Social support and caregiving circumstances as predictors of caregiver burden in Taiwan

The Impact of Caregiving on Informal Caregivers of People with Dementia: Family Functioning, Burden, and Burnout

Caregiving is a complex occupation, with a significant impact for informal caregivers (IC). Stress-process models propose a framework that considers that this impact depends on primary and secondary stressors, but also on the IC situation appraisal. This work aimed to verify: whether being, or not, an IC of an individual with dementia influenced the relationship between family functioning and burnout; the association between neuropsychiatric symptoms of the individual with dementia and IC burnout and whether the IC burden and perceived family functioning had a mediating role in such relationship. This cross-sectional study investigated differences in family functioning and its association with burnout between IC and non-IC. For IC specifically, the study examined a mediation model to explore the possibility of neuropsychiatric symptoms indirectly affecting IC burnout through the impact on family functioning and burden. Measures included the Copenhagen Burnout Inventory, the McMaster Family Assessment Device, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Results showed an association between poorer family function and high burnout, specifically in IC. They also showed that burden mediated the relationship between neuropsychiatric symptoms and burnout. The findings offer a significant contribution to the growing knowledge about the relationship between stressors associated with informal caregiving in dementia context, such as neuropsychiatric symptoms and its outcomes, like burnout.

The relationship between family resilience, post-traumatic growth, and caregiver burden among family caregivers of stroke survivors: a cross-sectional study

The study aimed to explore the relationship between family resilience, post-traumatic growth(PTG), and caregiver burden among family caregivers of stroke survivors. Researchers conducted a cross-sectional study to recruit 253 family caregivers of stroke survivors from a public hospital in Shandong Province, China. Caregivers completed sociodemographic information, the Shortened Chinese Version of the Family Resilience Assessment Scale, the Post-traumatic Growth Inventory, and the Zarit Caregiver Burden Interview. We used Amos 24.0 to construct structural equation models and examine the mediating effects of stroke survivors' post-traumatic growth. Family resilience was positively associated with post-traumatic growth, and both family resilience and post-traumatic growth were negatively associated with caregiver burden. Post-traumatic growth partially mediated the relationship between family resilience and caregiver burden, and the mediating effect accounted for 21.27% of the total effect. Targeted interventions should address family resilience and post-traumatic growth as protective factors of caregiver burden.

The Magnitude of Care Burden and Associated Factors in Caregivers of Children with Cancer at the Country's Largest Tertiary Referral Hospital, Ethiopia: A Cross-Sectional Study

Objectives. Many caregivers who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. This study aimed to determine the burden of care level and its related factors in the caregivers of children with cancer. Methods. A facility-based, cross-sectional study was conducted at Tikur Anbessa Specialized Hospital. Children diagnosed with cancer and treated at the hospital between July 1 and August 1, 2023, and their caregivers were included. The data were analyzed using SPSS version 25. Descriptive analysis and inferential statistics were used to summarize the data and to determine the association with the dependent variable. Statistical significance was set at P < .05. Results. A total of 208 children with cancer and their caregivers were included in the study. Most children (81, 38.9%) were below 5 years of age, and 80.3% (n = 167) of the patients came from out of Addis Ababa. The most common type of childhood cancer was haemato-lymphoid cancer (n = 117, 56.3%). The mean duration of cancer care after diagnosis was 289.55 days. The median age of caregivers was 35 ± 8.7 years, most of the caregivers were parents of the child (n = 185, 88.9%), married (n = 186, 87%), had a primary level education (n = 66, 31.7), and 87.5% (n = 182) had insufficient income for the cancer treatment cost. The average caring time was 19 to 24 hours for 76.4% (n = 159) of caregivers, and more than one-fourth of caregivers (n = 57, 27.4%) intended to abandon treatment if they couldn't get support to continue the care. The mean care burden in caregivers was 65.76 ± 14 and about, 53.4% (n = 111) and 35.1% (n = 73) of caregivers had moderate and severe care burden. Binary logistic analysis showed the factors associated with an increased care burden were the caregiver's occupational status (P = .034, 95 % CI; AOR (0.064, 0.890)), lack of support from NGOs (P = .037, 95 % CI; AOR (1.053, 5.254), and insufficient monthly income for the treatment (P = .034; 95% CI; AOR (0.064, 0.896)). Conclusion. Most of the caregivers of children with cancer were parents and had insufficient income for the treatment. More than one-fourth had an intention to abandon the cancer treatment. Most caregivers had moderate to severe care burdens.

Caregiver Employees' Mental Well-Being in Hong Kong

BACKGROUND

The rapidly aging global population has increased the demand for caregivers. Many caregivers simultaneously engage in paid employment, and the dual role makes the needs of caregiver employees conceivably more remarkable. However, there is a gap in the literature about the specific needs of caregiver employees.

METHOD

Caregiver employees (n = 1205) across Hong Kong caring for those ≥65 years were recruited for a cross-sectional face-to-face survey from December 2021 to January 2022, to evaluate mental well-being measured by the Short Warwick -Edinburgh Mental Well-being Scale. Univariate and multivariate analyses were conducted; significant variables (p < 0.05) were included in multiple linear regression, along with caregiver-friendly workplace policies' availability, to understand their association with their mental well-being.

FINDINGS

The mean score of the Short Warwick-Edinburgh Mental Well-being Scale among caregiver employees in this study was 24.9, with 7.2% indicative of probable clinical depression and 10.0% possible mild depression. In addition, the current study showed that 30.2% of the caregiver employees felt distressed about the caregiving role. Among external factors, family support (measured by the Lubben Social Network Scale) and workplace culture (measured by the Marshall Supervision Subscale) positively correlated with mental well-being with regression coefficients of 0.252 (p < 0.001) and 0.482 (p < 0.001), respectively. In the fully adjusted model, a negative regression coefficient was observed for overall spillover (-0.050, p < 0.001) and Short Warwick-Edinburgh Mental Well-being Scale scores, while positive regression coefficients were observed for overall self-rate (0.041, p < 0.001), Lubben (0.124, p < 0.001), and corporate culture (0.365, p < 0.001). Better Short Warwick-Edinburgh Mental Well-being Scale scores were observed when caregiver-friendly workplace policies were clearly stated than when they were made on a case-by-case discretionary basis.

CONCLUSIONS

Caregiver-friendly workplace policies may be critical to Hong Kong's sustainable future, both economically and socially, as they ensure a healthy and productive workforce to support an aging population.

Burden of Wilson Disease among patients and care partners in the United States: results from a cross-sectional survey

OBJECTIVE

This study assessed the burden of Wilson Disease (WD) among patients and care partners (WD-CPs) in the US and compared it to a US general population of adults (GPs) and care partners (GP-CPs).

METHODS

This cross-sectional, self-reported survey included patients with WD and WD-CPs aged ≥18 years recruited through the Wilson Disease Association (WDA), while data for GPs and GP-CPs were obtained from the 2022 National Health and Wellness Survey. GPs and GP-CPs were propensity score matched (3:1) with WD patients and WD-CPs for demographics and health characteristics. Bivariate analysis evaluated differences in comorbidity burden and health-related outcomes of the WD cohorts compared to matched GP cohorts.

