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King TL, Vitaliano PP, Maheen H, Taouk Y. Impact of informal caregiving on depressive symptoms among a national cohort of men. J Epidemiol Community Health 2024; 78:431-436. [PMID: 38583877 DOI: 10.1136/jech-2023-221814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men. METHODS We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations. RESULTS In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses. CONCLUSION These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.
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Affiliation(s)
- Tania L King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter P Vitaliano
- Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Humaira Maheen
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yamna Taouk
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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You J, Qiao J, Dong Y, Vitaliano PP. A Double Whammy? Psychosocial Disadvantages of Dementia Caregivers with Cancer Histories. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:1090-1107. [PMID: 37115196 DOI: 10.1080/01634372.2023.2207392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/19/2023]
Abstract
Guided by the Diathesis-Stress model, this study examined how cancer history interacted with caregiving status to determine the psychosocial functioning of dementia caregivers. This study assessed a set of indicators for psychological health and social connections among 85 spousal caregivers of persons with Alzheimer's disease and 86 age- and gender-matched spouses of healthy controls at study entry and 15-18 months later. Results showed that dementia caregivers with cancer histories reported lower social connections relative to caregivers without cancer histories or non-caregivers with or without cancer histories, and reported lower psychological health relative to non-caregivers with and without cancer histories at two time points. The findings highlight that a history of cancer is a predisposing vulnerability factor for psychosocial dysfunctions among dementia caregivers and address gaps in knowledge about the psychosocial adjustment of cancer survivors as caregivers.
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Affiliation(s)
- Jin You
- Department of Psychology, Wuhan University, Wuhan, China
| | - Jinhui Qiao
- Department of Psychology, Wuhan University, Wuhan, China
| | - Yue Dong
- Centre for Behavioral Economics, Society and Technology, School of Economics and Finance, Queensland University of Technology, Australia
| | - Peter P Vitaliano
- School of Medicine, University of Washington at Seattle, Seattle, Washington, USA
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Hiyoshi A, Rostila M, Fall K, Montgomery S, Grotta A. Caregiving and changes in health-related behaviour. Soc Sci Med 2023; 322:115830. [PMID: 36930838 DOI: 10.1016/j.socscimed.2023.115830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
Potential health risks for informal caregivers have been hypothesised to be partly related to adverse changes in health-related behaviour, but evidence is limited. We examined whether smoking, drinking, eating, physical activity or leisure pursuits change in relation to co-resident or out-of-home caregiving (for someone outside the household), and if associations differ by sex, educational attainment, and welfare state typology. We conducted a longitudinal study using six waves of the Survey of Health, Ageing and Retirement in Europe, collecting data repeatedly from 2004 to 2017 for adults aged 50 years and older living in 17 European countries (57,962 individuals). To control for measured and unmeasured within-individual time-invariant confounders, we used fixed effects logistic models to analyse the repeated measures of caregiving, behaviour and covariates and estimated odds ratios (OR) with 95% confidence intervals (95%CI). Among male participants, unhealthy eating increased while smoking decreased [ORs 1.26 (95%CI 1.01-1.58) and 0.53 (0.36-0.78), respectively] in survey waves in which they provided co-resident care, compared with the waves that they did not. Among female participants, there was little change in behaviour between waves with and without co-resident caregiving. When providing out-of-home care, lacks of physical activity and leisure pursuits declined. But in the same time, drinking increased both men and women, and especially among individuals with lower educational attainment and residing in non-Nordic countries. To conclude, overall, increased drinking when providing out-of-home care was most consistent, especially among individuals with lower educational attainment and residing in non-Nordic countries. Otherwise, the associations varied by the type of care, behaviour and population subgroups. These findings indicated that not all caregivers are susceptible to behavioural changes, and that not all behaviour may be involved similarly in linking caregiving to health risks. This opens possibilities to target specific behaviour and groups to prevent adverse changes in health behaviour in caregivers.
