Adaptive and maladaptive forms of disengagement coping in caregivers of children with chronic illnesses

Psychological conditions of caregivers of adult subjects with Prader-Willi syndrome

BACKGROUND

Prader-Willi syndrome (PWS) is a rare genetic neurodevelopmental disorder. Individuals with PWS face a range of cognitive, behavioral, and emotional challenges that require comprehensive and lifelong care, posing significant demands on their caregivers. The study is not only aimed to assess the psychological conditions of caregivers of adult subjects with PWS focusing on psychological distress and coping, but also to shed light on a crucial yet often overlooked aspect of healthcare. This study aims to compare the psychological well-being of individuals with PWS and their caregivers, providing valuable insights that can potentially improve the quality of care for these individuals. The sample recruited at the Division of Auxology, IRCCS Istituto Auxologico Italiano, was composed of 30 adult subjects with PWS (11 men and 19 women; mean age ± SD: 36.4 ± 10.31 years; mean Body Mass Index (BMI): 35.7 ± 8.92: kg/m2) and their caregivers (10 men and 20 women). To assess the psychological condition of caregivers, the Italian-validated versions of the Depression Anxiety and Stress Scale (DASS-21) and the Coping Orientation to the Problems Experiences (COPE) were used, while to assess the psychological well-being of individuals with PWS and their caregivers, the Italian validated version of the Psychological General Well-Being Index (PGWBI) was used.

RESULTS

Depression (p < 0.001), Stress (p = 0.050), and Total score (p = 0.009) of DASS 21 were higher in the caregivers of subjects with PWS than in the general population. PGWBI scores of caregivers were significantly lower than in individuals with PWS in Positive Well-being (p < 0.001), General Health (p = 0.006), Vitality (p = 0.004), and the total score (p = 0.006). The depression subscale of PGWBI was higher in caregivers than in subjects with PWS. Correlations between the subscales of COPE and the total score of PGWBI in caregivers revealed that the Avoidance subscale of COPE had a negative significant correlation with the total score of PGWBI (p = 0.003).

CONCLUSIONS

Our results highlighted several critical insights into the profound emotional and psychological challenges faced by the caregivers of individuals with PWS.

Predicting Recovery Pathways in Jewish Ultra-Orthodox Intimate Partner Violence Survivors: A Structural Equation Modeling Approach

Cultural and religious norms, as well as trauma-related cognitions and recovery actions, are known to impact the well-being of survivors of intimate partner violence (IPV). Although acknowledged as a key component, there is scant research on the recovery trajectories of women who have experienced IPV, in particular on survivors from collectivistic societies such as the Jewish Ultra-Orthodox (JUO) community in Israel. A mediation model examined the recovery process of 261 Israeli JUO survivors. In particular, it tested whether the normalization of violence and women's endorsement of Jewish religious norms that justify violence would be directly and negatively associated with women's well-being and positively associated with psychopathology. Additionally, it examined whether women's normalization of violence and support of religious norms would positively predict women's negative trauma-related cognitions. In turn, these cognitions were expected to negatively predict women's engagement in recovery actions, help-seeking behaviors, and faith-based responses but positively predict disengagement responses. The model further posited that women's engagement in steps toward recovery, help-seeking behaviors, and faith-based responses would positively predict women's well-being and negatively predict psychopathology. In contrast, women's disengagement responses would negatively predict women's well-being and positively predict their psychopathology. Bootstrap results indicated that supporting religious norms positively predicted women's trauma-related cognitions, which then negatively predicted women's recovery actions, help-seeking behaviors, and faith-based responses but positively predicted women's disengagement responses. Women's recovery actions and faith-based responses positively predicted women's well-being, while disengagement responses positively predicted women's psychopathology. Contrary to expectations, help-seeking behaviors positively predicted psychopathology.

Caregiver Burden, Parenting Stress and Coping Strategies: The Experience of Parents of Children and Adolescents with Osteogenesis Imperfecta

Only a few studies, mainly qualitative thematic analyses of interviews, have dealt with the psychological experience of parents of children and adolescents with osteogenesis imperfecta (OI), a rare genetic syndrome involving skeletal fragility and increased exposure to bone fractures. The aim of the present study was to evaluate both negative (i.e., parental burden and parenting stress) and positive (i.e., coping strategies and perceived social support) experiences of parents related to their children's disease and behaviour. The participants were 34 parents of children and adolescents with OI who completed a specifically developed online survey assessing their psychological experience with caregiving, their perception of the severity level of their children's condition and any possible behavioural problems experienced by their children. Data analyses showed that 65% of the parents showed a clinical level of caregiver burden and nearly 30% a clinical level of parenting stress. Caregiver burden was related to the perceived severity level of the condition and the externalising problems shown by their children. Concerning the positive aspects of the parents' experience, a high level of perceived social support was connected to a lower level of parenting stress; the same did not happen for caregiver burden. Coping strategies were connected to stress and burden; in particular, a higher level of stress corresponded to a higher level of avoidance, and a higher level of burden corresponded to a higher level of positive attitude.

Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions

OBJECTIVE

Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs.

METHOD

217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs.

RESULTS

: In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs.

CONCLUSIONS

: Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Our Life Is a Rollercoaster! A Qualitative Phenomenological Study Exploring the Impact of IBD on Family Members

BACKGROUND

Inflammatory bowel disease (IBD) significantly impacts patients and their families. To provide support, understanding the effects on the wider family is crucial. However, limited research exists on the impact of IBD on family members of adults diagnosed with IBD. This study addresses this knowledge gap.

METHODS

Underpinned by interpretive phenomenology, this study used in-depth, semi-structured online interviews to explore relatives' experiences. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using reflexive thematic analysis.

RESULTS

Forty-three purposively selected interviewees comprising 17 people with IBD and 26 family members (parents, children, siblings, and partners) revealed 3 main themes: (1) "life is a rollercoaster," (2) "there have been a lot of bridges to cross along the way," and (3) "my life would be better if…" Participants highlighted that IBD has both positive and negative impacts on family members in terms of emotional well-being, relationship, roles and responsibilities, day-to-day burden, and sibling suffering. Some employed adaptive coping strategies such as creating social networks and open communication, while others relied on maladaptive coping strategies, such as avoidance and alcohol abuse. Family members expressed the need for proactive communication, information, and support from healthcare professionals.

CONCLUSIONS

IBD affects the emotional and psychosocial well-being of family members, eliciting both adaptive and maladaptive coping strategies. Healthcare professionals need to adopt a holistic approach to managing IBD that considers the psychosocial and emotional challenges faced by individuals and their families.

Coping Mechanisms during the War in Ukraine: A Cross-Sectional Assessment among Romanian Population

On 24 February 2022, the Russian Federation invaded Ukraine, starting a military conflict that soon turned into a full-scale war. The Romanians have been actively involved in helping their neighbors, causing the accumulation of emotional and mental pressure upon the Romanian population exposed to such a close military conflict. This cross-sectional study assessed, through an online survey (1586 adult Romanian residents), the primary coping mechanisms, quality of life and anxiety levels in response to the psychological trauma associated with the Russo-Ukrainian war. Based on the results, focusing on and venting emotions along with behavioral disengagement were the coping strategies that had the strongest negative impact on anxiety and well-being. On the other hand, positive reinterpretation and growth were associated with less anxiety, a higher degree of overall health and better quality of life. To the best of our knowledge, this study is the first of its kind to be performed among the Romanian population so far. Thus, we equip mental health practitioners with the tools (real-life evidence data) that will allow them to establish a more meaningful doctor-patient relationship, maximizing therapy results.

Stress and coping strategies of families of pediatric solid organ transplant recipients in times of pandemic

Objective

Pediatric solid organ transplantation (SOT) is a chronic condition that impacts the whole family system. The objective of this study is to evaluate psychopathology, family stress, and coping strategies in families of SOT recipients compared to families of healthy children and adolescents. Moreover, it analyzes if the stress related to the COVID-19 pandemic has had an additional impact on these families.

Methods

The sample was recruited between May and July 2021, during the fourth and fifth wave of the pandemic in Spain. It consisted of 102 families, 51 with a pediatric recipient who had undergone a SOT (liver, kidney, heart, or lung) and 51 healthy controls, matched by child age and gender. A primary caregiver from each family answered an online sociodemographic questionnaire and different tests to evaluate family stress, depression, anxiety, coping strategies, and effects of the pandemic on the family.

Results

Caregivers were mostly mothers (89.2%). Families of SOT recipients showed greater anxiety (U = 863.5, p = 0.003) and more total stress, stress related to childcare (t = -2.043; p = 0.045), and parent-child interaction stress (U = 355.5, p = 0.015). SOT families used more avoidance strategies, specifically denial (U = 889.5; p = 0.010) and abandonment of coping efforts (U = 1,013; p = 0.047), more religious strategies (U = 792.5; p = 0.031), and fewer social support coping strategies (t = 2.098; p = 0.038). No differences were found between groups in terms of exposure, impact, and distress more than 1 year after the start of the pandemic.

