The association between individual attachment patterns, the perceived social support, and the psychological well-being of Turkish informal caregivers

Practices of Patient Relatives Aimed at Preventing Pressure Injuries and Their Experiences of Coping with the Burden of Care: A Qualitative Study

OBJECTIVE

To determine the practices and coping experiences of the relatives of patients with pressure injuries (PIs).

METHODS

The authors used a qualitative, phenomenologic research design. They interviewed 20 relatives of patients with PIs face-to-face using an in-depth semistructured interview form. The data were analyzed using the Colaizzi phenomenologic method.

RESULTS

Three categories, 8 main themes, and 22 subthemes emerged from the interviews. The category of "the impact of the need for care on the lives of the patient's relatives" was analyzed according to psychological, social, and physical effects. In the category of "practices to prevent pressure injuries," two themes emerged: practices toward the patient and the environment. Relatives of individuals with PIs have psychological, physical, and social needs.

CONCLUSIONS

Providing care to a patient with PIs has psychological, social, and physical effects on the patient's relatives. The care burden mostly affects these caregivers negatively, and they mainly need time for themselves and moral and companion support.

Level of caregiving burden and affecting factors in family caregivers of patients with lung cancer: A cross-sectional study

PURPOSE

To determine the caregiving burden level and affecting factors of family members caring for patients with lung cancer (LC).

METHODS

This study used a cross-sectional design and a convenience sampling method. The study was conducted between April 2023 and August 2023 with the LC patients (n = 448) and their caregivers (n = 448) who met the inclusion criteria and were followed up in seven clinics of a specialized hospital for pulmonary diseases in Turkey. Data were collected by using (1) a demographic questionnaire (for patient and caregiver), (2) the Zarit Burden Interview (ZBI), (3) the Beck Depression Inventory (BDI), and (4) the Caregiver Quality of Life Index-Cancer (CQoLC).

RESULTS

The study included 448 caregivers, with a mean age of 45.09 ± 13.48 years, and 71.4% were female. The mean ZBI score of 31.45 ± 16.71 indicated mild to moderate burden. Pearson correlation analysis showed that caregivers' depression levels increased and quality of life decreased significantly as the care burden increased. Multiple regression analysis indicated a significant relationship between the caregiver burden and the patient's age (p < 0.05), caregiver's chronic disease (p < 0.05), type of treatment given to the patient (p < 0.05), patient's metastasis status (p < 0.05) and caregiver's quality of life (p < 0.01).

CONCLUSION

The fact that most of the risk factors identified in this study are non-modifiable highlights the necessity of identifying caregiver burden early by nurses and initiating the appropriate support processes.

Association between Social Support and Depressive Symptoms in Informal Caregivers of Adult and Older Dependents: A Systematic Review and Meta-Analysis

Social support is an important determinant of a carer's mental health. In recent decades, despite many studies reporting on the relationship between social support and depressive symptoms in informal caregivers of adult and older dependents, there are no systematic reviews synthesizing the available evidence. The purpose of the present study was to perform a systematic review and meta-analysis on the relationship between social support and depressive symptoms in informal caregivers of adults and older dependent people. We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), and Scopus, up to 15 January 2023 for studies. We applied no date or language limits to our search. A random-effects model was used to pool effect estimates. The included studies were also independently assessed for quality. Publication bias was evaluated by funnel plots, Egger's regression test, and the Trim and Fill method. Ninety-three studies were included in the review, reporting on a total of 15,431 informal caregivers. We found a moderate negative association between perceived social support and caregiver depressive symptoms (78 studies; r = -0.35, 95% CI = -0.39, -0.31; low heterogeneity and low risk of publications bias) and a small negative association between received social support and caregiver self-reported depressive symptoms (12 studies; r = -0.14, 95% CI = -0.20, -0.07; low heterogeneity and low risk of publications bias). Our results indicate that social support is a clinically relevant construct for carer well-being and an important protective factor for depressive symptoms in informal caregivers of adult and older dependents.

Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health

Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes.

The Relationship between Social Support and Anxiety Symptoms in Informal Carers: A Systematic Review and Meta-Analysis

BACKGROUND

Providing care can be challenging for informal carers and increases the risk of mental health problems, such as experiencing clinical symptoms of anxiety. While strengthening social support for informal carers is a common recommendation to reduce this risk, no systematic review or meta-analysis to date has examined the relationship between social support and anxiety symptoms in informal carers. The aim of our study was to systematically review the current evidence on the association between perceived and received social support and anxiety symptoms in informal carers of dependent adults and older people, and to comment on the quality of the evidence.

METHODS

We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), Scopus, and LILACS up to 31 March 2021 for articles reporting on the association between caregiver anxiety symptoms and social support. A random-effects model was used to pool estimates, and each study was rated for quality using pre-specified criteria. Publication bias was assessed using a funnel plot and Egger's regression test, which was adjusted using trim and fill analysis.

RESULTS

From the 2180 identified articles, 35 studies met our inclusion criteria, reporting on 5036 informal carers in total. We found a moderate negative association between perceived social support and caregiver anxiety symptoms (r = -0.31, 95% CI = -0.35, -0.27) and a small, negative association between received social support and caregiver anxiety (r = -0.15, 95% CI = -0.22, -0.08).

