Family P ocess. 2021;00:1–16.
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wileyonlinelib a y.com/jou nal/ amp
Recei ed: 13 Sep embe 2019
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Re ised: 21 Ap il 2021
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Accep ed: 23 Ap il 2021
DOI: 10.1111/ amp.12684
ORIGINAL ARTICLE
E ec o suppo g oups on ca egi e ’s quali y o li e
ClaudiaBe nabéu- Ál a ez | Joaquín- Sal ado Lima- Rod íguez |
Ma aLima- Se ano
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion- NonComme cial- NoDe i s License, which
pe mi s use and dis ibu ion in any medium, p o ided he o iginal wo k is p ope ly ci ed, he use is non- comme cial and no
modi ica ions o adap a ions a e made.
© 2021 The Au ho s. Family P ocess published by Wiley Pe iodicals LLC on behal o Family P ocess Ins i u e
Facul y o Nu sing, Physio he apy and
Podia y, Uni e si y o Se ille, Se ille, Spain
Co espondence
Joaquín- Sal ado Lima- Rod íguez, Facul y
o Nu sing, Physio he apy and Podia y,
Uni e si y o Se ille, S ee A enzoa , 6,
Pos al Code 41009, Se ille, Spain.
Email: [email protected]
Abs ac
The objec i e o his s udy was o e alua e he e ec ha
pa icipa ing in suppo g oups o ca egi e s has on he
quali y o li e and psycho opic d ug use o amily ca -
egi e s o adul s wi h limi a ions in ac i i ies o daily
li ing. A con olled quasi- expe imen al longi udinal de-
sign was used wi h 134 ca egi e s (64 in he expe imen al
g oup and 70 in he con ol g oup). The ou comes we e
heal h- ela ed quali y o li e (Eu oQol 5D3L es ) and
psycho opic d ug use (no/yes). The analyses we e pe -
o med using SPSS and R s a is ical so wa e. An in e ac-
ion was obse ed be ween he condi ion and he le el o
limi a ions in ac i i ies o daily li ing o he ca e ecei e ,
ha ing an e ec on he ca egi e 's psycho opic d ug use
(p=0.003), wi h his use being lowe among ca egi e s
who a end suppo g oups when hei ela i es p esen
ewe limi a ions in ac i i ies o daily li ing. Mo eo e ,
he quali y o li e was highe in he pos - es in he expe i-
men al g oup (B=8.66, p=0.015). In conclusion, suppo
g oups could imp o e he ca egi e 's quali y o li e and
dec ease psycho opic d ug use when he ca e ecei e has
low limi a ions in ac i i ies o daily li ing.
KEYWORDS
Anxie y, Family ca egi e , Quali y o li e, Psycho opic d ug use,
Suppo g oup
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FAMILY PROCESS
INTRODUCTION
Aging— as well as disabling diseases such as demen ia, Pa kinson's disease, ca dio ascula
pa hologies, men al diso de s, o addic ions— inc eases he need o amily ca e (Pihe e al.,
2017; WHS 2020) o p o ide medica ion, emo ional suppo , o wha e e sui s he signs and
symp oms and allows o obse e he e olu ion o a disease (Lima- Rod íguez e al., 2015).
Good amily ca e educes he isk o a pa ien being hospi alized o he need o eme gency
se ices. Mo eo e , i educes amily anxie y when i is pai ed wi h amily- cen e ed ca e and
suppo o he amily ca egi e (Deek e al., 2016).
Howe e , amily ca egi e s usually su e om unsa is ied needs ela ed o die , physical
exe cise, o leisu e ime (Ta angelo e al., 2018), oge he wi h a eeling o guil . Full dedica-
ion o p o iding ca e can a ec ca egi e s’ heal h and quali y o li e, especially when he e
is only one pe son who akes on he ca egi e ole (Sands ed e al., 2018; Ullg en e al., 2018).
