Annals of Clinical Psychiatry, Vol. 12, No. 1, 2000 The Psychological and Physical Health of Hospice Caregivers Yulia Chentsova-Dutton, 1 Stephen Shuchter, 1 Susan Hutchin, 1 Linda Strause, 2 Kathleen Burns, 3 and Sidney Zisook 1,4 This study explores the psychological distress of caring for a dying family member and examines the differences in depression, anxiety, health, social and occupational functioning, and social support among hospice caregivers and community controls. It compares psychologi- cal functioning of spousal and adult child hospice caregivers. Caregivers of terminally ill hospice patients were assessed prior to death as a part of a longitudinal bereavement study. Caregivers reported experiencing higher levels of depression, anxiety, anger, and health problems than controls. Hospice caregiving was associated with deterioration in physical health and in social and occupational functioning. The comparisons between adult children and spouse caregivers revealed that levels of psychological and physical morbidity were very similar for the two generations of caregivers. An awareness of distress symptoms among hospice caregivers could lead to timely proactive clinical intervention that may prevent bereavement complications. KEY WORDS: hospice; caregivers; adjustment. INTRODUCTION Struggling with terminal illness is one of the most painful and stressful experiences one can face. This distressing ordeal not only affects the dying patient, but also reverberates through his or her entire family. The number of family caregivers can be expected to increase in the future with the recent cost contain- ment focus of the healthcare industry and growing elderly population in this country (1). Caring for a dying patient creates considerable stress in the life of caregivers, forcing them to readjust their working schedule, family life, and social rela- tionships. In addition, caregiving can be associated with a heavy financial burden. Caregivers are faced with the dual challenges of providing physical and 1 University of California at San Diego, La Jolla, California. 2 San Diego Hospice, San Diego, California. 3 Stevens Cancer Center, Scripps Hospital, San Diego, California. 4 To whom correspondence should be addressed, at Department of Psychiatry, 0603-R, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093-0603; e-mail: szisook @ucsd.edu 19 1040-1237/00/0300-0019$18.00/1  2000 American Academy of Clinical Psychiatrists emotional care for the patient and dealing with antici- patory grief. They often have little time to take ade- quate care of their own health, neglecting healthy eating habits, exercise, and adequate rest. Thus, it is of no surprise that caregiving is associ- ated with considerable physical and psychological vulnerability (2–4). Much of what we know about the stress of caregiving comes from studies focusing on other types of caregivers, such as caregivers of elderly patients with Parkinson’s and Alzheimer’s diseases. There is strong evidence that caring for such a patient is associated with elevated levels of depres- sion, anxiety, and general medical health problems as compared to population norms or control samples. Clinically significant levels of depression are detected in approximately 18–46% of caregivers of patients with dementia (5,6). Levels of depression are known to be higher among female caregivers, caregivers with poorer health (4,7), those from distant families, and those caring for more-disabled patients (7). Caregivers of hospice patients tend to be some- what younger and care for younger patients for shorter periods of time than their counterparts caring