Rachel Cousins
Professor Robert Cummins
School of Psychology, Deakin University

Introduction

The focus of my study was on the SQOL of carers of people with mental illness. The measurement of
SQOL has long been used to describe populations as it can provide valuable information about
individuals’ satisfaction with several life domains.

The impact of the caregiving role on Subjective Quality of Life

Whilst there are both positives and negatives to caregiving, it is the negatives that are more likely to
impact on SQOL. Carers of people with mental illness experience considerable burden and distress.
In fact, the introduction of mental illness into the family has often been described as a traumatic and
catastrophic event that gives rise to an array of emotionally painful and disturbing feelings including
anger, guilt, anxiety, sadness and grief.

As carers’ cope with difficult symptom behaviours and the relapsing and remitting nature of mental
illness, they often find themselves in a position where the needs and wishes of the person with mental
illness are constantly put before their own. Consequently, carers’ opportunity for work may become
limited and their social and leisure activities reduced which in may lead to social isolation.

Clearly, the caregiving role may have a negative impact on SQOL. Therefore, I am also interested in
examining processes that may help to maintain or improve carers’ SQOL.

Personality and Subjective Quality of Life

Research has shown that there is a strong relationship between personality and SQOL, particularly the
well substantiated personality characteristics, neuroticism and extroversion. Neuroticism, which
reflects emotional instability, has been shown to negatively correlate with SQOL. While extroversion,
which reflects sociability, has been shown to positively correlate with SQOL. In fact, theoretically and
empirically neuroticism and extroversion have been shown to predict SQOL. Given this strong
predictive relationship I believe it is necessary to account for the effect of personality in any
investigation of SQOL.

Perceived Control and Subjective Quality of Life

Another psychological process that has been found to have a significant relationship with SQOL, and
that is particularly relevant to carers, is perceived control. Perceived control refers to the belief that
one has at one’s disposal a response that can influence the aversiveness of an event. This variable
seemed particularly relevant to carers, who are likely to be continually faced with difficult or aversive
situations as they cope with the impact of mental illness in the family.

An interesting theory of control has been developed which conceptualises two processes or strategies
for maintaining perceived control. They are, Primary Control, where the person believes they can
change their external environment, and Secondary Control, where the person believes they can change
their internal environment. Along with this I believe it is important to consider, Relinquished Control,
where the person believes that change is not possible, and thus abandons the motivation to control.

Hence, the processes of primary, secondary and relinquished control work together to form a
perception of control that is likely to be lowered in carers’ as they cope with the negative impact of the
caregiving role. Given that personality has such a strong influence on SQOL, it is also likely that
personality will influence perceived control as the belief in the availability of primary, secondary or
relinquished control would be dependent upon an individual’s personal style or personality.

Hypothesis

Hence, it was hypothesised that, carers of people with mental illness will have lower SQOL and
Perceived Control than people who do not care for someone with a disability, after the effects of
personality have been removed.

Sample

The carer sample consisted of participants in educational courses and forums run by SFV for relatives
of people with mental illness. Of those who volunteered to participate in the study, only those who
indicated that they were the primary carer of someone with a mental illness were used in the
subsequent analyses, totalling 127.

The comparison sample consisted of participants who were randomly selected from a list of individuals
who had previously participated in Deakin University research. Of those who returned the
questionnaire (56% response rate) only those who indicated that they were not the primary carer of
someone with a disability were used in the subsequent analyses, totalling 114.

The two samples were comparable on a range of demographic variables with the exception of income,
where carers had a lower income than the comparison sample.

Demographic information

* The two groups significantly differed on income.

Measurement Tools

Comprehensive Quality of Life Scale, Cummins (1997)

SQOL was measured using the subjective scale of the Comprehensive Quality of Life Scale, developed
by Cummins (1997). This tool assesses the individual’s satisfaction with seven life domains weighted
by the importance they place on each of these domains. The seven domains are material well-being,
health, productivity, intimacy, safety, place in community and emotional well-being. The aggregate of
these domains provides a total SQOL score. Respondents were asked to rate the importance they
place on each domain and how satisfied they are with each domain on an eleven point likert scale.

Eysenck Personality Questionnaire, Eysenck and Eysenck (1991)

Personality was measured using the Extroversion and Neuroticism scales of the Revised Eysenck
Personality Questionnaire. Respondents were asked to provide yes/no responses to 12 questions on
each scale.

Perceived Control Scale

– Primary and Secondary Control Scale, Heeps (2000)

– Relinquished Control items, Thurber and Weisz (1997)

Perceived Control was measured using the primary and secondary control scale developed by Heeps
(2000) and relinquished control items taken from Thurber and Weisz, (1997). There was a total of 28
items on the Perceived Control scale, 7 PC, 17 SC and 4 RC items. Respondents were asked to rate
the extent to which they agreed with the statement on a 10 point likert scale.