CONCLUSION

The levels of perceived social support showed a significant negative association with caregiver anxiety symptoms. Policymakers and those working directly with informal carers should consider the development of targeted social support interventions that specifically enhance the levels of perceived social support to reduce symptoms of anxiety in informal carers.

Care burden and related factors among informal caregivers of patients with amyotrophic lateral sclerosis

Objective: Amyotrophic lateral sclerosis (ALS) affects the life of the family caregiver as well as the patient. This study aimed to determine the care burden and related factors among family caregivers of Turkish ALS patients. Methods: This descriptive study was conducted with 108 ALS patients and their informal caregivers through face-to-face interviews at home. The data were collected using the ALS Functional Rating Scale, Zarit Burden Interview, European Quality of Life-Five Dimensions Questionnaire, Multidimensional Scale of Perceived Social Support, and the Hospital Anxiety and Depression Scale. Results: The mean age of the caregivers was 48.1 ± 13.4 years; the vast majority were female, and they were either spouses or children of the patients. While 49.1% reported moderate or severe burden, the quality of life was moderate (mean 70.4 ± 22.8). The caregiver burden was related to sex and the functional state of the patient, as well as caregiver factors such as the relation to the patient, sex, health status, time spent for care, and living in the same house with a limited environment. Walking ability, percutaneous endoscopic gastrostomy, tracheostomy, and communication problems were not associated with the burden. Furthermore, burden was associated with the caregiver's quality of life, social support, anxiety, and depression. Conclusions: The present study draws attention to the fact that the care burden in family caregivers of ALS patients is high and their quality of life is impaired. Our findings reveal that not only ALS patients but also caregivers need to be supported with an organized and planned system.

Extremely Distant and Incredibly Close: Physical Proximity, Emotional Attachment and Caregiver Burden

Informal caregivers are at risk of caregiver burden, and physical proximity to the care recipient may add to this negative outcome. Yet, individual differences in emotional proximity to the care recipient such as attachment orientations may contribute to caregivers’ comfort towards different degrees of physical proximity, leading to varying levels of burden. The current study is the first to explore the role of physical proximity on caregiver burden as moderated by attachment orientations. A sample of 162 Israeli caregivers who are active users of the Camoni website completed our online survey. Sociodemographic characteristics, including a self-reported questionnaire on the physical proximity to the care recipient, were collected. Caregivers’ attachment orientations were assessed with the Experiences in Close Relationships–Relationship Structures questionnaire. Caregiver burden was assessed using the Caregiver Burden Inventory. Multiple regression and simple slope analyses were conducted. Attachment anxiety and avoidance were positively associated with burden, whereas physical proximity was not. Attachment avoidance, but not attachment anxiety, moderated the association between physical proximity and caregiver burden, with caregivers who live closer to their care recipient experiencing greater burden when high levels of avoidance were present. Our findings reveal the complex dynamics between attachment orientations and physical proximity in the context of informal care, highlighting the need for better integration of these two interlinked constructs in both care research and practice.

Loneliness, Social Support Level, Quality of Life and Symptom Management Among Turkish Oncology Patients

This cross-sectional and correlational study was performed in order to determine the relationships between the perceived loneliness and social support levels of Turkish oncology patients, as well as their quality of life and symptom management. A total of 370 oncology inpatients participated in this study. Data were collected using, the FACT-G Quality of Life Scale, the Multi-Dimensional Scale of Perceived Social Support (MSPSS), the UCLA-Loneliness Scale (UCLA-LS), and the Edmonton Symptom Assessment Scale. A negative advanced significant relationship was found between the MSPSS total scores (r = -0.754, p < 0.01) and the UCLA-LS total scores. As the social support levels of the patients increased, their loneliness levels were seen to decrease and their quality of life was seen to increase. The patients were found to experience the symptoms of fatigue, worry, and feeling unwell more often as their loneliness levels increased and social support levels decreased.

An Investigation of the Effect of Attachment on Distress among Partners of Patients with Ovarian Cancer and Their Relationship with the Cancer Care Providers

Caregivers of patients with ovarian cancer experience distress related to caregiving difficulties within cancer care. Attachment insecurity is a well-known protector of distress, particularly as it relates to support from others. Using multivariate analyses, this study sought to determine the contribution of attachment insecurity and experiences with cancer care on symptoms of depression and anxiety, and investigated whether attachment insecurity moderated the relationship between caregiving experiences and distress. Multiple hierarchical regression analyses were conducted as part of a larger cross-sectional questionnaire study of distress among partners of patients with ovarian cancer. Participants (n = 82) were predominantly male, white, had household incomes over $100,000 and postsecondary education. Caregiving experiences explained 56% of the variance in depression, and 28% of the variance in anxiety. Specifically, lack of time for social relations as a result of caregiving significantly predicted depression and anxiety. Attachment anxiety correlated with both depression and anxiety, but attachment avoidance did not. Neither attachment anxiety nor attachment avoidance significantly contributed to distress variance, and neither moderated any of the relationships between caregiving experiences and distress outcomes. This study highlights the importance for cancer care to recognize the effect of caregiving responsibilities upon caregivers’ mental health, regardless of vulnerability to distress.

