title: [Gender differences in caregiving experience changes over 2-years and effects on psychological well-being of spousal caregivers in a longitudinal study].
abstract: OBJECTIVE
  We examined spousal gender differences in change of caregiving experience over 2-years, focusing on care-recipient's physical and mental conditions, living arrangements, financial status, utilization of long-term care insurance (LTCI), availability of secondary caregivers, caregiver's coping strategies and psychological well-being. We also investigated causal associations between caregiving experiences and psychological well-being of the spousal caregivers.
  
  
  METHODS
  We conducted a 2-wave survey, in Oct. 2003 and 2005. The subjects were a stratified random sample of 5,000 users of LTCI in Higashi-osaka city in Japan. Data were collected through mailed, anonymous self-report questionnaires. Totals of 212 wives and 356 husbands were longitudinally analyzed. A cross-lagged effect model by simultaneous analysis of multiple populations was made to analyze a causal association between caregiving experiences and caregivers' psychological well-being.
  
  
  RESULTS
  There were no significant changes in care-recipient's physical and mental conditions. Over the 2 years, husbands increased the amount of ADL assistance and availability as secondary caregivers, and wives increased utilization of LTCI services. We also found gender differences in the priority of coping strategies. Husbands' preferred coping strategy over 2 years was more on 'willing commitment caregiver's role 'while for wives' it was 'instrumental support seeking'. Wives demonstrated a significantly reduced positive appraisal of caregiving. Though the amount of ADL assistance and 'instrumental support seeking' reduced husband's depression, husband's positive appraisal of caregiving significantly increased strategies of 'emotional support seeking' and 'willing commitment of care role'. Wives & depression decreased with 'valuing own leisure and refreshing' strategies. Furthermore, wives' positive caregiving appraisal increased both strategies of 'keeping own pace of caregiving' and willing acceptance of care role'.
  
  
  CONCLUSIONS
  The husband's results support an interpretation of adaptation to the caregiving role over two years. Therefore husbands who do not experience increase in ADL assistance might be at risk of caregiver's depression. We should monitor their situation of caregiving continually. Though wives increased utilization of LTCI services, this service use did not improve their psychological wellbeing, and they exhibited decreased positive appraisal of caregiving.
authors.affiliation: Division of Health Promotion Science, Nursing Science, Course of Health Science Graduate School of Medicine, Osaka University.
authors.forename: Keiko
authors.initials: K
authors.lastname: Sugiura
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ito
authors.forename: Masami
authors.initials: M
authors.lastname: Kutsumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mikami
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012737:Sex Factors