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Affiliation(s)
- Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK; Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
| | - Alessandra Grotta
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
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Hoshino J, Tamakoshi K, Hori Y, Sakakibara H. Relationships Between Care Recipients’ Psychological Symptoms and Family Caregivers’ Depressive States. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211058814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional study aims to clarify the relationship between the number of behavioral and psychological symptoms in long-term care recipients and family caregivers’ depressive states. Participants were 38 family caregivers who had provided care for their relatives for 6 years or more; they were recruited from in-home care settings in Aichi, Gifu, and Shiga Prefectures, Japan. Participants answered a self-administered questionnaire assessing their depressive state using the Japanese version of the Center for Epidemiologic Studies for Depression Scale (CES-D). They also answered questions inquiring about behavioral and psychological symptoms of care recipients, including resistance to care, irritability, and feelings of persecution. Using CES-D scores, 11 participants were categorized as depressed and 27 as non-depressed. Depressive symptoms were significantly greater in those with more behavioral and psychological symptoms, following adjustment for confounding factors. The odds ratio of being in a depressive state was 9.43 higher for those with more than 4 behavioral and psychological symptoms compared to those with none, showing a distinct threshold for the influence of behavioral and psychological symptoms on depressive state. Knowing the number of behavioral and psychological symptoms of care recipients may help quickly identify depressed caregivers and alleviate depressive symptoms.
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Affiliation(s)
- Junko Hoshino
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Koji Tamakoshi
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoko Hori
- Happy-Net Association, Nagoya, Aichi, Japan
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Luchetti M, Terracciano A, Stephan Y, Aschwanden D, Sutin AR. Personality and psychological health in caregivers of older relatives: a case-control study. Aging Ment Health 2021; 25:1692-1700. [PMID: 32347105 PMCID: PMC7606331 DOI: 10.1080/13607863.2020.1758907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Being a caregiver of an older adult is often associated with poor psychological outcomes and stress. Individual differences, such as personality, may moderate responses to caregiving. In this study, we examined (a) personality and psychological health of family caregivers compared to non-caregivers and (b) tested interactions between caregiver status and personality (both domains and facets) in predicting psychological outcomes. METHODS Data were from an online sample of caregivers of older relatives (N = 491; 71.9% females) and matched controls (N = 491). Participants completed the Big Five Inventory-2 and a comprehensive set of psychological health and well-being measures. RESULTS Compared to non-caregivers, caregivers had higher neuroticism, lower energy level (extraversion facet) and higher compassion (agreeableness facet). They also reported higher depression, anxiety, loneliness, and lower well-being and life satisfaction. Personality traits and facets had strong associations with psychological outcomes, and these associations were similar across the two groups. Only a few significant interactions between caregiver status and personality were found: For instance, higher neuroticism (in particular, higher scores on anxiety and depression facets) exacerbated anxiety among caregivers. CONCLUSIONS Personality is a relevant correlate of psychological health. In the context of caregiving, its assessment may help to identify caregivers at risk of poor outcomes and inform intervention programs. Further research is needed to replicate the findings and investigate longitudinal interrelations among variables.
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Affiliation(s)
- Martina Luchetti
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | | | - Damaris Aschwanden
- Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Angelina R Sutin
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
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Iacob CI, Avram E, Cojocaru D, Podina IR. Resilience in Familial Caregivers of Children with Developmental Disabilities: A Meta-analysis. J Autism Dev Disord 2021; 50:4053-4068. [PMID: 32215818 DOI: 10.1007/s10803-020-04473-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this meta-analysis was to investigate factors associated with resilience in familial caregivers of children with developmental disabilities. The protocol was registered in the PROSPERO database, with the registration number CRD42018105180. Several electronic databases were searched for studies. A random-effects meta-analysis was performed on 26 selected studies that associated resilience to an array of other variables (i.e., psychological distress, social support, coping, perceived health, life satisfaction). Overall, the significant pooled effect sizes were small to medium, ranging from r = 0.291 for coping to r = 0.442 for social support. Although the literature on the topic has improved, there is a lot of study heterogeneity and the need for focusing on male caregivers becomes evident.