RESULTS

Thirty-seven patients with WD and 53 WD-CPs completed the survey. Most patients reported some treatment burden (73.3%), experienced sleep problems (60%), and visited a healthcare provider (HCP) in the past 6 months (91.9%). Compared with matched GPs, patients with WD had a significantly higher mortality risk (p < .001) and reported greater rates of chronic liver disease, cirrhosis (both, p < .001), migraines (p = .032), non-alcoholic steatohepatitis (p = .004), sleep problems (p = .009) and HCP visits (p = .002). Most WD-CPs (75.5%) reported high burden of caring (mean ZBI-12 score, 26.5) and more negative impact on esteem than GP-CPs.

CONCLUSION

This study highlights the burden of WD experienced by patients and WD-CPs, with patients experiencing high treatment burden, comorbidity burden and healthcare resource utilization, and WD-CPs experiencing high impact of caring, including impact on employment and self-esteem.

Experience of Caregivers for Older Adults in Rural Ethiopia: Challenges and Available Social Support for Family Caregivers in Co-Residential Living Arrangement

Family and kinship care is a common way of caring for older adults, particularly in rural Ethiopia, where institutional care arrangements are nonexistent. Moreover, the majority of studies on family caregivers of older adults were conducted in western cultures, which makes it difficult to understand family caregivers in the Ethiopian context. This study aims at exploring the experience of family caregivers for older adults in a co-residential setting. Specifically, it focuses on answering caregiving challenges and available social supports for family caregivers in a co-residential living arrangement. This study used a qualitative research method employing phenomenology to understand the lived experience of family caregivers for older adults in rural northwestern Ethiopia. Data were collected through a semi-structured interview with eight purposefully selected family caregivers of rural older adults. Regarding family caregivers's challenges and available social supports, four themes emerged from the collected data. These are economic challenges, the incongruence of older adult needs and caregiving capacity, work-caregiving conflict, work-social life conflict, and the presence of social support from different individuals and community-based institutions. In addition to strengthening caregiver support environments, it's critical to develop the capacity of family caregivers through training, economic support, and the integration of family caregivers with health extension workers.

Beyond the illness: a qualitative exploration of the burden of caring for people with tuberculosis on caregivers and their households in South Africa

Tuberculosis (TB) affects not only the person sick with TB but also their households. Our study aimed for a deeper understanding of the multiplicative impact of TB on households, and more specifically on caregivers of people with TB, as well as factors that influence the burden on caregivers in South Africa. We conducted an exploratory qualitative study focusing on the lived experiences of people providing care to a family member sick with TB. The study found that the burden of caregiving is significant and falls disproportionally on women and poorer households whose resilience has already been compromised by pre-existing multiple stressors and demands, contributing to health inequities and gender inequalities. Having to care for a household member sick with TB imposed an additional strain causing further health, financial and social problems, leaving the household in a worse-off position, and at a higher risk of continued ill health and further poverty. Social support was found to mediate the burden, however, was lacking for many as kinship bonds are weakened by high levels of poverty and unemployment. Support to households is recommended to ensure recovery of the person with TB and their household post-TB illness, and prevent further ill health and poverty.

Caring load and family caregivers' burden in China: the mediating effects of social support and social exclusion

Objective

Caring for older adults with disabilities is a source of stress for family caregivers, and the lack of social support and the pressure of social exclusion might aggravate family caregiver burden. This study aimed to examine the association between caring load and family caregivers' burden, as well as the mediating effects of social support and social exclusion.

Methods

Data used in this study was derived from the nationally representative database of the aged population in China, and 3,125 households with disabled old adults and their home-bound caregivers were eventually selected for this analysis. Regression methods and mediation analysis methods were employed in this study.

Results

The results indicated that there was a significant positive association between caring load and the caregiver burden, and specifically, social support intensity (rather than social support breadth) and passive social exclusion (rather than active social exclusion) played partial mediating effects. Furthermore, the contributions of mediating effects of social support intensity and passive social exclusion were 13-15 and 27-29%, respectively, and the total contribution of mediating effects was about 35-38%.

Conclusion

Family caregivers' burden should be paid more attention to in the large population with rapidly aging speed like China, and more guidance services as well as support should be provided to family caregivers. In addition, it is crucial to focus on the community's social support and social exclusion in public policy innovation.

Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

The relationship between dyspnea-related kinesiophobia and physical activity in people with COPD: Cross-sectional survey and mediated moderation analysis

BACKGROUND

Changing the behavior of physical activity (PA) in COPD patients remains a challenge, because this population faces the same barriers to PA as the general population, as well as disease-specific barriers, especially dyspnea-related kinesiophobia.

OBJECTIVES

This study aimed to assess the status of dyspnea-related kinesiophobia in people with COPD, and investigate its impact on PA levels, further examine the mediated moderation effects of exercise perception and social support on this relationship.

METHODS

A cross-sectional survey was conducted with COPD patients recruited from four tertiary hospitals in Jinan Province, China. We used Breathlessness Beliefs Questionnaire to identify dyspnea-related kinesiophobia. International Physical Activity Questionnaire-short-form, Exercise Benefits/Barriers Scale, and Social Support Rating Scale were used to assess PA, exercise perception and social support, respectively. The data were statistically processed using correlation analysis and a test of mediated moderation model.

RESULTS

A total of 223 COPD patients were included, and all of them had a symptom of dyspnea-related kinesiophobia. Dyspnea-related kinesiophobia was negatively correlated with exercise perception, subjective social support and PA. Exercise perception partially mediated the impact of dyspnea-related kinesiophobia on PA levels, and subjective social support indirectly influences PA by moderating the relationship between dyspnea-related kinesiophobia and exercise perception.

CONCLUSIONS

People with COPD commonly have dyspnea-related kinesiophobia and experienced physical inactivity. The mediated moderation model provides a better understanding of how dyspnea-related kinesiophobia, exercise perception, and subjective social support work together to influence PA. Interventions seeking to improve the levels of PA in COPD patients should consider these elements.

Family function, self-efficacy, care hours per day, closeness and benefit finding among stroke caregivers in China: A moderated mediation model

AIMS AND OBJECTIVES

The aim of this study was to explore the moderated mediation mechanism of the relationships among family function, self-efficacy, care hours per day, closeness and benefit finding in family caregivers of patients with stroke in China.

BACKGROUND

Benefit finding can provide a new means of resolving depression among family members caring for an ill loved one. However, current research has paid little attention to the benefit finding of family caregivers of stroke patients in China.

DESIGN

A cross-sectional study.

METHODS

Three hundred fifty family caregivers of patients with stroke were recruited from community service centres and hospitals in Zhengzhou, China. The participants completed the family APGAR index, caregiver benefit finding scale and Chinese general self-efficacy scale during a study conducted in 2017. Descriptive analyses and a moderated mediation model were computed. Reporting adhered to the STROBE checklist.

RESULTS

A total of 311 family caregivers completed this study. Closeness between family caregivers and patients with stroke moderated the relationship between family function and caregiver benefit finding. Self-efficacy partially mediated the relationship between family function and caregiver benefit finding; moreover, care hours per day moderated the mediation.

CONCLUSION

This study shows important factors associated with benefit finding in family caregivers of patients with stroke. This indicates elements that could help improve benefit finding intervention programmes for family caregivers of patients with stroke.

RELEVANCE TO CLINICAL PRACTICE

The findings in our study provide valuable information on benefit finding and indicate some interventions to improve the mental health of family caregivers of stroke patients.

Burdens on caregivers of patients with stroke during a pandemic: relationships with support satisfaction, psychological distress, and fear of COVID-19

BACKGROUND

Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic.

METHODS

A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden.

RESULTS

The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19.

