Inventory of Overburden in Alzheimer's Patient Family Caregivers with no Specialized Training

Prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia: Cross-sectional study

Background

Mental illness exposes persons to stigma and this stigma also affects family caregivers of persons with mental illness. The objective of the study was to assess the prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia.

Methods

A cross-sectional study design and systematic random sampling technique were used to recruit 408 participants at St. Paul’s Hospital Millennium Medical College and Yekatit-12 Hospital Medical College, Addis Ababa, Ethiopia. We collected the data by face-to-face interview. Devaluation of Consumer Families Scale was used to measure perceived stigma. Patient Health Questionnaire-9 and Oslo-3 social support scale were the instruments used to assess the factors. Coded variables were entered into Epidata V.3.1 and exported to SPSS V.21 for analysis. Binary logistic regression was used for analysis.

Result

A total of 408 participants were interviewed, with a response rate of 96.5%. The magnitude of perceived stigma was 38.5% with 95% CI (33.6-43.1). Majority (68.6%) of the respondents were female. In the multivariate logistic regression, being mother (AOR = 2.8, 95% CI: 1.59, 4.91), absence of other caregiver (AOR = 2.0, 95% CI: 1.15, 3.49), poor social support (AOR = 3.9, 95% CI: 1.59, 6.13), and symptoms of depression (AOR = 2.9, 95% CI: 1.88, 3.65) were factors significantly associated with perceived stigma.

Conclusion

The prevalence of perceived stigma among primary caregivers of children and adolescents with mental illness was high. Being mother, absence of other caregiver, poor social support, and symptoms of depression were factors significantly associated with perceived stigma.

Effects of a home-based exercise program on mental health for caregivers of relatives with dementia: a randomized controlled trial

OBJECTIVE

This study was aimed to evaluate the effectiveness of a home-based physical exercise program on participants' mental health: psychological symptoms, depression, and burden of female informal caregivers.

DESIGN AND PARTICIPANTS

In a randomized controlled trial, a sample of 48 female informal primary caregivers completed the entire study, 25 were randomly allocated to the intervention group (IG), and 23 participants to the control group (CG).

INTERVENTION

Participants in the IG performed two 60-minute-long physical exercise sessions per week (36 weeks) that were supervised by a personal trainer at caregivers' home during 9 months. The CG continued their habitual leisure-time activities.

MEASUREMENTS

Subjective burden was assessed by the Zarit Burden Interview. The risk of depression was measured by the Geriatric Depression Scale Short Form 15-item version, and psychological symptoms were evaluated by the Symptom Check List-90-Revised (SCL-90-R). All participants were evaluated at baseline and at the end of the intervention.

RESULTS

A promising positive impact of the intervention on caregivers' subjective burden and risk of depression was found in the IG. In addition, no significant between-group differences were found in any of nine subscales scores of the SCL-90-R. Finally, care recipients' level of functional independence and area of residence were found to be predictors of the promising positive impact on caregivers' subjective burden and risk of depression.

CONCLUSIONS

The present home-based physical exercise intervention that was individually implemented has shown promising results to reduce subjective burden and risk of depression in female caregivers of relatives with dementia. However, future research efforts should elucidate both the particular dose of physical exercise and the particular duration of the intervention that are required to obtain the expected significant positive impact. Finally, future inclusion of psychological approaches, besides physical exercise, might help reduce female caregivers' psychological symptoms.

Effects of supporting patients with dementia: A study with dyads

PURPOSE

This study aimed to examine the factors associated with the development of higher burden in informal caregivers of patients with dementia, using dyadic data.

DESIGN AND METHODS

Seventy-two dyads of patients with dementia and their informal caregivers were assessed, the former in terms of behavioral-psychological symptoms and autonomy, the latter in terms of burden and individual needs.

FINDINGS

Caregivers at risk for developing higher burden are those who are female, whose care recipient present psychiatric symptoms and lower autonomy, and those who recognize the need for more information/support.

PRACTICE IMPLICATIONS

Interventions should offer caregivers the tools to provide care, maintaining their psychological well-being. Interventions should target not only common aspects of caregiver burden but also the specificities of caring for a person with dementia.