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Affiliation(s)
- Claudia I Iacob
- Faculty of Psychology and Educational Sciences, University of Bucharest, Panduri Avenue, No. 90, Sector 5, Bucharest, Romania.
| | - Eugen Avram
- Faculty of Psychology and Educational Sciences, University of Bucharest, Panduri Avenue, No. 90, Sector 5, Bucharest, Romania
| | - Daniel Cojocaru
- Faculty of Psychology and Educational Sciences, University of Bucharest, Panduri Avenue, No. 90, Sector 5, Bucharest, Romania
| | - Ioana R Podina
- Faculty of Psychology and Educational Sciences, University of Bucharest, Panduri Avenue, No. 90, Sector 5, Bucharest, Romania
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Miller LM, Utz RL, Supiano K, Lund D, Caserta MS. Health profiles of spouse caregivers: The role of active coping and the risk for developing prolonged grief symptoms. Soc Sci Med 2020; 266:113455. [PMID: 33126099 PMCID: PMC7669721 DOI: 10.1016/j.socscimed.2020.113455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/23/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
STUDY AIMS 1) To characterize distinct profiles of cancer caregivers' physical and mental health during the end-of-life caregiving period; 2) to identify the background and antecedent factors associated with the distinct profiles of caregivers; 3) to determine the relevance of caregiver profiles to the risk for developing prolonged grief symptoms. DESIGN & METHODS This study was a secondary analysis of spouses/partners (n = 198) who participated in the Cancer Caregiver Study. Latent profile mixture modeling was used to characterize caregiver health profiles from data collected prior to their spouse's death. Regression analyses were used to determine the impact of caregiver health profiles on the risk of developing prolonged grief symptoms (PG-13 scale). RESULTS Two health profiles were identified, one of which was comprised of a minority of caregivers (n = 49; 25%) who exhibited higher anxiety and depressive symptoms, greater health impact from caregiving, more self-reported health problems, and greater difficulty meeting physical demands of daily activities. Caregivers who were observed in this poorer health profile had significantly lower levels of active coping (p < 0.001) in adjusted models. Additionally, according to subsequent bereavement data, caregivers' preloss health profile was a significant predictor of developing prolonged grief symptoms (p = 0.018), controlling for caregivers' age (p = 0.040) and amount of active coping (p = 0.049), and there was a mediating effect of caregiver health on the relationship between active coping and prolonged grief symptoms. CONCLUSIONS Caregiving and bereavement should not be considered separately; caregivers adapt to bereavement with the resources and coping attained throughout the life course, culminating in the experience of providing end-of-life care. Interventions aimed at supporting caregivers and bereaved persons should focus on maintaining physical and mental health during stressful life transitions, and especially during the period in which they are providing care to a spouse at end-of-life.
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Affiliation(s)
| | | | | | - Dale Lund
- California State University San Bernardino, Department of Sociology, USA
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8
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Ornstein KA, Wolff JL, Bollens-Lund E, Rahman OK, Kelley AS. Spousal Caregivers Are Caregiving Alone In The Last Years Of Life. Health Aff (Millwood) 2020; 38:964-972. [PMID: 31158025 DOI: 10.1377/hlthaff.2019.00087] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers-that is, the only caregivers (paid or unpaid) who provided assistance with a spouse's self-care or household activities-would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.
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Affiliation(s)
- Katherine A Ornstein
- Katherine A. Ornstein ( ) is an assistant professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, in New York City
| | - Jennifer L Wolff
- Jennifer L. Wolff is a professor of public health at Johns Hopkins University, in Baltimore, Maryland
| | - Evan Bollens-Lund
- Evan Bollens-Lund is an analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Omari-Khalid Rahman
- Omari-Khalid Rahman is an analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Amy S Kelley
- Amy S. Kelley is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
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9
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Subih M, AlBarmawi M, Bashir DY, Jacoub SM, Sayyah NS. Correlation between quality of life of cardiac patients and caregiver burden. PLoS One 2020; 15:e0237099. [PMID: 32745147 PMCID: PMC7398537 DOI: 10.1371/journal.pone.0237099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Caregivers experience high strain related to care giving. There is increasing interest in examining the caregiver burden of cardiac patients and studying the characteristics of caregivers. Purpose To explore the correlation between quality of life cardiac patients and caregiver’s burden. Methods A cross-sectional design using a convenience sample of caregivers and patients with cardiac conditions. Sociodemographic sheet, Dutch Objective Burden Inventory (DOBI), and Quality of Life (QLI-Cardiac 4). Linear regression was used to explore the predictors. Results 200 caregivers and 200 patients with cardiac diseases completed the study. The overall mean scores of both DOBI and QLI-4 indicated moderate results 1.51(SD 0.4), 19.8 (SD 4.7) respectively. Predictors of caregiver burden were young, less educated caregivers and high QoL of cardiac patients. Conclusion Caregivers should receive more support and training from healthcare providers to develop their coping and resilience skills in a way that decreases their care burden and improves their quality of care and self-confidence.
