A two-factor model of caregiving appraisal and psychological well-being

The Family Stress Model as it Applies to Custodial Grandfamilies: A Cross Validation

There is scant research on how the parenting practices of custodial grandmothers affect the psychological adjustment of grandchildren in their care. Yet, the findings from a handful of prior studies suggest the relevance of the Family Stress Model (FSM) to these caregivers. The present study further tested the FSM with baseline data from 343 custodial grandmothers (Mage= 58.5 years) enrolled in a clinical trial of the efficacy of interventions for improving the well-being of their families. Not only was this "help-seeking" sample atypical of prior FSM studies, but also unique to the present study was our addition of multiple parenting practices, self-reported and clinical ratings of grandmothers' distress, and reports of grandchildren's internalizing and externalizing difficulties from grandchildren and grandmothers. Mplus 7.31 was used to test a model where the effect of grandmother distress on grandchildren's internalizing and externalizing difficulties was hypothesized to be indirect through five distinct parenting practices. The findings regarding both the measurement and structural models fit the observed data well, and invariance was largely found across grandchildren's gender and age (4-7 vs. 8-12). Although grandchildren's self-reported internalizing and externalizing difficulties were unrelated to grandmothers' distress and parenting practices, the grandmothers' reports of these outcomes were generally related to their own distress and parenting practices as hypothesized. However, considerable variation was found across the five parenting practices in terms of their relationships to the other FSM constructs. We conclude that data from multiple informants and measures of assorted parenting practices are essential to future research and practice.

Unravelling positive aspects of caregiving in dementia: An integrative review of research literature

BACKGROUND

Family caregiving is the crucial informal care resource to lessen the burdens associated with dementia. Research in this field has focused on reducing the caregiver's burden, but little attention has been given to promoting the positive aspects of caregiving.

OBJECTIVES

To conduct a systematic critical review of research on the nature of positive aspects of caregiving, and the factors predicting this phenomenon among family caregivers of dementia patients, with the ultimate purpose of gaining insights to explain how and why it emerges.

REVIEW METHODS

A systematic search of the literature was undertaken in the databases OvidMedline, CINAHL, PsycINFO, Web of Science and Scopus, using the keywords 'care* AND Alzheimer OR dementia AND 'positive aspect' OR 'positive experience' OR 'positive perceptions' OR reward OR gain OR 'satisfaction with care*' OR 'care* satisfaction' OR benefit OR uplift OR meaning OR enjoyment OR pleasure OR growth OR hope OR gratification. The Critical Appraisal Skills Programme checklists for qualitative and cohort studies were used to evaluate data quality. Narrative data synthesis was undertaken using the five-stage Whittermore and Knafl method.

RESULTS

A total of 3862 articles were identified, of which 41 were included in this review. The key findings are that positive aspects of caregiving among family caregivers of dementia patients form a multi-dimensional construct which covers four key domains: a sense of personal accomplishment and gratification, feelings of mutuality in a dyadic relationship, an increase of family cohesion and functionality, and a sense of personal growth and purpose in life. By integrating the findings about the nature and conditions predicting positive aspects of caregiving, the presence of three conditions was identified as promoting the emergence of such qualities i) personal and social affirmation of role fulfilment, ii) effective cognitive emotional regulation and iii) contexts which favour finding meaning in the caregiving process.

CONCLUSION

The findings of this review provide insight into catalysing the paradigm shift from 'reducing stress' to 'optimising positive experience' in developing caregiving support services for dementia, and may guide future empirical study to explain this unique dimension of caregiving experience.

Medical Care Activities Among Spouses of Older Adults With Functional Disability: Implications for Caregiving Difficulties and Gains

OBJECTIVES

Spouses of older adults with functional disability often provide help with their partner's medical care. Yet little is known about the implications of these activities for spouses' caregiving experiences. We examined how spouses' medical care activities are linked to both positive and negative aspects of caregiving (difficulties and gains), and whether these associations vary by their age, gender, or education.

DESIGN

Retrospective analysis of data from the 2011 National Health and Aging Trends Study and National Study of Caregiving cross-sectional studies.

SETTING

Caregivers and care recipients/proxies were interviewed by telephone at home.

PARTICIPANTS

Nationally representative U.S. sample of 345 spousal caregivers and their community-dwelling care recipients aged 65 years and older.

MEASUREMENTS

Caregivers' self-reported sociodemographics, care activities, health conditions, well-being, and support resources. Care recipients (or proxies) reported on their health conditions and dementia status.

RESULTS

A higher number of health system interaction tasks (e.g., making appointments) were significantly associated with greater emotional caregiving difficulties, whereas a higher number of medical/nursing tasks (e.g., giving shots/injections) were significantly linked to greater caregiving gains. A higher number of medical/nursing tasks were also significantly associated with greater physical difficulties for caregiving wives and spouses with less education.

CONCLUSIONS

Medical care activities may have both positive and negative consequences for spousal caregivers, which depend partly on sociodemographics. This study underscores the importance of ensuring that spouses have the resources and support needed to provide complex care to their partners.

Positive psychology outcome measures for family caregivers of people living with dementia: a systematic review

BACKGROUND

Family caregivers of people living with dementia can have both positive and negative experiences of caregiving. Despite this, existing outcome measures predominately focus on negative aspects of caregiving such as burden and depression. This review aimed to evaluate the development and psychometric properties of existing positive psychology measures for family caregivers of people living with dementia to determine their potential utility in research and practice.

METHOD

A systematic review of positive psychology outcome measures for family caregivers of people with dementia was conducted. The databases searched were as follows: PsychINFO, CINAHL, MEDLINE, EMBASE, and PubMed. Scale development papers were subject to a quality assessment to appraise psychometric properties.

RESULTS

Twelve positive outcome measures and six validation papers of these scales were identified. The emerging constructs of self-efficacy, spirituality, resilience, rewards, gain, and meaning are in line with positive psychology theory.

CONCLUSIONS

There are some robust positive measures in existence for family caregivers of people living with dementia. However, lack of reporting of the psychometric properties hindered the quality assessment of some outcome measures identified in this review. Future research should aim to include positive outcome measures in interventional research to facilitate a greater understanding of the positive aspects of caregiving and how these contribute to well-being.