Mindfulness in Family Caregivers of Persons with Dementia: Systematic Review and Meta-Analysis

Social and healthcare problems associated with dementia not only affect those who suffer from this disease, but their caregivers as well. The purpose of this study was to analyze the efficacy of mindfulness intervention on psychological variables of caregivers of persons with dementia. A search for scientific articles published from 2000 to 2019 in the PubMed, Web of Science and PsycINFO databases found a total of 282 articles. After screening with preestablished inclusion criteria, ten studies with participation of 161 caregivers remained for the meta-analysis. The results were significant in favor of mindfulness intervention for the variables studied with a standardized difference of mean of 0.71 at a 95% CI, 0.71 (0.52, 0.89); p ≤ 0.00001. Heterogeneity of the studies included was moderate (I² = 40%). The main conclusion suggested by empirical evidence was that mindfulness intervention seems to be effective for the variables analyzed. However, continued in-depth study of this subject is recommended.

Mindfulness for Preventing Psychosocial Risks in the Workplace: A Systematic Review and Meta-Analysis

Organizations today are implementing psychological interventions to promote the job performance and wellbeing of their employees. Mindfulness-based interventions (MBIs) can contribute to providing workers with competencies and skills and develop their strengths. MBIs are therefore becoming more and more present in the workplace, sometimes using online intervention programs, which offer a promising direction in prevention and intervention for health. The objective of this study is to analyze the efficacy of MBIs on psychological variables in the workplace. For this purpose, a search for scientific articles published from 2009 to 2019 was made in the Psicodoc, PsycINFO, and Web of Science databases, where a total of 468 articles were found. After filtering with preestablished inclusion criteria, 24 studies were included in the systematic review and meta-analysis. The results of the meta-analysis suggest that intervention in mindfulness positively influences psychological variables related to employee health and wellbeing. However, it is recommended to continue performing new studies to confirm this finding.

Cost-Effectiveness and Effects of a Home-Based Exercise Intervention for Female Caregivers of Relatives with Dementia: Study Protocol for a Randomized Controlled Trial

Previous research has proposed a range of support interventions to mitigate the adverse impact of caregiving on the daily life of caregivers of relatives with dementia. However, the effectiveness of these interventions shows a high variability. Informal caregivers usually lack the time and/or live too far from conventional facilities to do physical exercise, especially those who live in rural areas. Thus, home-based interventions may be more efficacious due to their greater convenience for this population. The present work proposes and describes a study protocol for a randomized control trial that will analyze the efficacy and cost-effectiveness of a home-based, structured individual physical exercise intervention to improve the health-related quality of life and the mental health of female informal caregivers of relatives with dementia. The nine-month-long intervention will comprise participation in two supervised physical exercise sessions per week at the caregiver’s home. The proposed study outcomes will be: (1) feasibility of and adherence to the home-based provision of the intervention; (2) improvement in physical fitness and quality of life; and (3) reduction in subjective burden, psychological symptomatology and depression. Analyses will also be performed to determine the cost-effectiveness after the intervention. In conclusion, this intervention might thus represent a tailored and feasible strategy to help caregivers cope with the physical and psychological stress resulting from caregiving-related responsibilities, and it could represent a novel cost-effective support home-based intervention for caregivers.

A Low-Cost Cognitive Assistant

In this paper, we present in depth the hardware components of a low-cost cognitive assistant. The aim is to detect the performance and the emotional state that elderly people present when performing exercises. Physical and cognitive exercises are a proven way of keeping elderly people active, healthy, and happy. Our goal is to bring to people that are at their homes (or in unsupervised places) an assistant that motivates them to perform exercises and, concurrently, monitor them, observing their physical and emotional responses. We focus on the hardware parts and the deep learning models so that they can be reproduced by others. The platform is being tested at an elderly people care facility, and validation is in process.

