In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
Emo ional Exhaus ion in Housewi es and Alzheime
Pa ien s’ Ca egi e s: I s E ec s on Ch onic Diseases,
Soma ic Symp oms and Social Dys unc ion
Alina de las Me cedes Campos-Puen e 1, Ma ía Luisa A a gues-Na a o 2, Me cedes Bo da-Mas 2,
Milag osa Sánchez-Ma ín3, JoséM. Aguila -Pa a 4,* and Rubén T igue os 4,*
1Resea ch Di ec o a e, Inca Ga cilaso de la Vega Uni e si y, Ce cado de Lima 7476, Pe u
2Depa men o Pe sonali y, E alua ion and Psychological T ea men , CTS-432 Resea ch Team,
Uni e si y o Se ille, 41004 Se ille, Spain
3Depa men o Psychology, Uni e si y o Loyola Andalusia, 41014 Se ille, Spain
4Depa men o Psychology, Hum-878 Resea ch Team, Heal h Resea ch Cen e, Uni e si y o Alme ia,
04120 Alme ia, Spain
*Co espondence: [email p o ec ed] (R.T.); [email p o ec ed] (J.M.A.-P.); Tel.: +34-950-015376 (R.T.)
Recei ed: 1 Augus 2019; Accep ed: 2 Sep embe 2019; Published: 4 Sep embe 2019

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Abs ac :
Backg ound: Emo ional exhaus ion causes ad e se e ec s in hose who su e om i .
Housewi es a e no excluded. Domes ic and ca e cho es, which a e conside ed o be sou ces o s ess,
inc ease when aking on he ole o ca egi e o a amily membe wi h Alzheime ’s disease. Objec i e:
To analyse he in luence o emo ional exhaus ion, soma ic symp oms and social dys unc ion, based
on he ac i i y hey ca y ou . Me hodology: C oss-sec ional su ey. 193 women pa icipa ed,
o which: housewi es (HWs) (n =97), and Alzheime ’s pa ien ca egi e -housewi es (CHWs)
(
n=96
). The e alua ion ools we e: sociodemog aphic/wo king da a ques ionnai e (ad hoc), Maslach
Bu nou In en o y (MBI) and Goldbe g Gene al Heal h Ques ionnai e (GHQ-28). Resul s: High a es
o emo ional exhaus ion a e obse ed, as well as an exis ing posi i e link be ween ch onic diseases,
soma ic symp oms and social dys unc ion. The s uc u al model indica es ha emo ional exhaus ion
p edic s he amoun and ex en o diseases, soma ic symp oms and social dys unc ion. The in luence
is highe in CHWs. Limi a ions: Sample p ocedu e implemen ed a con enience; he a iable o he
g ade o dependence o he Alzheime ’s pa ien ca egi e was no included in he s udy. Conclusions:
The domes ic and ca e cho es ha HWs and CHWs ca y ou a ec hei heal h. Hence he need o
de elop psychoeduca i e p og ammes ha a e adap ed o he pa icula needs o hese women and
ocused on he di e en a eas o hei e e yday li es.
Keywo ds:
emo ional exhaus ion; ch onic diseases; soma ic symp oms; housewi es; ca egi e
housewi es; main ca egi e s o Alzheime ’s pa ien s
1. In oduc ion
Bu nou , as a “ h ee-dimensional synd ome cha ac e ised by emo ional exhaus ion,
depe sonalisa ion and educed pe sonal accomplishmen ” (Maslach and Jackson, 1981), has been an
objec o s udy o many in es iga ions o e he las ew decades, due o i s inc easing impo ance and
consequences. This synd ome is conside ed o be an impo an isk ac o o bo h physical and men al
heal h, wi h consequences in he su e e ’s amily and wo king li e. Ou o he h ee dimensions o
bu nou , emo ional exhaus ion is he basic indi idual s ess componen o he synd ome [1].
Maslach and Lei e [
2
] de ine exhaus ion as eelings o excessi e physical and emo ional demands.
They a e he esul o daily con ac wi h he pa ien s hey p o ide se ice o, which en ails a s a e o
exhaus ion ha d ains hei pe sonal esou ces.