A longitudinal view of factors that influence the emotional well-being of family caregivers to individuals with heart failure

OBJECTIVES

Caring for community-residing patients with heart failure can affect caregivers' emotional wellbeing. However, few studies have examined caregivers' well-being longitudinally, or identified factors associated with positive and negative outcomes. The objective of this longitudinal cohort study was to examine changes in caregivers' well-being over time, and to identify patient and caregiver factors associated with positive and negative outcomes.

METHOD

Fifty caregiver/heart failure patient dyads were recruited from an acute care facility and followed in the community. All participants completed surveys at hospital admission and 3, 6 and 12 months later. Caregivers completed assessments of depression symptoms and positive affect and standardized measures to capture assistance provided, mastery, personal gain, social support, participation restriction, and patients' behavioral and psychological symptoms. From patients, we collected demographic characteristics and health-related quality of life. Individual Growth Curve modelling was used to analyze the data.

RESULTS

Caregivers' negative and positive emotions remained stable over time. Depression symptoms were associated with higher participation restriction in caregivers. Positive affect was associated with more personal gain and more social support. Patients' health-related quality of life and their behavioral and psychological symptoms were not significantly associated with caregivers' emotional outcomes.

CONCLUSION

Interventions should be offered based on caregivers' needs rather than patients' health outcomes, and should focus on fostering caregivers' feelings of personal gain, assisting them with securing social support, and engaging in valued activities.

Positive Aspects of Caregiving Questionnaire

OBJECTIVE

The potential role of positive aspects of caregiving in enhancing caregivers' health is an important issue. The aim of this study was to develop and validate Positive Aspects of Caregiving Questionnaire (PACQ) in caregivers of patients with dementia in Iran.

METHODS

Content validation process was used to content valid development. Cronbach α and intraclass correlation coefficient (ICC) were calculated as reliability indices. We used exploratory factor analysis to extract potential latent factors and evaluate the factor structure of PACQ. We assess correlation between PACQ and caregiver burden for divergent validity. For convergent validity, correlation between PACQ and self-rated health was specified.

RESULTS

Content validity indices (CVIs), internal consistency, and test-retest reliability were CVI > 0.80, α = 0.785, and ICC = 0.905, respectively. Moreover, item-total correlations confirmed good reliability of PACQ. Two factors were identified by factor analysis in this 10-item measure: patient and caregiver relationship and caregiver's psychological well-being. Divergent validity and convergent validity were established by high negative correlation between positive aspect of caregiving (PAC) and caregiver burden along with significant positive correlation between PAC and self-rated health, respectively. While Cronbach α for the entire scale was 0.785, Cronbach αs for both of the scale components were 0.71.

CONCLUSION

The PACQ demonstrated acceptable psychometric properties of reliability and performs well in preliminary tests of validity as a measure of positive aspects of caregiving. This measure can be used to determine the outcome of interventional programs on positive, not only negative, aspect of caregiving.

Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis

BACKGROUND

Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable.

METHODS

We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies.

RESULTS

Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities.

CONCLUSION

We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.

Do caregiving burden and satisfaction predict loneliness in older care recipients?

OBJECTIVES

The goal of this study was to assess the extent to which caregiving burden and satisfaction of primary family caregivers in Israel predict loneliness among their older care recipients.

METHOD

The study included a convenience sample of 325 dyads of respondents. The short version of Zarit Caregiving Burden Interview and Lawton Caregiving Appraisal measures were used to assess caregiving burden and satisfaction; the de Jong Gierveld Loneliness Scale was used to assess care recipient's loneliness.

RESULTS

The results showed that greater caregiving burden was significantly correlated with increased loneliness, whereas greater caregiving satisfaction was significantly correlated with lower levels of loneliness.

CONCLUSION

The literature has broadly addressed the association between caregiving burden and satisfaction and the caregivers' well-being, whereas this association with regard to care recipients' well-being has been barely examined. The multivariate analyses showed that caregiving burden was insignificant in explaining loneliness, whereas greater caregiving satisfaction was found significant in explaining lower levels of loneliness. The results and implications for further research and practice are discussed.

Subjective burden among spousal and adult-child informal caregivers of older adults: results from a longitudinal cohort study

Background

Pressures on informal caregivers are likely to increase due to increasing life expectancy and health care costs, which stresses the importance of prevention of subjective burden. The present study examined the correlates of overall subjective burden and multiple burden dimensions among spousal and adult-child caregivers of Dutch older adults, both cross-sectional and longitudinal (12-months follow-up).

Methods

In 2010 and 2011 baseline and follow-up data was collected in a sample of informal caregivers and care recipients in the Northern provinces of the Netherlands. Subjective burden included 7 burden dimensions and a summary score for overall subjective burden, based on the Care-Related Quality of Life Instrument (CarerQoL-7D). Objective stressors were the time investment in caregiving (hours of household care, personal care, practical care) and the health situation of the care recipient, including multimorbidity, functional limitations (Katz Index of Independence Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), and cognitive functioning problems (EQ-5D + C). Correlates of subjective burden were evaluated with linear and logistic regression analyses.

Results

The sample consisted of 356 caregivers at baseline (43% spousal, 57% adult-child caregivers), and 158 caregivers at follow-up (45% spousal, 55% adult-child caregivers). At baseline and follow-up, spousal caregivers experienced a higher overall subjective burden, and reported more often mental health problems, physical health problems, and problems with combining daily activities, compared to adult-child caregivers. For spousal caregivers, a poorer health situation of the care recipient was associated with higher subjective burden, while adult-child caregivers reported higher levels of subjective burden when their time investment in caregiving was high. Subjective burden at follow-up was mainly explained by baseline subjective burden.

Conclusions

These results indicate that for effective caregiver support, it is crucial to take the type of care relationship into account, since the level and correlates of overall subjective burden and burden dimensions varied for spousal and adult-child caregivers. In addition, reducing subjective burden will also positively impact the subjective burden over time.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0387-y) contains supplementary material, which is available to authorized users.

Care Giving Offspring to Aging Parents: How it Affects Their Marital Relations, Parenthood, and Mental Health

The study examined the effect of direct and indirect stresses on the mental health of offspring caring for an aging parent. The study is based on Pearlin, Lieberman, Menaghan, and Mullan's (1981) Stress Development Model. The research examined 345 subjects, men and women aged 40-59 who filled a questionnaire sent by post within their workplace. The research findings show that the various stresses of the caregiver role are mutually connected and have a significant positive effect on the mental health of caregiving offspring. Another finding shows that the extended family support variable acts as a buffer on the caregiving burden on the adult child.