Psychosocial Problems in Relation to Spiritual Orientation and Religious Coping Among Oncology Muslim Patients

BACKGROUND

Patients generally turn to religion and spirituality when coping with the diagnosis and treatment of chronic diseases.

OBJECTIVE

The aim of this study was to assess psychosocial problems in relation to spiritual orientation and religious coping among Muslim oncology patients.

METHODS

This cross-sectional, correlational study enrolled 406 oncology inpatient participants. Participants completed the Distress Thermometer, the Religious Coping Styles Scale, the Spiritual Orientation Scale, and the The Functional Assessment of Cancer Therapy - General Quality of Life Scale.

RESULTS

As the spiritual orientation levels of the participants increased, use of a positive religious coping strategy also increased and distress levels decreased. In addition, general perceived quality of health increased as spiritual orientation levels and positive religious coping strategy use increased. Participants reported using prayer, daily prayer attendance, offerings, and consulting religious experts to seek healing.

CONCLUSIONS

Oncology patients in Turkey experience increased spiritual orientation levels while coping with illness-related psychosocial problems and use positive religious coping methods.

IMPLICATIONS FOR PRACTICE

The religious beliefs and spiritual orientations of Turkish oncology patients affect their cancer experience, their care, and their quality of life. Determining the religious and spiritual coping methods used by patients to cope with illness-related psychosocial problems may make it easier for nurses to plan patient-specific nursing care.

Caregiving burden, depression, and anxiety in family caregivers of patients with cancer

PURPOSE

The purpose of this cross-sectional study was to determine the caregiving burden, depression and anxiety of family caregivers of Turkish patients with cancer and the affecting factors.

METHODS

This cross-sectional study was conducted between January-May 2018 with one hundred and fifty-eight caregivers and one hundred and fifty-eight patients with cancer who were treated at a university hospital in Edirne, Turkey. Data were collected with a questionnaire form, Zarit Burden Interview (ZBI) Scale and the Hospital Anxiety Depression Scale (HADS).

RESULTS

This study found that 51.3% of the patients with cancer were male, 70.3% of the caregivers were female and more than half of them (57.0%) were the spouses of the patients. The mean ZBI score of the caregivers was 24.62 ± 14.19. There was a positive relationship between the ZBI scores and HADS scores of family caregivers (p < 0.05). As the caregiving burden of caregivers increased, their anxiety and depression levels were increased too. It was found that as the caregiving duration of family caregivers increased, the caregiving burden increased, and caregivers' anxiety depression scores got worse (p < 0.05). In the multivariate analysis, the duration of caregiving per day/hours, ECOG score and the age of the caregiver independently affected the caregiving burden (p < 0.05). As the functional status of the patient with cancer got worse, caregiving burden increased. Caregiving burden was found to be higher in those who were younger, female and giving care for longer times per day (p < 0.05).

CONCLUSION

This study found that as the caregiving burden and caregivers' daily patient care duration increased, the level of anxiety and depression increased too. Caregivers of patients with cancer should take appropriate psychological intervention to decrease their distress. In addition, we thought that healthcare professionals must consider the factors affecting the caregiving burden which affect the patient care directly.

Psychological Attachment Orientations of Surrogate Decision-Makers and Goals-of-Care Decisions for Brain Injury Patients in ICUs

Supplemental Digital Content is available in the text.

To determine whether ICU surrogates with “insecure” psychologic attachment orientations are more prone to requesting tracheostomy and gastrostomy (i.e., life-sustaining therapy) for severe acute brain injury patients with poor prognosis compared to surrogates with “secure” orientations.

Relationship Between Health Literacy and Social Support and the Quality of Life in Patients With Cancer: Questionnaire Study

Background

Low health literacy is associated with factors such as not taking medication as prescribed as well as poor health status and increased hospitalization and mortality risk, and has been identified as a risk factor for decreased physical function in older individuals. Health literacy is becoming an increasingly important issue because of the increased number of people affected by cancer who must make complicated treatment decisions. Health literacy has been shown to be positively associated with quality of life (QOL), and social support has been identified as important for addressing health-related problems and reducing the relative risk of mortality in patients with cancer. However, few studies have examined the relationship between health literacy, social support, age, and QOL.

Objective

The aim of this study is to examine the effects of health literacy, social support, and age on the QOL of patients with cancer.

Methods

An anonymous, self-administered online questionnaire was conducted from March 28 to 30, 2017, in Japan on patients with lung, stomach, or colon cancer that were voluntarily registered with an internet survey company. The survey covered basic attributes, health literacy, social support, and QOL. The European Health Literacy Survey Questionnaire, a comprehensive measure of health literacy instrument, was used to measure health literacy; the Japanese version of the Social Support Scale was used to measure social support; and the Japanese version of the Functional Assessment of Cancer Therapy-General (7-item version) assessment tool was used to measure QOL.