Psychological Symptomatology in Informal Caregivers of Persons with Dementia: Influences on Health-Related Quality of Life

Informal caregivers of persons with dementia often report high levels of anxiety, depression and burden. Nonetheless, other less evaluated psychological symptoms might also influence their health-related quality of life (HRQoL). The aim of this study was to comprehensively analyse other psychological symptoms and their influence on the health-related quality of life of informal caregivers. Fifty-four informal women caregivers and fifty-six women non-caregivers were recruited to participate in the study. Psychological symptoms were assessed using the Symptom Check-List-90-Revised (SCL-90-R) questionnaire and the HRQoL with the EuroQoL-Five Dimensions and Three Levels (EurQoL-5D-3L) questionnaire. Significant between-group differences were found in the majority of scales in the SCL-90-R questionnaire (p < 0.01) and caregivers also reported a worse HRQoL than non-caregivers (p < 0.05). Several psychological symptoms such as obsession-compulsive (β = 0.47), hostility (β = 0.59), and somatization (β = −0.49) had a significant impact on caregivers’ HRQoL (R² explained between 0.17 and 0.30 of the variance). Caregivers are at a higher risk of suffering other psychological symptoms and show a moderate–high level of psychiatric morbidity, which therefore explains the poorer HRQoL outcomes. Supporting interventions should be provided to mitigate these psychological symptoms in order to improve their general distress and HRQoL.

The Development and Validation of the Healthcare Professional Humanization Scale (HUMAS) for Nursing

Introduction: The approach and use of the term “humanization” is very much present in healthcare. However, instruments for measuring the concept of the humanization of care are yet to be designed and developed. Objective: The main objective of this study was to evaluate and validate the Healthcare Professional Humanization Scale (HUMAS) for nursing professionals. Method: The sample was made up of 338 adults, who were nurses working at health centers and hospitals, and aged between 22 and 56. Results: The results of the analyses confirm that the Healthcare Professional Humanization Scale (HUMAS) has an adequate construct validity and reliability, and defines the humanization of care as a multidimensional construct, made up of five factors: Affection, Self-efficacy, Emotional understanding, Optimistic disposition and Sociability. Conclusions: The new HUMAS scale may be an easily administered and coded instrument for approaching the humanization of care, not only in research, but also in practice.

Analysis of the Risk and Protective Roles of Work-Related and Individual Variables in Burnout Syndrome in Nurses

Aims: Burnout syndrome is a phenomenon that is becoming ever more widespread, especially in workers such as nurses who have heavy workloads and time pressures. The progression of burnout syndrome has been shown to be related to both individual and work-related variables. The objective of this study is to examine the risk and protective roles played by work-related and personal variables, both sociodemographic and psychological, in the development of burnout in nurses. Method: The sample was composed of 1236 nurses aged between 21 and 57 years, with a mean age of 31.50 years (SD = 6.18). Women accounted for 84.5% (n = 1044), and the remaining 15.5% (n = 192) were men. Exploratory tests were performed to understand the relationships between burnout and other variables, and a binary logistic regression was conducted to understand the roles of these variables in the incidence of this syndrome. Lastly, a regression tree was constructed. Results: The results show that the sociodemographic variables examined are not related to the level of burnout in nurses. However, certain work-related variables, such as spending more time with colleagues and patients and reporting good-quality relationships, exhibit a negative relationship with the occurrence of burnout. Of the psychological variables, the stress factors conflict-social acceptance and irritability-tension-fatigue, as well as informative communication, are shown to be risk factors for the appearance of burnout in nurses. In contrast, the communication skills factor, empathy, and energy-joy exert a protective function. Conclusion: Identifying the variables that influence the occurrence of burnout syndrome and understanding the manner in which they exert their influence are key elements in the development of effective prevention and intervention of burnout in nursing.

Emotional Intelligence, Self-Efficacy and Empathy as Predictors of Overall Self-Esteem in Nursing by Years of Experience

Empirical research on self-esteem has a special interest in nursing professionals, because they work in a challenging environment that requires, in order to continue working during their working age, a strong physical, social and emotional involvement. The objective was to determine the explanatory value of individual variables such as Self-efficacy, Empathy and Emotional Intelligence on Self-esteem in a sample of nursing professionals, to identify which variables have the most explanatory value for overall self-esteem with years of experience. The study sample consisted of a total of 1,601 Spanish nurses aged 22–60, with a mean age of 31.19 (SD = 6.59) years. The emotional intelligence factors in all cases were observed to have positive correlations with overall self-esteem. Mood was still the predictor with the most explanatory weight in all the groups. General Self-Efficacy disappeared in the model of professionals with the most experience. Organizations and management nursing should implement intervention programs that promote wellbeing and satisfaction in workers during their working age. It would be of interest to train nursing professionals in such necessary competences as Empathy, Emotional Intelligence and Self-Efficacy.

