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Lee YT, Yuan Q, Zhang Y, Samari E, Goveas R, Ng LL, Subramaniam M. Evaluating a mobile-based intervention to promote the mental health of informal dementia caregivers in Singapore: Study protocol for a pilot two-armed randomised controlled trial. PLoS One 2024; 19:e0305729. [PMID: 38913625 PMCID: PMC11195940 DOI: 10.1371/journal.pone.0305729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Informal caregivers of persons with dementia (PWD) often suffer adverse impacts on their mental health and require interventions for effective support. As they are often occupied with providing care, web-based interventions could be more convenient and efficient for them. However, there is currently a dearth of evidence-based mobile interventions to enhance the mental well-being of dementia caregivers locally, especially ones that are user-centered and culturally relevant. Hence, having designed an app based on feedback from local dementia caregivers, this study will evaluate the effectiveness of this mobile app in promoting the mental health of informal caregivers of PWD in Singapore. METHODS A pilot two-armed randomised controlled trial will be conducted on 60 informal caregivers of PWD recruited via convenience and snowball sampling. Thirty participants will be assigned to the intervention group, while another 30 will be in a waiting-list control group. Questionnaires will be administered at baseline and one month after, with the primary outcome being the difference in the change of depressive symptoms among the two groups. STATISTICAL ANALYSIS Primary analyses will follow the intention-to-treat principle and compare changes from baseline to the one-month follow-up time point relative to the control group. A repeated measures ANOVA will be conducted to examine differences between the groups over time. SIGNIFICANCE To our knowledge, this is the first study in Singapore that seeks to promote the mental health of informal dementia caregivers through a mobile-based intervention. The findings can inform the development and evaluation of future evidence-based digital interventions for local informal caregivers of PWD to address the gap in availability of such resources for them. TRIAL REGISTRATION ClinicalTrials.gov (NCT05551533). Registration date: September 22, 2022.
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Affiliation(s)
- Yun Ting Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - YunJue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Richard Goveas
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
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López-Martínez C, Orgeta V, Frías-Osuna A, Del-Pino-Casado R. Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden. J Nurs Scholarsh 2024; 56:371-381. [PMID: 38282022 DOI: 10.1111/jnu.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time. DESIGN Prospective longitudinal study. METHODS We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time. RESULTS Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping. CONCLUSIONS Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers. CLINICAL RELEVANCE Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.
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Affiliation(s)
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Antonio Frías-Osuna
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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Montejano-Lozoya R, Alcañiz-Garrán MDM, Ramos-Pichardo JD, Sánchez-Alcón M, García-Sanjuan S, Sanjuán-Quiles Á. Affective Impact on Informal Caregivers over 70 Years of Age: A Qualitative Study. Healthcare (Basel) 2024; 12:329. [PMID: 38338215 PMCID: PMC10855777 DOI: 10.3390/healthcare12030329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Given today's rapidly ageing society, family members providing informal care to dependent older adults face ever-increasing challenges. The aim of this study was to describe the affective impact on older adults over 70 years of age caring for a dependent older person at home. A qualitative study was designed from a phenomenological perspective. Thirteen in-depth interviews were conducted with caregivers aged 70 or older. A content analysis of the interviews was carried out in five stages. Three themes were identified: "Emotions", "Feelings", and "Looking to the future". Caregivers express negative emotions (sadness, anger, and fear) and feelings of social and emotional isolation, and they feel abandoned by health professionals, family, and friends. In conclusion, prolonged caregiving by older adults has a negative affective impact and creates uncertainty about the future. There is a need to devise social and healthcare policies and actions, creating social support networks to improve their health and emotional wellbeing.
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Affiliation(s)
| | | | | | | | - Sofía García-Sanjuan
- Department of Nursing, University of Alicante, 03690 San Vicente del Raspeig, Spain; (S.G.-S.); (Á.S.-Q.)
| | - Ángela Sanjuán-Quiles
- Department of Nursing, University of Alicante, 03690 San Vicente del Raspeig, Spain; (S.G.-S.); (Á.S.-Q.)
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Muro Pérez-Aradros C, Navarro-Prados AB, Satorres E, Serra E, Meléndez JC. Coping and guilt in informal caregivers: a predictive model based on structural equations. PSYCHOL HEALTH MED 2023; 28:819-830. [PMID: 35057683 DOI: 10.1080/13548506.2022.2029917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Caregivers experience great stress, and coping can be one of the factors, which determine the extent of stress. The aim of the present paper is to analyze the effects of coping strategies on distress of the older adult's caregiver, including guilt as a mediating factor in those maladaptive strategies. The sample consisted of 201 informal caregivers of institutionalized older adults. The three constructs measured were: stress, guilt, and coping strategies. Results showed that strategies that have a better ability to reduce stress are active, positive reframing and acceptance; on the contrary, behavioral disengagement, self-distraction, self-blame and venting positively predicted the feeling of guilt that facilitated the perception of stress. Given the important association obtained between the experience of guilt and psychological distress in caregivers, it could be relevant to develop psychoeducational interventions with caregivers including techniques to reduce this feeling of guilt and develop cognitive behavioral strategies that facilitate adaptation.
