Identifying depression in caregivers: Signs, causes, and what to do

Apart from reading, singing, and plodding up muddy trails, Grace enjoys scribbling notes and thinking up a storm. She is particularly interested in community support for the special needs population, and learning and education.

Being a caregiver comes with a multitude of challenges, such as having to look after your loved one's daily living needs. Unsurprisingly, caregivers in Singapore are at a high risk of depression.

A local study has found that over four in ten caregivers are susceptible to depression, in part due to the various difficulties that they face with caring for their loved one, combined with having to balance their caregiving duties with their work, family obligations, and their own mental health.

However, conversations around mental health and well-being are not enough on their own. It is by knowing what depression looks like, learning how to identify worrying signs in our loved ones, and taking the steps to help caregivers address their struggles, that we can better support our caregivers.

With this, how can you tell if you or a loved one whom you know is at risk of caregiver depression and what can be done to cope with it?

What is depression?

Depression is a mental health condition that can have a huge impact on someone's life. When it comes to symptoms of clinical depression, it is more than feeling blue or down once in a while.

Rather, depressive moods stay for extended periods of time and can cause you to lose interest in your daily activities and hobbies. Being depressed may affect your relationships, friendships, and even your behaviour at work and at school. A depressive episode can last most of the day and occur nearly every day. 

It is important to spot signs of depression in caregivers before it is too late. A caregiver with depression will not be able to perform and help their care recipient, and this may also cause their condition to worsen over time.

What are the symptoms of caregiver depression?

Some symptoms of depression include: 

• Poor concentration
• Feelings of excessive guilt or low self-worth
• Hopelessness about the future
• Thoughts about dying or suicide
• Disrupted sleep
• Fatigue
• Changes in appetite or weight
• Feeling very tired or low in energy

What may contribute to caregiver depression?

Often, there is no one answer for why caregivers may begin to feel depressed.

However, for many caregivers, depression becomes a likelihood because they simply do not have the bandwidth to care for anyone other than their loved one, including themselves. Without the energy to care for themselves, this can lead to exhaustion, difficulties at work or at school, and having little time to take a breather or spend time with other loved ones.

Moreover, caring for another and having to watch out for their care recipient's safety usually puts additional stress on someone. Caregivers are expected to be on alert mode to look after their loved ones round the clock. This can inevitably cause caregivers to feel that they no longer have time for themselves or their own needs.

In addition, seeing the care recipient decline may not be an easy experience for caregivers as well, leading to a higher possibility of feelings of guilt and depression.

However, there are a few factors that commonly contribute to depression in caregivers and caretakers:

1. Having to find a balance between caregiving and other responsibilities

Besides caregiving, a caregiver may also be a parent, employee, or spouse among other roles. Some may feel strongly towards not being able to perform all their roles meaningfully or may be burnt out from having to perform all their roles. 

2. Caring for a loved one with a terminal condition

In such cases, the caregivers know that they are caring for their loved one, likely till their last days. Having to manage and grapple with this day in and day out, and seeing the decline happen over the days they spend with their loved ones, can be very painful to watch. Moreover, the care recipient's needs increase as they decline, adding to the physical burden the caregiver has to shoulder. 

3. Being in a poorer state of health 

With caregiving, there are many sacrifices caregivers have to make which can affect their personal health. Sleep is normally affected, with the caregiver not getting enough rest, not getting quality rest, or getting insomnia. Minimally, we all need about seven to eight hours of sleep a day.

Moreover, there may be other physical issues a caregiver is facing, such as menopause, childbirth, thyroid disease, or nutritional deficiencies. Usually, caregiving leaves no time for exercise, leading to poorer overall fitness and health, which are all contributors to depression. 

4. Having to make important decisions for the care recipient

Besides making care decisions like whether to move the care recipient to a nursing home, the administrative details of managing finances and the transfer may add on to stress on the caregiver. 