CONCLUSIONS

Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.

A cluster analysis to explore the burden of primary caregivers of children with cancer in Oman

PURPOSE

Few studies have sought to evaluate the risk burden of primary caregivers, particularly in Oman. This study aimed to explore whether different risk patterns of caregiver burden exist among the primary caregivers of Omani children with leukemia.

DESIGN AND METHODS

A cross-sectional study was conducted between May and November 2020. A total of 101 primary caregivers of children with leukemia were recruited from a public hospital in Oman. The Caregiver Burden Inventory (CBI) was used to assess caregiver burden.

RESULTS

A two-step cluster analysis indicated that the cohort was not homogeneous (silhouette value: 1.41). Caregivers in Cluster 1 (n = 42; 41.6%) were relatively older, less educated, and had a higher caregiving burden (mean CBI score: 37.7 ± 19.9). In contrast, caregivers in Cluster 2 (n = 59; 58.4%) were younger, more highly educated, and had a moderate caregiving burden (mean CBI score: 26.3 ± 13.6). As such, Clusters 1 and 2 were characterized as the "high-risk" and "moderate-risk" burden groups, respectively.

PRACTICE IMPLICATIONS

This study highlights the need for a policy draft to target and reduce the caregiver burden in Oman, Nursing professionals should seek to develop and implement customized care depending on the caregiver risk burden, including additional financial, psychological, and physical support. They should seek to stratify caregivers by risk burden as some groups may require additional support. However, in light of recent precautionary measures due to the current pandemic situation, such services will have to be provided online or via telephone instead of in person for the foreseeable future.

Caregiving-related experiences associated with depression severity and its symptomatology among caregivers of individuals with a severe mental disorder: an online cross-sectional study

Caring for a relative with a severe mental disorder puts family caregivers to a great risk of depression. While overall caregiving burden is a strong predictor of depression, the contribution of the various dimensions of burden to caregivers' depression as well as their relationships with depressive symptoms has received little attention. 384 family caregivers completed a cross-sectional online survey including the Center for Epidemiological Studies Depression (CES-D) scale, the Zarit Burden Interview (ZBI), and the Brief Experience of Caregiving Inventory (BECI), measuring caregiving burden and experience. We estimated the structure of the relationships between caregiving experiences (i.e., ZBI and BECI subscales) and CES-D symptoms using a network approach. Negative Emotion/Consequences, (lack of) Positive Personal Experience, and Stigma/Effects on Family were the most connected caregiving dimensions to depression. To untangle the role of the Negative Emotion/Consequences component (by far the most central node in estimated networks), a secondary analysis incorporating its composing items was estimated. Losing control over life, feeling strained around the relative and impaired self-perceived health emerged as central nodes. Interestingly, these caregiving-related dimensions or experiences were differentially connected to depressive symptoms. We discuss how these findings might help future research and inform tailored psychoeducational interventions for family caregivers of people with a severe mental disorder.

Caregiver burden in cerebral palsy: Validity and reliability of the Turkish version of caregiver difficulties scale

BACKGROUND

This study aims to translate the caregiver difficulties scale (CDS) into Turkish language and to reveal its reliability and validity in Turkish informal family caregivers of children with cerebral palsy (CP).

METHODS

This study included 130 participants (39.9 ± 7.8 years; range 24-58 years; 106 females and 24 males). Demographic properties of participants, relationship with the care recipient, income, caregiving time, CP type and diseases of the child (e.g., epilepsy, hydrocephalus and congenital heart disease) and the caregiver were recorded. The CDS, caregiver well-being scale (CWBS), World Health Organization Quality of Life (WHOQOL-BREF) and Beck depression inventory (BDI) were used for data collection. The internal consistency of the CDS was assessed using the calculation of Cronbach's alpha coefficient. A test-retest interval of 2 weeks was used to assess the reliability. The intercorrelation of variables was evaluated using the Spearman correlation coefficient. The receiver operating characteristic (ROC) analysis was performed to find the predictive power of CDS scores for depression.

RESULTS

A total of 130 family caregivers of children with CP completed the test/retest procedures. The Cronbach alpha coefficients were found as 0.878 for the test and 0.852 for the retest. Intraclass correlation coefficient (ICC) value was found between 0.83 and 0.90 for test-retest reliability of the CDS. In addition, the CDS showed a significantly strong correlation with CWBS-activities of living subscale and WHOQOL-BREF psychological, physical and environment domains, as well as a significantly moderate correlation with CWBS basic needs subscale, BDI and WHOQOL-BREF general health and social domains. CDS scores that are >46 resulted in a sensitivity of 81.48% and a specificity of 73.79% for moderate-severe depression.

CONCLUSION

The Turkish version of the CDS is a valid and reliable measure for caregiver burden of family caregivers of children with CP.

Interventions and strategies to improve social support for caregivers of children with chronic diseases: An umbrella review

BACKGROUND

Social support is an important approach to improve the psychosocial health status and promote positive coping for caregivers of children with chronic diseases. Such an approach can reduce parenting stress, help resolve parenting difficulties through the use of various social support relationships.

METHODS

We performed an umbrella review methodology using the method of examination, analysis and synthesis of systematic reviews. A PRISMA flow diagram was used to show the search process. The Joanna Briggs Institute was used to appraise the quality of papers and a narrative synthesis was undertaken. Relevant English and Chinese systematic reviews were searched in Embase, PubMed, Web of science, OVID, CNKI, CBM, Wan Fang and Cochrane Library databases, until November 2021, June 2022.

RESULTS

Out of 1,905 records, we included fourteen systematic reviews for a synthesis. Evidence to promote social support for caregivers of children with chronic diseases was identified from four key aspects: (i) Intervention content; (ii) Intervention forms; (iii) Intervention time; and (iv) Sources of support.

CONCLUSIONS

The findings of this review suggest that a combination of differing interventions, especially for early family, including the content of parenting training or education, attitude building and resource provision, which can implement online is recommend. More interventional studies and quantitative evidence syntheses are still needed.

IMPACT

Adequate social support is essential to promote the psychological wellbeing of caregivers of children with chronic diseases. In the early stage of children's diseases, integrating different content and forms of interventions for caregivers' families and actively helping caregivers to identify available support resources can improve social support. The findings from this review can be used to guide caregivers of children with chronic diseases and provide evidence for healthcare professionals and social workers to carry out relevant interventions.

The Moderating Effects of Personal Resources on Caregiver Burden in Carers of Alzheimer's Patients

Caring for persons with Alzheimer's disease can be an extremely difficult experience. To date, there has been a lack of research into the role of intermediary variables in the relationship between caregiver personality and psychosocial functioning. The growing numbers of dementia patients worldwide mean that more people are involved in their care, making research into this area a pressing concern. Both a caregiver's personality and personal resources play a key role in their capacity to cope with stressful situations. In order to determine how personal resources moderate the relationship between personality and burden of care, a total of 100 caregivers of Alzheimer's patients (78 women and 22 men) were asked to complete a set of questionnaires to assess personality, personal resources (sense of coherence, generalized self-efficacy, and perceived social support), as well as their levels of stress, depression, and commitment to care. Structural equation modeling and latent growth analysis suggest that personal resources explain the mechanisms underlying burden of care and moderate its relationship with personality. Our findings indicate that personal resources are a critical predictor of burden of care. Therefore, caregivers must be provided with appropriate support, taking into account their resources and personality profiles.