Ca egi e s a e e en mo e p one han he es o he popula ion o de eloping anxie y and/o
dep ession symp oms and sleep diso de s (Ca od- A al e al., 2013; Dahl up e al., 2015; Jamani
e al., 2018; Mo imo o e al., 2003) and o using psycho opic d ugs such as an idep essan s and
anxioly ics (Cama gos e al., 2012; Sallim e al., 2015). A me a- analysis on he p e alence o
men al heal h diso de s among ca egi e s o people wi h Alzheime 's disease showed a p e -
alence o dep ession o 34.0% (2.51 imes mo e likely in spouse ca egi e s), anxie y o 43.6%,
and psycho opic d ug use o 27.2% (Sallim e al., 2015). Mo eo e , p e ious s udies showed he
ela ionship be ween psycho opic d ug use and he ca egi e bu den (T eichel e al., 2020), as
well as he lack o social suppo (Cama gos e al., 2012; Colell e al., 2014; Ma eo e al., 1997;
Pé ez e al., 2009).
Suppo g oups (SGs) a e an example o social ca e p o ided o ca egi e s. SGs a e made up
o people who sha e a common p oblem, and hey ga he olun a ily and eely in o de o cope
wi h and o e come hei si ua ion h ough pe sonal and/o social changes (Ahmadi, 2018). In
1994, Monking (1994) showed ha a ending SGs educes he bu den and physical complain s
o hose who ca e o people wi h men al heal h diso de s. O he au ho s ound ha di e en
ypes o ca egi e SGs— especially o people wi h Alzheime 's and o he demen ias— had
posi i e e ec s on psychological well- being, dep ession, bu den, and social suppo (Chien
e al., 2011; Guay e al., 2017), as well as on sel - e icacy and quali y o li e (Pa ke - Oli e e al.,
2017), al hough he e ec s on he la e we e no conclusi e (Cheng & Zhang, 2020). Rega ding
psycho opic d ug use, p e ious au ho s s a ed ha SGs could help o educe d ug p esc ip ion
(Huno e al., 2007; P ei e e al., 2011).
The in eg a ion o psychosocial p ocesses, such as he exchange o emo ions and eelings,
expe iences and in o ma ion, as well as pee lea ning, could ansla e in o he bene i s men-
ioned. SGs help ca egi e s o exp ess ep essed emo ions, which gi es hem a sense o elie
and p o ec ion. The exchange o expe iences allows o alida e hese expe iences and p oduces
he eeling o ha ing some hing in common, bu also a eeling o au onomy in ca ing. In his
exchange, he e is open discussion, in o ma ion, and ad ice. Rega ding he in o ma ion, his
in ol es any hing ela ed o communi y esou ces and coping and p oblem- sol ing s a egies.
Being pa o a new g oup allows people o inc ease hei social ne wo k, educing eelings o
loneliness and p omo ing con inui y o ca e (Be nabéu- Ál a ez e al., 2020; Cipolle a e al.,
2019; Toseland e al., 1990; T ail e al., 2020). When he SGs a e led by p o essionals, he ca e-
gi e s can lea n new skills o beha io al change, iden i ying ba ie s, and p oblem- sol ing
(Domínguez O ozco, 2012; Guay e al., 2017).
We decided o ca y ou his s udy because we did no ind any s udies ha assessed he e -
ec o SGs on ca egi e s’ psycho opic d ug use, and nei he did we ind any con olled expe -
imen al o quasi- expe imen al s udies in ou ield ha e alua e he e ec o SGs on ca egi e s’
quali y o li e. We s a ed om he hypo hesis ha suppo g oups ha e a posi i e impac on
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BERNABÉU- ÁLVAREZ E AL.
heal h- ela ed quali y o li e and educe he psycho opic d ug use o ca egi e s o people wi h
limi a ions in ac i i ies o daily li ing, compa ed o hose who do no pa icipa e in SGs.
METHOD
S udy design
We used a quasi- expe imen al longi udinal design wi h an expe imen al g oup (EG) and a
con ol g oup (CG) and ook measu emen s a he beginning o he s udy and 6mon hs a e .
CONSORT guidelines (Mon gome y e al., 2018) we e ollowed. The da a collec ion p ocess
was ca ied ou be ween Janua y and Sep embe 2016 in P ima y Heal h Ca e a eas in Se ille,
Huel a, and Cadiz (Spain).
Popula ion and sample
The s udy popula ion we e ca egi e s o adul people wi h limi a ions in ac i i ies o daily li -
ing (people who need help o ca y ou ce ain basic ac i i ies o daily li ing a leas once a day,
e e y day [Minis y o equali y and social policies, 2016]).