Results

Factor Analysis for the Perceived Control Scale

To refine the reliability and validity of the tool for the measurement of primary, secondary and
relinquished control for use in the subsequent analyses, a series of factor analyses and other data
reduction methods were conducted on the combined sample of 241. The data adequately met the
necessary assumptions for testing and factorability.

The results showed that there were two distinct factors. Initially items loading less than .3 on either
factor or greater than .3 on both factors were deleted. However, some items had very low reliability,
so a final cut off criterion of .4 was used. The resultant solution showed that the two factors were
independent (r= .284) and together accounted for 43.80% of the variance. Internal consistency was
high for Factor One (a=.82) and slightly lower for Factor Two (a=.73).

The two factors were meaningful and reflected different perceptions of control. Factor One consisted
of 10 items, 6 Primary Control and 4 Secondary Control items. Factor Two consisted of 5 Secondary
Control items, and it is interesting to note that before the more stringent cutoff criterion was used
relinquished control items also loaded on this second factor. Effectively the factor analysis suggests
that there is a distinction in the secondary control items where some are similar to primary control and
some are similar to relinquished control. In examining the content of the items we can see that the first
factor reflects items where the problem is being addressed in some way, eg’s. I have termed this
factor Approach Control. The second factor reflects items where the problem is being avoided, eg’s.
I have termed this factor Avoidant Control.

Results

Multivariate analysis of covariance

A multivariate analysis of covariance was used to test the hypothesis that, once the effects of
personality have been removed, carers would show significantly lower SQOL and Perceived Control
than the comparison sample.

Hence, the independent variable, is group (carer or comparison), the covariate is personality
(extroversion and neuroticism) and dependent variables are total SQOL, Approach Control and
Avoidant Control.

The data did violate some of the assumptions for testing, suggesting findings should be interpreted with
caution.

While the multivariate analysis was non significant, there was an interesting trend in the univariate
analyses which showed that, once the effects of neuroticism and extroversion had been removed, the
two groups differed significant on total SQOL. Examination of the means showed that carers have
significantly lower total SQOL than the comparison group.

When the covariates were taken out of the analysis the two groups differed significantly on both total
SQOL and Approach Control.

Evaluated at covariates appeared in the model: TNEURO = 4.63, TEXTRO = 6.57.

Results

Multivariate analysis of covariance

A second multivariate analysis of covariance was used to examine the differences between the two
groups on each of the seven SQOL domains with the effects of personality removed.

Here the multivariate analysis was significant and examination of the univariate analyses revealed that
after the effects of neuroticism and extroversion had been removed the two groups differed
significantly on the domains health and emotional well-being. Examination of the means showed that
carers had significantly lower satisfaction with their health and emotional well-being than the
comparison group.

When the covariates were taken out of the analyses the two groups differ significantly on all of the
domains of SQOL.

Evaluated at covariates appeared in the model: TNEURO = 4.63, TEXTRO = 6.57.

Conclusion

Once the effects of personality have been removed, carers of people with mental illness have lower
Subjective Quality of Life than people who do not care for someone with a disability.

In conclusion, there is a clear trend in the data that shows that even after the effects of personality are
removed, carers show lower total SQOL and more specifically lower satisfaction with their health and
emotional well-being than the comparison sample. Providing some support for the hypothesis and
indicating that the impact of the caregiving role is most prominent on health and emotional well-being.
Highlighting two important areas that must be addressed when trying to improve the SQOL of carers
of people with mental illness.

Once the effects of personality have been removed, carers of people with mental
illness did not have lower Perceived Control than people who do not care for
someone with a disability.

Unfortunately, after the effects of personality had been removed, there were no significant differences
between the carer and comparison samples for Perceived Control. The inability of the analysis to
detect a difference between the samples in Avoidant Control suggests that it is not a particularly
important control strategy and that carers’ perceived control is not so low that they are resorting to
avoiding their problems. The inability of the analysis to detect a difference between the samples on
Approach Control, a difference that is evident when the effects of personality have not been removed,
suggests that there is a strong relationship between personality and perceived control that needs to be
further examined.

Finally, some interesting conclusions can be drawn from the factor analysis. Here, the relationship
between primary control and some forms of secondary control appears so strong that the analysis was
unable to make a distinction between them, suggesting that there are important similarities between
primary and secondary control. The fact that the secondary control items were divided between the
two factors indicates that we must be careful about treating all types of secondary control in the same
manner and that some types may be more useful for maintaining a perception of control than others.