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Affiliation(s)
- Maha Subih
- School of Nursing-Al-Zaytoonah University of Jordan (ZUJ), Amman, Jordan
- * E-mail:
| | - Marwa AlBarmawi
- School of Nursing-Al-Zaytoonah University of Jordan (ZUJ), Amman, Jordan
| | - Dalal Yehia Bashir
- School of Nursing-Al-Zaytoonah University of Jordan (ZUJ), Amman, Jordan
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Rosato M, Tseliou F, Wright DM, Maguire A, O’Reilly D. Are volunteering and caregiving associated with suicide risk? A Census-based longitudinal study. BMC Psychiatry 2019; 19:296. [PMID: 31601191 PMCID: PMC6788116 DOI: 10.1186/s12888-019-2255-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/22/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Opposing risks have been identified between different prosocial activities, with volunteering having been linked to better mental health while caregiving has been associated with higher prevalence and incidence of depression. This study explored suicide risk of people engaged in prosocial activities of caregiving and/or volunteering. METHODS A Census-based record linkage study of 1,018,000 people aged 25-74 years (130,816 caregivers; 110,467 volunteers; and 42,099 engaged in both) was undertaken. Caregiving (light: 1-19; intense: ≥20 h/week), volunteering and mental health status were derived from 2011 Census records. Suicide risk (45 months follow-up) was assessed using Cox models adjusted for baseline mental health. RESULTS Intense caregiving was associated with worse mental health (ORadj = 1.15: 95%CI = 1.12, 1.18) and volunteering with better mental health (OR = 0.87: 95%CI = 0.84, 0.89). For those engaged in both activities, likelihood of poor mental health was determined by caregiving level. There were 528 suicides during follow-up, with those engaged in both activities having the lowest risk of suicide (HR = 0.34: 95%CI = 0.14, 0.84). Engaging in either volunteering or caregiving was associated with lower suicide risk for those with good mental health at baseline (HR = 0.66: 95%CI = 0.49, 0.88) but not for their peers with baseline poor mental health (HR = 1.02: 95%CI = 0.69, 1.51). CONCLUSIONS Although an increased risk of poor mental health was identified amongst caregivers, there was no evidence of an increased risk of suicide.
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Affiliation(s)
- Michael Rosato
- 0000000105519715grid.12641.30Bamford Centre for Mental Health and Wellbeing, Ulster University, Cromore Road, Coleraine, BT52 1SA Londonderry, Northern Ireland
| | - Foteini Tseliou
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Institute of Clinical, Sciences, Block B, Queen's University Belfast, Belfast, BT12 6BA, Northern Ireland.