A sample size o 51 pa icipan s was es ima ed o each g oup (expe imen al and con ol
g oups) in o de o pe o m a one- ailed compa ison o he a e ages be ween wo independen
g oups ( - es ), wi h an alpha e o o 5%, a powe o 80%, and a mean e ec size (d=0.5),
aking in o accoun a d op- ou a e o 40% (Be ge - Höge e al., 2019; Wal e s, 2004). The
p og am G*Powe 3.1.7. was used. Finally, in he p e- es , he e we e 134 ca egi e s, 64 in
he EG (47.8%), and 70 in he CG (52.2%). The ca egi e s we e selec ed h ough in en ional
sampling, and hey we e s a i ied by geog aphical a ea, wi h 47.8% li ing in u ban a eas and
52.2% li ing in u al a eas. In he pos - es , he a i ion a e was 20.9%, wi h easons being he
dea h o he ela i e, discon inued a endance a he SGs (in he EG), and e usal o con inue
pa icipa ing in he s udy (Figu e 1, Table 1).
The pa icipan s in he EG mus ha e been aking pa in suppo g oups o less han a
yea and a ending a leas 60% o he sessions. Ten SGs o ca egi e s we e ec ui ed, wo o
ca egi e s o people wi h Alzheime 's, one o people wi h epilepsy, wo o people wi h addic-
ions, one o people wi h Pa kinson's disease, one o people wi h men al diso de s, and h ee o
people wi h limi a ions in ac i i ies o daily li ing wi hou a speci ic pa hology. The SGs we e
led by p o essionals, consis ing o psychologis s (5), nu ses (3), and social wo ke s (1), excep
wo SGs ha we e led by he ca egi e s hemsel es. The numbe o pa icipan s anged be-
ween 4 and 15. The equency o mee ings was biweekly o hal o he g oups and weekly o
he o he hal . The du a ion o sessions oscilla ed be ween one hou and a hal , and wo hou s.
They we e open g oups ha pa icipan s could join o lea e wi hou a session limi es ablished
o e ime. Among he suppo echniques used we e ee exp ession o emo ions, o e ing o
mu ual suppo , iden i ica ion o s ess ul si ua ions and beha io s ha could be changed,
knowledge o wha he illness en ails, and acquisi ion o empowe men ools. Resou ces such
as speci ic li e a u e, music, elaxa ion echniques, laugh e he apy, o p o essional suppo
could be used.
To a oid selec ion bias whene e i was possible, he pa icipan s in he CG we e selec ed
om he same geog aphical a ea, and we ied o make i so ha he ela i e o he ca egi e
in he CG had a simila pa hology o ha o he ca egi e in he EG. Howe e , i was di icul
o ma ch bo h g oups, mainly due o di icul ies o inding simila ca egi e s o because some
ca egi e s declined o pa icipa e in he s udy. As a consequence, he e we e di e ences in
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FAMILY PROCESS
some cha ac e is ics o he ca egi e s, as well as in he limi a ions in ac i i ies o daily li ing o
he ela i es o bo h g oups (Table 1).
Measu emen
The independen a iable was he ca egi e s’ a endance/non- a endance a he SGs. The de-
penden a iables we e he heal h- ela ed quali y o li e, measu ed h ough Eu oQol- 5D, and
he use o psycho opic d ugs. These a iables we e measu ed a he beginning o he s udy
and 6mon hs a e .
Eu oQol- 5D- 3L (B ooks, 1996; He dman e al., 2001) comp ises i e heal h dimensions (mo-
bili y, sel - ca e, ac i i y, pain/discom o , and anxie y/dep ession), and each one o hem has
h ee le els o se e i y, which a e no p oblems, some o mode a e p oblems, and se ious p ob-
lems. The second pa o EQ- 5D- 3L is he o e all quali y o li e index, a 20- cen ime e e ical
FIGURE 1 Flow diag am o he sample di e ences be ween p e- es and pos - es No e. Flow diag am o he
sample di e ences be ween p e- es and pos - es (a e 6mon hs; eligibili y, alloca ion, ollow- up, da a analysis) as
speci ied in he Conso S a emen (Mohe e al., 2005)
Da a analysis Follow-up Alloca ion
Ca egi e s e alua ed o
inclusión in he s udy
(n=134)
Expe imen al g oup
Ca egi e s (a ended SG)
(n = 64)
Follow up (a e 6 mon hs)
comple ed (n=52)
-Dea h o he sick (8)
-Non-assis ance o SG (4)
Da a analysis (n=52)
-Excluded om analysis
(0)
Con ol g oup Ca egi e s
(no a ended SG)
(n = 70)
Follow up (a e 6 mon hs)
comple ed (n=54)
-Dea h o he sick (15)
-Re usal o pa icipa e (1)
Da a analysis (n=54)
-Excluded om analysis
(0)
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BERNABÉU- ÁLVAREZ E AL.