Results

A total of 735 survey invitations were randomly sent to patients with lung, stomach, or colorectal cancer, and responses were obtained from 619 (82.2% response rate). Significant effects on the QOL in patients with lung, stomach, or colon cancer were observed for health literacy, social support, and age, and for the interactions of health literacy and social support and of social support and age. Health literacy, social support, and the interaction between these variables also showed a significant effect on the QOL in patients 50 years or older, but not on those younger than 50 years.

Conclusions

The results of this study revealed that higher health literacy, social support, and age were associated with the QOL in patients with cancer. In addition, the relationship with QOL was stronger for social support than for health literacy. These findings suggest the importance of health literacy and social support and indicate that social support has a greater effect on QOL than does health literacy, while the QOL in patients with cancer aged younger than 50 years was lower than that of those 50 years or older. Therefore, elucidating the needs of these patients and strengthening social support based on those needs may improve their QOL.

Typology of Social Network Structures and Late-Life Depression in Low- and Middle-Income Countries

Background:

Rapid social changes and youth migration ensures a continuous drain on the social networks of the elderly in Low- and Middle-Income Countries (LMICs).

Objective:

We reviewed available literature on the relationship between social network structures and depression among community dwelling older persons in LMICs with a view to identifying patterns that might provide information for designing preventive psychosocial interventions.

Methods:

We searched the MEDLINE database through Pubmed, extracted information on the typologies of social network structures in LMICs and identified dimensions with the strongest systematic association with late-life depression, by weight, using the inverse of variance method. All analyses were conducted using the Cochrane review manager version 5.3.

Results:

Fourteen community-based surveys drawn from 16 LMIC contexts met criteria for syntheses. They included a total of 37,917 mostly female (58.8%) participants with an average age of 73.2 years. Social network size, contact with network, diversity of network, co-residency with own child, having more friends than family in the network, and prestigious standing of persons in the social network were protective structures against late-life depression. Conversely, low network diversity contributed 44.2% of the weight of all social network structures that are predictive of late-life depression.

Conclusion:

Recommendations are made for the design of new measures of social network structures in LMICs that captures the key dimensions identified. Epidemiological studies using such tools will provide more precise information for planning and prioritization of scarce resources for the prevention of late-life depression in LMICs.

Informal carers' experiences and feelings during rehabilitation

The purpose of this study was to explore the experiences and feelings of people caring for patients with long-term diseases in a rehabilitation centre. A qualitative research approach was used. Fifteen informal carers were interviewed. The study was conducted in a rehabilitation centre in Greece. Three themes emerged. The first was feelings regarding the patient and the carers themselves, as well as the type of care provided and life at home after discharge from the rehabilitation unit. The second was experiences regarding health professionals and delivered care, and other carers. The third theme was expectations and thoughts about the future. Health professionals should plan and implement support interventions within rehabilitation settings in order to address carers' needs in terms of practical guidance not only within the framework of patient care but also relating to the psychological and physical wellbeing of informal carers.

Influence of caregiver burden on well-being of family member caregivers of older adults

BACKGROUND

Caregiving to older adults is one of the most important social issues associated with aging. While caregiving provides a suitable care and supportive environment for older adults, changes in the lives of caregiving family members also affect their health. The aim of this study was to examine the effect of care burden on the well-being of family members providing care for older adults.

METHODS

The study used a cross-sectional design. The study sample included 363 family caregivers of older adults. Socio-demographic questionnaire form, Burden Interview and Caregiver Well-Being Scale were used as data collection tools. Multiple linear regression analysis was performed to explore the predictors of well-being in the family caregivers of older adults.

RESULTS

The caregiver burden mean score was 32.63 ± 15.72 and Caregiver Well-Being Mean score was 159.38 ± 24.55. Caregiver burden, perceived health status of the older adults, marital status, perceived health status of caregiver and social support of caregiver were found to be statistically significant predictors of well-being in family member caregivers of older adults. Caregiver burden level was found to be the strongest predictor of well-being in the family caregivers of older adults.

CONCLUSION

Results showed that caregiver burden had an important effect on well-being of the caregiver. For this reason caregiver burden should be considered during interventions for improving well-being in family caregivers of older adults. Findings of our study revealed the necessity of showing special attention to caregivers by healthcare professionals and the importance of conducting interventional studies that aim to reduce caregiver burden in order to promote well-being.

Adult Attachment Patterns Modify the Association Between Social Support and Psychological Distress

Introduction: Social support is an important protective factor for psychological distress, and adult attachment patterns—which are the basis of human relationships—may modify the association between social support and psychological distress. The objective of this study was to investigate whether adult attachment patterns modify the association between social support and psychological distress.

Methods: A commercial online survey service was used to collect data from 1648 men and women of 30–69 years of age in Japan. We assessed the association between social support and psychological distress, as measured by the Kessler Psychological Distress Scale (K6), and stratified it by adult attachment patterns using multiple linear models. Adjustments were made for age, sex, presence of a spouse and child in the household, level of education, employment, and household income.

Results: There was a significant interaction effect between social support score and a dismissing attachment pattern on psychological distress (p = 0.015); social support was associated with reduced level of psychological distress only in participants with a secure attachment pattern (β:−0.86, 95% CI: −1.56 to −0.16), whereas the point estimate was of opposite sign in participants with a dismissing attachment pattern (β:1.02, 95% CI: −0.32 to 2.37).