Emotional Exhaustion in Housewives and Alzheimer Patients' Caregivers: Its Effects on Chronic Diseases, Somatic Symptoms and Social Dysfunction

Background: Emotional exhaustion causes adverse effects in those who suffer from it. Housewives are not excluded. Domestic and care chores, which are considered to be sources of stress, increase when taking on the role of caregiver for a family member with Alzheimer’s disease. Objective: To analyse the influence of emotional exhaustion, somatic symptoms and social dysfunction, based on the activity they carry out. Methodology: Cross-sectional survey. 193 women participated, of which: housewives (HWs) (n = 97), and Alzheimer’s patient caregiver-housewives (CHWs) (n = 96). The evaluation tools were: sociodemographic/working data questionnaire (ad hoc), Maslach Burnout Inventory (MBI) and Goldberg General Health Questionnaire (GHQ-28). Results: High rates of emotional exhaustion are observed, as well as an existing positive link between chronic diseases, somatic symptoms and social dysfunction. The structural model indicates that emotional exhaustion predicts the amount and extent of diseases, somatic symptoms and social dysfunction. The influence is higher in CHWs. Limitations: Sample procedure implemented at convenience; the variable of the grade of dependence of the Alzheimer’s patient caregiver was not included in the study. Conclusions: The domestic and care chores that HWs and CHWs carry out affect their health. Hence the need to develop psychoeducative programmes that are adapted to the particular needs of these women and focused on the different areas of their everyday lives.

Burnout, Perceived Efficacy, and Job Satisfaction: Perception of the Educational Context in High School Teachers

Burnout is closely related to personal and contextual variables, especially job satisfaction and commitment, and other less studied psychological variables, such as perception of teaching efficacy or educational context. Objective. The general objective of this study was to examine the relationships of burnout with perceived educational context, perceived teaching efficacy (personal and collective), and job satisfaction and commitment. Materials and Methods. A battery of instruments was administered to 500 high school teachers at different schools in several Italian provinces. Results. The cluster analysis found that one-third of high school teachers had high burnout. Evidence was also found associating elevated burnout with low scores in perceived efficacy (personal and collective), low job satisfaction, and low professional commitment. Furthermore, perception of the educational context is less positive when the teachers experience high levels of burnout. Finally, the results showed the mediating effect of perceived personal efficacy on the relationship between burnout and job satisfaction. Conclusions. The results are discussed from the perspective of developing teaching autonomy on improving personal efficacy, decreasing burnout, and increasing job satisfaction in an educational system which reinforces individual and collective competence.

Evaluation of the perceived health of caregivers of patients in mild-to-moderate stage Alzheimer's disease

PURPOSE

To know the health perceived by the family caregivers of Alzheimer's disease, according to the relationship of kinship and the duration of the care in mild-to-moderate stage of dementia.

DESIGN AND METHODS

Cross-sectional descriptive study in 255 caregivers. The instruments used were an ad hoc questionnaire and the Goldberg General Health Questionnaire (GHQ-28).

FINDINGS

The presence of acute and chronic mental pathology has been observed. Specifically in the spouses and children, severe depression and social dysfunction, and in periods of care between 2 and 5 years, mainly anxiety and insomnia have been observed.

PRACTICE IMPLICATIONS

The relationship of kinship and the duration of care must be taken into account in the planning of specific interventions in these caregivers.