[A Prediction Model for Unmet Needs of Elders with Dementia and Caregiving Experiences of Family Caregivers]

PURPOSE

The purposes of this study were to develop and test a prediction model for caregiving experiences including caregiving satisfaction and burden in dementia family caregivers.

METHODS

The stress process model and a two factor model were used as the conceptual frameworks. Secondary data analysis was done with 320 family caregivers who were selected from the Seoul Dementia Management Survey (2014) data set. In the hypothesis model, the exogenous variable was patient symptomatology which included cognitive impairment, behavioral problems, dependency in activity of daily living and in instrumental activity of daily living. Endogenous variables were caregiver's perception of dementia patient's unmet needs, caregiving satisfaction and caregiving burden. Data were analysed using SPSS/WINdows and AMOS program.

RESULTS

Caregiving burden was explained by patient symptomatology and caregiving satisfaction indicating significant direct effects and significant indirect effect from unmet needs. The proposed model explained 37.8% of the variance. Caregiving satisfaction was explained by patient symptomatology and unmet needs. Mediating effect of unmet needs was significant in the relationship between patient symptomatology and caregiving satisfaction.

CONCLUSION

Results indicate that interventions focusing on relieving caregiving burden and enhancing caregiver satisfaction should be provided to caregivers with high levels of dementia patients' unmet needs and low level of caregiving satisfaction.

Caregiving reduces mortality risk for most caregivers: a census-based record linkage study

BACKGROUND

Countries with advanced welfare systems are increasingly relying on the input of informal caregivers, and there are growing concerns for their mental and physical wellbeing. However, the evidence about the relationship between caregiving and mortality risk is less clear.

METHODS

A census-based record linkage study with mortality follow-up of 33 months: participants totalled 1 122 779 individuals including 183 842 caregivers, of whom 28.2% (51 927) were providing 50 or more hours caregiving per week.

RESULTS

Over 33 months of follow-up a total of 29 335 deaths occurred, 2443 of these among caregivers. Mortality risk for caregivers was lower than for non-caregivers [hazard ratio (HR) = 0.72: 95% confidence interval (CI) = 0.69, 0.75 in the fully adjusted model], and the lower risk was evident even for those providing 50 or more h of caregiving per week (adjusted HR = 0.77: 95% CI = 0.71, 0.83 and 0.76: 95% CI = 0.69, 0.83 for men and women, respectively). There was no evidence that this relationship varied by either age or marital status. Even among people with chronic health problems such as poor mental health, caregivers had lower mortality risk than non-caregivers. Caregiving is associated with reduced mortality risk for most causes—for example, the risk of death from ischaemic heart disease for caregivers providing 50 or more h was 27% and 31% lower for men and for women, respectively, compared with non-caregivers (HR = 0.73: 95% CI = 0.60, 0.88 and HR = 0.69: 95% CI = 0.51, 0.92).

CONCLUSIONS

This large population-based study confirms that for the majority of caregivers the beneficial effects of caregiving in terms of short-term mortality risk appear to outweigh any negative effects, even among people with significant health problems. These results underscore the need for a reappraisal of how caregiving is perceived.

Short-Term Effects of a Gain-Focused Reappraisal Intervention for Dementia Caregivers: A Double-Blind Cluster-Randomized Controlled Trial

OBJECTIVE

To examine the effects of a benefit-finding intervention, the key feature being the use of gain-focused reappraisal strategies to find positive meanings and benefits in caring for someone with dementia.

METHODS

In a cluster-randomized, double-blind, controlled trial conducted in social centers and clinics, 129 caregivers aged 18 + and without cognitive impairment, providing at least 14 care hours per week to a relative with mild-to-moderate Alzheimer disease, and scoring ≥ 3 on the Hamilton Depression Rating Scale were studied. Exclusion criterion was care recipient having parkinsonism or other forms of dementia. The benefit-finding intervention was evaluated against two treatment-as-usuals, namely, simplified psychoeducation (lectures only) and standard psychoeducation. Each intervention lasted 8 weeks, with a 2-hour session per week. Randomization into these conditions was based on center/clinic membership. Primary outcome was depressive symptom. Secondary outcomes were Zarit Burden Interview, role overload, and psychological well-being. Self-efficacy beliefs and positive gains were treated as mediators. Measures were collected at baseline and post-treatment.

RESULTS

Regression analyses showed benefit-finding treatment effects on all outcomes when compared with simplified psychoeducation and effects on depressive symptoms and Zarit burden when compared with standard psychoeducation. Effect sizes were medium-to-large for depressive symptoms (d = -0.77 to -0.96) and medium for secondary outcomes (d = |0.42-0.65|). Furthermore, using the bootstrapping method, we found significant mediating effects by self-efficacy in controlling upsetting thoughts and positive gains, with the former being the primary mediator.

CONCLUSION

Finding positive gains reduces depressive symptoms and burden and promotespsychological well-being primarily through enhancing self-efficacy in controlling upsetting thoughts.

A Multidimensional Examination of the Psychological and Social Well-Being of Caregivers of a Demented Relative

This article focuses on a detailed examination of stressors, their appraised disturbance and a broad range of resources as well as on an assessment of their relationships with five dimensions of psycho-social well-being. Caregivers (n = 265) who cohabit with a demented relative composed the sample. The results indicate the importance of a multidimensional examination of both factors and well-being. Indeed, the saliency of the occurrence of the stressor and the degree of its disturbance seem to depend on the meaning of the stressor and/or its predictability/unpredictability in relation to a specific dimension of well-being. Only one stressor, the occurrence of disruptive behaviors, is linked to three dimensions of well-being (psychological distress, negative and positive feelings about the caregiver role). Stressors/appraisal factors are most often associated with negative indicators of psychological well-being (psychological distress and negative feelings about the caregiver role) than with positive indicators (positive affect and positive feelings about the caregiver role). Moreover, positive resources are linked to positive indicators of psychological well-being while negative resources emerged as relevant for negative indicators.

