The impacts of guilt on the request of help of the family caregiver

Objectives. - The literature often indicates the reluctance of family caregivers to seek help, when confronted to the dependence of a close family member but the psychological reasons remain badly known. This research makes the hypothesis that the sense of guilt represents one of the main obstacle to the search of help from the family caregiver of a close family member affected by dementia, when the patient lives at home. It aims to differentiate the guilt of the family caregiver, according to its place of spouse or descendant, in the relation of caregiving. But it also aims to clarify the foundations and the mechanisms of family caregivers' guilt, by articulating it with the problem of loss, which is at the heart of dementia diseases. The work of the pre-mourning and the theory of attachment proposes then to shed a new light, on the elaboration of losses and the sense of guilt of the family caregiver, in the psychic and relational space. Materials and methods. - This research proposes to put in perspective the data collected on the sense of guilt of the family caregiver, through a qualitative and quantitative approach. To test these hypotheses, 38 semi-directive interviews were realized, and completed by the scales of attachment (RSQ), of caregiving (CRA) and depression (Beck). The interviews were the object of a study of thematic analysis based on a psychoanalytical approach. The statistical significance of results was determined thanks to Fisher's Exact test and Chi-Square test. Results. - The results show that depressed family caregivers feel more guilty than not depressed. But guilt cannot be reduced to a disorder of mood. Indeed the descendants feel more guilty than the spouses while they are also depressed as them. The results show a link between the type of attachment of the descendants and their guilt. The descendants-secure feel less guilty than the descendants-insecure. Secure attachment could embody a protective factor against the guilt, even if the statistical results must be handled with caution considering the small sample size. Conclusions. - If guilt slows down the request of help from the spouses, it motivates that of the descendants. Guilt is not the only obstacle to the request of help of the family caregiver. Other factors such as the sense of shame, powerlessness, loyalty ... can prevent his request of help. Also the psycho-behavorial disorders of the patient, which are more pronounced in some dementias can also affect the request of help of the family caregiver (English text read by Francois Petitjean). (C) 2016 Published by Elsevier Masson SAS.