| | - David M. Wright
- 0000 0004 0374 7521grid.4777.3Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Institute of Clinical, Sciences, Block B, Queen’s University Belfast, Belfast, BT12 6BA Northern Ireland
| | - Aideen Maguire
- 0000 0004 0374 7521grid.4777.3Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Institute of Clinical, Sciences, Block B, Queen’s University Belfast, Belfast, BT12 6BA Northern Ireland
| | - Dermot O’Reilly
- 0000 0004 0374 7521grid.4777.3Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Institute of Clinical, Sciences, Block B, Queen’s University Belfast, Belfast, BT12 6BA Northern Ireland
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Chiao C, Chen YY. Is caregiving by baby boomer women related to the presence of depressive symptoms? Evidence from eight national surveys. BMC WOMENS HEALTH 2018; 18:203. [PMID: 30567543 PMCID: PMC6299930 DOI: 10.1186/s12905-018-0696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A common hypothesis is that caregiving is deleterious to women's mental health. International studies continue to emphasize the importance of mental health issues for women. Yet only a few researchers have used population-based surveys to explore the association between caregiving and depressive symptomatology in the context of the community, and even less is known about this aspect of Baby Boomer women in a global context. METHODS The present study uses eight international surveys covering nineteen nations (N = 15,100) and uses multilevel logistic models to examine possible linkages between caregiving and the likelihood of depressive symptoms among Baby Boomer women, when taking individual-level and country-level social factors into consideration. RESULTS The various analyses found a significant variation in the likelihood of depressive symptoms among these Boomer women across the nations investigated and across both individual-level and country-level characteristics. The significant association of caregiving by women and the likelihood of depressive symptoms is related to their social status in some nations (OR = 1.30; p < 0.001). Boomer women living in countries with high rates of female participation in managerial/professional work (OR = 1.04; p < 0.05) and living in countries where women are often in vulnerable employment (OR = 1.01; p < 0.05) are at greater risk of depressive symptomatology. CONCLUSIONS These findings demonstrate that the depressive consequences of caregiving by women are, to some degree, contingent upon social context and structure. Policies aimed at promoting mental health among female Baby Boomers should therefore be context specific.
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Affiliation(s)
- Chi Chiao
- Institute of Health and Welfare Policy and Institute of Public Health, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., 112, Taipei, Taiwan, Republic of China.
| | - Yun-Yu Chen
- Institute of Health and Welfare Policy and Institute of Public Health, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., 112, Taipei, Taiwan, Republic of China
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12
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Ma M, Dorstyn D, Ward L, Prentice S. Alzheimers' disease and caregiving: a meta-analytic review comparing the mental health of primary carers to controls. Aging Ment Health 2018; 22:1395-1405. [PMID: 28871796 DOI: 10.1080/13607863.2017.1370689] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To quantitatively review the literature comparing depressed mood, anxiety and psychological distress in caregivers (CGs) of older adults with Alzheimer's disease (AD) with non-caregivers (NCGs) Methods: Eighteen independent studies comparing AD CGs (N = 2378) with NCGs (N = 70,035) were evaluated in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Standardised mean differences (Hedges' g) with associated 95% confidence intervals and p-values were calculated using a random-effects model. RESULTS Studies generally conformed to STROBE criteria in terms of their methodological and procedural detail, although data management issues that may contribute to methodological bias were identified. Pooled effect estimates revealed medium to large group differences in depression (gw = 1.01 [CI: 0.73, 1.29] p < 0.01) and anxiety (gw = 0.64 [CI: 0.39, 0.89] p < 0.01): AD caregivers reported higher symptom severity. Gender was a significant moderator: female caregivers experienced poor self-reported mood (gw = 1.58 [CI: 1.11, 2.05], p < 0.01), although this analysis was limited in power given the small number of contributing studies. DISCUSSION Caregivers of patients with AD experience poor mental health in comparison to the general population, with female caregivers being disproportionately affected. Further exploration of the psychosocial variables that contribute to these group differences is needed to inform effective support services and, in turn, help caregivers manage the emotional demands of AD.
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Affiliation(s)
- Mandy Ma
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
| | - Diana Dorstyn
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
| | - Lynn Ward
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
| | - Shaun Prentice
- a Faculty of Health and Medical Sciences, School of Psychology , University of Adelaide , Adelaide , Australia
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Wolf DA, Middleton FA. A role for genes in the 'caregiver stress process'? Transl Psychiatry 2018; 8:228. [PMID: 30348966 PMCID: PMC6197190 DOI: 10.1038/s41398-018-0275-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 06/21/2018] [Accepted: 07/31/2018] [Indexed: 12/01/2022] Open
Abstract
The stress that accompanies caring for one's parent, and the contribution of that stress to adverse physical and mental-health outcomes, is extensively studied and widely acknowledged. Yet there has been almost no attempt to incorporate the well-documented role of genetic variation in psychological distress into research on caregiving. We use phenotypic data from a large, population-based sample linked to extensive genotype data to develop a polygenic risk score (PRS) for depression, and test for both direct and interactive effects of the PRS in a multilevel repeat-measures model of caregiver-related stress. We distinguish three groups: potential caregivers (those with a living parent who does not need care), noncaregivers (those who do not provide care to their parent that needs care), and caregivers. We also obtain separate estimates according to the gender of both the parent and child. We found that a parent's need for care, and the child's provision of care, are associated with depression in some but not all cases; in contrast the PRS was significantly associated with the risk for increased depressive symptoms (with P ≤ 0.01) in all cases. These findings support an additive genetic contribution to the diathesis-stress model of depression in the context of caregiving.