In . J. En i on. Res. Public Heal h 2019,16, 3250; doi:10.3390/ije ph16183250 www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2019,16, 3250 2 o 11
Emo ional exhaus ion is conside ed by di e en au ho s as he cen al axis o he synd ome [
3
–
5
].
Fo Maslach and Lei e [
6
], i is he mos p edic i e dimension o he s ess-linked heal h esul s.
The o e load p oduced by wo king condi ions hinde s es , eco e y and he es o a ion o balance.
The e a e e y ew s udies ha ha e been ca ied ou wi h housewi es, despi e he ac ha ,
adi ionally, i is hey who ake on domes ic and ca egi e oles. This unpaid and socially unde alued
ask a ou s he de elopmen o s ess, wi h a highe impac on hose who assume he ole o p ima y
ca egi e o he Alzheime ’s pa ien , wi hou p e ious aining o expe ience [
7
]. This has a high-le el
o e load impac ha a ec s he pe cep ion o one’s heal h condi ion [8] and psychosocial balance [9].
Along hese lines, in a s udy o Campos-Puen e [
10
], which was ca ied ou wi h housewi es and
Alzheime ’s pa ien ca egi e housewi es, we can obse e a highe le el o emo ional exhaus ion in
compa ison wi h he o he dimensions o he bu nou synd ome. Equally, di e en s udies epo on
he e ec s on heal h [
11
], exp essed in he amoun o pa hologies [
12
]. They o en poin a exhaus ion,
physical symp oms, back pain, headaches, myalgia [
13
], as well as mul iple pa hologies, mainly
os eoa icula - ela ed [
14
], al e a ions o he immunological sys em [
15
], ca dio ascula sys em and
me abolic changes [16].
On he o he hand, di e en s udies make e e ence o he exis ence o soma ic symp oms ha
ha e no o ganic cause, no clinical explana ion [
17
], which e lec emo ional complica ions in i al
amily and social si ua ions [
18
], and which ha e a highe p e alence in women [
19
]. Addi ionally,
hey poin ou slow-p og essing and long-las ing ch onic diseases (mo e han h ee mon hs), wi h no
ini ial symp oms, ha could be p e en ed and/o con olled, bu ha in some cases ha e no cu e [
20
].
Ca egi e s some imes su e om a ious medical pa hologies. Hence he need o de elop ac ions a a
psychosocial le el, due o i s impac on he ulne abili y o illness [21].
Alzheime ’s disease as su e ed by he pa ien is conside ed o be an added psychosoma ic isk
ac o o he amily ca egi e s. This disease has ad e se e ec s, no only o hose who su e i , bu i
also debili a es amily membe s [
22
], a ec ing he ca egi e ’s heal h [
23
] as a esul o i s physical and
emo ional impac .
As o social dys unc ion, ca egi e s o Alzheime ’s pa ien s adop a sel -des uc i e a i ude, hey
lose hei iden i y and he p ospec o a u u e in hei own li es [
24
] and show a endency o isola e
hemsel es, wi h a lack o in e es in social in e ac ion. A home, hey display i i abili y, which has a
de imen al e ec on pe sonal ela ions. I also con ibu es o he appea ance, inc ease o dec ease o
beha iou al and psychological symp oms o demen ia in he ill amily membe , as hey depend on he
quali y o he in e ac ion wi h hei ca egi e s [25].
F om his poin o iew, inadequa e beha iou is obse ed in he displays o a ec ion wi hin
he amily, which hinde s mu ual suppo in he ace o he eali y hey ha e o deal wi h, con lic
managemen and amily decision making. Likewise, dys unc ional coping mechanisms a e linked
o a highe subjec i e load, ega dless o he ca egi e ’s objec i e load su e ed, gende o le el o
kinship [26].
A p esen , women s and ou pe o ming p o essionally in di e en a eas o he labou ma ke .