TABLE 1 Baseline cha ac e is ics o pa icipan s by condi ion
Va iable To al Expe imen al g oup Con ol g oup
Baseline
di e ence p
Age (25– 80) 58.43 (11.95) 59.19 (13.51) 57.73 (10.38) 0.496c 0.482
Rela ionship
Pa en s 16 (11.9%) 8 (12.5%) 8 (11.4%) 21.160a 0.001
Spouse 45 (33.6%) 33 (51.6%) 12 (17.1%)
Son/daugh e 55 (41%) 15 (23.4%) 40 (57.1%)
O he 18 (13.4%) 8 (12.5%) 10 (14.3%)
Educa ional le el
Wi hou s udies o
P ima y educa ion
41 (30.6%) 20 (31.3%) 21 (30%) 5.584a 0.134
Compulso y seconda y
educa ion
35 (26.1%) 12 (18.8%) 23 (32.9%)
Baccalau ea e/
Voca ional aining
37 (27.6%) 18 (28.1%) 19 (27.1%)
Uni e si y s udies 21 (15.7%) 14 (21.9%) 7 (10%)
Gende
Male 25 (18.7%) 19 (29.7%) 6 (8.6%) 9.823a 0.002
Female 109 (81.3%) 45 (70.3%) 64 (91.4%)
A ea
U ban 64 (47.8%) 41 (64.1%) 23 (32.9%) 13.049a 0.001
Ru al 70 (52.2%) 23 (35.9%) 47 (67.1%)
Yea s ca ing 10.01 (10.24) 12.16 (12.7) 8.06 (6.83) 2029b 0.346
Daily hou s ca ing 19.35 (6.63) 18.69 (7.05) 19.96 (6.2) 2001b 0.232
Ill's dependence le el (Ba hel es )
To ally 39 (29.1%) 7 (10.9%) 32 (45.7%) 28.661a 0.000
High 43 (32.1%) 19 (29.7%) 24 (34.3%)
Pa ially 27 (20.1%) 18 (28.1%) 9 (12.9%)
Minimally 8 (6.0%) 7 (10.9%) 1 (1.4%)
Independen 17 (12.7%) 13 (20.3%) 4 (5.7%)
Social suppo (MOS es )
Good 103 (76.9%) 42 (65.6%) 61 (87.1%) 8.705a 0.003
Bad 31 (23.1%) 22 (34.4%) 9 (12.9%)
Likelihood o illness (The Social Readjus men Ra ing Scale)
Low 73 (54.5%) 34 (53.1%) 39 (55.7%) 7.663a 0.022
In e media e 46 (34.3%) 18 (28.1%) 28 (40%)
High 15 (11.2%) 12 (18.8%) 3 (4.3%)
Ca egi e 's ela i e illness
Neu ological disease 22 (16.4%) 12 (18.8%) 10 (14.3%) 53,719a 0.000
Demen ias 30 (22.4%) 22 (34.4%) 8 (11.4%)
Plu ipa hology 53 (39.6%) 7 (10.9%) 46 (65.7%)
Men al o addic ions 24 (17.9%) 22 (34.4%) 2 (2.9%)
Cance o pallia i e 5 (3.7%) 1 (1.5%) 4 (5.7%)
No e: m (SD)=missing alues pe a iable.
aχ2=chi- squa e.
bU=Mann– Whi ney es .
cANOVA.

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FAMILY PROCESS
isual analogue scale measu ed in millime e s. I anges om 0 (wo s imaginable heal h s a-
us) o 100 (bes imaginable heal h s a us).