Conclusions: Higher social support reduced the risk of distress among participants with secure attachment. On the contrary, social support can be harmful for those with a dismissing attachment pattern. Our results suggest that further assessment of adult attachment patterns is needed to maximize the positive effects of social support to prevent psychological distress.

A systematic review of the psychometric properties of the cross-cultural translations and adaptations of the Multidimensional Perceived Social Support Scale (MSPSS)

BACKGROUND

Social support (SS) has been identified as an essential buffer to stressful life events. Consequently, there has been a surge in the evaluation of SS as a wellbeing indicator. The Multidimensional Perceived Social Support Scale (MSPSS) has evolved as one of the most extensively translated and validated social support outcome measures. Due to linguistic and cultural differences, there is need to test the psychometrics of the adapted versions. However, there is a paucity of systematic evidence of the psychometrics of adapted and translated versions of the MSPSS across settings.

OBJECTIVES

To understand the psychometric properties of the MSPSS for non-English speaking populations by conducting a systematic review of studies that examine the psychometric properties of non-English versions of the MSPSS.

METHODS

We searched Africa-Wide Information, CINAHL, Medline and PsycINFO, for articles published in English on the translation and or validation of the MSPSS. Methodological quality and quality of psychometric properties of the retrieved translations were assessed using the COSMIN checklist and a validated quality assessment criterion, respectively. The two assessments were combined to produce the best level of evidence per language/translation.

RESULTS

Seventy articles evaluating the MSPSS in 22 languages were retrieved. Most translations [16/22] were not rigorously translated (only solitary backward-forward translations were performed, reconciliation was poorly described, or were not pretested). There was poor evidence for structural validity, as confirmatory factor analysis was performed in only nine studies. Internal consistency was reported in all studies. Most attained a Cronbach's alpha of at least 0.70 against a backdrop of fair methodological quality. There was poor evidence for construct validity.

CONCLUSION

There is limited evidence supporting the psychometric robustness of the translated versions of the MSPSS, and given the variability, the individual psychometrics of a translation must be considered prior to use. Responsiveness, measurement error and cut-off values should also be assessed to increase the clinical utility and psychometric robustness of the translated versions of the MSPSS.

TRIAL REGISTRATION

PROSPERO - CRD42016052394.

Adaptation of a scale to measure coping strategies in informal primary caregivers of psychiatric patients

WHAT IS KNOWN ON THE SUBJECT?: Informal caregivers of psychiatric patients are vulnerable to many disturbances associated with the stress related to their activity. Caregivers who show a coping style focused on problem-solving report less psychological distress, and this approach positively influences the recovery process of the psychiatric patient. There are some questionnaires to measure coping styles in caregivers of psychiatric patients, but most of them do not have the minimum psychometric properties that a scale must fulfil. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The authors present an adapted and validated scale for measuring both active and passive coping strategies used by informal caregivers to face daily stressful situations with psychiatric patients. The study is an example of how scales can be adapted to small samples (n < 200). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The scale could be helpful for generating strategies to support the family caregiver, as well as for measuring the results of interventions. The scale could also be used to identify how coping styles of informal caregivers are related to recovery process of psychiatric patients.

ABSTRACT

Background The recovery process of a psychiatric patient is related to his primary informal caregiver's style of coping with stress. There is insufficient literature on validations of instruments that measure coping styles in this population. Objective To adapt and validate a scale to measure coping strategies in primary informal caregivers. Method The adapted scale was based on the Extreme Coping Scale of López-Vázquez and Marván. Items from that scale were adapted for application to informal caregivers. The scale was administered to 122 primary informal caregivers of patients from two psychiatric institutions in Mexico. Psychometric analyses were performed to determine the scale's properties. Results The scale was composed of 20 items (six less than in the original scale) and two factors: (i) active coping (Cronbach's alpha = .837) and (ii) passive coping (Cronbach's alpha = .718). Discussion The findings are discussed in the light of the importance of studying the relationship between coping styles and the well-being of both informal caregivers and psychiatric patients. Implications for practice The scale could be used by health practitioners and researchers to generate strategies to support the family caregiver, as well as to measure the results of interventions.

Caregiving Burden and Life Satisfaction Among Caregivers of Cancer Patients Admitted to the Emergency Department

This descriptive and cross-sectional study aimed to determine caregiving burden and life satisfaction among caregivers of cancer patients admitted to the emergency department. The study included 272 caregivers. Data were collected using an information form, the Zarit Burden Interview (ZBI), and the Satisfaction With Life Scale (SWLS). Among the patients, 19.1% were diagnosed with lung cancer; 44.1% were in the fourth stage of their disease; and 52% had metastasis. The mean ZBI total score was 41.2 ± 9.7, while the mean SWLS total score of caregivers was 17.6 ± 4.0. It was concluded that the mean ZBI and SWLS scores of patients' caregivers were moderately and negatively correlated ( p < .001, r = -.485). There was a negative and significant relationship between caregiving burden and quality of life.