Howe e , in Spain, as in o he coun ies o he Eu opean Union, hei pa icipa ion is lowe han ha o
men. This si ua ion de i es om ce ain di e ences e e ing o he ype o employmen hey pe o m,
he quali ica ion in he ac i i y, among o he easons, which gi e ise o an “unequal gende sala y
gap” [
27
]. An impo an pa o he popula ion o women wo k as housewi es, ca ying ou domes ic
wo k and ca e wi hin hei amily en i onmen , wi hou emune a ion, o long hou s, wi h poo social
suppo , which is agg a a ed when hey also ca e o a amily membe wi h Alzheime ’s disease,
ab up ly limi ing hei le els o wel a e and adequa e enjoymen o hei social li e, a ec ing he gene al
de e io a ion o hei heal h. This is a la en and cu en p oblem ha dese es o be s udied, because
i is a wo k ha a ises om he needs obse ed in clinical p ac ice in his popula ion.
Taking all he o egoing in o accoun , he gene al objec i e o his s udy is o ind ou he in luence
ha emo ional exhaus ion has on ch onic diseases, soma ic symp oms and social dys unc ion in
housewi es and Alzheime ’s pa ien ca egi e housewi es.
In . J. En i on. Res. Public Heal h 2019,16, 3250 3 o 11
The speci ic objec i es a e: (1) o de e mine he ex en o which emo ional exhaus ion a ec s
ch onic diseases, soma ic symp oms and social dys unc ion in he pa icipan s; (2) o ind ou whe he
he e is a link based on he ype o ac i i y ha hey ca y ou as housewi es o ca egi e housewi es
o he Alzheime ’s pa ien .
2. Me hods
2.1. Pa icipan s
The sample was made up o 193 women, di ided in o: housewi es (HWs) (n =97) and Alzheime ’s
pa ien ca egi e housewi es (CHWs) (n =96), all belonging o he Con ede aci
ó
n Andaluza de Asociaciones
de Familia es de En e mos de Alzheime (Andalusian Con ede a ion o Alzheime ’s Pa ien s’ Families
Associa ion) and Women’s Associa ions o Se ille, in Spain. They we e be ween 20 and 80 yea s old
(Mean =49, S anda d De ia ion =11.31), mainly holding p ima y (59.6%) and seconda y educa ion
(20.2%). Rega ding hei ma i al s a us, 78% li ed wi h hei pa ne s, o which 87.6% had child en, and
only 74.1% o hose li ed wi h hem. The Alzheime ’s pa ien s anged in age om 67 o 85. The leng h
o ime hey we e in ca e anged om 2 yea s o 14 yea s.
These women olun a ily pa icipa ed once a week in he di e en wo kshops o ganised by
he associa ion.
The inclusion c i e ia o he wo g oups (housewi es and ca egi e housewi es) we e: o be a
woman, o be olde han 20 yea s o age, o only wo k a home and o his ac i i y o be unpaid.
In addi ion, o he ca egi e s i was essen ial o be ela ed o he pa ien and o ha e been ca ing
o he pa ien o mo e han wo yea s.
2.2. Ins umen s
Sociodemog aphic da a and heal h indica o s ques ionnai e (ad hoc). I consis s o 10 open and
close ques ions ela ed o sociodemog aphic a iables (ma i al s a us, educa ion, child en, numbe
o child en wi h whom hey li e), cha ac e is ics o he ac i i y hey ca y ou and heal h indica o s
(whe he hey su e om ch onic diseases, numbe o ch onic diseases su e ed, ype o medical
pa hologies, numbe o mon hs/yea s o medical ea men ).
Maslach Bu nou In en o y (MBI; [
4
]) wi h he Spanish adap a ion by Seisdedos [
27
]. I consis s
o 22 i ems ela ed o eelings and a i udes a wo k, and owa ds people who ecei e hei se ices.
The answe s a e based on a Like scale om 0 (ne e ) o 6 (e e yday). I was p oduced ollowing
he h ee-dimensional s uc u e: emo ional exhaus ion (EE), depe sonalisa ion (DP) and pe sonal
accomplishmen (PA) ha concep ualises he bu nou synd ome. Fo his s udy, we ha e only used
he emo ional exhaus ion dimension (EE), composed o nine i ems (1-2-3-6-8-13-14-16-20). In o de o
classi y pa icipan s in o high (>24), a e age (15–24) o low (<15) sco es in his dimension, we used he
alida ion and eliabili y c i e ia p o en by he au ho s o he Spanish popula ion sample (n =1.138)
wi h an in e nal eliabili y and consis ency o 0.75 and 0.90 [28].
