Signs of Caregiver Stress

Ongoing chronic stressors decrease energy, reasoning ability and the body’s immune system response. Some caregivers focus so much on the needs of the loved one that they don’t notice what their body, their actions and their feelings are telling them about their stress until it is too late. Caring for yourself as a caregiver starts with recognizing the signs of stress.

The Caregiver Strain Index (CSI) is a 13-question test for measuring the strain related to caregiving. It was designed for those who provide care for older adults, but may be useful for identifying stress levels of other family caregivers as well. It was developed at the Hartford Institute for Geriatric Nursing,Division of Nursing at New York University and is reprinted here with their permission.

Download a PDF copy of the Caregiver Strain Index.

When you try to do too much for too long, your body lets you know.Here are some of the common physical symptoms of stress:

• Fatigue
• Sleep problems (difficulty getting to sleep or staying asleep, nightmares, or sleeping more than usual)
• Tension headaches
• Backache (due to muscle tension rather than to lifting)
• Muscle tension, especially in the shoulders and neck
• Upset stomach
• Change in appetite
• Weight loss or gain
• High blood pressure
• Shortness of breath
• Sweaty palms
• Cold hands and/or feet

A person’s actions related to objects or other people can also be a sign of stress. Watch for the following common behavioural signs of stress:

• Snapping at people or taking out your frustrations on others or objects
• Accidents or near accidents, e.g., dropping things due to loss of concentration or attention
• Increased forgetfulness
• Crying for no apparent reason or for problems that would not previously have led to that response
• Avoiding contact with others (e.g., not returning calls)
• Loss of sense of humour
• Substance abuse or overuse
• Procrastinating or failing to follow through on responsibilities

There is no doubt that caregiving for a loved one is an emotional experience. No one should be expected to feel happy all of the time, particularly when managing the needs of someone with a chronic disability.While keeping a positive perspective is helpful overall, it is natural to feel negative emotions at times.Long-term stress may cause these negative emotions to prevail, resulting in the following common signs of stress:

• Irritability or increased frustration
• Hostility or anger
• Anxiety (e.g., for the loved one’s well-being, or about one’s personal adequacy to carry out the role of caregiver or roles previously held or shared by the person with a chronic disability )
• Feeling guilty for wanting respite from the loved one, or for being healthy when the loved one is not
• Ambivalence about or feeling trapped by the situation
• Jealousy (e.g., of the loved one for getting all of the attention and care, or of others who are free from the demands of caregiving)
• Loss of self-esteem
• Feelings of helplessness, mental fatigue or being overwhelmed
• Humiliated by the need to ask for help or to share private information in order to get services or financial support
• Feeling lonely or isolated from others, including the loved one at times
• Boredom with the routine of caregiving
• Sadness or loss
• Despair or depression

All of these are common responses to caregiving at times. However, if these feelings become frequent or constant, caregiver burnout may follow.

Burnout is a state of emotional, mental and physical exhaustion caused by excessive, prolonged stress. People who are burning out eventually respond to the overwhelming negative emotions by losing their motivation and sense of effectiveness. They feel helpless to make a difference with their caregiving actions, and may stop caring, become cynical and/or increasingly dissatisfied.

Depression is the most common emotional lead-in to burnout. Mental health professionals define a major depressive episode as (a) having five or more of the following symptoms present during the same two-week period and (b) having the first and/or second symptom on the list.

1. Depressed mood lasting for most of the day, nearly every day
2. Markedly reduced interest or pleasure in all, or almost all, activities
3. Significant weight loss or weight gain
4. Sleeping too little or sleeping too much, relative to the person’s usual sleep pattern
5. High level of activity or lethargy
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive, inappropriate guilt
8. Diminished ability to think and concentrate, or indecisiveness
9. Recurrent thoughts of death or suicidal thoughts or attempted suicide.

You may notice these symptoms or others may make remarks about them. These symptoms cause significant distress or impairment of day-to-day functioning. Although they may be signs of depression,these symptoms are also side effects of some medications. It is wise to tell your physician about your symptoms if you are taking any medication. Likewise, the symptoms may be natural responses to loss and be part of the grieving process. If you or someone else is thinking about suicide, seek assistance immediately.