The Influence of Health Literacy and Social Support on Loneliness Among Patients With Severe Mental Illness in Rural Southwest China

Loneliness is an important risk factor for poor health outcomes among adults, especially among those with severe mental illnesses (SMIs). Existing research has shown that adults with SMIs often lack health literacy, which contributes to more restricted social networks and low levels of social support. The objective of this cross-sectional study was to examine the influence of health literacy and social support on the loneliness of patients with SMI in rural Southwest China. We recruited 300 patients with SMI in rural Southwest China between December, 2017 to May, 2018 via a multi-stage stratified random sampling approach. We used structural equation modeling (SEM) test the hypothesized relationships among the variables of the 270 patients who completed the survey. Results of the SEM showed that health literacy was both directly and indirectly associated with loneliness, with social support playing a mediating role. These findings suggest psychoeducation for SMI patients, and their informal caregivers, may offer beneficial effects toward reducing loneliness in this vulnerable population. Further, social support is another potential target for intervention development for improving patient outcomes.

Understanding the impacts of feline epilepsy on cats and their owners

BACKGROUND

Epilepsy is the most common neurological condition reported in cats. Characterised by recurrent seizures, treatment involves the administration of anti-epileptic drugs up to multiple times a day. Epilepsy and its associated treatments may impact both cats and their owners. The present study aimed to assess factors associated with quality of life (QOL) in cats with epilepsy and the burden of care in their owners.

METHODS

An online survey was developed using demographic information and the following validated measures: cat QOL, Zarit burden interview (ZBI) and the cat owner relationship scale (CORS). Regression analysis was conducted using SPSS 26.

RESULTS

Responses were completed by 141 owners from 22 countries. QOL was significantly higher in cats with controlled seizures, no adverse effects from medication and epilepsy onset before 5 years of age. ZBI was significantly lower in owners who felt supported by their veterinarian, who were over 55 and had cats with controlled seizures. Higher CORS was significantly correlated with both higher cat QOL and lower owner ZBI.

CONCLUSIONS

Adequate seizure control and close cat-owner relationships may play an important role in mitigating the impact of epilepsy on cats and their owners. Further research into understanding cat-owner relationships and successfully controlling epilepsy in cats is needed.

Impact of day care services on physical and cognitive functions in old people with dementia in a medical center in central Taiwan

Background

Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions.

Methods

This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants’ families was also assessed.

Results

The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2–86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0–80.0) at baseline to 77.5 (IQR 65.0–90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5–20.0) to 18 (IQR 15.8–24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002).

Conclusions

The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families’ stress burden was alleviated.

Caregiver burden in Buruli ulcer disease: Evidence from Ghana

BACKGROUND

Buruli ulcer disease (BUD) results in disabilities and deformities in the absence of early medical intervention. The extensive role of caregiving in BUD is widely acknowledged, however, associated caregiver burden is poorly understood. In this paper we assessed the burden which caregivers experience when supporting patients with BUD in Ghana.

METHOD/ PRINCIPAL FINDINGS

This qualitative study was conducted in 3 districts in Ghana between August and October 2019. 13 semi-structured interviews were conducted on caregivers of BUD patients in the local language of Twi. Data was translated into English, coded into broad themes, and direct content analysis approach was used to analyse results. The results show the caregivers face financial, psychological and health issues as a consequence of their caregiving role.

CONCLUSION/ SIGNIFICANCE

This study found significant caregiver burden on family members. It also highlighted the psychological burden caregivers experience and the limited knowledge of the disease within endemic communities. Further research is needed to quantify the caregiver burden of BUD at different economic levels in order to better understand the impact of possible caregiver interventions on patient outcomes.

Becoming a family caregiver of a patient living with cancer

BACKGROUND

There is insufficient information on how the burden of caregiving is affected when the family caregiver is a health professional. Studies are needed to investigate this issue.

AIMS

The purpose of this study was to reveal difficulties experienced by a nurse family caregiver offering care to a family member diagnosed with end-stage cancer and how she coped with these difficulties.

METHODS

This was an autoethnographic study.

FINDINGS

Findings were grouped under three headings: being both a researcher and a subject; effects of caregiving; and coping.

CONCLUSIONS

Offering care to a cancer patient has many physiological and psychological effects. If a family caregiver is a health professional, his/her caregiving burden can be even higher. Cultural values affect both life and coping ways of caregivers. It should be kept in mind that family caregivers need support from health professionals whatever their occupations are. Support to caregivers plays an important role in their coping.

Effectiveness of dyadic psychoeducational intervention for stroke survivors and family caregivers on functional and psychosocial health: A systematic review and meta-analysis

OBJECTIVES

Stroke is the third leading cause of disability worldwide, influencing the whole family's health and well-being. Dyadic (i.e., stroke survivor and family caregiver) psychoeducational intervention is a potential alternative to disease management and support, targeting at the dyads of stroke survivors and their caregivers as active participants in partnership. This review aimed to evaluate the current evidence on supporting the dyadic psychoeducational intervention for the functional and psychosocial health of stroke survivors' and their family caregivers.

DESIGN

Systematic review and meta-analysis DATA SOURCES: Nine English databases (Cochrane Library, Medline, CINAHL, PsycINFO, EMBASE, British Nursing Index, PubMed, Web of Science and Digital Dissertation Consortium) and two Chinese databases (CNKI and Wanfang) were searched to identify eligible studies published from their inception to April 2020. Additional relevant studies were identified from the reference lists and bibliographies of the identified articles and a manual search of relevant journals.

REVIEW METHODS

Studies were searched using keywords based on the 'PICOS' framework. The eligibility of individual full-text articles was independently assessed by two reviewers in accordance with the selection criteria. The risk of bias of the included studies was assessed using Cochrane RoB 2.0. The main outcomes were subjected to meta-analysis whenever possible; otherwise, narrative syntheses were conducted.

RESULTS

Eleven studies with 1769 stroke survivors and 1578 family caregivers were identified. The meta-analysis of pooled data suggested that the dyadic psychoeducational intervention had a significant immediate (<1 month) effect on family caregivers' burden (SMD = -0.25, 95% CI: -0.50 to -0.01, p = 0.04) and a long-term (≥6 months) effect on survivors' quality of life (SMD = -0.30, 95% CI: -0.53 to -0.07, p = 0.01). Subgroup pooled analyses indicated that the interventions initiated in hospitals could significantly improve the survivors' functional independence immediately after intervention (SMD = 0.40, 95% CI: 0.08 to 0.72, p = 0.01). Conversely, the interventions initiated at home did not significantly affect this functional outcome.

CONCLUSIONS

This review supports the notion that the dyadic psychoeducational intervention can be effective in improving the stroke survivors' functional independence and their family caregivers' burden for a short period and the survivors' quality of life in the long run. However, its effectiveness is not conclusive because other psychosocial health outcomes for the stroke survivors and their family caregivers have not yet been found to significantly improve after intervention. Therefore, further large-scale randomised controlled trials with a high-quality design are warranted to evaluate their effectiveness in diverse functional and psychosocial health outcomes for stroke survivors and their family caregivers.

Tensions in support for family caregivers of people with dementia in Singapore: A qualitative study

BACKGROUND

Family members as informal caregivers are considered the first line of support for people with dementia across the world. In Singapore, caregiving expectations revolve around the cultural expectations of providing care in the home environment. However, studies in Singapore have identified a lack of family support for primary caregivers. Family support has been discussed in the literature as the provision of care for people with dementia, and rarely as a resource for family caregivers.