Gene al Heal h Ques ionnai e GHQ-28 [
29
], Spanish e sion [
30
]. I consis s o 28 i ems, ela ed
o symp oms o beha iou expe ienced, di ided in o ou subscales: A (soma ic symp oms), B (anxie y
and insomnia), C (social dys unc ion) and D (dep ession). Each i em has ou possible answe s, and he
sco e scales go om “less han usual” in columns 1 and 2, wi h a alue o “0”, o “much mo e han
usual”, in columns 3 and 4, wi h a alue o “1”. Fo his s udy, only subscales A (soma ic symp oms)
and C (social dys unc ion) we e used. The alidi y and eliabili y index e e ed o by he au ho s a e
sa is ac o y a 0.67 and 0.76, espec i ely.
2.3. P ocedu e
P io o commencing he s udy, people in cha ge o di e en o ganisa ions we e con ac ed in
o de o access he sample popula ion. The e o e, he con enience sampling me hod was used,
based on accessibili y. Once he associa ion’s consen was ob ained and he women who wan ed o
In . J. En i on. Res. Public Heal h 2019,16, 3250 4 o 11
olun a ily pa icipa e in he s udy we e selec ed, one day o he week was selec ed o summon all he
pa icipan s o ill ou all he ques ionnai es, which we e answe ed anonymously. One membe o he
in es iga ion g oup p o ided he in o med consen o m and he ques ionnai e o each pa icipan .
The pa icipan s answe ed anonymously and all e hical p ocedu es we e espec ed in acco dance
wi h he ecommenda ions o he Ame ican Psychological Associa ion. Fu he mo e, he da a we e
ob ained in s ic adhe ence o cu en p i acy and da a p o ec ion laws and guidelines om he
Helsinki Decla a ion.
2.4. Da a Analysis
In his s udy, we ca ied ou desc ip i e s a is ical analyses, bi a ia e co ela ions and eliabili y
analyses using he s a is ic so wa e SPSS .24. Mo eo e , s uc u al equa ion modelling (SEM) was
ca ied ou using AMOS .21 [
31
] in o de o es he ela ions es ablished in he hypo hesised model,
a MANOVA and a uni a ia e analysis.
Gi en ha Ma dia’s a e was high (25.07) o he analysed hypo hesised model (see Figu e 1),
he es ima ion me hod o maximum au hen ici y was used, oge he wi h he boo s apping p ocedu e.
Es ima o s we e no a ec ed by he lack o no mali y and we e he e o e conside ed s ong [
32
].
Wi h he aim o accep ing o ejec ing he es ed models and he con i ma o y ac o y analysis (CFA),
we used a se ies o adjus men indexes [
33
]: chi-squa e alue di ided by he deg ee o eedom
(
χ2
/d ); CFI (Compa a i e Fi Index); IFI (Inc emen al Fi Index); RMSEA (Roo Mean Squa e E o o
App oxima ion) oge he wi h i s con idence in e al (CI) o 90% and SRMR (S anda dised Roo Mean
Squa e Residual). Gi en ha he
χ2
is e y sensi i e o he sample size [
34
],
χ2
/d was used, conside ing
as accep able hose alues ha we e below 5 [
33
]. Inc emen al indices (CFI and IFI) displayed a good
adjus men wi h 0.90 alues o abo e [
35
], while he e o indices (RMSEA and SRMR) we e conside ed
accep able wi h alues ha we e equal o o below 0.08 [36].
Figu e 1.
S uc u al equa ion model shows he links be ween emo ional exhaus ion, he numbe
o diseases, social dys unc ion and soma ic symp oms. All pa ame e s a e s anda dised and a e
s a is ically signi ican . Explained a iances a e shown abo e he small a ows. No e: *** p<0.001.
In . J. En i on. Res. Public Heal h 2019,16, 3250 5 o 11
3. Resul s
3.1. P elimina y Analysis
Desc ip i e s a is ics and he bi a ia e co ela ions h ough C onbach’s
α
be ween he s udy’s
a iables can be obse ed in Table 1.