Understanding Stress in Informal Caregiving

The poor psychological health of caregivers of the frail aged is examined using the stress paradigm and the crises of decline model of caregiving burden. Whereas stress paradigms generally focus on environmental stressors and individual resources, the crises of decline model conceptualizes stress within the social dynamics of the caregiving dyad. Data from a cross-sectional study of 144 caregivers supported both models. Burden was more likely when the primary caregiver experienced degeneration, conflict, enmeshment, unpreparedness, and unwillingness. Minor psychiatric symptoms were explained in part by burden but also by more traditional stressors (supervisory workload) and resources (physical health, self- esteem, mastery, coping strategies, social network availability). Individualistic interventions to relieve burden and symptoms are justifiable on the basis of this study, but with limits to their likely success-limits imposed by family institutions of care in which primary carers lack experience and feel discomfort with degenerative conditions.

Mothers and Fathers of Adults with Chronic Disabilities

The stressors, resources, caregiving appraisals, and mental health of aging women and men who have a child with a chronic disability were contrasted. Data from 251 women and their husbands indicated that while mean level differences characterize the reports of mothers and fathers, predictors of caregiving satisfaction, caregiving burden, depression, and life satisfaction were relatively similar. With similar mechanisms linking stressors, resources, appraisals, and outcomes for mothers and fathers, these data provide strong evidence for the application of a common model for understanding the experiences of aging men and women who have a child with a chronic disability.

The Stress Process among Dementia Spouse Caregivers

This study examines the relationship between the demands of providing care to a spouse with dementia and caregiver health behaviors, specifically exercise, sleep patterns, weight maintenance, smoking, and alcohol consumption. Structural equation modeling was used to test a model predicting health behavior change from personal and environmental characteristics, perceived stress, social support, and depressive symptoms in a sample of 233 spouse caregivers of dementia patients and to examine gender differences in these relationships. Results support the hypothesis that caregiving negatively influences health behaviors. Among both women and men, health behavior change is directly influenced by depressive symptoms and objective burden. In addition, depressive symptoms mediate the effects of self-efficacy and objective burden on health behavior change. These results support the notion that health behavior change may represent one mechanism by which caregiving stress leads to adverse health outcomes.

Effect of Giving Care on Caregivers’Health

This longitudinal study of 121 caregivers of the elderly evaluates the change in their self-assessed mental and physical health over two years. The care recipients, who were drawn from a random sample of noninstitutionalized urban elders, showed increased need for help with personal and instrumental activities of daily living in this period. Both the physical and mental health of the caregivers declined significantly during the study. Predictors of decline in physical health of the caregivers at the end of the study were poorer physical health at the start, the amount of help they provided, a decline in their own mental health, and an increase in the number of other persons also available to provide care. In contrast, decline in caregivers’ mental health at the end was predicted only by poorer mental health at the start and by decline in physical health.

Testing a Symmetrical Model of Caregiving Outcomes During Recovery from Heart Attacks

This study focused on predictors of psychological distress among caregivers to elderly patients with heart disease using a symmetrical model of caregiving stress. Based on a 1-year longitudinal study of 104 caregiver-care receiver dyads, findings indicate that caregivers continue to face challenges a year after the initial heart attack. Psychological distress of the recovering heart patient plays an important role in predicting caregiver psychological distress. In contrast, patient cardiac symptoms and functional limitations showed no effects. Among caregiver characteristics, physical health, prior psychological distress, and caregiver burden were significant predictors of caregiver psychological distress. Finally, caregiving hours displayed an unexpected negative direct effect on caregiver distress. However, the indirect effect of caregiving hours on distress (via burden) was in the expected positive direction. These data support the usefulness of symmetrical models that consider characteristics of both members of the caregiving dyad in predicting caregiving outcomes.

Beyond Burden

This analysis compares the results of an open-ended study on the effects of informal caregiving with data obtained from a separate investigation that used the same sample but employed fixed-item measures of burden. Informal caregivers ( N = 229) were interviewed with both approaches six weeks after the patients (care receivers) were discharged from the hospital. Percentages, t tests, and analyses of variance were used to compare and contrast the data. The analysis found substantial correspondence between the results from the two approaches, especially around the negative effects of caregiving. Less correspondence was found on the positive effects of caregiving, particularly with regard to subjective fixed items.

Effects of Hardiness and Appraisal on the Psychological Distress and Physical Health of Caregivers to Elderly Relatives

The goal of this study was to identify characteristics of caregivers that contribute to differences in psychological distress and physical health in family caregivers to elderly relatives. It was hypothesized that hardiness would predict caregiver's distress and physical health beyond what could be accounted for by the demands of caregiving (relative's cognitive impairment and functional/behavioral impairment, and caregiver's level of responsibility for needed care); that hardiness would decrease distress and increase physical health; and that the effect of hardiness would be mediated by appraisals of caregiving. In a sample of 53 caregivers to relatives age 65 or older, results indicated that both hardiness and appraisals predicted psychological distress (depression and life satisfaction). Neither predicted physical health. Appraisals partially explained the relationship between hardiness and psychological distress, but it appears that both general personality characteristics and situation-specific perceptions determine the impact on the caregiver.

Positive Aspects of Caregiving

The aim of this study was to assess a newly developed measure for the positive aspects of caregiving using a sample of dementia caregivers. The measure was developed and administered to 1,229 participants in a national collaborative Alzheimer’s disease caregiver study and evaluated for validity and reliability using standard psychometric analyses. Factor analysis identified two components in this nine-item measure: Self-Affirmation and Outlook on Life. Cronbach’s alphas for the components were .86 and .80, respectively. For the entire scale, Cronbach’s alpha was .89. The Positive Aspects of Caregiving measure, tested with a large, diverse, and well-characterized sample shows promise as a valid and reliable instrument. With additional implementation and testing, the measure has the potential to substantially increase our understanding of basic caregiving research and the outcomes of intervention efforts.

Effect of Moderate to Vigorous Physical Activity Intervention on Improving Dementia Family Caregiver Physical Function: A Randomized Controlled Trial

OBJECTIVE

Alzheimer's disease and related dementias (ADRD) affect more than five million Americans and their family caregivers. Caregiving creates challenges, may contribute to decreased caregiver health and is associated with $9.7 billion of caregiver health care costs. The purpose of this 12 month randomized clinical trial (RCT) was to examine if the Enhancing Physical Activity Intervention (EPAI), a moderate to vigorous physical activity (MVPA) treatment group, versus the Caregiver Skill Building Intervention (CSBI) control, would have greater: (1) MVPA adherence; and (2) physical function.