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Affiliation(s)
- Douglas A. Wolf
- 0000 0001 2189 1568grid.264484.8Aging Studies Institute, Syracuse University, Syracuse, NY USA
| | - Frank A. Middleton
- 0000 0000 9159 4457grid.411023.5Department of Neuroscience & Physiology, SUNY Upstate Medical University, Syracuse, NY USA ,0000 0000 9159 4457grid.411023.5Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY USA ,0000 0000 9159 4457grid.411023.5Department of Biochemistry & Molecular Biology, SUNY Upstate Medical University, Syracuse, NY USA
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14
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Abstract
AbstractPopulation ageing and the global burden of dementia pose a major challenge for human societies and a priority for public health. Cognitive enhancement,i.e.the targeted amplification of core cognitive abilities, is raising increasing attention among researchers as an effective strategy to complement traditional therapeutic and assistive approaches, and reduce the impact of age-related cognitive disability. In this paper, we discuss the possible applicability of cognitive enhancement for public health purposes to mitigate the burden of population ageing and dementia. After discussing the promises and challenges associated with enhancing ageing citizens and people with cognitive disabilities, we argue that global societies have a moral obligation to consider the careful use of cognitive enhancement technologies as a possible strategy to improve individual and public health. In addition, we address a few primary normative issues and possible objections that could arise from the implementation of public health-oriented cognitive enhancement technologies.
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15
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Bidwell JT, Lyons KS, Mudd JO, Grady KL, Gelow JM, Hiatt SO, Chien CV, Lee CS. Patient and Caregiver Determinants of Patient Quality of Life and Caregiver Strain in Left Ventricular Assist Device Therapy. J Am Heart Assoc 2018; 7:e008080. [PMID: 29514804 PMCID: PMC5907562 DOI: 10.1161/jaha.117.008080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although current guidelines emphasize the importance of social support to the success of left ventricular assist device (LVAD) therapy, few studies examine the influence of the caregiver on patient outcomes or quantify the impact of LVAD caregiving on caregiver outcomes. The purpose of this analysis was to identify patient and caregiver determinants of patient quality of life (QOL) and caregiver strain in response to LVAD therapy. METHODS AND RESULTS Data on patients receiving LVAD therapy and their caregivers (n=50 dyads) were prospectively collected pre-implantation and 1, 3, and 6 months post-implantation. Growth curve modeling was used to describe change in patient QOL (Kansas City Cardiomyopathy Questionnaire) and caregiver strain (Multidimensional Caregiver Strain Index). Patient QOL improved most in the first month (β=23.22±3.76, P<0.001), followed by gradual gains over 6 months (β=1.90±0.64, P<0.01). Caregivers experienced worsening of strain in the first month (β=4.30±1.42, P<0.01), followed by gradual resolution to pre-implantation levels by 6 months (β=-0.71±0.23, P<0.01). Worse pre-implantation patient symptoms were associated with greater improvement in patient QOL (β=0.53±0.19, P<0.01) but worsening caregiver strain (β=0.15±0.07, P=0.04). Better relationship quality was associated with greater improvement in patient QOL (β=14.39±5.85, P=0.01) and less pre-implantation caregiver strain (β=-9.31±2.28, P<0.001). Nonspousal caregivers experienced less pre-implantation strain (β=-8.60±3.10, P=0.01), and patients with nonspousal caregivers had less improvement in QOL (β=-3.70±1.62, P=0.02). CONCLUSIONS A combination of patient and caregiver characteristics predicts patient and caregiver response to LVAD therapy. Including caregiver factors in future studies may be helpful in developing interventions that improve patient and caregiver outcomes, together.