Table 1. Desc ip i e s a is ic and bi a ia e co ela ions.
Fac o M SD α1 2 3 4
1. Amoun o diseases 0.73 0.82 0.23 ** 0.14 * 0.17 *
2. Emo ional exhaus ion 3.32 1.72 0.82 0.47 ** 0.58 **
3. Social dys unc ion 0.24 0.29 0.73 0.66 **
4. Soma ic symp oms 0.41 0.35 0.75
** p<0.01; * p<0.05. No e: M =Mean; SD =S anda d de ia ion.
The co ela ion analyses showed a posi i e ela ion amongs all ac o s. In his manne , he amoun
o diseases showed a posi i e ela ion wi h emo ional exhaus ion, soma ic symp oms and social
dys unc ion. As o emo ional exhaus ion, i showed a posi i e ela ion wi h soma ic symp oms and
social dys unc ion. Las ly, social dys unc ion showed a posi i e ela ion wi h soma ic symp oms.
3.2. S uc u al Equa ion Modelling
Be o e es ing he hypo hesised model and checking he p edic i e ela ions be ween he
dimensions s udied, he wo-s ep me hod sugges ed by Ande son and Ge bing [
37
] was ollowed.
The e o e, a CFA was ini ially ca ied ou wi hou es ic ions in he model. The second s ep was o es
he SEM and o analyse he exis ing links be ween he a iables ha belong o he model sugges ed.
In o de o achie e his, a educ ion in he numbe o la en a iables pe ac o was made, which is
pa icula ly ele an when he sample is no oo la ge compa ed o he numbe o a iables o he
model [
38
,
39
]. This educ ion could hen be achie ed h ough he combina ion o pai ed i ems. In his
manne , hal o he i ems on he i s scale we e a e aged oge he in o de o o m he i s block o
i ems, he second hal o i ems we e a e aged oge he o o m he second block o i ems, and so on.
This p oposal is highly eliable, as hey end o be dis ibu ed no mally, and i also hal es he a io o
he a iables in he model.
E en so, he CFA’s adjus men index was:
χ2
(9, N =193) =24.39,
χ2
/d =2.71, p<0.05,
IFI =0.98,
CFI =0.98, RMSEA =0.054 (In e al Con idence 90% =0.045–0.071), SRMR =0.042. The hypo hesised
p edic i e ela ions model (Figu e 1) shows ha he adjus men indexes we e alid:
χ2
(12,
N=193
)
=53.72,
χ2
/d =4.48, p<0.001, IFI =0.92, CFI =0.92, RMSEA =0.079 (IC 90% =0.065–0.090),
SRMR =0.059.
These esul s co espond o he es ablished pa ame e s, and he e o e we can accep
he sugges ed model as alid [
33
]. Equally, he con ibu ion ha each ac o made o he p edic ion o
o he a iables was examined h ough he s anda dised eg ession weigh .
In Figu e 1we can obse e how emo ional exhaus ion posi i ely p edic ed he amoun o diseases,
as well as social dys unc ion and soma ic symp oms.
MANOVA’s in e e en ial analysis showed he exis ence o impo an di e ences be ween
housewi es and ca egi e housewi es in ela ion o he whole o he h ee a iables o emo ional
exhaus ion, soma ic sys ems and social dys unc ion, showing he ollowing adjus men indices:
p=0.001,
F (189) =26.46, Wilks’ lambda
η2
=0.704; R
2
=0.30. We can obse e ha i can a ec hem in
di e en ways depending on he ac i i y hese women do.
Uni a ia ely, we can obse e how meaning ul di e ences exis be ween Alzheime pa ien
ca egi e housewi es and housewi es, as a as emo ional exhaus ion is conce ned, wi h he ollowing
adjus men indices: p=0.001, F (189) =38.50;
η2
=0.17; R
2
=0.16. Rega ding soma ic symp oms,
he adjus men indices we e: p=0.000, F (72.05) <1;
η2
=0.27; R
2
=0.27, and las ly, o social
dys unc ion, adjus men indices we e: p=0.000, F (189) =40.04;
η2
=0.17; R
2
=0.17. F om his poin o

In . J. En i on. Res. Public Heal h 2019,16, 3250 6 o 11
iew, we can obse e ha aking on he ole o he ca egi e impac s emo ional exhaus ion, soma ic
symp oms and social dys unc ion.