METHOD

To understand family support among primary caregivers in Singapore, 24 semi-structured interviews were conducted. Thematic analysis found four themes: excuses for lack of physical support for the caregiver, tensions between cultural expectations of caregiving and the provision of support, unmet emotional support, and lack of awareness of dementia and caregiving needs.

FINDINGS

Caregivers rationalized and forgave the absence of physical support but were frustrated when the lack of support impacted people with dementia. This was seen as a lack of fulfilling cultural obligations of caring for elderly parents. The caregivers also felt frustrated with the lack of emotional support provided to them, but these were unspoken between the caregiver and the family members. Insufficient and unhelpful support giving was exacerbated with the perception of family members' limited understanding of the demands of caregiving.

CONCLUSION

The findings offer four practical suggestions to address unmet support needs. First, public education is needed to enhance general knowledge about the symptoms and progression of dementia. Second, help is needed to address miscommunication about support within the family. Third, the development of guidebooks is needed to help family caregivers communicate with family members about their various support needs. Fourth, the relationship between cultural expectation and caregiving must be understood within the context of modernity and urbanism.

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.

Schizophrenia, social support, caregiving burden and household poverty in rural China

PURPOSE

Household poverty associated with schizophrenia has been long described. However, the mechanisms by which schizophrenia may have influenced the economic status of a household in rural communities are still unclear. This study aimed to test an integrated model of schizophrenia, social support and caregiving burden on household poverty in a rural community in China.

METHODS

A mental health survey using identical methods and ICD-10 was conducted in six townships of Xinjin County (population ≥ 15 years old, n = 152,776), Chengdu, China in 2015. Identified persons with schizophrenia (n = 661) and their caregivers completed a joint questionnaire of sociodemographic information, illness conditions, social support and caregiving burden. Descriptive analysis was applied first to give an overview of the dataset. Then, multivariable regression analyses were conducted to examine the associative factors of social support, caregiving burden and household income. Then, structural equation modeling (SEM) was used to estimate the integrated model of schizophrenia, social support, caregiving burden and household income.

RESULTS

Households with patient being female, married, able to work and having better social function were better off. Larger household size, higher social support and lower caregiving burden also had salient association with higher household income. The relationship between schizophrenia and household poverty appeared to be mediated by the impacts of schizophrenia on social support and caregiving burden.

CONCLUSION

There was a strong association between schizophrenia and household poverty, in which social support and caregiving burden may had played significant roles on mediating it. More precise poverty alleviation policies and interventions should focus on supporting recovery for persons with schizophrenia, as well as on increasing social support and on reducing family caregiving burden.

Aging in Place With a Spouse in Need: Neighborhood Cohesion and Older Adult Spouses' Physical and Mental Health

This study examines the association of perceived neighborhood cohesion (NC) with older adults' health and the buffering effects of NC against the negative effects of spousal caregiving on health. Data of 3329 community-living older adults living with a spouse in need of care from the Health and Retirement Study were collected at two time-points. Multiple regression analyses were computed for each of the four health outcomes. For men, NC predicted fewer depressive symptoms and better cognition. NC buffered the negative effect of providing activities of daily living (ADL) help to the wife on cognition. For women, NC predicted fewer depressive symptoms and better cognition. NC buffered the negative effect of providing ADL help to the husband on ADL difficulties. The results accentuate the importance of residency location for older adults' physical and mental health. The health benefits of NC may have more implications for older adults providing spousal care.

Mediators of burden and depression in dementia family caregivers: Kinship differences

OBJECTIVES

To investigate kinship differences in the caregiver stress process by developing multiple mediation models for two distinct caregiver subgroups (spouses and adult children of older adults living with dementia). The effect of four potential mediating variables (mastery, self-efficacy, satisfaction with social support, positive caregiving appraisals) on the relationship between perceived burden and depression was evaluated.

METHOD

Family caregivers of a person living with dementia were recruited through national dementia and carer organisations. Participants completed a paper-based or electronic version of the study survey. A bias-corrected, accelerated bootstrapping method was used to test the effect of the four proposed mediating variables on the relationship between perceived burden and depression in each caregiver subgroup (spouses and adult children).

RESULTS

Perceived burden was directly and significantly related to depression for both spouse caregivers and adult child caregivers. The mediation models explained approximately 50% of the variance in the burden-to-depression pathway for both caregiver subgroups. Mastery and social support (but not self-efficacy, nor positive caregiving appraisals) were found to individually significantly influence the impact of perceived burden on depression in spouse caregivers. All four proposed mediators failed to reach statistical significance as individual mediators of the burden-to-depression pathway in adult child caregivers.

CONCLUSION

These findings demonstrate differences in the dementia caregiver experience according to kinship, and that certain mediating variables are more relevant for some subgroups of caregivers than others. Implications for the design of psychosocial interventions are discussed.

Household poverty in people with severe mental illness in rural China: 1994-2015

BACKGROUND

Little is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development.

AIMS

This study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China.

METHOD

Two mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses.

RESULTS

The proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015.

CONCLUSIONS

This study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.

Understanding the Obstacles to Uptake of Intervention Programmes and Services for Persons with Dementia

BACKGROUND

Utilisation of intervention programmes and services for Persons with Dementia (PWD) has been generally modest despite the growing numbers. One reason has been the lack of knowledge about dementia and information on such services.

OBJECTIVE

We sought to close this gap by providing caregivers with an information session about dementia and the importance and availability of related services. We explored the uptake of intervention programmes and services and reasons for non-uptake thereafter.

METHODS

Two hundred and seventy-five PWD and caregiver dyads attended the Dyad Education and Empowerment Programme (DEEP). At the DEEP, while caregivers underwent an information session, PWD were assessed by a multidisciplinary team on their need and suitability for programmes and services such as daycare, cognitive engagement programmes and physical rehabilitation. The dyads then received individualized recommendations on the appropriate services, if any. Follow-up through medical records review and phone calls was conducted one month after DEEP to ascertain if the dyads had acted upon the recommendations and if not, what difficulties they encountered.

RESULTS

One hundred and eleven PWD received recommendations, of which 40 (36.0%) agreed and enrolled in the services while 71 (64%) declined. Thematic analysis of the reasons for non-uptake revealed 3 themes: PWD-related factors (e.g., refusal, functional improvement or decline), caregiverrelated factors (adequacy of care at home, other care arrangements), and service-related factors (e.g., cost, timing).

CONCLUSION

Despite adequate information, there are other reasons for non-uptake of dementia- related services, some of which should be addressed to improve service updates and to provide better care for PWD.

Risk and Protective Factors for PTSD in Caregivers of Adult Patients with Severe Medical Illnesses: A Systematic Review

Caregivers of severely ill individuals often struggle to adjust to new responsibilities and roles while experiencing negative psychological outcomes that include depression, anxiety and Post-Traumatic Stress Disorder (PTSD). This systematic review aims to outline potential risk and protective factors for the development of PTSD in caregivers of adult subjects affected by severe somatic, potentially life-threatening illnesses. Twenty-nine studies on caregivers of adult patients affected by severe, acute, or chronic somatic diseases have been included. Eligibility criteria included: full-text publications reporting primary, empirical data; PTSD in caregivers of adult subjects affected by severe physical illnesses; risk and/or protective factors related to PTSD; and English language. Specific sociodemographic and socioeconomic characteristics, besides the illness-related distress, familiar relationships, exposure characteristics, coping style, and support, were identified as relevant risk/protective factors for PTSD. The review limitations are the small number of studies; studies on different types of diseases; studies with same samples. It is crucial to consider factors affecting caregivers of severely ill adult patients in order to plan effective intervention strategies aimed at reducing the risk of an adverse mental health outcome and at enhancing the psychological endurance of this population.