The use o psycho opic d ugs was measu ed in daily doses, and pa icipan s we e asked
how many psycho opic d ugs hey consumed pe day in o de o elax, o imp o e hei
mood, o educe anxie y, o o all asleep, using as examples lo azepam, alp azolam, luoxe-
ine, esci alop am, o diazepam. La e , answe s we e ans o med in o a quali a i e a iable
(“Yes”/“No”), gi en he he e ogenei y in he daily doses.
In addi ion, cha ac e is ics o he ca egi e s we e measu ed as con ounde s and consis ed
o gende , age in yea s, ela ionship wi h he pe son wi h limi a ions in ac i i ies o daily li -
ing (pa en , spouse, son/daugh e , o he ), ime dedica ed o ca egi ing (measu ed in hou s o
he day), yea s dedica ed o ca egi ing, educa ional le el (no s udies o jus p ima y educa-
ion [simila o g ades 1– 6 in he Uni ed S a es], compulso y seconda y educa ion [simila o
g ades 7– 10], seconda y school o p o essional aining [g ades 10– 12], and uni e si y s udies)
and a ea o esidence (u ban s. u al, conside ed u al i he popula ion o aled 30,000 o
less), social suppo measu ed h ough he MOS scale (Londoño e al., 2012), and s ess ul li e
e en s measu ed h ough he Holmes and Rahe S ess Scale (Holmes & Rahe, 1967; Tesca i
Quiñones & Po eda De Agus ín, 2012).
The MOS Social Suppo Scale measu es he quan i y (o e all social suppo ) and he qual-
i y o social suppo based on nine een i ems wi h i e answe op ions ha explo e he ollow-
ing domains o social suppo : emo ional/in o ma ional suppo , angible suppo , a ec i e
suppo , and posi i e social in e ac ions. The minimum sco e is 19, and he maximum is 94.
The highe he sco e, he be e he pe son pe cei ed hei social suppo (Londoño e al.,
2012). C onbach's alpha alue o his s udy was α=0.94. We use he cu - o poin o 57 o
di e en ia e good suppo om bad suppo .
The S ess Scale consis s o o y- h ee i ems ha e lec di e en s ess ul li e e en s which
a e gi en speci ic sco es. The inal impac is ob ained by adding he sco e o he di e en
e en s ha he pe son su e ed in he las yea . The isk o ge ing sick can be conside ed low
isk (<150 poin s), mode a e isk (be ween 150 and 300 poin s), and high isk (mo e han 300
poin s). C onbach's alpha alue o his s udy was α=0.67.
Fu he mo e, he le el o limi a ions in ac i i ies o daily li ing o he ca egi e 's ela i e
was measu ed using he Ba hel Index ha assesses pe o mance in di e en ac i i ies o daily
li ing (ba hing, g ooming, d essing, eeding, oile use, mobili y, climbing s ai s, and bowel/
bladde con ol). The ange a ies be ween 0 (g ea e limi a ions in ac i i ies o daily li ing)
and 100 poin s ( ewe limi a ions in ac i i ies o daily li ing), wi h 5 cu - o poin s: o al limi a-
ion (0– 20), high limi a ion (21– 60), pa ial limi a ion (61– 90), minimal limi a ion (91– 99), and
no limi a ion (100 poin s; Mahoney & Ba hel, 1965). This ques ionnai e showed C onbach's
alpha index o 0.943.
P ocedu e
The ec ui men o he EG was ca ied ou h ough he people esponsible o /mode a o s o
he SGs. They we e ound h ough key in o man s om he heal h se ices o he uni e si y
and h ough associa ion inde s (La uen e- Robles, 2015). We con ac ed he pe son in cha ge o
he SG ia e-mail and elephone, and we p esen ed he s udy o hem. The pa icipan s in he
CG we e ec ui ed h ough amily nu ses who wo k in he heal h cen e s om he geog aphical
a eas in which he pa icipan s o he EC we e ec ui ed.
Da a collec ion was ca ied ou in p ima y ca e cen e s o in he homes o he pa icipan s
(CG) and in he places whe e he pa icipan s o he EG mee . The ques ionnai es we e he e o
adminis e ed o a oid in o ma ion loss (Haneuse, 2016; Pannucci & Wilkins, 2010).
