSETTS AMHERST Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Genevieve E. Chandler Individuals who live with depressed partners have increased rates of anxiety, depression, and difficult coping. They experience greater burdens of parenting and financial responsibilities, and often feel isolated and restricted. Much of this is similar to what has been termed caregiver burden in the context of other illnesses. This study used qualitative interviews to explore the day-to-day experience of what it is like to live with a depressed partner, as well as to test the fit of the term ‘caregiver burden’ in the context of depression. Participants were seven individuals who were in long-term relationships with depressed partners. Analysis of the interviews identified four stages of a helping process that individuals go through as they care for their depressed partners and transition from partners to caregivers. These individuals are experts on their partners and have important perspective and essential support to offer when their depressed partners are seeking care. Findings underline the importance of advanced nursing and medical care that recognizes the significant burden that nondepressed partners experience and the important ways that they can help their depressed partners seek and stay with treatment. vi CONTENTS ACKNOWLEDGEMENTS .................................................................................................v ABSTRACT ........................................................................................................................vi LIST OF TABLES ..............................................................................................................xi CHAPTER 1. INTRODUCTION ...........................................................................................................1 The Problem .............................................................................................................3 Purpose .....................................................................................................................4 Significance ..............................................................................................................6 Definitions ................................................................................................................7 Depression ....................................................................................................7 Partner ..........................................................................................................7 Depressed Partner ........................................................................................8 Nondepressed Partner ..................................................................................8 Caregiver Burden .........................................................................................9 2. LITERATURE REVIEW ...............................................................................................10 Introduction ............................................................................................................10 Partners and Depression .........................................................................................10 Background ................................................................................................10 Researcher Perspective ...........................................................................................11 Samples ..................................................................................................................13 Study Purposes. ......................................................................................................14 Methods, Designs, and Instruments .......................................................................15 Findings. .................................................................................................................16 How Individuals are Affected by their Partners’ Depression .....................16 How Nondepressed Individuals Affect their Partners’ Depression ............17 How Couples’ Relationships are Affected .................................................18 What Nondepressed Partners Need ............................................................19 Differences in how men and women manage effects of partners’ depression ......................................................20 Qualitative studies ..................................................................................................21 Caregiver burden ....................................................................................................23 vii Purpose ...................................................................................................................27 Method ...................................................................................................................28 Sample and procedure ................................................................................28 Analysis. .................................................................................................................30 Theory ........................................................................................................30 Methods ......................................................................................................31 Instruments .................................................................................................32 Participants .................................................................................................34 Results ....................................................................................................................37 What elements make Up caregiver burden? ...............................................37 Determining patient factors that influence caregiver burden .....................39 Determining caregiver factors that influence caregiver burden .................39 How the relationship between partners and patients was affected .............42 What caregivers need .................................................................................42 Discussion ..............................................................................................................43 Conclusion .............................................................................................................44 3. METHOD ......................................................................................................................48 Introduction ............................................................................................................48 Method ...................................................................................................................48 Sample ....................................................................................................................50 Inclusion Criteria ....................................................................................................51 Exclusion Criteria ...................................................................................................52 Procedure ................................................................................................................52 Recruitment of Participants ....................................................................................53 Setting ....................................................................................................................53 Inclusion of Women, Minorities, and Children ......................................................53 Protection of Human Subjects ...............................................................................54 Data Collection ......................................................................................................55 Interview Protocol ..................................................................................................55 Benefits to participants ...........................................................................................57 Data Analysis .........................................................................................................57 Safeguards of Trustworthiness and Integrity of the Study .....................................57 Credibility and dependability .....................................................................58 Transferability ............................................................................................61 Confirmability ............................................................................................62 viii 4. RESULTS .......................................................................................................................63 Introduction ............................................................................................................63 Identifying onset signals ........................................................................................63 The nature of their partners’ depression .....................................................63 Recognizing that partners are depressed and need help .............................64 Trying to help: Balanced partnership transitions to caregiving .............................68 Telling partners they need to begin or resume medication ........................68 Medications and Therapies ........................................................................72 Taking care of a depressed partner .............................................................73 Feeling “Like it’s too much” .....................................................................79 Caregiver burden ........................................................................................80 Internal management of the illness ........................................................................83 Privacy .......................................................................................................83 Stigma ........................................................................................................85 Isolation ......................................................................................................88 Supports for the Nondepressed partner ......................................................89 Partnership disrupted: Carrying on with life when one partner is depressed .........92 Effect on employment ................................................................................92 Raising children .........................................................................................93 Communication ..........................................................................................96 Feelings of love ..........................................................................................97 Sharing affection ........................................................................................99 Positive effects .........................................................................................101 5. DISCUSSION ..............................................................................................................103 Introduction ..........................................................................................................103 Findings of this study that support previous research ..........................................104 New findings of this study ...................................................................................106 Identifying onset signals ..........................................................................107 Trying to help ...........................................................................................109 Internal management of the diagnosis .....................................................112 Partnership disrupted: carrying on with life when one partner is depressed: ................................................................113 Reckoning biases with results ..............................................................................116 ix