Cognitive Appraisal , Coping and Psychological - Adjustment of those who Care for People with Physical Disability

Care giving is an exhausting job, and carers are reported to experience very significant strain. This research examined burden, cognitive appraisal, coping, and psychological adjustment of carers of physically disabled people with specific reference to post-onset personality and physical changes. Two studies were conducted. Study one examined subjective burden in carers in relation to post-onset personality changes, severity of disability, and other objective symptoms in disabled people (objective burden). The carers rated both the current and pre-morbid personality of disabled people, and they were interviewed to assess subjective and objective burden 4-9 months and 12-18 months post-onset. Physically disabled people were frequently reported as showing personality changes, and these changes were reported in a negative direction on both occasions. Personality changes and severity of disability showed a positive relationship with carers' subjective burden at both assessment times. The carers' subjective burden was also associated with objective burden categories, and the number of objective symptoms which related to carers' subjective burden, increased over time. It was concluded that although carers' burden was related to both personality changes and severity of disability, their burden was associated more with personality changes, behavioural problems, emotional disturbances and subjective symptoms. Study two investigated carers' cognitive appraisal of post-onset personality and physical changes, coping, and psychological adjustment to these changes. In addition to examining the relationships between different variables, Lazarus' cognitive model of coping was also tested. Carers completed a series of self-report measures 4-18 months post-disability. It was confirmed that carers experienced an immense amount of subjective burden and psychological distress, and that carers' subjective burden was determined by both personality and physical changes in patients. However, compared with physical changes, the personality changes of patients were perceived as more stressful, more threatening, as of greater centrality and they elicited more concerns. Physical changes, on the other hand, were perceived as more manageable compared to personality changes. A variety of strategies were employed to cope with post-onset changes. However, a greater number of strategies were used to cope with personality changes as compared to physical changes. Carers depended more on emotion-focused strategies when coping with personality changes, whereas more problem-focused strategies were utilized to cope with physical changes. As far as the relationship between cognitive appraisal and coping is concerned, findings showed a general consensus with Lazarus' cognitive model of coping. Cognitive appraisal of threat, centrality, and levels of concerns showed a positive relationship with carers' subjective burden and psychological distress. The appraisal of manageability and controllability had a negative association with subjective burden and psychological distress. Those carers who used a greater number of coping strategies and those who employed more emotion-focused strategies were more subjectively burdened as well as psychologically distressed. Looking at the predictability of subjective burden and psychological distress by cognitive appraisal and coping, cognitive appraisal emerged as a strong predictor of subjective burden and distress. Coping, however was a weak predictor of carers' subjective burden and psychological distress. It was concluded that cognitive factors, in particular cognitive appraisal plays an important role in predicting carers' adjustment to post-onset changes in physically disabled people.