METHODS

Caregivers were randomly assigned to EPAI or CSBI (N=211). MVPA was assessed using a self-report measure; and physical function was objectively assessed using two measures. Intention-to-treat analyses used descriptive, categorical and generalized estimating equations (GEE), with an exchangeable working correlation matrix and a log link, to examine main effects and interactions in change of MVPA and physical function over time.

RESULTS

At 12 months, EPAI significantly increased MVPA (p=<0.001) and number of steps (p=< .01); maintained stable caregiving hours and use of formal services; while CSBI increased hours of caregiving (p=<0.001) and used more formal services (p=<0.02). Qualitative physical function data indicated that approximately 50% of caregivers had difficulties completing physical function tests.

CONCLUSION

The EPAI had a stronger 12 month effect on caregiver MVPA and physical function, as well as maintaining stability of caregiving hours and formal service use; while CSBI increased caregiving hours and use of formal services. A study limitation included greater EPAI versus CSBI attrition. Future directions are proposed for dementia family caregiver physical activity research.

Measuring psychological well-being in cognitively impaired persons

An objective measure of psychological well-being (a previously understudied outcome for persons with dementia) was developed and tested as part of a longitudinal study ( n= 96 participant pairs; n= 73 pairs remaining at 18 months). The reliability and validity of the Psychological Well-being in Cognitively Impaired Persons (PWB-CIP) scale was examined as a measure of one dimension of quality of life (QoL) as persons progress in the disease. The original 16-item PWB-CIP Likert-type scale required only five to 10 minutes to complete and was reduced to 11 items following factor analysis. Cronbach's alpha for the total scale was .79 at baseline and .82 at 18 months. Two subscales were identified: positive affect/interaction and negative affect/interaction. One item ('involved in a single activity for > five minutes') loaded on a different subscale at baseline (early disease stages) compared to 18 months (reflecting disease progression). The internal consistency of the two subscales remained acceptable across the two measurement intervals. Controlling for mental status, the PWB-CIP's construct validity was supported through significant relationships with depression, personal characteristics (personality), and the behavioral competence QoL dimensions at baseline and at 18 months. Because both rural (55%) and urban populations were sampled and the PWB-CIP was used across care settings, the findings support the PWB-CIP as a psychometrically sound measure of psychological well-being for diverse populations of persons with dementia.

Rural and Urban Caregivers for Older Adults in Poland: Perceptions of Positive and Negative Impact of Caregiving

This study examines rural-urban differences in informal caregivers' perceptions of caregiving. The study's theoretical framework is based on the two-factor model of caregiving, which views caregiving as having both positive and negative impact. Data were collected in personal interviews with 126 rural and 127 urban caregivers in the Bialystok region. The COPE-Index was used to assess caregivers. Rural caregivers reported a greater negative impact of caregiving than their urban counterparts, controlling for caregiver socio-demographic characteristics and care-recipient disability level. There was no difference in caregivers' perceptions of positive aspects of caregiving. These findings are consistent with previous research, which suggests that rural caregivers experience greater caregiver burden. Better understanding of rural-urban differences in caregiving outcomes can be useful in designing supportive services for informal caregivers in Poland.

A path analysis of patient dependence and caregiver burden in Alzheimer's disease

BACKGROUND

The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants.

METHODS

Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence.

RESULTS

The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress.

CONCLUSIONS

Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Caregiver Psychological Adjustment and Institutionalization of Persons With Alzheimer’s Disease

This prospective study examines the relationship between caregiver psychological adjustment and institutionalization of persons with Alzheimer’s disease (AD). Method: A 3-year longitudinal study was conducted with a clinic-based cohort of 396 persons with AD and their respective family caregivers. Caregiver adjustment was sequentially measured in 3-month intervals using standard scales of appraisal (perceived burden and satisfaction) and emotion (depressive symptoms and positive affect). Results: In multivariable proportional hazards regression models predicting time to institutionalization controlling for AD severity, hazard ratios were significant for appraisal measures of caregiver adjustment, perceived burden (1.053; 95% confidence interval [CI], 1.014, 1.093), and satisfaction (.929; 95% CI, .883, .977). In contrast, levels of caregivers’ positive and negative emotion did not reliably predict institutionalization. Discussion: The findings highlight the importance of caregiver appraisals in decisions to institutionalize persons with a dementia syndrome, but the limited impact of caregiver emotion was unexpected and requires further study.

When a Case Management Program Closes: Impact as Perceived by Frail Elders and Their Family Caregivers

Geriatric case management programs benefit elders and their caregivers by providing technical and emotional support and linkages to services and financial assistance. This study used qualitative and quantitative data to document the perceived impact felt by clients and their families when this assistance is withdrawn. Attempts were made to contact all 205 former clients of a case management program in Honolulu 6 months after program closure. Of these, 118 were still living at home, 20 had entered nursing homes, 28 had died, and 39 were lost to follow-up. Compared to a previous 6-month period, the percentage who entered nursing homes was similar, whereas the percentage that died was higher. Half of responding caregivers reported a deterioration of their own health and increased emotional fatigue. Data suggest that the program was perceived by elders and their caregivers to be a critical component in providing support and maintaining the safety of frail elders in home settings.

Predictors of the Psychological Well-Being of Primary Caregivers Living With a Demented Relative: A 1-Year Follow-Up Study

This 1-year follow-up study aimed to examine the predictors of change in psychological well-being, using two negative indicators (psychological distress and negative feelings about the caregiver role) and two positive indicators (positive feelings about the caregiver role and positive affect) of well-being. The sample consisted of primary caregivers (n = 180) cohabiting with a demented relative. Four variables were involved in predictive relationships with psycho logical well-being The first variable, appraisal of the disturbance from dysfunctional behaviors at Time 1, was selectively predictive of an increase in the two negative indicators over a year. The second and third variables, increased conflicts in the exchange of informal support and less frequent informal support at Time 1, were predictive of an increase in psychological distress. The fourth variable, frequent use of affective-stimulative dementia management strategies at Time 1, appeared to predict an increase in the two positive indicators of well-being. Knowledge of these four predictors can be useful in designing interventions that target the improvement of well-being.