Attachment orientations and psychological adjustment of parents of children with cancer: A matched-group comparison

OBJECTIVE

To investigate the impact of childhood cancer on parents' adult attachment, social support, marital adjustment, anxiety, and depression.

METHODS

30 parents of children with childhood cancer and 30 matched controls completed the following questionnaires: Experiences in Close Relationships-Revised, Dyadic Adjustment Scale-4, Multidimensional Scale of Perceived Social Support, State-Trait Anxiety Inventory - form Y, and Beck Depression Inventory.

RESULTS

Parents of children with childhood cancer had a significantly lower dyadic adjustment than controls, and higher levels of insecure-avoidant attachment, state anxiety, and depression.

CONCLUSION

It is important for health-care personnel to take into account these parents' propensity to show increased levels of avoidant attachment during children's treatment to foster effective communication and supportive relationships between clinicians, pediatric patients, and parents.

Psychometric evaluation of the Shona version of the Multidimensional Scale of Perceived Social Support Scale (MSPSS-Shona) in adult informal caregivers of patients with cancer in Harare, Zimbabwe

BACKGROUND

Providing care for a patient with cancer can negatively affect the health and psychosocial well-being of informal caregivers. However, social support has been enlisted as an essential buffer to stressful life events. There is now a greater call to routinely measure and provide support for caregivers and this is only feasible through use of validated outcome measures. The multidimensional scale of perceived social support (MSPSS) is one of the most commonly used social support outcome measure. Consequently, the MSPSS has been translated into several languages and validated across several populations. The aim of the present study was to translate the MPSS to Shona (Zimbabwean native language) and validate it in caregivers of patients with cancer.

METHODS

The MSPSS was translated to Shona using a backward-forward translation method, pretested on a group of caregivers (n = 10) before being administered to large sample (N = 126) at Parirenyatwa Group of Hospitals. Both exploratory and confirmatory factor analysis were performed to assess the structural validity of the MSPSS-Shona version. Reliability was assessed using the Cronbach's alpha.

RESULTS

Data for 120 caregivers were analysed. Most were females (69.2%), had attained at least secondary education (81.7%) and married (75%). There was moderate evidence for structural validity for the 2-factor model and excellent evidence for internal consistency as the scale yielded α = 0.905.

CONCLUSIONS

Despite moderate evidence for structural validity, the translation of MSPSS into native languages (e.g. MSPSS-Shona) in low resource settings can be deemed as "steps in the right direction" for evidence based practise in management of cancer. There is also need for further psychometric evaluation of the MSPSS-Shona.

Family Relationships and Psychosocial Dysfunction Among Family Caregivers of Patients With Advanced Cancer

CONTEXT

Caring for a family member with advanced cancer strains family caregivers. Classification of family types has been shown to identify patients at risk of poor psychosocial function. However, little is known about how family relationships affect caregiver psychosocial function.

OBJECTIVES

To investigate family types identified by a cluster analysis and to examine the reproducibility of cluster analyses. We also sought to examine the relationship between family types and caregivers' psychosocial function.

METHODS

Data from 622 caregivers of advanced cancer patients (part of the Coping with Cancer Study) were analyzed using Gaussian Mixture Modeling as the primary method to identify family types based on the Family Relationship Index questionnaire. We then examined the relationship between family type and caregiver quality of life (Medical Outcome Survey Short Form), social support (Interpersonal Support Evaluation List), and perceived caregiver burden (Caregiving Burden Scale).

RESULTS

Three family types emerged: low-expressive, detached, and supportive. Analyses of variance with post hoc comparisons showed that caregivers of detached and low-expressive family types experienced lower levels of quality of life and perceived social support in comparison to supportive family types.

CONCLUSIONS

The study identified supportive, low-expressive, and detached family types among caregivers of advanced cancer patients. The supportive family type was associated with the best outcomes and detached with the worst. These findings indicate that family function is related to psychosocial function of caregivers of advanced cancer patients. Therefore, paying attention to family support and family members' ability to share feelings and manage conflicts may serve as an important tool to improve psychosocial function in families affected by cancer.

Psychological distress and loneliness in caregiver of advanced oncological inpatients

The objective of this study is to compare and examine the relationships between levels of loneliness, anxiety, depression, and other variables on primary caregivers and cancer inpatients. The study involved 100 Turkish primary caregivers of inpatients with advanced or terminal stages of cancer. Loneliness and anxiety scores were significantly higher for the primary caregivers of inpatients with terminal stage of cancer than primary caregivers of inpatients with advanced stage of cancer. Excluding the cancer stage, loneliness and anxiety were primarily associated with the socio-demographic factors of primary caregivers rather than the characteristics of patients.

Depression among Low-Income Female Muslim Uyghur and Kazakh Informal Caregivers of Disabled Elders in Far Western China: Influence on the Caregivers' Burden and the Disabled Elders' Quality of Life

Background

Paying attention to and improving the mental health of the informal caregivers of disabled elders has become a global public health priority. This study focused on low-income female Uyghur and Kazakh informal caregivers of disabled elders residing in China’s far west. It investigated the prevalence of and the major related factors of depressive emotion.