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BERNABÉU- ÁLVAREZ E AL.
S a is ical analysis
Fo he desc ip i e analysis o he da a, equencies and pe cen ages we e used o quali a i e
a iables, while means and s anda d de ia ions we e used o quan i a i e a iables. In he bi-
a ia e analysis, o check he di e ences be ween he CG and EG in he p e- es and pos - es ,
as well as he di e ence be ween hose who emained and hose who d opped ou , Pea son's
chi- squa ed es was used o quali a i e a iables, and he F es (o i s non- pa ame ic al e -
na i es, he Mann– Whi ney's U- es , and he K uskal– Wallis es ) was used o quan i a i e
a iables. In o de o check he di e ence be ween he p e- es and he pos - es in he ou come
a iables (heal h- ela ed quali y o li e and psycho opic d ug use dimensions), we used he
McNema es ; and he Wilcoxon es was used o he o e all quali y o li e index.
Finally, in o de o de e mine hose a iables associa ed wi h he ca egi e 's heal h- ela ed
quali y o li e (o e all quali y o li e index) and he use o psycho opic d ugs, mul i a ia e
analyses we e ca ied ou using linea eg ession models and bina y logis ic models, espec-
i ely. A he beginning, he models included all he possible con ounde s, as well as hei in e -
ac ions wi h he in e en ion. La e , o he selec ion o he inal model, he analysis was done
based on he heo y and s a is ic c i e ia. Thus, he non- signi ican in e ac ions (p>0.05) we e
emo ed om he model, and he con ounde s ha achie ed a leas one o he ollowing c i-
e ia we e main ained: p < 0.10, o ha hey p oduced a su icien ly la ge change (o 20% o
g ea e ) in he magni ude o he β coe icien o he o he independen a iables ha emained
in he model (Hosme & Lemeshow, 2000; Ka z, 2006; Ve e & Mascha, 2017).
The SPSS PASW S a is ics 18.0 and R and Rcommande 3.5.2so wa e we e used o he
analyses. The null hypo hesis wi h isk e o o 5% was ejec ed (Field & Babbie, 2011).
RESULTS
Compa ison o baseline da a
The ini ial sample consis ed o 134 ca egi e s wi h an a e age age o 58.43yea s (SD 11.95),
he majo i y o hem being women (CG [91.4%] s. EG [70.3%]; p=0.002). The ca egi e s
we e mainly spouses o sons/daugh e s (wi h a signi ican di e ence be ween EG and CG;
p=0.001) who had been ca ing o hei ela i e o a ound 10yea s, dedica ing an a e -
age ime o 19.35h a day o ca egi ing (SD 6.63). Almos a hi d o hem had a low le el o
educa ion (lowe han seconda y educa ion), wi hou signi ican di e ences be ween he EG
and he CG. 64.1% o pa icipan s in he EG li ed in an u ban a ea e sus 32.9% in he CG
(p=0.001). Mos o hem had good social suppo (CG=87.1% s. EG=65.6%, p=0.003).
Mos o he ca egi e s’ ela i es had high limi a ions in ac i i ies o daily li ing (32.1%),
wi h a s a is ical di e ence be ween CG and EG in he a e age o he Ba hel es (33.86
[SD30.99] s. 65.62 [SD 31.58]; p<0.001, espec i ely). The a e age impac o s ess ul li e
e en s was o 153.3 poin s (SD 115.1). Acco ding o he measu emen o s ess ul li e e en s,
he isk o ge ing ill was highe o he ca egi e s in he EG (18.8%) han hose in he CG
(4.3%, p=0.022).
A i ion
When compa ing hose who emained and hose who d opped ou , bo h in he bi a ia e analy-
sis and h ough bina y logis ic eg ession, only he le el o limi a ions in he ac i i ies o daily
li ing o he ca egi e 's ela i e and he a ea o esidence we e co ela ed, wi h he la e being
ma ginally co ela ed. The ewe he limi a ions in ac i i ies o daily li ing o he ca egi e 's
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FAMILY PROCESS
ela i e, he highe he p obabili y o he ca egi e emaining in he s udy (OR 1.02, p=0.011).