Stresses and Satisfactions of Family Caregivers to Older Stroke Patients

This research investigated the daily stresses (hassles) and satisfactions (uplifts) reported by 78 family members caring for a relative who had recently experienced a stroke. Four domains of hassles and uplifts were examined for their direct effects on three indices of caregiver well-being (caregivers' social activities, social relationships, depression), as well as for the protective effects of uplifts on well-being. Caregivers reported more uplifts than hassles, and care-recipient characteristics were stronger predictors of both hassles and uplifts than were caregiver characteristics. Hassles demonstrated the strongest associations with well-being, with caregivers who reported more hassles also reporting lower levels of well-being. Although uplifts failed to demonstrate consistent direct assoctations with well-being, when the net effects of appraisals were positive (that is, when caregiving uplifts outweighed caregiving hassles), caregivers reported lower levels of distress. Results concerning the protective effects of uplifts are consistent with transactional models of stress.

An Inquiry Into Latino Caregivers' Experience Caring for Older Adults With Alzheimer's Disease and Related Dementias

The literature on the experiences of Latino caregivers of older adults with Alzheimer's disease and related disorders (ADRD) is scarce. Shedding light on ethnocultural influences may facilitate providing more culturally appropriate services. The purpose of this study is to explore Latino caregivers' cultural explanatory models of caring for an older adult with ADRD. Seven focus groups are conducted with 33 Spanish-speaking Latino caregivers in three U.S. states: Florida, Colorado, and Minnesota. Standardized focus group interviews are audiotaped, transcribed, translated into English, and systematically examined using grounded theory techniques. The qualitative findings answer three primary research questions about (a) the meanings of caregiving and caregiver self-definitions, (b) overall experience of Latino caregivers, and (c) caregivers' understanding of ADRD and the skills needed to manage the disease. The experience of Latino caregivers is described for each of the research questions, followed by a discussion in the context of the existent literature.

The Relationship Between Work Strategies Used by Informal Caregivers and Care Receivers and Clinical Outcomes

Historically, informal caregiving literature has focused on caregivers' reports of the burden associated with the work of care. Increasingly, however, both care givers and care receivers are beginning to accentuate the positive aspects of care in the home and identify work strategies that work for them. This study sought to examine the relationship between use of three care-related work strategies (delegating, developing competence, and positive problem orientation) and the following two outcome measures: mood disturbance and subjective well-being. Significant correlations were found between usage of each of these strategies and desired outcomes, indicating value in using these strategies. Different conditions of the variables of care receiver functional status, kin relationship, and gender were found to influence the degree of correlation between work strategies and desired outcomes, suggesting the need to individualize implementation of these strategies for each caregiver/care receiver situation.

The Psychological and Physical Costs of Caregiving: The Canadian Study of Health and Aging

Persons with dementia and their caregivers were randomly identified as part of the Canadian Study of Health and Aging. The current study examines the interrelation among demographic and illness variables relative to various outcomes of caregiving ( n = 181). From these analyses, two pairings of canonical variates emerge as significantly correlated: The first suggests an underlying affective construct related to activities of daily living and problematic behaviors; the second reflects a caregiver health construct composed of demographic variables, depressive affect, and diagnosis of the care-recipient. These findings suggest that negative caregiving outcomes may arise within distinct affective and physical health domains. Illness would appear to manifest within either system where a predisposition exists among caregivers faced with specific stressors.

The Relationship Between Challenging Behaviour, Cognitions and Stress in Mothers of Individuals with Intellectual Disabilities

Background: Cognitions are starting to receive more prominence as important when examining a number of factors including the topography of challenging behaviour. This study examined the relationships between maternal stress, challenging behaviour (aggressive and self-injurious behaviours) and parental cognitions and specifically whether maternal cognitions mediated the effect of challenging behaviour on parenting stress. Method: 46 mothers of children and young adults with ID completed questionnaires regarding their child's challenging behaviour, maternal cognitions and stress. Results: Significant correlations were found between challenging behaviour and maternal stress. The overall mediation models for aggression and self-injurious behaviour were significant. The Challenging Behaviour Perception Questionnaire: Consequences client subscale was the only independent significant mediator for both behaviours. Conclusions: Cognitions do play an important part in mediating the relationship between challenging behaviour and stress. Further research is needed to examine the similarities and differences between the mediation models for aggression and self-injurious behaviour.

Family-to-work spillover and appraisals of caregiving by employed women caring for their elderly parents in Japan

We examined the differences in family-to-work spillover between employed women who did and did not have caregiving responsibilities for elderly parents and the relationship between family-to-work spillover and negative and positive appraisals of caregiving using moderation analysis. A cross-sectional survey was conducted with middle-aged employed women (age ≥40 years) from four large companies. Negative and positive family-to-work spillover (FWNS and FWPS, respectively) and negative and positive appraisals of caregiving were measured. Data from 386 non-caregivers and 82 caregivers were analyzed using Fisher's exact tests, Welch's t-tests, and hierarchical multiple regression. Results showed that FWNS was higher in caregivers than in non-caregivers, while there was no significant difference in FWPS. Caregiver "fulfillment from the caregiving role" (a subscale of positive appraisal) buffered the effects of caregiver "feelings of social restriction" (a subscale of negative appraisal) on FWNS. On the other hand, caregiver "commitment to caregiving tasks" (another positive subscale) intensified the effects of "feelings of social restriction" on FWNS. However, there was no relationship between negative and positive appraisals of caregiving and FWPS. These findings suggest that both negative and positive appraisals of caregiving are important contributors to FWNS among employed women caring for their parents.

Direct Care Worker Training to Respond to the Behavior of Individuals With Dementia: The CARES® Dementia-Related Behavior™ Online Program

Only a handful of online training programs are available for direct care workers (DCWs) to acquire the strategic skills needed to improve dementia care in instances of challenging or inappropriate behavior. Utilizing pre- and post-test data from a convenience sample of 40 DCWs, the present study sought to determine (a) whether DCWs' knowledge of responding to dementia-related behavior increased following participation in the CARES® Dementia-Related Behavior^™ Online Training Program (or CARES® Behavior) and (b) if CARES® Behavior was acceptable and useful. The average number of correct scores on a dementia care knowledge measure was significantly higher among DCWs after viewing the online modules when compared with pre-test scores (p < .01). Descriptive empirical and open-ended data also suggested that the interactive, "real-world" content of CARES® Behavior was feasibly delivered online, acceptable, and may influence how DCWs deliver clinical care to individuals with dementia-related behavior.