Test of the stress process model of family caregivers of people living with schizophrenia in China

Across the world, people living with schizophrenia (PLS) are often cared for by family caregivers. This is especially true in China where community-based systems of care for PLS are underdeveloped. Thus, family caregivers of PLS may experience emotional distress and burden in the absence of community-based services. Pearlin (1990) proposed a highly influential model for understanding the stress process and its relationship to health and wellbeing. Although the model has been examined worldwide, it has yet to be studied in China for caregivers of PLS. In the present study, we use Pearlin's stress process model to examine the mediating effect of perceived caregiver burden, family functioning, and caregivers' positive feelings about caregiving on PLS global functioning and caregiver depressive symptoms. We also examine whether the model differs for parent and spouse caregivers. A total of 327 primary family caregivers of PLS in Hunan province, China, were assessed cross-sectionally using culturally-validated measures. Bootstrap methods with Hayes's PROCESS Macro were used to test multiple mediation models of global functioning scores of PLS and caregiver depressive symptoms. In this first study of the stress process model of family caregivers of PLS in China, the results generally support the model. Caregiver perceived burden, family functioning, and positive caregiver feelings about caregiving all mediate the relationship between PLS global functioning and caregiver depression, with perceived caregiver burden having the strongest indirect effect. Analyses also show that the stress process differs between parent and spouse caregivers, with perceived caregiver burden a mediator for both groups but family functioning only a mediator for parent depressive symptoms. We discuss implications of these findings for extending the stress process model cross-culturally; suggest hypotheses for future research to examine parent and spouse differences; and discuss fruitful directions for intervention.

A cross-sectional study on spouse and parent differences in caregiving experiences of people living with schizophrenia in rural China

BACKGROUND

Conflicting evidence exists on whether parent or spouse caregivers experience better outcomes when caring for family members with schizophrenia. The current study aims to examine relative caregiving experiences and impacts of spouse and parent caregivers for people living with schizophrenia (PLS) in China.

METHODS

A cross-sectional study was conducted in a sample of 264 community-dwelling primary family caregivers of PLS. Face-to-face interviews were conducted to collect information on family caregiving activities; negative caregiving impacts including objective and subjective burden, and caregiver psychological distress such as depression and anxiety; positive caregiving impacts including caregiving rewarding feelings, and family functioning for spouse and parent caregivers.

RESULTS

Both types of caregivers report engaging in similar caregiving activities and report comparable levels of objective burden. However, parent caregivers report significantly higher subjective burden than spouse caregivers (b = 7.94, 95%CI:2.08, 13.80, P < 0.01), which is also reflected in significantly higher depression (b = 3.88, 95%CI:1.35, 6.41, P < 0.01) and anxiety (b = 2.53, 95%CI: 0.22, 4.84, P < 0.05), and lower family functioning (b = - 1.71, 95%CI: - 2.73, - 0.49, P < 0.01). Despite these differences, both groups of caregivers report comparable rewarding feelings about caregiving.

CONCLUSIONS

Our findings have implications for family caregivers globally, but especially for countries that adhere to Confucian cultural values and provide guidance for future family intervention programs. Such programs may do well to incorporate cultural values and beliefs in understanding caregiving and kinship family dynamics so as to support family caregivers, and in particular, the specific vulnerabilities of parent caregivers.

Health Burden, Support Adequacy, and Depressive Symptoms in Older Men With HIV

BACKGROUND AND OBJECTIVES

Older adults with HIV face greater health burden than HIV-uninfected counterparts. Little is known about resources that might mediate the influence of physiological health burden on psychological well-being. Informed by the stress process model, we assessed the influence of multifaceted health burden indicators on depressive symptoms and evaluated the mediating effects of social support adequacy.

RESEARCH DESIGN AND METHODS

This cross-sectional study used structural equation modeling with data from 640 older men who participated in the Research on Older Adults with HIV study in the United States. Health burden assessment included number of age-related chronic conditions, multiple HIV-related chronic conditions, and self-rated health. Perceptions of instrumental and emotional support adequacy measured support as a coping resource. Depressed mood as assessed by the 10-item Center for Epidemiologic Studies Depression Scale was the indicator of psychological well-being.

RESULTS

Higher incidence of age-related conditions and worse self-rated health was significantly associated with more depressed mood. Self-rated health and HIV-related conditions showed a significant indirect effect on depressed mood via emotional support adequacy.

DISCUSSION AND IMPLICATIONS

Each dimension of health burden demonstrated a distinct pathway to psychological well-being for men with HIV, which should be considered when prioritizing care plans. Complementing research on medical interventions for people with HIV, these findings suggest that nonpharmacological interventions may be important for improving overall well-being.

Investigating psychological problems in caregiver of pediatrics with cancer: A systematic review

PURPOSE

Cancer is a type of chronic illness that causes many issues for patients and their caregivers, including a wide range of psychological problems. This study was conducted to determine the status and psychological problems of caregivers of pediatric patients with cancer who live in Iran.

METHODS

All articles from 2000 to March 2019 related to the psychological of caregivers and their child's cancer were included in the search. Domestic websites in Iran and international databases were searched. Keywords of the search included child, cancer, malignancy, care burden, stress, anxiety, depression, coping strategies, psychological hardiness, posttraumatic stress, parents, father, mother, and pediatric. The search, data extraction, quality assessment and screening were conducted independently by two researchers.

RESULTS

In the initial search, 345 articles were extracted regarding the psychological problems of caregivers. After final screening 15 articles were selected; from these four referred to care burden, four articles for coping skills, three articles for posttraumatic stress disorder (PTSD) and four articles for stress, anxiety, and depression among carers of children with cancer.

CONCLUSION

Considering the existence of psychological problems such as caregiver burden, PTSD, stress, anxiety, and depression in caregivers of children with cancer, it is necessary to provide nursing interventions for this group of parents; particularly interventions that provide the necessary ground for reducing psychological problems and improving caregivers' mental health.

Psychological distress among carers and the moderating effects of social support

BACKGROUND

Carers provide both practical and emotional support and often play an important role in coordination of care for recipients. The demands of caring may lead to increased levels of stress for the carer, which can affect mental health and quality of life. This study examined the relationship between being a carer and psychological distress (assessed using the Kessler Psychological Distress Scale [K10]), and explored the moderating effect of social support in that relationship using a large sample.

METHODS

The study used data from the 45 and Up study, a large cohort study of individuals aged 45 years and over in New South Wales, Australia, and applied multiple regression methods and moderation analysis. The sample for the current study comprised 267,041 participants drawn from the baseline dataset, with valid data on the primary outcome (carer status).

RESULTS

The mean age of participants was 62.73 (±11.18) years, and 4.23% and 7.13% were identified as full-time and part-time carers, respectively. Compared to non-carers, full-time carers had K10 scores that were on average, higher by 1.87, while part-time carers' K10 scores were on average higher by 1.60 points. A perception of social support reduced the strength of the relationship between carer status and psychological distress by 40% for full-time carers and 60% for part-time carers.