4. Discussion
In his s udy we analyse he in luence o emo ional exhaus ion in ch onic diseases, soma ic
symp oms and social dys unc ion, based on he ype o ac i i y done as HWs o CHWs.
Among he a iables s udied, emo ional exhaus ion achie es he highes a e age sco e.
These esul s a e consis en wi h di e en au ho s’ indings [
13
,
40
], ega ding women who ca y
ou long hou s o unpaid housewo k and ca e asks. Taking in o accoun he le el o o e load hese
women expe ience due o he asks hey pe o m [
41
], emo ional exhaus ion is p edic ed [
42
], and as
he le el o o e load inc eases, esilience dec eases [
43
]. They gene ally ace his ask alone, wi hou
he social o amily suppo hey need, and a e le ulne able o s ess, emo ional exhaus ion and isk
o hei heal h [
44
]. Fo he mos pa , hey conside his job o be a ole ha is assigned o hem and
hey accep i , e en sac i icing hei pe sonal p ojec s, which a ou s he de elopmen o emo ional
exhaus ion [
45
]. Social suppo con ibu es o a educ ion o he e ec s o s ess and o e load [
46
] and
wo ks as a p o ec ion.
As o he numbe o ch onic diseases, ou esul s ma ch p e ious s udies ha epo ed on he
impac on heal h acco ding o he numbe o diseases su e ed by amily ca egi e s [
47
,
48
] who endu e
illnesses ha could empo a ily incapaci a e hem om pe o ming hei du ies. Howe e , only 53.4%
o pa icipan s we e conside ed o ha e ch onic diseases in ou s udy. When g ouping hem oge he
based on he numbe o diseases su e ed, 37.9% su e ed only one, 11.9% su e ed wo and 3.6%
su e ed h ee. One ele an inding was ha in 46.6% o pa icipan s, hei symp oms we e no
conside ed ch onic diseases, which could explain he a iable o he numbe o diseases ob aining a
lowe a e age sco e han expec ed.
Ou o he di e en pa hologies (ca dio ascula , endoc ine-me abolic, mobili y- ela ed and o he s)
ha hey su e ed, he highes impac appea ed in mobili y- ela ed issues (24.4%), ma ching he esul s
om a s udy o Muñoz and Ba ba [
49
]. Equally, ou da a show ha HWs and CHWs o en su e om
pain, a common symp om o se e al ch onic diseases such as ib omyalgia and heuma oid a h i is,
bo h diseases ha p o oke swelling, pain and hinde mobili y, limi ing pe sonal ca e as well as in e es
in physical and social in e ac ion [
50
]. A h osis is pa icula ly incapaci a ing when i a ec s hips and
knees, shoulde pain hinde s daily ac i i y and sleep quali y [
51
] and os eopo osis causes in ense
pain. F om his poin o iew, some s udies link he immune sys em wi h bone loss in swelling and
oes ogen-de icien condi ions [
52
], hence he need o pos menopausal os eopo osis o be checked
by se e al specialis s [
53
]. The decline o unc ional capaci y, p o oked by ch onic disease, is o en
expe ienced wi h anxie y and/o hopelessness, an a i ude ha makes i di icul o accep and ace up
o eali y in a manne ha makes eco e y possible.
Ou s udy con i ms he posi i e and di ec link be ween emo ional exhaus ion, numbe o
diseases, soma ic sys ems and social dys unc ion. In o he wo ds, he numbe o ch onic diseases
su e ed con ibu es o a highe le el o emo ional exhaus ion, social dys unc ion and soma ic sys ems.
This could be due o he ac ha any ch onic disease en ails high s ess, being wo se when mo e han
one disease is su e ed om. In his sense, musculoskele al diseases lead o a signi ican dec ease in
women’s physical ac i i y [
54
], as well as social in e ac ion and communica ion issues wi h ela i es,
s ess p o oking ac o s ypical o ch onic disease [
18
] ha cause emo ional changes such as i i abili y
and/o hopelessness. Su e ing om mo e han one disease he e o e impac s quali y o li e om a
heal h poin o iew [55].