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Affiliation(s)
- Julie T Bidwell
- Oregon Health and Science University School of Nursing, Portland, OR
| | - Karen S Lyons
- Oregon Health and Science University School of Nursing, Portland, OR
| | - James O Mudd
- Oregon Health and Science University Knight Cardiovascular Institute, Portland, OR
| | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jill M Gelow
- Oregon Health and Science University Knight Cardiovascular Institute, Portland, OR
| | - Shirin O Hiatt
- Oregon Health and Science University School of Nursing, Portland, OR
| | | | - Christopher S Lee
- Oregon Health and Science University School of Nursing, Portland, OR
- Oregon Health and Science University Knight Cardiovascular Institute, Portland, OR
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16
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Rosas-Santiago FJ, Marván ML, Lagunes-Córdoba R. Adaptation of a scale to measure coping strategies in informal primary caregivers of psychiatric patients. J Psychiatr Ment Health Nurs 2017; 24:563-569. [PMID: 28544130 DOI: 10.1111/jpm.12403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 12/26/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
- F J Rosas-Santiago
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, México
| | - M L Marván
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, México
| | - R Lagunes-Córdoba
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, México
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17
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Maguire A, Rosato M, O'Reilly D. Mental health and morbidity of caregivers and co-residents of individuals with dementia: a quasi-experimental design. Int J Geriatr Psychiatry 2017; 32:1104-1113. [PMID: 27594205 DOI: 10.1002/gps.4573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine if providing informal care to a co-resident with dementia symptoms places an additional risk on the likelihood of poor mental health or mortality compared with co-resident non-caregivers. DESIGN A quasi-experimental design of caregiving and non-caregiving co-residents of individuals with dementia symptoms provides a natural comparator for the additive effects of caregiving on top of living with an individual with dementia symptoms. METHODS Census records, providing information on household structure, intensity of caregiving, presence of dementia symptoms and self-reported mental health were linked to mortality records over the following 33 months. Multi-level regression models were constructed to determine the risk of poor mental health and death in co-resident caregivers of individuals with dementia symptoms compared with co-resident non-caregivers, adjusting for the clustering of individuals within households. RESULTS The cohort consisted of 10 982 co-residents (55.1% caregivers), with 12.1% of non-caregivers reporting poor mental health compared with 8.4% of intense caregivers (>20 h of care per week). During follow-up, the cohort experienced 560 deaths (245 to caregivers). Overall, caregiving co-residents were at no greater risk of poor mental health but had lower mortality risk than non-caregiving co-residents (adjusted odds ratio (ORadj) = 0.93, 95% confidence interval (CI) 0.79, 1.10 and ORadj = 0.67, 95% CI 0.56, 0.81, respectively); this lower mortality risk was also seen amongst the most intensive caregivers (ORadj = 0.65, 95% CI 0.53, 0.79). CONCLUSION Caregiving poses no additional risk to mental health over and above the risk associated with merely living with someone with dementia and is associated with a lower mortality risk compared with non-caregiving co-residents. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Aideen Maguire
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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18
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Irfan B, Irfan O, Ansari A, Qidwai W, Nanji K. Impact of Caregiving on Various Aspects of the Lives of Caregivers. Cureus 2017; 9:e1213. [PMID: 28589062 PMCID: PMC5453737 DOI: 10.7759/cureus.1213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective This study was designed to assess the impact of caregiving on the lives of the caregivers. Methods A cross-sectional study was conducted between July and September 2015 at a teaching hospital in Karachi, Pakistan. Participants who were more than 18 years old and were involved in caregiving (former or current) of a family member were invited to participate in the study. The participants were recruited through consecutive sampling technique. A total of 400 caregivers were interviewed. Written informed consent was obtained from all the participants. A pretest structured questionnaire was used for data collection and included sections on demographic details and impact of caregiving on various aspects of the lives of caregivers. The data was analyzed using SPSS version 19 (IBM, NY, USA). Results Information about a total of 400 caregivers (215 men and 185 women) was included in the final analysis. The majority (57.0%) of the participants were aged between 18 and 30 years. About three-fifths (60%) of the participants were single and the majority of the participants were students. Approximately 64% of the participants were currently involved in caregiving and about 48% of the participants responded that caregiving has an overall negative impact on various aspects, such as physical (40.8%), psychological (47.8%), and professional aspects (51.8%) of their lives. Conclusion Negative impact of caregiving was observed among caregivers due to extensive demands of caregiving and limited resources. Therefore, it is imperative for health care providers to explore, identify and support caregivers to cope in a better way to the challenging task of caregiving.