Analysis of the Mediating Role of Self-Efficacy and Self-Esteem on the Effect of Workload on Burnout's Influence on Nurses' Plans to Work Longer

At the present time, we know that there is a positive relationship between self-efficacy and self-esteem in which positive beliefs about one’s own efficacy increase one’s sense of self-worth as stressful situations of a heavy workload are coped with successfully, and this, in turn, affects the nurses’ plans to work longer. Analyze the mediating role of self-efficacy and self-esteem in the effect of workload, measured as the number of users attended to during a workday, on burnout in nursing professionals. A sample of 1307 nurses aged 22 to 60 years who were administered the Brief Burnout Questionnaire, the General Self-Efficacy Scale, and the Rosenberg Self-Esteem Scale, and workload, measured as the number of users attended to during the workday. The results show that professionals with high levels of self-efficacy also scored higher on global self-esteem. Burnout correlated negatively with both variables (self-efficacy and self-esteem). Three clusters were found with the variables (self-efficacy, self-esteem, and workload) showing significant differences in burnout scores among clusters. Self-efficacy and self-esteem function as buffers of the negative effects of workload on burnout. Organizations should design interventions for promoting the personal resources of their workers through training activities and organizational resources (e.g., redesigning job positions) to promote satisfaction and wellbeing of employees, making their stay at work greater.

Empathy in informal dementia caregivers and its relationship with depression, anxiety, and burden

Background/Objective: Recent interventions aim to heighten informal caregivers’ empathy levels assuming that this will lead to better well-being. However, previous studies have explored linear associations between empathy and aspects of well-being and yielded mixed results. We hypothesized that quadratic models may be more fitting to describe these relationships. Method: A cross-sectional study, with two groups (201 informal caregivers, and 187 non-caregivers) was conducted. Participants completed questionnaires on cognitive and affective empathy, and depression, anxiety, and caregiver burden. AN(C)OVA's and multiple hierarchical regression analyses including linear and quadratic terms were used to analyze the data. Results: For caregivers, there was a negative quadratic relationship between depression and cognitive empathy, and a positive linear relationship between anxiety and affective empathy, irrespective of sociodemographic characteristics. For non-caregivers, there were positive quadratic relationships between depression and cognitive and affective empathy, and between anxiety and affective empathy. The empathy levels did not differ between the groups. Conclusions: While caregivers and non-caregivers had the same amount of empathy, the relationships between empathy and depression and anxiety differed between the groups. Interventions for informal caregivers could aim to heighten cognitive empathy and to lower affective empathy to diminish depression and anxiety symptoms.

New Burnout Evaluation Model Based on the Brief Burnout Questionnaire: Psychometric Properties for Nursing

Health care personnel are considered one of the worker sectors most exposed to heavier workloads and work stress. One of the consequences associated with the exposure to chronic stress is the development of burnout syndrome. Given that evaluating this syndrome requires addressing the context in which they are to be used, the purpose of this work was to analyze the psychometric properties and structure of the Burnout Brief Questionnaire (CBB), and to propose a more suitable version for its application to health professionals, and more specifically nurses. The final study sample was made up of 1236 working nursing professionals. An exploratory factorial analysis was carried out and a new model was proposed through a confirmatory factorial analysis. Thus, validation of the CBB questionnaire for nursing health care personnel showed an adequate discrimination of the items and a high internal consistency of the scale. With respect to the factorial analysis, four factors were extracted from the revised model. Specifically, these new factors, called job dissatisfaction, social climate, personal impact, and motivational abandonment, showed an adequate index of adjustment. Thus, the Brief Burnout Questionnaire Revised for nursing staff has favorable psychometric properties, and this model can be applied to all health care professionals.

Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale

Background/Objective: The Devaluation of Consumer Families Scale (DCFS) is commonly used to measure perceived stigma towards family members of people with mental illness. However, its factorial structure has never been confirmed using confirmatory factor analysis (CFA). This study aimed to test the psychometric properties of the DCFS Taiwan version (DCFS-TW). Method: Family caregivers (N=511) completed the DCFS-TW (97 completed the DCFS again after 2 to 4 weeks) and other instruments. CFA, test-retest reliability, internal consistency, concurrent validity, and known-group validity were analyzed. Results: The three-factor structure of the DCFS-TW performed better than the one-factor structure. Test-retest reliability (r = .66) and internal consistency were satisfactory (α = .85); concurrent validity (absolute r = .20 to .58) was acceptable; known-group validity was supported by the significantly different DCFS-TW scores in clinical characteristics (had been vs. had not been hospitalized; had been vs. had not been compulsorily admitted). Conclusions: The DCFS-TW has decent psychometric properties and is suitable for health professionals to measure perceived stigma towards family members of people with mental illness.