Retrospective Appraisals Mediate the Effects of Combat Experiences on PTS and Depression Symptoms in U.S. Army Medics

A life-threatening traumatic experience can cause physical and psychological distress, but it can also be remembered with pride from having demonstrated one's courage and abilities under severe circumstances. Characteristics of the event, early response, as well as later personal reflection, together determine the individual's response to a traumatic event. We investigated how traumatic combat experiences and retrospective appraisals of those experiences affected reports of symptoms of posttraumatic stress and depression in 324 U.S. Army medics. Higher levels of combat experiences were associated with both appraisals of threat to life (r = .40) and appraisals of personal benefit of the deployment (r = .15). Threat appraisals were associated with increases (r = .33 and .29), whereas benefit appraisals were associated with decreases (r = -.28 and -.30, respectfully), in symptoms of posttraumatic stress and depression. These opposing mediation pathways led to weak or nonsignificant total effects, which concealed the effects of combat intensity on posttraumatic stress (R(2) = .28) and depression (R(2) = .24). Acknowledging the beneficial effects that a combat experience had on one's life was associated with less intense behavioral health symptoms and offset the detrimental effects of traumatic combat experiences.

A Randomized Controlled Trial to Evaluate the Veterans' In-home Program for Military Veterans With Traumatic Brain Injury and Their Families: Report on Impact for Family Members

BACKGROUND

Traumatic brain injury (TBI) creates many challenges for families as well as for patients. Few intervention studies have considered both the needs of the person with TBI and his or her family and included both in the intervention process. To address this gap, we designed an innovative intervention for veterans with TBI and families-the Veterans' In-home Program (VIP)-targeting veterans' environment, delivered in veterans' homes, and involving their families.

OBJECTIVES

To determine whether the VIP is more effective than standard outpatient clinic care in improving family members' well-being in 3 domains (depressive symptoms, burden, and satisfaction) and to assess its acceptability to family members.

DESIGN

In this randomized controlled trial, 81 dyads (veteran/family member) were randomly assigned to VIP or an enhanced usual care control condition. Randomization occurred after the baseline interview. Follow-up interviews occurred 3-4 months after baseline, and the interviewer was blinded to group assignment.

SETTING

Interviews and intervention sessions were conducted in veterans' homes or by telephone.

PARTICIPANTS

A total of 81 veterans with TBI recruited from a Veterans Affairs (VA) polytrauma program and a key family member for each participated. Of the 81 family members, 63 completed the follow-up interview.

INTERVENTION

The VIP, guided by the person-environment fit model, consisted of 6 home visits and 2 telephone calls delivered by occupational therapists over a 3- to 4-month period. Family members were invited to participate in the 6 home sessions.

MAIN OUTCOME MEASURES

Family member well-being was operationally defined as depressive symptomatology, caregiver burden, and caregiver satisfaction 3-4 months after baseline. Acceptability was operationally defined through 3 indicators.

RESULTS

Family members in the VIP showed significantly lower depressive symptom scores and lower burden scores when compared to controls at follow-up. Satisfaction with caregiving did not differ between groups. Family members' acceptance of the intervention was high.

CONCLUSIONS

VIP represents the first evidence-based intervention that considers both the veteran with TBI and the family. VIP had a significant impact on family member well-being and thus addresses a large gap in previous research and services for families of veterans with TBI.

Depression and distress in caregivers of children with brain tumors undergoing treatment: psychosocial factors as moderators

OBJECTIVE

This study's objectives were to examine the effects of depression on the distress of caregivers of children with brain tumors and to identify the factors moderating depression and caregiver distress.

METHODS

Participants were 82 caregivers of children with brain tumors undergoing treatment in the National Cancer Center of South Korea. The depression subscale of the Symptom Checklist 90-Revised (SCL-90-R) and the Burden of a Primary Caregiver (BPC) Scale were used to measure participants' depression and caregiver distress, respectively. The Korean version of the Parenting Sense of Competence (K-PSOC) Scale, Family Environmental Scale-Revised (K-FES-R), and the DUKE-UNC Functional Social Support Questionnaire-S (DUKE-UNC-FSSQ) were used to assess parental efficacy, family relationships, and perceived social support, respectively.

RESULTS

Younger patient age, lower family income, and caregivers' greater number of years of education significantly predicted caregiver distress. Caregivers with depression experienced significantly more distress than those without depression. The interaction of depression with parenting efficacy and social support affected caregiver distress. For highly depressed caregivers, parental efficacy, social support, and family relationships played weaker roles as protective factors against caregiver distress. High parental efficacy and social support were protective factors against distress in caregivers without depression.

CONCLUSIONS

A multi-dimensional assessment of the psychosocial factors that may affect caregivers of children with brain tumors should precede interventions for distress management. Interventions tailored to individuals' psychosocial factors are needed.

The Role of Coping Strategies in Psychological Outcomes for Frontotemporal Dementia Caregivers

BACKGROUND

Caregiving for a person with frontotemporal dementia (FTD) is related to poor caregiver outcomes. Coping strategies adopted by caregivers are known to influence psychological outcomes in other dementia caregiver populations, however, their influence on psychological outcomes in FTD caregivers is poorly understood at present.

METHODS

Questionnaire data for 94 German primary caregivers (mean [M] 59.11 years, 68 females) of FTD care-recipients living in the community (M 63.94, 30 females) were investigated. Standardized measures completed by the caregiver included the Caregiver Strain Index (CSI), Beck Depression Inventory II (BDI-II), Quality of Life-Alzheimer's Disease (QoL-AD), and the Brief Coping Orientations to Problems Experienced (COPE). Care-recipients' nursing care level was collected as a measure of the intensity of their care needs.