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Affiliation(s)
- Babar Irfan
- Medicine, Jinnah Sindh Medical University (SMC)
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19
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O'Reilly D, Rosato M, Maguire A. Caregiving reduces mortality risk for most caregivers: a census-based record linkage study. Int J Epidemiol 2016; 44:1959-69. [PMID: 26371207 DOI: 10.1093/ije/dyv172] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Dermot O'Reilly
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland.
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Burden and Depression among Caregivers of Visually Impaired Patients in a Canadian Population. Adv Med 2016; 2016:4683427. [PMID: 27051859 PMCID: PMC4802024 DOI: 10.1155/2016/4683427] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/24/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose/Background. This study reports the degree of burden and the proportion at risk for depression among individuals who provide care to visually impaired patients. Study Design. This is clinic-based, cross-sectional survey in a tertiary care hospital. Methods. Caregivers were considered unpaid family members for patients whose sole impairment was visual. Patients were stratified by vision in their better seeing eye into two groups: Group 1 had visual acuity between 6/18 and 6/60 and Group 2 were those who had 6/60 or worse. Burden was evaluated by the Burden Index of Caregivers and the prevalence of being at risk for depression was determined by the Center for Epidemiologic Studies Depression scale. Results. 236 caregivers of 236 patients were included. Total mean BIC scores were higher in Group 2. Female caregivers, caregivers providing greater hours of care, and caregivers of patients who have not completed vision rehabilitation programs are at higher risk for depression.
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Dassel KB, Carr DC, Vitaliano P. Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study. THE GERONTOLOGIST 2015; 57:319-328. [DOI: 10.1093/geront/gnv148] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/17/2015] [Indexed: 11/12/2022] Open
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Litzelman K, Witt WP, Gangnon RE, Nieto FJ, Engelman CD, Mailick MR, Skinner HG. Association between informal caregiving and cellular aging in the survey of the health of wisconsin: the role of caregiving characteristics, stress, and strain. Am J Epidemiol 2014; 179:1340-52. [PMID: 24780842 DOI: 10.1093/aje/kwu066] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The pathophysiological consequences of caregiving have not been fully elucidated. We evaluated how caregiving, stress, and caregiver strain were associated with shorter relative telomere length (RTL), a marker of cellular aging. Caregivers (n = 240) and some noncaregivers (n = 98) in the 2008-2010 Survey of the Health of Wisconsin, comprising a representative sample of Wisconsin adults aged 21-74 years, reported their sociodemographic, health, and psychological characteristics. RTL was assayed from blood or saliva samples. Median T and S values were used to determine the telomere-to-single copy gene ratio (T/S) for each sample, and log(T/S) was used as the dependent variable in analyses. Multivariable generalized additive models showed that RTL did not differ between caregivers and noncaregivers (difference in log(T/S) = -0.03; P > 0.05), but moderate-to-high levels of stress versus low stress were associated with longer RTL (difference = 0.15; P = 0.04). Among caregivers, more hours per week of care, caring for a young person, and greater strain were associated with shorter RTL (P < 0.05). Caregivers with discordant levels of stress and strain (i.e., low perceived stress/high strain) compared with low stress/low strain had the shortest RTL (difference = -0.24; P = 0.02, Pinteraction = 0.13), corresponding to approximately 10-15 additional years of aging. Caregivers with these characteristics may be at increased risk for accelerated aging. Future work is necessary to better elucidate these relationships and develop interventions to improve the long-term health and well-being of caregivers.
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