CONCLUSIONS

The findings have important implications, for both prevention and treatment of psychological problems among carers. In terms of prevention, they suggest that public health campaigns focused on increasing awareness regarding the psychological burden faced by carers would be useful. In terms of intervention, potential treatments that focus on improving social support networks may be helpful. The results are particularly important in the current context of an ageing population in Australian and other developed countries, where caregiving is likely to play an increasing role in the care and support services.

Predictors of Caregiver Burden in Caregivers of Bedridden Patients

BACKGROUND

Caregivers are at risk of experiencing caregiver burden. It is therefore important to determine the caregiver burden of caregivers who provide care to bedridden patients and related factors.

PURPOSE

The aim of this study was to determine the caregiver burden of caregivers who provide care to bedridden patients and the factors that impact this burden.

METHODS

This cross-sectional study was executed at a state hospital in Istanbul, Turkey, on bedridden patients registered in the home healthcare unit and their caregivers. During study period, the researchers made 312 visits to patients and their caregivers. A sociodemographic questionnaire, the Burden Interview, and the Katz Index of Independence in Activities of Daily Living were used to collect data. Descriptive statistics, an independent sample t test, one-way analysis of variance, and stepwise multiple regression analysis were used for data analysis.

RESULTS

The participants reported a moderate level of caregiver burden. Existing caregiver health problems, caregiver employment status, the ability of the caregiver to maintain his or her own good health, type of home, and the degree of patient dependence in terms of activities of daily living were each found to be significant predictors of caregiver burden.

CONCLUSIONS/IMPLICATIONS OF PRACTICE

The support provided to caregivers by home healthcare units is important in terms of protecting the physical, mental, and social health conditions of caregivers and preventing the exacerbation of caregiver burden.

Gender Difference in the Relationship Among Family Function, Health Behavior, and Stress in Midlife

This study investigated whether there are gender-based differences in the process wherein family functions influence stress through various health behaviors in midlife adults. A cross-sectional study was done using a convenience sample of 250 middle-aged Koreans. Data on the family APGAR index, four health behaviors (i.e., seeking health information, physical activity, healthy diet, and social interaction), and stress were collected by a self-administered survey and analyzed using hierarchical multiple linear regression analyses and a PROCESS macro for SPSS. The study results showed that an indirect effect of family function on stress through health behaviors was significant in women, whereas such a relationship was not shown in men. This study found that the process wherein family function is linked with stress through health behaviors differs by gender. Developing gender-specific interventions is essential to decrease stress in midlife adults.

Social support and depressive symptoms among family caregivers of older people with disabilities in four provinces of urban China: the mediating role of caregiver burden

BACKGROUND

To examine the relationship between social support and depressive symptoms of Chinese family caregivers of older people with disabilities, and to evaluate the role of caregiver burden as a potential mediator of that relationship.

METHODS

A survey questionnaire was completed face-to-face by 567 primary family caregivers of older people with disabilities in four provinces in China. Covariates that may affect depressive symptoms, such as the characteristics of disabled people (socio-economic factors, functional and cognitive capacity) and caregivers (caregiver duration and self-rated health of caregivers) were collected. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS); depressive symptoms were assessed by the shortened 10 item version of Center for Epidemiological Studies Depression scale (CES-D); and the caregiver burden was assessed by the Zarit Burden Interview (ZBI).

RESULTS

The prevalence of depressive symptoms among caregivers was 37.7%. Higher levels of social support was negatively associated with lower depressive symptoms. This relationship was partially mediated by the caregiver burden, where higher levels of the caregiver burden were negatively associated with depressive symptoms. Furthermore, caregivers who were women, spent extended time in caregiving and were in poor health, reported significantly higher depressive symptoms.

CONCLUSIONS

Our results indicated that social support was negatively associated with depressive symptoms in family caregivers and in the caregiver burden. The caregiver burden partially mediated the social support-depressive symptoms association. Interventions for family caregivers should include increasing social support, health monitoring and structured interventions to reduce the caregiver burden and attenuate family caregivers' depressive symptoms.

The mediating roles of caregiver social support and self-efficacy on caregiver burden in Parkinson's disease

BACKGROUND

Most studies in Parkinson's disease (PD) have focused on the direct effects of social support and self-efficacy on caregiver burden. This study aimed to test our prediction that caregiver self-efficacy and social support were two chaining mediator variables on the paths for patient factors affecting caregiver burden, caregiver anxiety, and depression.

METHOD

We enrolled patients with PD and their caregivers from the First Affiliated Hospital of Shanxi Medical University in China between July and December 2017. Patients completed scales evaluating their cognition, motor function, and depression. Caregivers completed scales evaluating social support, self-efficacy, anxiety, depression, and caregiver burden. We applied Partial Least Squares Structural Equation Modeling (PLS-SEM) to analyze the mediating effects.

RESULTS

Caregiver self-efficacy was a partial mediator on the path of patient motor function effects on caregiver burden (Variance Accounted For, VAF = 0.741), caregiver anxiety (VAF = 0.498) and caregiver depression (VAF = 0.471). Social support for caregivers was a partial mediator on the path for patient motor function effects on caregiver self-efficacy (VAF = 0.247). Caregiver social support and self-efficacy were two chaining mediator variables on the pathway for patient motor function effects on caregiver burden (VAF = 0.768) and caregiver depression (VAF = 0.510).

LIMITATIONS

Our sample only met the minimum sample size requirement for the PLS-SEM and we only focused on a part of variables we collected.

CONCLUSIONS

Our prediction has been validated in this study. And this work supports the decision-making of health authorities and policymakers in managing caregiver social support and caregiver self-efficacy with the aim of reducing caregiver burden in PD.

Burden among caregivers of people with mental illness at Jimma University Medical Center, Southwest Ethiopia: a cross-sectional study

BACKGROUND

Burden of caregivers of people with mental illness (PWMI) is considered to be a negative impact of the care provided by the family to the patient. However, little is known about the extent of the burden among caregivers of PWMI in Ethiopia. The aim of this study, therefore, is to assess the magnitude and associated factors of burden among caregivers of PWMI at Jimma University Medical Center, 2017.

METHODS

Institution-based cross-sectional study design was employed among 406 conveniently selected caregivers of PWMI and interviewed using a structured questionnaire. Family burden interview schedule (FBIS) was used to assess burden of caregivers. Bivariate and multivariable linear regression analyses were performed to determine the predictors of burden among caregivers.

RESULTS

Nearly two-thirds [264 (65.0%)] of the participants were male with a mean age of 38.45 ± 12.03 years. The mean score for burden among caregivers on family burden interview schedule was 23.00 ± 10.71. Age of the caregivers (β = 0.18, p < 0.001), being female caregiver (β = 2.68, p < 0.01), duration of contact hours with the patient per day (β = 0.74, p < 0.001), perceived stigma by the caregiver (β = 0.47, p < 0.001), and providing care for patients who had history of substance use in life (β = 1.52, p < 0.05) were positive predictors of higher burden among caregivers. Whereas, caregivers' income (β = 7.25, p < 0.001), caregivers who had no formal education (β = 4.65, p < 0.01), and caregivers' social support (β = 0.78, p < 0.001) were negatively associated with higher burden among caregiver.

CONCLUSION

Caregivers of people with mental illness experience enormous burden during providing care for their relatives with mental illness. Therefore, creating community awareness and targeted interventions in the area of treatment access, stigma, financial, and other social support for people with mental illness and their caregivers would help out to reduce these burdens.