RESULTS

Mediation analyses showed that the effect of the intensity of care-recipients' care needs on caregiver well-being depended on caregivers' experience of strain. High levels of caregiver strain did not predict depression (-0.22, 95% confidence interval CI: [0.16 to 2.04]) but predicted reduced QoL (-0.44, CI: [-1.15 to -.16]). Moreover, caregivers' experience of strain was exacerbated by their use of dysfunctional coping (β = .21; p = .04), care-recipients' intensity of care needs (β = .25; p = .01), and fewer financial resources (β = .23; p = .02). In turn, caregivers' use of dysfunctional coping as a response to their strain increased the levels of depression (0.46, CI: [0.19-0.82]). By contrast, use of problem-focused coping strategies increased caregivers' QoL (0.10, CI: [0.00 to 0.31]).

SIGNIFICANCE

This study identifies variables amenable to clinical interventions that can improve caregivers' well-being: specifically, caregiver strain and coping strategies. For a disease without cure yet increasing prevalence and cost, ameliorating the caregiver experience through targeted interventions is essential.

Parental disability, parent care, and offspring mental health outcomes

Decades of research supports a widely held view that providing parent care is stressful, and that these stresses are associated with adverse mental health outcomes. However, some recent studies suggest an additional possibility, namely that "noncaregiver stress"-a consequence of having a parent with major care needs, but not being an active caregiver-may be a serious problem as well. This finding emerges in data which permit separate controls for parental needs for care and offspring provision of parent care. We extend these results using Generations and Gender Programme data from five countries-Bulgaria, France, Georgia, Romania, and Russia-for which the necessary variables can be comparably measured. Our outcome variable is a depression score based on a 7-item scale. In country-specific regressions, we find two instances of statistically significant associations of depression with the regular provision of personal care to a parent with care needs, i.e., the usual "caregiver stress" result. However, we also find two instances of statistically significant differences in respondents' depressive symptoms that are associated with having a parent with care needs, i.e., instances of "noncaregiver stress." We find limited evidence of gender-specific responses to both forms of stress. Our evidence supports both the typical caregiver stress response and the less-studied noncaregiver stress response, which suggests the need for additional research.

The Association of Satisfaction and Perceived Burden With Anxiety and Depression in Primary Caregivers of Dependent Elderly Relatives

Some researchers have viewed caregiver burden and satisfaction as two ends of the same continuum rather than as independent aspects of the caregiving experience. We conducted a cross-sectional study of primary caregivers of dependent elderly relatives in Spain (N = 200; probabilistic sample), to determine whether satisfaction and perceived burden coexisted in caregivers, and whether these variables, considered separately and in combination, were associated with anxiety and depression, while controlling for objective aspects of care recipients' needs. Data on satisfaction with care, perceived burden, objective burden, anxiety, and depression were gathered in 2013 by interviews in caregivers' homes. Descriptive, bivariate, and multivariate analyses were performed. Of the 200 primary caregivers, 12.5% reported both high satisfaction with care and high perceived burden. Anxiety and depression levels were lower in caregivers with high satisfaction and low perceived burden than in those with low satisfaction and high burden or with high satisfaction and high burden. Our findings support the following conclusions: (1) Satisfaction may be experienced despite the presence of stressful factors; (2) the combination of high satisfaction and low burden might have protective effects on anxiety and depression in caregivers.

Informal caregiving and its impact on health: a reappraisal from population-based studies

Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. A landmark study by Schulz and Beach that reported higher mortality rates for strained spouse caregivers has been widely cited as evidence for the physical health risks of caregiving and is often a centerpiece of advocacy for improved caregiver services. However, 5 subsequent population-based studies have found reduced mortality and extended longevity for caregivers as a whole compared with noncaregiving controls. Most caregivers also report benefits from caregiving, and many report little or no caregiving-related strain. Policy reports, media portrayals, and many research reports commonly present an overly dire picture of the health risks associated with caregiving and largely ignore alternative positive findings. As the pool of traditional family caregivers declines in the coming years, a more balanced and updated portrayal of the health effects of caregiving is needed to encourage more persons to take on caregiving roles, and to better target evidence-based services to the subgroup of caregivers who are highly strained or otherwise at risk. Recommendations are discussed for research that will better integrate and clarify both the negative and potential positive health effects of informal caregiving.

A triadic perspective on elder neglect within the home care arrangement

The present study evaluates a conceptual model of elder neglect within the home care arrangement that takes into consideration the older adult, his or her family members, and the home care worker. Data from 223 complete care-giving units, which consist of an older adult, a family member and a home care worker, were analysed using structural equation modelling. Overall, 31.5 per cent of the older adults, 18 per cent of the care workers and 32.3 per cent of the family members reported at least one type of elder neglect. The proposed model showed a reasonable fit to the data. There was an inverse effect from type of home care to family member's burden and elder neglect, with live-in (around the clock) care being associated with lower levels of family member burden and elder neglect compared with live-out Israeli home care (provided for several hours per week). The amount of informal assistance provided by family members was inversely related to the amount of burden reported by home care workers, with greater informal assistance being associated with lower levels of worker burden. The findings call for the important role of formal home care by demonstrating a potentially protective effect for live-in migrant home care. The study also emphasises the shared burden between formal and informal sources of care.

Burden, reward, and coping of adult offspring of patients with depression and bipolar disorder

Background

In previous years, research has focused on the situation of psychiatric patients' minor children. The aims of this qualitative study were to describe the experience of adult children of depressed and bipolar patients, including positive and negative factors as well as coping mechanisms, and to investigate possible predictors of burden in order to identify children in need of professional support.

Methods

A total of 30 adult children were interviewed using a semi-structured interview. In addition, all children completed the Freiburg Questionnaire of Coping with Disease (Freiburger Fragebogen zur Krankheitsverarbeitung, FKV). Regression analysis indicated the most relevant predictors of burden.

Results

All (100%) of the children reported emotional burden due to the illness of their parent, 90% suffered from impaired family life, and 77% experienced burden due to the parent's symptoms. Reward (positive experience) was reported regarding the intensification of the parent-child relationship. Linear regression analysis shows predictors for highly burdened children as well as for children who are more prone to maladaptive ways of coping. Higher burden was significantly associated with the child's age, severity of illness of the parent, and specific diagnosis.

Conclusions

Although some positive aspects of parental affective disorder exist, this study underlines that children primarily suffer from their parent's disorder and that this burden does not stop in adulthood. Providing professional support to adult as well as to minor children of affected individuals should become standard of care in clinical settings.