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Affiliation(s)
| | - Ana-Belén Navarro-Prados
- Department of Developmental Psychology, Faculty of Psychology, University of Salamanca (Spain), Salamanca, Spain
| | - Encarna Satorres
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Emilia Serra
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Juan C Meléndez
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
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Marr NS, Zainal NH, Newman MG. Focus on and venting of negative emotion mediates the 18-year bi-directional relations between major depressive disorder and generalized anxiety disorder diagnoses. J Affect Disord 2022; 303:10-17. [PMID: 35065091 PMCID: PMC8917061 DOI: 10.1016/j.jad.2022.01.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myriad emotion regulation and coping theories have proposed that avoidant/emotion-oriented coping is a cause and consequence of anxiety and depression. However, few studies have investigated potential mechanisms underlying the prospective anxiety-depression disorder relation. The current study examined various coping strategies (i.e., denial, focus on and venting of emotion (FOAVE), and behavioral disengagement) as potential longitudinal mediators between generalized anxiety disorder (GAD) and major depressive disorder (MDD). METHODS In a nationally representative sample of adults (N = 3,294), MDD and GAD were assessed at Time 1 (T1) and Time 3 (T3) (Composite International Diagnostic Interview - Short-Form), and avoidant coping strategies (denial, behavioral disengagement, and FOAVE) were measured at Time 2 (T2) (Coping Questionnaire). Assessments occurred over 18 years, each spaced approximately 9 years apart. Structural equation modeling mediation analyses examined whether T1 MDD predicted T3 GAD (and vice versa), and if T2 avoidant coping mediated these relations, above and beyond baseline comorbidity. RESULTS FOAVE mediated the T1 MDD-T3 GAD association, and vice versa. Presence of T1 MDD and GAD predicted more T2 FOAVE, and greater T2 FOAVE forecasted T3 MDD and GAD, accounting for 16-21% of the longitudinal MDD-GAD relations. However, behavioral disengagement and denial did not mediate the prospective MDD-GAD relations. Also, T1 MDD and GAD forecasted greater T2 behavioral disengagement. CONCLUSIONS The use of FOAVE, may be a mechanism by which MDD earlier in life may lead to GAD 18 years later, and vice versa. Theoretical and potential clinical implications are discussed.
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Del-Pino-Casado R, López-Martínez C, Osuna AF, Orgeta V. The relationship between perceived social support and psychological distress in carers of older relatives: A longitudinal cross-lagged analysis. J Affect Disord 2022; 297:401-406. [PMID: 34715173 DOI: 10.1016/j.jad.2021.10.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/30/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Although a large body of research has examined the relationship between social support and psychological health of family carers of frail older people, the exact nature and direction of this relationship is not well understood with most research to date being cross-sectional. This longitudinal study explored the relationship between perceived social support and psychological distress in carers of older relatives. METHODS We used data from two longitudinal cohorts which included a total of 332 family carers of frail older people. We used cross-lagged panel analysis to investigate the longitudinal association between perceived social support and carer psychological distress controlling for a number of covariates over time. RESULTS Fully-adjusted Generalised Estimating Equations (GEE) and cross-lagged models indicated that higher social support was significantly associated with lower carer psychological distress over time (regression coefficient [B] = -0.178, standard error [SE] = 0.028), with levels of perceived social support exerting an effect on psychological distress rather than vice versa (β = 0.03, p = 0.32). LIMITATIONS All observations were based on self-report data, and there may be other variables that may explain the results that we did not account for. DISCUSSION AND IMPLICATIONS Our study finds that the directionality of the relationship appears to be from perceived social support to carer psychological distress suggesting that social support directly affects carer psychological health but not vice versa. This finding has important implications for the provision of social support interventions for carers of frail older people at risk of experiencing psychological distress.
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Affiliation(s)
- Rafael Del-Pino-Casado
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, Jaén 23071, Spain.