Family Caregivers' Perspectives for the Effect of Social Support on their Care Burden and Quality of Life: A Mixed-Method Study in Rural and Sub-Urban Central Japan

Japan has adopted community-based integrated long-term care, which has shifted the burden of care from institutions to the home. However, family caregivers have received less attention compared with care recipients. Many family caregivers are also older adults, and it is important that caregivers receive appropriate support to alleviate the burden of care. In rural and sub-urban area with limited resources compared to urban area, it is necessary to know which support to be prioritized. Therefore, this study aimed to understand family caregivers' perceptions of social support, the type and source of support which were considered important, and how it affected their caregiving burden and quality of life (QOL). We conducted a convergent mixed-method study with 174 primary family caregivers of older adults receiving home care in rural and suburb area of Central Japan. The mixed-method approach enabled qualitative data to complement quantitative results. Strong family support and higher education had positive effects on QOL, while higher caregiving burden and longer duration of care had negative effects on QOL. Provision of tangible support from family and healthcare professionals was central in reducing caregiving burden and improving caregivers' QOL. Support from distant relatives or neighbors, which was deemed inappropriate by caregivers, had a negative effect on caregivers' emotional status. In conclusion, family caregivers perceived support positively, but the effects depended on who provided support. While tangible support from close family and professionals was perceived positively, support from neighbors or distant relatives should consider caregivers' needs and condition to avoid a negative impact.

Social support and self-rated health among caregivers of people with dementia: The mediating role of caregiving burden

The purpose of this study was to examine the associations between three indicators of social support and self-rated health among caregivers of people with dementia, and whether caregiving burden mediated such associations. Data from the Resources for Enhancing Alzheimer's Caregiver Health II (REACH II; N = 637) was used and multivariate analyses were conducted to test the mediation effects of caregiving burden by PROCESS for v3.2.03. The results revealed that three indicators of social support (received support, social network, and negative interactions) were all significantly associated with self-rated health. Findings also showed that caregiving burden acted as a mediator mechanism through which the associations between social network and self-rated health, negative interactions and self-rated health occurred. Results suggest that there is a need for more comprehensive caregiving assessments as well as multicomponent interventions that include improving and expanding social networks for caregivers of people with dementia. Findings also highlight the importance of minimizing interpersonal conflicts with others and providing more multicomponent programs aimed at reducing caregiving burden.

Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.

The Effect of Telenursing on Referral Rates of Patients With Head Trauma and Their Family's Satisfaction After Discharge

We aimed to assess the effect of telenursing on referral rates of patients with head trauma and their family's satisfaction after discharge. Seventy-two patients with head trauma were randomly allocated to equal intervention and control groups. The caregivers in both groups were provided with 1-hr face-to-face training on patients' home care and educational booklets, 2 days before discharge. The cell phone numbers of the telenurse was given to the caregivers of the intervention group. Then, the patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks and the patient status checklists were completed. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data were analyzed using SPSS software, version 19. Ultimately, 33 patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years were studied in the intervention group (p = .098). The 2 groups differed significantly with respect to referral rates; 39.4% of the participants in the control group referred to physicians whereas only 25.7% of the patients in the intervention group needed to refer to physicians (p = .017). Also, the mean times of referring to a physician differed significantly in both groups. In general, 53.8% of the caregivers were satisfied with the telenursing program. Follow-up programs using telephone calls were effective and would lead to higher caregiver satisfaction.

"I Can't Do This Alone": a study on foreign domestic workers providing long-term care for frail seniors at home

ABSTRACTBackground:Foreign domestic workers (FDWs) play an important role in long-term caregiving of seniors at home. However, how FDWs cope with the caregiving demands, the dynamic interaction between familial and FDW caregivers and its impact on care recipients remain largely un-explored. Existing caregiver interventions mainly target familial caregivers; little assistance is available for FDW caregivers. This study explores FDWs' challenges, coping strategies, and the support they need in caring for seniors.

METHODS

FDWs were recruited from a geriatric ward and outpatient clinic of a tertiary hospital in Singapore. Qualitative in-depth interviews were conducted with 25 FDWs caring for frail seniors and five healthcare staff. Interviews were transcribed and analyzed using thematic analysis.

RESULTS

FDWs were from Indonesia, Philippines, and Myanmar. Nineteen cared for seniors with dementia (SWDs). We derived six subthemes, clustered into three salient themes: two described social support to FDWs by the senior's family members, two described their coping strategies, and two described their job satisfaction. Those who cared for SWDs faced more difficulties. We derived two family models of care: FDW-centered family dynamics, where family members rely on FDWs to perform most duties, causing poor impact on seniors' well-being and team-based family dynamics, where family members and FDWs share the caregiving burden, resulting in better impact on seniors' well-being.

CONCLUSION

FDWs face significant challenges in eldercare. Improving FDWs' access to training courses in eldercare, providing them with more emotional support, engaging employers to create healthy caregiving spaces at home, and improving access to senior care services can be helpful.

Effect of Telenursing on Outcomes of Provided Care by Caregivers of Patients With Head Trauma After Discharge

Telenursing is a suitable tool for increasing health-related awareness of the caregivers for a better home care. But its efficacy may be affected by several factors. Considering the important complications of head trauma injury and high rate of readmission, we aimed to assess the effect of telenursing on care provided by the family members of patients with head trauma.This randomized controlled trial investigated 72 patients with head trauma, who were randomly allocated to intervention and control groups (36 patients in each group). The caregivers in both groups were provided with 1-hr face-to-face training session on patients' home care and educational booklets. The patients in the intervention group were followed up every week through phone calls by the telenurse for 12 weeks, who recorded the patient's status, as well. Caregivers in the intervention group could call the telenurse any time they desired. The health status of the control group was followed once by a phone call after 12 weeks. Data on patients' readmission and pressure ulcer (based on Norton's scale) rate and time were compared between the groups and analyzed using SPSS software, version 19. Thirty-three patients with a mean ± SD age of 31.12 ± 10.83 years were studied in the control group and 35 patients with a mean ± SD age of 34.11 ± 12.34 years in the intervention group (p = .098). None of the patients in the intervention group were readmitted, whereas 2 patients in the control group were readmitted s(p = .139). Risk of pressure ulcer did not differ between the groups (p = .583). Telenursing had no significant effect in readmission and decubitus prevention for patients with head trauma. Considering the chronic nature of the illness, a longer follow-up period is deemed necessary for an accurate conclusion.

Multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong

OBJECTIVES

The objective of this study was to examine multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Based on a modified stress process model, this study explored how background and contextual factors (demographic characteristics and mental health status of caregivers, caregiving-related factors, and support and services), primary stressors (degree of care dependency and special care needs), and secondary stressors (self-efficacy and gender role conflict) might affect the caregiving burden among male caregivers.

METHOD

A questionnaire survey was completed by 204 male caregivers who considered themselves as primary caregivers for older family members with care needs aged 60 and over. Descriptive, bivariate, and multivariate analyses were conducted.

RESULTS

Being the son of the care receiver, the presence of depressive symptoms, a higher degree of gender role conflict, a lower degree of caregiving self-efficacy, and the use of support and services all predicted greater caregiving burden among male caregivers.

CONCLUSION

This study established a modified stress process model specifically for male caregivers. Gender role conflict and caregiving self-efficacy were introduced into the model as secondary stressors and found to be significantly associated with the degree of caregiving burden. The findings of this study could inform the development of services and interventions to reduce the caregiving burden among male caregivers.