Methods

A cross-sectional study was performed from September 2013 to January 2014 in Shawan Prefectures, Tuokexun Prefectures, Bole Prefecture and Urumchi city. Shawan Prefecture has the highest proportion of Kazakhs, whereas Tuokexun Prefectures, Bole Prefecture and Urumchi city have the highest proportion of Uyghurs in Muslim ethnic Uygur and Kazakh communities. Xinjiang Uyghur Autonomous Region is located in remote western China; this area is approximately 3,105 km (1,929 miles) away from Beijing. A total of 444 female Uyghur and Kazakh informal caregivers of disabled elders participated in this study. The self-rating depression scale, the Zarit burden interview, and the SF-36 questionnaire were used to evaluate the state of caregiver depression, caregiver burden, and quality of life (QOL), respectively. Statistical analyses were performed using multivariate logistic regression analyses, correlation with Spearman’s rho and independent-sample t-tests; a P-value of <0.05 was considered statistically significant.

Results

Up to 38.5% (n = 217) of informal caregivers reported having depression, whereas 61.5% (n = 273) of them reported a lack of depression. Age of disabled elders more than 60 years old, total hours spent on caring daily≥8h, duration of caring≥5 years, negative self-evaluation of health condition, having caregiver burden, elders’ medium degree of disability and elders’ heavy degree of disability had a higher risk of caregiver depression. By contrast, daughter/daughter-in-law of disabled elders; unemployed carers, family’s per capita income >US$235.48(1500 yuan), high social support, and high QOL of disabled elders were each associated with a lower risk of depressive emotion. Moreover, informal caregivers with depression obtained high care burden scores; at the same time, disabled elders who were looked after by caregivers with depression obtained low QOL scores.

Conclusions

Our findings suggest that the demographics characteristics of informal caregivers, and caregiver burden, and the disabled elders’ degree of disability and QOL had the most significant correlation with depressive emotion among women informal caregivers. The results had a enlighten that these variables should be considered while planning interventions to improve depression of informal caregivers.

Caregiver Burden and Perceived Social Support among Caregivers of Patients with Cancer

The purpose of this study is to describe the relationship between caregiver burden and perceived social support among caregivers of patients with cancer. The research was conducted in a university hospital in Izmir, Turkey. Eighty patient relatives who provided care service to patients with cancer who were admitted at hematology and oncology clinics participated in the study. The findings indicated that the care burden score was mild level. The mean of the perceived social support score was 58.4±21.0 supporting the conclusion that there is a weak and negative-direct relation between caregiver and perceived social support and that as the perceived social support increased, conversely, care burden decreased.

Correlates of self-rated attachment in patients with cancer and their caregivers: a systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the association between an anxious/avoidant attachment style and psychosocial variables in patients with cancer and their caregivers.

METHODS

PsycINFO, PubMed, Google Scholar, and SCOPUS were searched for empirical studies published in peer-reviewed journals between 1994 and 2015, and unpublished data from one cohort were added. Meta-analyses synthesized results from studies investigating the correlates of attachment styles, measured with validated scales, among patients with cancer or their caregivers.

RESULTS

Thirteen studies (k = 13) were included in the quantitative synthesis (including unpublished data from one cohort). Anxious attachment was associated with depression (r = 0.29, CI 0.19-0.38, I(2)  = 76%), anxiety (r = 0.34, CI 0.13-0.52, I(2)  = 69%), and social support (r = -0.39, CI -0.55-0.21, I(2)  = 87%). Avoidant attachment was associated with depressive symptoms (r = 0.20, CI 0.15-0.25, I(2)  = 16%), anxiety (r = 0.13, CI 0.01-0.24, I(2)  = 4%), and social support (r = -0.28, CI -0.42-0.14, I(2)  = 75%).

CONCLUSIONS

Patients with cancer and their caregivers showing high levels of insecure attachment are at risk of experiencing higher levels of depressive symptoms, anxiety, and poor social support. Findings suggest that clinicians' awareness of attachment styles may serve as important clinical insight to improve treatment outcomes. Large-scale studies and longitudinal studies are required to investigate distinct longitudinal pathways in cancer-related distress across different attachment styles Copyright © 2016 John Wiley & Sons, Ltd.

Living close to a person with cancer: a review of the international literature and implications for social work practice

To help family caregivers (FCs), social workers need to understand the complexity of FC's experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC's own health risk, caregiver burden, and experiences over time can enhance a social worker's awareness of an FC's challenging situation and the potential impact this has on the FC's ability to provide care to the patient.

Perceptions of burden of caregiving by informal caregivers of cancer patients attending University of Calabar Teaching Hospital, Calabar, Nigeria

INTRODUCTION

Cancer care is devastating to families. This research studied the informal caregivers' perceptions of burden of caregiving to cancer patients attending University of Calabar Teaching Hospital, Calabar.

METHODS

The research adopted a cross-sectioned descriptive design and 210 caregivers providing care to advanced cancer patients were purposively selected. Data were collected using a researcher developed questionnaire and standardized Zarit Burden Interview scale (ZBIS). Data collected were analysed using descriptive and chi-square statistics with the help of SPSS 18.0 and PAS 19.0 softwares.