A second inding shows ha as emo ional exhaus ion inc eases, so do soma ic symp oms and
social dys unc ion. Ou esul s a e along he lines o exis ing li e a u e, as emo ional exhaus ion is
conside ed o be linked o s ess in he wo kplace [
56
]. Pe o ming he wo k ac i i y a home, wi h li le
acknowledgemen and suppo , leads o disag eemen s in amily ela ionships, which in u n a ec s
wo kplace ela ionships, as he physical space o oles is sha ed. The a o emen ioned wo k– amily
In . J. En i on. Res. Public Heal h 2019,16, 3250 7 o 11
con lic gi es ise o emo ional exhaus ion, which in u n wo sens he pe cep ion o he wo k– amily
con lic [
57
]. A wo sening in he le el o emo ional exhaus ion has an impac on he appea ance o
unc ional soma ic s ess, causing symp oms o unc ional decline ha can be linked o he exis ence
o an exis en ial c isis o ch onic and li e-incapaci a ing symp oms [
17
]. The emo ional exhaus ion
expe ienced leads hem o isola e hemsel es, gi ing ise o inadequa e a i udes o emo ional dis ega d
owa ds he people ha hey a e aking ca e o . While s ill looking a e hem ou o a sense o du y.
I could howe e a ec he s anda d o hei wo k [
1
]. The e o e, as a esul o social dys unc ion,
he endency o dis ance hemsel es om amily and iends limi s hei social in e ac ion [6].
A hi d inding con i ms ha an inc ease in social dys unc ion wo sens soma ic symp oms.
Family unc ionali y in ol es a dynamic p ocess wi h a cons an demand o eadap . The e o e,
when dys unc ion occu s du ing he exchange o in e pe sonal bonds be ween amily membe s, as a
consequence o he ailu e o adap o he demands caused by he de elopmen o i s membe s in
he di e en s ages o hei li e cycle, i could a ou he appea ance o con lic [
58
], la gely e lec ed
in soma ic symp oms. The e o e, achie ing adequa e en i onmen s based on iendly in e pe sonal
ela ionships would lead o lowe le els o exhaus ion and symp oms o anxie y and dep ession [59].
On he o he hand, we can see om he model de eloped ha emo ional exhaus ion wo ks
as a p edic i e ac o o he numbe o ch onic diseases, soma ic symp oms and social dys unc ion,
a di e en deg ees depending on he ype o ac i i y pe o med as a HW o CHW. These esul s
ma ch indings obse ed in p e ious esea ch, whe e emo ional exhaus ion was conside ed o be he
dimension o bu nou ha bes p edic s s ess- ela ed e ec s on heal h [
6
]. Ca egi ing p oduces a
nega i e e ec on he physical and men al heal h o hose women who ake on he ole o an in o mal
amily ca egi e [12].
The mos common illness amongs CHWs was a inding ha was expec ed, and ma ched wha
was epo ed by au ho s ha alked abou an o e load inc ease expe ienced when aking ca e o an
ill amily membe [
24
]. In his sense, he exis ence o neu opsychia ic symp oms associa ed wi h
demen ia ha ex e nalise beha iou al diso de s such as hallucina ions, i i abili y and dep ession a e
conside ed o be p edic i e ac o s o ca egi e s’ o e load [
60
]. On he o he hand, he ca egi e ’s
men al and physical heal h, as well as he agg essi eness shown by he ill amily membe , a e linked o
a isk o su e ing om high le els o o e load [61].
The p esence o beha iou al diso de s such as es lessness/agg essi eness, i i abili y, abno mal
mobili y and hallucina ions in ill amily membe s wi h demen ia inc ease ca egi e s’ le el o emo ional
exhaus ion [
62
], and hei quali y o li e is wo se han ha o he gene al popula ion and wo sens
h oughou he p og ession o he disease [63].