The ca egi e s who li ed in u ban a eas d opped ou o he s udy mo e equen ly han hose
who li ed in u al a eas (OR 0.45, p=0.076; Table S1).
Psycho opic d ug use
A ound 38% o he sample consumed psycho opic d ugs a he beginning o he s udy (34.4%
in he EG and 41.4% in he CG). A e 6mon hs, he EG educed he consump ion o 30.8%,
while he consump ion inc eased up o 46.3% in he CG, e en hough he di e ences we e no
s a is ically signi ican (Table S2). Rega ding he daily dose, in he p e- es , he mean was 0.49
(SD 0.87) in he EG and 0.65 (SD 0.97) in he CG; in he pos - es , i was 0.59 (SD 1.29) in he
EG and 0.67 (SD 0.93) in he CG.
In he bi a ia e analysis, he use o psycho opic d ugs co ela ed wi h gende (7.1% in men
s. 92.9% in women, p=0.008), a e age age (56.11 [SD 11.91] in non- consume s s. 62.05 [SD
10.42] in consume s, p=0.010), and he a e age numbe o yea s spen ca egi ing (8.69 [SD
8.59] in non- consume s s. 13.90 [SD 13.67] yea s o ca egi ing in consume s, p=0.036). Thus,
he consump ion o psycho opic d ugs was highe in women, he olde he age and he g ea e
he numbe o yea s hey had spen p o iding ca e.
In he mul i a ia e analysis o he ou come psycho opic d ug use, a signi ican s a is ical
in e ac ion was ound (p=0.003) be ween a ending SGs and he le el o limi a ions in ac-
i i ies o daily li ing o he ca egi e 's ela i e (Ba hel es ). This in e ac ion e ealed ha
belonging o he EG had a s a is ically signi ican posi i e e ec on hose ca egi e s whose
ela i e showed lowe limi a ions in ac i i ies o daily li ing. Fu he mo e, he use o psycho-
opic d ugs was highe in women han in men (OR 8.95, p=0.049). Mo eo e , he ca egi e 's
age (OR 1.07, p=0.004) and he numbe o yea s spen ca egi ing (OR 1.11, p=0.008) we e
posi i ely associa ed wi h he use o psycho opic d ugs and, ma ginally, wi h he le el o lim-
i a ions in he ac i i ies o daily li ing o he ca egi e 's ela i e (OR 1.02, p=0.094)— ha is,
a highe sco e in he Ba hel es (Table 2).
In Figu e 2, he use o psycho opic d ugs is compa ed in he pos - es acco ding o he
condi ion (EG s. CG) and he le el o limi a ions in ac i i ies o daily li ing o he ca egi e 's
ela i e. I was ound ha , below pe cen ile 50— ha is, wi h highe limi a ions in ac i i ies o
daily li ing— he use o psycho opic d ugs is highe in he EG e sus in he CG (50% s. 42%,
X2=0.312 [p=0.577]). Howe e , abo e pe cen ile 50— lowe limi a ions in ac i i ies o daily
li ing— psycho opic d ug use is lowe in he EG e sus in he CG (22.2% s. 61.1%; X2=7.958
[p=0.005]), his associa ion being s a is ically signi ican .
Quali y o li e
Rega ding he EQ- 5D- 3L’s dimensions, he pe cen age o pa icipan s wi h anxie y p oblems
was educed in he EG (71.9% wi h p oblems in he p e- es and 50% wi h p oblems in he pos -
es , p=0.031), whe eas in he CG, i emained s able (71.4% wi h p oblems in he p e- es and
74% in he pos - es ). Mo eo e , he di e ence in he pos - es was also s a is ically signi ican
and a o able o he EG (p=0.001). The pos - es also highligh s ha 61.1% o he ca egi e s
in he CG had ex eme p oblems in he ac i i y dimension, compa ed o 5.8% in he EG, he
di e ence being signi ican (p=0.001). Howe e , i is necessa y o no e ha he e we e al eady
di e ences in his dimension in he p e- es and, using he McNema es wi h ga he ed da a
(p oblems s. no p oblems in ac i i y), no s a is ically signi ican di e ence was ound be-
ween he p e- es and he pos - es in bo h g oups.
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9
BERNABÉU- ÁLVAREZ E AL.
