Joan K. Monin, Ph.D., researches how exposure to a loved one’s suffering affects the physical and emotional health of older adult caregivers. It is a situation faced by an increasing number of people and the health toll on the person who is providing care is a growing concern. Monin’s research combines survey methods and laboratory experiments to understand the mechanisms (e.g. emotional contagion and cardiovascular reactivity) and moderators (e.g., gender and individual differences in attachment) that are involved in these still poorly understood processes. She joined Yale in 2010 and is an assistant professor in the division of Chronic Disease Epidemiology.
You recently completed a study of spouses who are caring for an ailing and oftentimes elderly mate. This is a pretty common scenario, one that appears to have health repercussions for the care provider. What did you find?
JM: I found that there are differences in peoples’ ability to cope with the emotional stress of caring for a chronically ill spouse, and these differences have important implications for caregivers’ physical and psychological well-being. Specifically I found that caregivers who are able to empathize with their loved one’s suffering but also stay in tune with their positive emotions exhibit less cardiovascular reactivity than other caregivers.
How strong is this mind-body link and what does it mean for an individual’s personal health?
JM: Research overwhelmingly shows that caregiving-related stress is associated with negative health consequences, not just psychological but also physical. In fact, people who take care of sick relatives have significantly shorter lives. Results from my program of research suggest that one reason for these negative health consequences is that caregivers experience heightened cardiovascular arousal in reaction to their loved one’s suffering which can negatively affect multiple physiological systems in the body.
Is caregiving always considered harmful to health?
JM: Caregiving is an important part of all societies. Without out it, we would be in trouble. As Rosalynn Carter put it, “There are only four kinds of people in the world – those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers”. Although most research shows negative health consequences for caregivers, this is mainly due to high levels of perceived stress. For caregivers who experience low levels of stress there are actually health benefits. Unfortunately not everyone is able to provide effective and sensitive care to others, and not everyone is able to provide this care without feeling overwhelmed.
Why are some care providers more resilient than others?
JM: In my recent study I found that people who experience more positive emotions and who think more analytically about their partner’s experiences tend to be protected from experiencing cardiovascular stress, which may indicate they are more resilient. Where these differences in positivity and analytic tendencies come from is also an important question. My future research involves examining these antecedents as well. Specifically I am interested in genetic factors and early childhood experiences with primary attachment figures as predictors of being a successful and resilient caregiver.
Can people who are less resilient become more so?
JM: I hope so. Although changing a person’s personality seems unlikely, health care professionals and clinicians can help change how caregivers and care recipients relate to and support one another. For caregivers of family members who are less able to reciprocate support because of cognitive decline, there are interventions specifically designed for caregivers. For example, interventions that use problem solving therapy can help caregivers decrease objective stressors in their environment and change how stress is appraised, especially when the source of the stress is not under caregivers’ control.
You have previously studied the health benefits of marriage. Do men benefit more from this arrangement?
JM: It is important to say that both men and women who are married are healthier and live longer than those who are single. This is even when adjusting for a multitude of potential confounds, for example, that healthier people are more likely to get married. That being said, research suggests that men benefit from this arrangement more so than women in terms of physical health outcomes.
Does this mean that married women do not fare as well?
JM: It depends. The quality of the marriage seems to have a stronger impact on women’s than men’s health. For instance, there is substantial evidence that women are more sensitive to conflict in marriage than men are. But these are not the only reasons why men and women differ in the health benefits of marriage. You also have to consider that men often rely on their marriage as their primary source of support whereas women tend to receive support from multiple others in their social networks.
Is there any indication that the gap is closing, i.e., are men and women getting closer to an equal amount of satisfaction, or benefit, from marriage?
JM: There is recent evidence that self-rated health of never-married men has improved over the past three decades but this is not the case for women. Interestingly, it also seems that the adverse affects of divorce have increased for women. In addition because women are much more likely to be caregivers of other family members besides their spouse they may experience more psychological, economic, social, and physical stress than men.
How did you come to public health?
JM: My primary research topic—informal caregiving—is an important public health issue. It impacts all peoples’ quality of life and is becoming an increasingly important topic given the aging baby boomers. My work on caregiving is also interdisciplinary, making public health an ideal atmosphere.
A lot of your research is focused on elderly people and the particular challenges that come with that stage in life. What draws you to this?
JM: I have always been interested in how people take care of each other during times of stress and the idea that not everyone is good at taking care of their partners even when they love them. This can apply to many different relationship contexts such as between young parents and their infants, spouses, and friends. I find all of these relationship contexts interesting but I am most fascinated with how family members help each other as they age and become more functionally disabled.
You must encounter a lot of people who are struggling emotionally as they watch the health of a loved one decline. Are there public health interventions that can make this process any easier or less painful?
JM: My research suggests that it is important for caregivers and care recipients to be involved in support interventions together, because oftentimes both partners can learn how to improve how they support each other emotionally, even if not physically. In cases where a care recipient is not cognitively intact and can no longer provide emotional support it is imperative that caregivers receive support from other members of their social networks or community. It is also important that caregivers take advantage of respite care regularly so that they have time to focus on themselves, recharge their batteries, and not feel isolated.
What are your future research goals?
JM: My short term goal is to better understand the dyadic, or interpersonal processes, that occur between caregivers and care recipients and how these processes affect each person’s health. Much of the research on caregiving has focused on caregivers as individuals; however, there are at least two people involved in caregiving relationships. It is important to understand how each person’s actions contribute to each person’s well-being. My long term goal is to develop ways to improve caregivers’ and care recipients’ health by helping them cope with the stress that often comes with the chronic illness experience. Most of all I want to help people care for their loved ones effectively without sacrificing their own well-being.
When you are not doing research, what are some of your interests and pursuits?
JM: I enjoy spending lots of time with my family which mostly consists of eating the delicious food my husband, Matthew, cooks, chasing after my 3-year-old son, Alex, and walking Lilly, our cocker spaniel. I also like oil painting and playing tennis when I have the chance.
What have you painted recently?
JM: My last painting was inspired by my new home on the shoreline. It is a landscape of the ocean with a sailboat in the distance.