Following up on caregivers with suspected depression 

If you spot any symptoms of the above in a caregiver, do have a chat with them to see how open they are with receiving help or being flagged up for support. Some caregivers may not be keen or ready to face this mental issue now, as they may feel that their care recipient's needs are greater than their own.

Find a time when the caregiver is free, and sit down to have a heart-to-heart talk with them about your concerns. If they are not receptive to further treatment for now, respect their decision and be a source of support for them. Mindline.sg may be a helpful tool for caregivers who want to explore their mental state but prefer to do so on a more informal basis. 

As for caregivers who are ready to seek further support, you can encourage them to:

1. Speak to their family doctor or go to the polyclinic

Caregivers can seek further help from general practitioners, polyclinics and restructured hospitals. Homages offers online consultations and house call doctors should the caregiver wish for more privacy in seeking follow-up. The doctors will assess and determine what is necessary for the caregiver, such as referring for services elsewhere. 

2. Seek help at family service centres (FSCs)

Family service centres are community-based social services that provide support for low-income and/or vulnerable individuals and families with social and emotional issues. FSCs are open to all individuals seeking support. If the FSC determines that the caregiver will be better supported elsewhere, they will refer to relevant partner agencies. 

3. Consider counselling services or therapy

Besides public options available, the caregiver can consider private counselling services or therapy. These may be more expensive than public services, but the caregiver will be able to get help faster and also choose the practitioners he or she is most comfortable with.

Other tips for caregiver well-being

Besides seeking treatment for depression, there are some other ways to help a caregiver with depression and support them in their role and life better. Remember that treatment does take time to take effect and everyone responds differently to depression treatment as well. 

Some things you can do for a caregiver with depression would be to:

1. Find a support group that they can join

Support groups can be helpful as there are other caregivers facing the same situation, and may provide a more suitable sounding board and safe place for the caregiver to share their troubles or feelings. 

2. Provide practical help according to what they need

When caregivers are consumed in their role, they find it difficult to spare time or effort for other matters. Consequently, they may have no choice but to stay home constantly as they are unable to leave their care recipients alone. Even if they go out, it may be only for doctor's appointments for the care recipient or to run errands. All these can be very isolating for a caregiver.

When possible, ask the caregiver what they may wish for you to help with — is it doing the chores, or taking the care recipient out for a walk or appointment? More importantly, the help you offer should be something the caregiver finds useful.

3. Help them to set realistic goals

There is a whole list of errands and tasks to do with caregiving, and aside from that, the caregiver may have other activities they need to attend to as well. Help the caregiver set goals which are attainable and realistic, to help to ease off the mental burden of having to accomplish everything. Sometimes caregivers are in auto-pilot mode as well and do not have the mental space to think about how to prioritise their tasks. It may be helpful for someone else to help them to do so. 

4. Encourage them to seek social support from friends and family

Having someone to talk with and chat about how things are going can be a useful source of support for a caregiver. Day in and day out, they may only interact with the care recipient and need to interact with others as well. Have a friend call, chat over text, or even drop by for a house visit if possible. 

5. Encourage them to incorporate daily habits that can be beneficial for their health

This could be taking a certain number of steps a day, having a few servings of fruit, doing relaxation exercises or a quick workout. How are these habits beneficial? Having small health goals like these daily can give the caregiver a sense of achievement and also help them to remember to invest in themselves, rather than solely being preoccupied with the care recipient. This can also help to maintain their sense of self as well. 

Having an accountability partner who is joining them in their journey towards a healthier mindset may be of great support to them. As such, you may want to consider adding these habits to your own lifestyle too and be their encouragement when they find it difficult to sustain these habits on their own.

Conclusion

Caregiving can be a strenuous journey, and it is a deeply personal one that varies from individual to individual. Yet the underlying commonality between caregivers would be the physical and mental stress they face on a day-to-day basis.

What is important is remembering that it is not wrong to take a break from time to time.

ALSO READ: At 26, she jumped from 16th floor of her condo block and survived - 'for a reason'

This article was first published in Homage.