Conclusion

SOT families showed clinical levels of anxiety, more parent-child interaction stress, more difficulties in taking care of their child, more avoidance and religious strategies, and less use of social support strategies, even 4 years after transplantation. The pandemic did not have an additional differential effect on SOT families. Caregivers of SOT patients can benefit from psychological interventions focused on parents' mental health, parent-child connectedness, skill building, and social support aid groups, with attention to multiculturalism and promoting a better balance between caregivers. There is a need for family interventions that are maintained over time. Strategies that offer this support to families through digital resources can facilitate adjustment to chronic illness, especially in pandemic times.

Coping with COVID-19: the efficacy of disengagement for coping with the chronic stress of a pandemic

BACKGROUND

The COVID-19 pandemic was a novel chronic stressor that necessitated figuring out how to cope with it. We hypothesized that disengagement coping - coping with a stressor by disengaging from it - would be effective because the pandemic featured heightened uncertainty and enduring intensity.

DESIGN

We assessed the disengagement strategies of distraction - taking a break from a stressor - and avoidance - avoiding thoughts and feelings associated with a stressor - and emotional well-being outcomes (positive/negative emotions, stress) in three waves one week apart (305 participants completed all three waves).

RESULTS

Distraction was one of the most frequently endorsed coping strategies. The results of multi-level models and cross-lagged panel models showed that participants who used distraction habitually experienced better emotional well-being overall and that using distraction led to better emotional well-being that week, but did not predict increases in well-being from one week to the next. Those who used avoidance also experienced better emotional well-being that week, but habitual use of avoidance was associated with worse emotional well-being overall.

CONCLUSIONS

These findings suggest that in the midst of chronic stressors like this pandemic, the disengagement coping strategy of distraction is popular and effective for temporarily improving people's well-being.

Positive distraction in daily activities as a predictor of good coping: A "day in the life" during the COVID-19 pandemic

Introduction

The early part of the coronavirus pandemic (COVID-19) was a chronic stressor that led to decreased life satisfaction, increased psychopathology, and decreased social interaction, making it important to study coping strategies that stimulate increases in emotional well-being. Previous research has demonstrated that disengagement coping may be beneficial in scenarios where engagement coping is too difficult or not possible. We hypothesized that disengagement coping would be related to good emotional well-being (high positive emotions and/or perceived control, lower negative emotions and/or stress), with distraction (taking a break from a stressor) related to better emotional well-being than is avoidance (avoiding thoughts and feelings associated with a stressor).

Methods

Using a daily reconstruction method that represents a "day in the life" of people in the United States during the early stages of the COVID-19 pandemic, we assessed people's (N = 329) activities, their intention to distract from or avoid the stressor during these activities, emotions, and thoughts about and motivation to deal with COVID.

Results

Between-subjects' analyses revealed that habitual distraction did not predict any outcomes, while habitual avoidance related to poorer emotional well-being. Within-subject analyses, however, demonstrated that engaging in distraction (and to a smaller extent, avoidance) was associated with better concurrent emotional well-being and less thinking about COVID. Furthermore, the intent to distract/avoid was more reliable in predicting emotional outcomes than was the activity type.

Conclusion

These findings suggest that disengagement from stress can be an adaptive coping behavior during global pandemics and possibly other chronic stressors with similar attributes.

How Caregivers Cope and Adapt When a Family Member Is Diagnosed With a Hematologic Malignancy: Informing Supportive Care Needs

BACKGROUND

Informal family caregivers (FCs) of adults with various diseases including hematologic malignancy (HM) experience low quality of life and psychological well-being. Although HMs are life-threatening cancers associated with high mortality, numerous symptoms, and lengthy hospitalizations and are therefore likely to be challenging for FCs to cope with, there is scant research exploring FC experiences.

OBJECTIVE

The aim of this study was to describe the coping and adaptation of FCs of patients during diagnosis and treatment of HM.

METHODS

This study used a qualitative descriptive design to analyze semi-structured interview responses from FCs (N = 28) within 3 months of the patients' HM diagnosis. A content analysis was conducted to generate common themes.

RESULTS

Family caregivers endorsed adaptive and maladaptive coping. Adaptive strategies included taking one day at a time, spirituality, engaging in pastimes, and utilizing emotional and instrumental family and community support. Maladaptive coping included wishful thinking, harmful habits, avoidance, and lacking or being unable to accept family and community support.

CONCLUSIONS

Findings highlight the complexities of caregiver burden as they support their loved ones with HM.

IMPLICATIONS FOR PRACTICE

Family caregivers would benefit from receiving an interdisciplinary family-centered approach as their HM person is initiating treatment. Nurses should consider assessing the FCs' psychosocial needs to help facilitate appropriate services, such as palliative care consultations, social work referrals, support groups, and/or counseling.