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Social Determinants of Health Affect Caregivers’ Coping Strategies

March 1, 2025

By Stacey Kusterbeck

Many individuals with heart failure rely on informal caregivers, such as friends or family. Unfortunately, the demands of informal caregiving can surpass a caregiver’s ability to adapt. “Those who fail to develop effective coping strategies are at risk of becoming care recipients themselves,” warns Austin M. Matus, PhD, RN, a postdoctoral fellow at University of Pennsylvania School of Medicine.

Caregivers with poor coping skills may struggle with stress, anxiety, and depression — all risk factors for poor health outcomes. Caregivers facing higher social determinants of health (SDH) risks (such as limited financial resources or lack of access to quality healthcare) may have diminished capacity to cope with stressors.

“There is conceptual reason to believe that SDH risk may influence the health of informal caregivers by impacting how they cope with the stress of caregiving. However, this has not been demonstrated in the literature,” notes Matus. Matus and colleagues analyzed data on 250 caregivers of adults with heart failure to explore the relationships between SDH risk and coping styles.1

Caregivers’ SDH risk was associated with avoidant and minimization coping strategies, which can cause caregivers to ignore a situation or perceive it as an insurmountable obstacle. Caregivers from racial and ethnic groups other than white and caregivers caring for multiple people (in addition to the heart failure patient) were most likely to engage in avoidant coping. “Addressing SDH risks can help reduce caregiver stress, promote healthier ways of coping, and improve caregivers’ overall well-being,” concludes Matus. Hospital ethicists can foster a supportive environment for caregivers with these approaches, suggests Matus:

  • During consults, the ethicist must consider the social contexts of the patient and the caregiver. This may require the clinical team to assess the caregiver’s social supports or financial stability. Ethicists then can recommend referring the caregiver for resources, such as mental health referrals or social work consults.
  • Ethicists can advocate for discharge plans that better support the caregiver in their role.
  • Ethicists can work with hospital administrators to establish policies that incorporate caregiver well-being into care planning. Such policies may include assessment of caregiver readiness or regular wellness checks for caregivers.
  • Ethicists can provide training that highlights the effect of SDH risks on informal caregivers.

Clinicians may not realize that caregivers face significant burdens because of limited resources. “Ethicists may play a role in raising awareness of this to help support more equitable and fair decision-making,” says Matus.

Reference

  1. Matus A, Quinn R, Stawnychy MA, et al. Social determinants of health are associated with coping of informal caregivers of adults with heart failure. Clin Nurs Res. 2024;33(5):334-343.