Rega ding he EQ- 5D- 3L o e all quali y o li e index, signi ican di e ences we e ound
in he pos - es , wi h a sco e o 71.35 (SD 15.6) in he EG e sus 58.70 (SD 20.9) in he CG
(p=0.001). Mo eo e , he index imp o ed o e ime in he EG (p=0.022), while i wo sened
in he CG (no signi ican ).
In he bi a ia e analysis, he EQ- 5D- 3L o e all quali y o li e index also co ela ed wi h gen-
de (75.24 [13.1] o men s. 62.35 [19.96] o women, p=0.004), use o psycho opic d ugs (69.1
[17.84] o non- consume s s. 57.69 [20.19] o consume s, p=0.005), and he le el o limi a ions
in ac i i ies o daily li ing o he ca egi e 's ela i e (Rho Spea man=0.210, p=0.031). Thus,
he quali y o li e index was lowe in ca egi e s who did no a end SGs, in women, in use s o
psycho opic d ugs and in ca egi e s o adul s wi h signi ican limi a ions in ac i i ies o daily
li ing.
In he mul i a ia e analysis (Table 3), a s a is ically signi ican e ec o he ca egi e s’ a -
endance a SGs on he EQ- 5D- 3L o e all quali y o li e index was ound, which was 8.66
poin s highe in he EG (p=0.015). Fu he mo e, ega ding he ela ionship wi h he ela i e,
pa en s ob ained 11.49 poin s less han spouses on he EQ- 5D- 3L o e all quali y o li e index
(p=0.032). Simila ly, sons and daugh e s had a lowe sco e han spouses, bu his associa ion
was no signi ican (p=0.061).
DISCUSSION
The aim o his s udy was o ind ou he e ec o a ending ca egi e s’ SGs on psycho opic
d ug use and on heal h- ela ed quali y o li e, as well as o unde s and o he sociodemog aphic
a iables associa ed wi h hese ou comes.
A endance a SGs seems o signi ican ly in luence he educ ion o he use o psycho opic
d ugs among he ca egi e s when hei ela i e has ewe limi a ions in ac i i ies o daily li -
ing. This in e ac ion could be explained by he no ion ha he ewe he limi a ions in ac i i ies
o daily li ing he ela i e has, he mo e he ca egi e can a end he g oups and bene i om
hem (Biegel e al., 2004; Usshe e al., 2008). P e ious au ho s poin o online suppo g oups
as a s a egy o allow ca egi e s o a end he g oups, as well as o p o ide he ela i e p o es-
sional ca e while he amily ca egi e s a end he SGs (Wyn e e al., 2015).
I was ound ha psycho opic d ug use was mo e common among women (almos 9 imes
mo e han men), and ano he associa ed ac o was he numbe o yea s spen p o iding ca e.
The Eu opean Moni o ing Cen e o D ugs and D ug Addic ion indica es ha Eu ope is he
TABLE 2 Mul i a ia e eg ession model o dependen a iable: psycho opic d ugs
Es ima e
S d.
e o pOR
95% Con idence in e al
Lowe Highe
Psycho opic d ugs (p e- es )
[T. Yes]
3.16 0.69 0.000 23.52 6.85 105.77
A endance o SG [T. Yes] 1.91 1.23 0.119 6.79 0.60 82.31
Ill's dependence (Ba hel es ) 0.02 0.01 0.094 1.02 0.99 1.05
Gende [T. Female] 2.19 1.11 0.048 8.95 1.23 101.55
Age 0.07 0.03 0.040 1.07 1.01 1.14
Yea s ca ing 0.10 0.04 0.008 1.11 1.03 1.20
SG [T. Yes] by Ill's
dependence
−0.07 0.02 0.003 0.93 0.89 0.97
No e: R2 = 0.492. Adjus ed R2 = 0.455. F = 13.55. p = 0.000.
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SUPPORTING INFORMATION
Addi ional suppo ing in o ma ion may be ound online in he Suppo ing In o ma ion sec ion.
How o ci e his a icle: Be nabéu- Ál a ez, C., Lima- Rod íguez J.- S., & Lima- Se ano
M. (2021). E ec o suppo g oups on ca egi e ’s quali y o li e. Family P ocess, 00:
1– 16. h ps://doi.o g/10.1111/ amp.12684