| | - Catalina López-Martínez
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, Jaén 23071, Spain
| | - Antonio Frías Osuna
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, Jaén 23071, Spain
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom
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Tan X, An Y, Chen C. Avoidant coping as mediator of the relationship between rumination and mental health among family caregivers of Chinese breast cancer patients. Eur J Cancer Care (Engl) 2021; 31:e13523. [PMID: 34658090 DOI: 10.1111/ecc.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/07/2021] [Accepted: 09/24/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Family caregivers of cancer patients were often referred to the 'forgotten patients', yet little researches have been conducted on their mental health. Rumination might put family caregivers at risk for psychological distress during the caregiving, such as stress and anxiety. The aim of the present study was to explore the relationship between rumination, stress and anxiety among family caregivers of breast cancer patients in China and examine the mediating role of avoidant coping in this relationship. METHODS Face-to-face questionnaire interviews were conducted with a sample of 99 caregivers from the public oncology hospital. They were assessed with stress, anxiety, rumination and avoidant coping by Chinese Perceived Stress Scale, Zung's Self-Rating Anxiety Scale, Ruminative Responses Scale and Coping Strategy Indicator. Structural equation modelling was applied to assess the mediation analysis. RESULTS The reporting scores of participants indicated the incidence of anxiety was 17.2%. Rumination could directly predict stress (β = 0.58, p < 0.01) and anxiety (β = 0.46, p < 0.01) and also predict stress and anxiety via the mediator of avoidant coping (stress: β = 0.087, p < 0.01; anxiety: β = 0.109, p < 0.01). CONCLUSIONS The important role played by family caregivers in supporting breast cancer patients is well recognised. The findings suggested that rumination and avoidant coping may be two critical risk factors for family caregivers of breast cancer developing stress and anxiety. This study highlights the importance of preventing avoidant coping, which plays a critical role for developing interventions for this vulnerable group.
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Affiliation(s)
- Xing Tan
- School of Psychology, Nanjing Normal University, Nanjing, China.,School of Psychology, South China Normal University, Guangzhou, China
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Chen Chen
- Department of Social and Behavioural Sciences, City University of Hongkong, Hongkong, China
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Munkejord MC, Ness TM, Gao IAWS. "This Life is Normal for Me": A Study of Everyday Life Experiences and Coping Strategies of Live-in Carers in Taiwan. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:533-546. [PMID: 33896408 DOI: 10.1080/01634372.2021.1917032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
Recruiting migrant live-in carers has become the main strategy to address the rapid increase in the number of older persons with intensive care needs in many parts of the developed world. This is also the case in northern Taiwan, where this study took place. Thirteen live-in carers from Indonesia and the Philippines were interviewed in the fall of 2019. In this article, we discuss their two main coping strategies: a) "accepting destiny", which refers to carers accepting their life and viewing their role as a live-in carer as a job that allowed them to meet their parents' expectations of financial support; and b) "connecting to significant others", which is the most important way carers found motivation to keep going. However, despite their coping strategies, working as a live-in carer was experienced as a challenging and precarious lifestyle. In the conclusion, we discuss how professional social workers in collaboration with decision-makers and non-governmental organizations in Taiwan could contribute to fostering a system that would support live-in carers in ways that allow them, and the older persons they care for, to thrive.
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Affiliation(s)
- Mai Camilla Munkejord
- Department of Business Administration, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tove M Ness
- Department of Nursing Sciences, Nord University, Namsos, Norway
| | - I-An W S Gao
- CEREN, Swedish School of Social Science, University of Helsinki, Helsinki, Finland
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Lan X, Wu Q, Chen X, Jin S, Yi B. Caregiver burden among informal caregivers of hospitalized patients with frailty: A cross-sectional survey. Geriatr Nurs 2021; 42:948-954. [PMID: 34134042 DOI: 10.1016/j.gerinurse.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to investigate the status of caregiver burden among informal caregivers of hospitalized frail older patients and explore the associated factors. A total of 191 frail older patients and their informal caregivers were recruited from the inpatient units of the three teaching hospitals. We collected data using the FRAIL scale, the Zarit Burden Interview, and the Simplified Coping Style Questionnaire. We used descriptive statistics, Pearson correlation coefficients, one-way analysis of variance, and multiple linear regression for the data analysis. The caregivers of hospitalized frail older patients experienced a moderate caregiver burden (26.476±11.289). The regression model for caregiver burden was significant. Male caregivers, taking care of patients before hospitalization, experiencing negative emotions, and negative coping styles were significantly associated with caregiver burden, F (7, 183) = 15.13, p <. 001. The findings suggest that early identification of caregiver burden and focused interventions for alleviating caregiver burden are needed.
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Affiliation(s)
- Xiuyan Lan
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China; Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China.
| | - Qingqing Wu
- The Second Affiliated of Fujian Traditional Chinese Medical University
| | - Xiaohuan Chen
- Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China; Nursing Department, Fujian Provincial Hospital, Fuzhou, China.
| | - Shuang Jin
- Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China; Nursing Department, Fujian Provincial Hospital, Fuzhou, China
| | - Bilan Yi
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China; Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China
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del-Pino-Casado R, Priego-Cubero E, López-Martínez C, Orgeta V. Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis. PLoS One 2021; 16:e0247143. [PMID: 33647035 PMCID: PMC7920375 DOI: 10.1371/journal.pone.0247143] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.
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Affiliation(s)
- Rafael del-Pino-Casado
- Faculty of Health Sciences, Department of Nursing, University of Jaén, Jaén, Andalusia, Spain
- * E-mail:
| | - Emilia Priego-Cubero
- Faculty of Health Sciences, Department of Nursing, University of Jaén, Jaén, Andalusia, Spain
| | - Catalina López-Martínez
- Faculty of Health Sciences, Department of Nursing, University of Jaén, Jaén, Andalusia, Spain
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom
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