RESULTS

The results indicated that the caregivers were in their youthful and active economic age, dominated by females, Christians, spouses, partners and parents. The burden levels experienced by the caregivers were as follows: severe (46.2%), moderate (36.2%) and trivial of no burden (17.6%). The forms of burden experienced were physical (43.4%), psychological (43.3%), financial (41.1%) and social (46.7%), quite frequently and nearly always. Psychological and social forms of burden had the highest weighted score of 228 in terms of magnitude of burden. The result further showed that there was a significant (P = 0.001) and inverse association between caregivers' burden and the care receivers' functional ability. The level of burden also increased significantly (P = 0.000) with the duration of care, while there was also a significant (P = 0.01) relationship between caregivers' experience of burden and their desire to continue caregiving.

CONCLUSION

Caregiving role can be enhanced by provision of interventions such as formal education programme on cancer caregiving, oncology, home services along side with transmural care.

Effects of care burdens of caregivers of cancer patients on their quality of life

In this study, the aim was to examine the effects of caring burdens of family caregivers of cancer patients on their quality of life in the east of Turkey. Data were collected at the Chemotherapy unit of Yakutiye Research Hospital of Ataturk University. Participants were 18 years old and older. The sample included 190 family caregivers who were living in the same flats with the patients during caregiving. Data were collected using a questionnaire that included socio-demographic questions for family caregivers and the Burden Interview, and the Caregiver Quality of Life Index-Cancer (CQOLC) Scale. SPSS version 14.0 was used to analyse the data. Descriptive statistics were computed for demographic variables of family caregivers. Pearson correlation analysis was used to analyze the relationship between the care burden and quality of life, linear logistic regression analysis was applied to determine the effect care burdens have on the quality of life, and logistic regression analysis was employed to determine the effect descriptive characteristics and care-related properties have on the quality of life. The score mean of the burden interview of caregivers was 36.6 ± 11.2; and their score mean of CQOLC was 81.4 ± 17.3. This study concluded that there was a negative relationship between caring burdens and the quality of life (p<0.001); descriptive characteristics, caring-related properties, and caring burden variables were all significant predictors of the quality of life. It is recommended that caregivers are given support by being offered training about providing care.

Enhancing quality of life and mastery of informal caregivers of high-grade glioma patients: a randomized controlled trial

High-grade gliomas (HGG) are serious primary brain tumors that may prevent the patient from functioning normally in social, emotional and cognitive respect. Often the partner's role will convert to that of informal caregiver. Consequently, they may experience significant stress and reductions in caregiver mastery, negatively affecting their health-related quality of life (HRQOL). We aimed at (1) determining factors that impact HRQOL and mastery of caregivers of HGG patients, and (2) investigate if a structured intervention consisting of psychoeducation and cognitive behavioral therapy leads to improvements in the mental component of HRQOL and mastery of caregivers. Fifty-six patient-caregiver dyads were randomly assigned to the intervention group or the care as usual group. The intervention program consisted of six one-hour sessions with a psychologist. Participants completed questionnaires concerning their perceptions of the patients' HRQOL (SF-36), neurological functioning (BN20), and cognitive functioning (MOS), and concerning their own HRQOL (SF-36) and feelings of caregiver mastery (CMS) both at baseline (i.e. before randomization) and every 2 months thereafter until 8 months later, five times in total. Patients' HRQOL and neurological functioning were found to be related to HRQOL and feelings of mastery of the informal caregiver at baseline. The intervention helped caregivers in maintaining a stable level of HRQOL and improved feelings of mastery over an 8 month period. Our findings suggest that informal caregivers can benefit from a psychological intervention as it is a helpful tool in maintaining a stable level of mental functioning and caregiver mastery.

Family experience with difficult decisions in end-of-life care

OBJECTIVE

The difficult decisions encountered by family caregivers in the process of care for patients with terminal cancer are seldom studied. Investigating their experiences with difficult decisions may help relieve their psychological distress. The purpose of this study was to determine the frequency and difficulty of decisions experienced in end-of-life care and to identify related factors.

METHODS

A cross-sectional study using questionnaires was conducted with family caregivers of patients who died of cancer in a university hospital. Difficulty of decisions and relevant influencing variables including demographic data, knowledge in palliative care and the Natural Death Act, and beliefs on the Natural Death Act were measured.

RESULTS

A total of 302 bereaved family caregivers were included in the final analysis. The most difficult decisions commonly encountered in both hospice and non-hospice wards related to truth telling, place of care, and alternative treatments. Logistic regression analysis demonstrated that older age (odds ratio = 0.92, 95% confidence interval = 0.89-0.95), not being the main family caregiver (0.20, 0.06-0.62), and less perception of burdens regarding the Natural Death Act (0.61, 0.37-0.99) were negatively correlated with the difficulty of decisions.

CONCLUSIONS

Families frequently encountered difficult decisions while caring for terminally ill loved ones. Better communication with family members, particularly the main caregiver, to diminish negative perceptions of the Natural Death Act could help to decrease psychological distress.