Ou indings a e along he lines o p e ious s udies, con i ming ha ela ionships gene a ed om
aking ca e o o he s equi e a cons an and in ense le el o pe sonal/emo ional in e ac ion. Al hough
ewa ding, his is e y s ess ul o he ca egi e , causing e y demanding wo king en i onmen s wi h
limi ed esou ces [1]. This is why emo ional exhaus ion has a highe impac on CHWs [10].
We can he e o e conclude ha emo ional exhaus ion is a p edic i e ac o o he numbe o
diseases, as well as o he soma ic symp oms and social dys unc ion. Mo eo e , depending on he ype
o ac i i y pe o med by HWs o CHWs, hey can be impac ed di e en ly a an emo ional, social and
o e all heal h le el. Looking a he p e ious esul s, we see ha being an Alzheime pa ien ca egi e ,
as an added ole o ha o domes ic du ies, in luences emo ional exhaus ion, o e all heal h pe cep ion
and social ela ionships.
As o he s udy’s limi a ions, i is impo an o poin ou ha he popula ion sampled was no
easily accessible, gi en ha hey pe o m hei wo k ac i i y wi hin hei own amily en i onmen .
Fo his eason, he me hod we used was con enience sampling. Besides, had he sample been b oade ,
highe numbe s migh ha e been ob ained in he a e age sco es o emo ional exhaus ion and numbe
o ch onic diseases. Equally, had he s udy included he Alzheime pa ien ’s deg ee o dependence,
he CHWs’ esul s migh ha e been a ou ed. Finally, he ac ha his is a ela ional s udy does no
allow us o ex apola e cause–e ec ela ionships and he esul s ob ained could be in e p e ed in a
In . J. En i on. Res. Public Heal h 2019,16, 3250 8 o 11
a ie y o di e en ways, depending on he pe spec i e o he indi idual. On he o he hand, u u e
s udies should analyse he possible in ag oup di e ences o ca egi e housewi es depending on he
le el o esponsibili y o ca e, social suppo , whe he hey ha e young child en o no , whe he hey
ha e o he employees o no and depending on le els o esilience.
5. Conclusions
Ou esul s enabled us o know he de ails o how wo k and ca e ac i i ies a ec HWs and CHWs’
heal h, wi h he aim o designing psychosocial and educa ional in e en ions o p e en he isks
de i ed om he ac i i y hey pe o m. In e en ions should be di ec ed h ough physical heal h
p og ammes in o de o imp o e hei sleep quali y [
64
], psychosocial p og ammes o ca egi e s
ha p o ide hem wi h in o ma ion ega ding he disease and how o ea i a each s age, o e ing
emo ional suppo , and implemen ing s a egies o cope, manage s ess [
65
], and educe anxie y [
66
]
and seden a y beha iou [
67
], encou aging a heal hy al e na i e o ca egi ing [
68
] ha includes
posi i e conno a ion a iables, acili a ing a change in he pe cep ion o hei o e load and o e all
heal h condi ion, wi h he objec i e o p o iding a highe le el o sa is ac ion and be e li e quali y
indices [69].
Au ho Con ibu ions:
Fo esea ch a icles wi h se e al au ho s, a sho pa ag aph speci ying hei indi idual
con ibu ions mus be p o ided. The ollowing s a emen s should be used “concep ualiza ion, A.d.l.M.C.-P.
and M.L.A.-N.; me hodology, J.M.A.-P. and R.T.; so wa e, R.T.; alida ion, M.L.A.-N. and M.B.-M.; o mal
analysis, J.M.A.-P. and R.T.; in es iga ion, M.B.-M.; esou ces, M.B.-M. and M.S.-M.; da a cu a ion, A.d.l.M.C.-P.;
w i ing—o iginal d a p epa a ion, A.d.l.M.C.-P.; w i ing— e iew and edi ing, M.L.A.-N.; isualiza ion, M.S.-M.;
supe ision, M.L.A.-N.; p ojec adminis a ion, M.S.-M.; unding acquisi ion, M.B.-M.”, please u n o he CRediT
axonomy o he e m explana ion. Au ho ship mus be limi ed o hose who ha e con ibu ed subs an ially o
he wo k epo ed.
Funding: This esea ch ecei ed no ex e nal unding.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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