Longitudinal analysis of resourcefulness, family strain, and depressive symptoms in grandmother caregivers

Exploring self-care practices of African American informal kinship caregivers

African American caregivers providing informal kinship care are vulnerable to chronic stress. Research has indicated stress increases individuals' risk for many adverse physical and mental health outcomes, including cardiovascular disease, Alzheimer's disease and depression. Given the adverse outcomes related to stress, identifying mechanisms to help these caregivers lower and manage their stress is critical to their overall health and well-being. This pilot qualitative study aimed to explore the self-care practices of 12 African Americans providing informal kinship care using a phenomenological approach. Three themes emerged: (a) behaviours to manage stress levels, (b) support network reminding caregivers to take care of themselves and (c) prioritizing my own needs. Specifically, our findings indicate that some caregivers have high-stress levels and engage in maladaptive coping behaviours. The children they cared for reminded them to take care of themselves by attending doctors' appointments or getting their nails done. Nevertheless, some caregivers prioritized their needs by participating in positive self-care behaviours, such as listening to jazz and gospel music and exercising. Prevention and intervention programs that focus on improving caregivers' health should consider the role of self-care practices.

Effects of resourcefulness on internet game addiction among college students: The mediating role of anxiety and the moderating role of gender

Introduction

The mechanism of internet game addiction is unclear. Whether anxiety mediates between resourcefulness and internet game addiction and whether gender affect its mediation role have not been studied previously.

Methods

A total of 4,889 college students from a college in southwest China were included in this study to complete the investigation, in which three questionnaires were used for evaluation.

Results

Pearson's correlation analysis indicated a remarkable negative correlation between resourcefulness with internet game addiction and anxiety, as well as a significant positive correlation between anxiety and this addiction. The structural equation model confirmed the mediation role of anxiety. The multi-group analysis confirmed the moderating role of gender in the mediation model.

Discussion

These findings have advanced the results of existing studies, indicating the buffering effect of resourcefulness on internet game addiction and revealing the potential mechanism of this relationship.

Self-management of chronic disease in Latina Kinship caregivers: an integrative review

In the United States, Latinos experience a higher prevalence of chronic diseases with concomitant complications when compared to Non-Latino Whites. Older Latina women often manage a chronic illness while also providing kinship care. This article presents an integrative review of Latina kinship caregivers' self-management of chronic disease. An extensive review of the literature was conducted in seven databases. Four resulting studies included qualitative, quantitative, and mixed methods research and suggested health outcomes for Latina kinship caregivers were often worse when compared to other groups. A major gap in the literature identified an absence of disease-specific self-management behaviors for this population.

Grandmothers raising grandchildren: managing, balancing and maintaining family relationships

Most grandparents raising grandchildren are embedded in a network of family members who either help them carry out the caregiving task or complicate that role. This study examined how grandmothers described family relationships, that is, with the grandchild's parents, grandmother's spouses/partners, and other relatives. Data were drawn from 457 weekly journal entries submitted by 129 grandmother caregivers. Using thematic analysis, a three-person team coded using NVIVO 12. Grandmothers described three overarching relationship themes: managing conflicted relationships with the grandchild's parents, balancing relationships with their spouse/partner, and maintaining relationships with other relatives. Implications for practice are provided.

The Role of Contact Care by Adult Children in Relieving Depression in Older Adult Individuals

The purpose of this study is to investigate how contact care by adult children influences the effect of caring for grandchildren on depression in older adult individuals. Studies have shown that caring for grandchildren either increases or decreases the symptoms of depression in older adult individuals, while other studies have shown no effect. The reason for these inconsistent results is that the key control variable, contact care by adult children, has been omitted from these previous studies. An analysis of panel data consisting of observations from 162 older adult respondents in the Korean Longitudinal Study of Aging over the 2008-2016 period confirms that the positive effect of caring for grandchildren on depression in older adults increased as the number of adult children who visited their older adult parents after entrusting their children to them increased. As more of their adult children visited the older adult individuals, the latter were more likely to feel that caring for their grandchildren was healing rather than stressful.

"Who is going to take care of these grandkids if I go?": End-of-life planning by caregivers in grandparent-headed households

This qualitative study applied thematic analysis to semi-structured interviews with 15 key informants who self-identified as primary caregivers to at least one grandchild. Using Family Systems Theory and Theory of Planned Behavior as guiding frameworks, this study reports grandparent caregivers' end-of-life planning behaviors while illuminating factors influencing these behaviors. The analysis revealed two themes related to grandparents' communicative behaviors surrounding end-of-life planning (formal and informal behaviors) and four themes related to factors that influence grandparents' end-of-life planning (emotional paradoxes, legal/custodial conundrums, concerns about child wellbeing, and resources needed to plan). Findings extend end-of-life planning literature to often overlooked nontraditional family populations.

Resourcefulness revisited: Further psychometric evaluation of resourcefulness scale

Resourcefulness, a collection of problem-solving, coping, self-control and emotion regulation skills, has been shown to moderate health outcomes in various caregiver populations. Caregivers of children with neurodevelopmental disorders, such as autism spectrum disorder (ASD), report higher levels of stress, anxiety and depressive symptoms with poorer health-related quality of life. The current study replicated and extended psychometric research on the Resourcefulness Scale (RS) among caregivers of children with ASD (n = 287) and a comparison group of caregivers of non-affected children (n = 207). Results suggest acceptable internal consistency and construct validity when using the RS among caregivers of children with and without ASD. The RS demonstrated poor temporal stability over an average of 4 weeks (r = 0.087, p = 0.434). Caregivers of children with ASD report higher levels of general, social, and personal resourcefulness than non-affected caregivers. Findings validate the use of the RS within caregiving populations with implications for clinical use and future research in the development of interventions to enhance caregiver QoL.

Reunification in Custodial Grandfamilies: An Examination of Resilient Family Processes

OBJECTIVE

This study examined how custodial grandmothers navigated the process of their grandchildren being reunified with a biological parent.

BACKGROUND

Prior research has focused on factors associated with unsuccessful reunification instead of resilient family processes that may support successful reunification. How custodial grandfamilies navigate reunification has not been examined, despite their unique relational configuration and grandparents' frequent involvement in raising their grandchildren.

METHOD

Guided by Walsh's model of family resilience, semistructured, in-depth qualitative interviews were conducted with a convenience sample of 17 grandmothers whose custodial grandchildren had been reunified with a biological parent. Data analysis was guided by grounded theory methodology.

RESULTS

Grandmothers believed in parents fulfilling their obligations, prioritizing grandchildren's needs, and coping via their faith. Grandmothers supported reunified parents and children by providing emotional support and instrumental assistance, while maintaining clear role boundaries. Accessing resources and engaging in open family communication were helpful to the reunification, although there were still challenges in navigating family relationships.

CONCLUSION

Within custodial grandfamilies, not all reunifications were a positive outcome for the grandchildren. Grandmothers remained heavily involved in supporting and monitoring the reunifications, with the quality of the grandmother-parent relationship being paramount.

IMPLICATIONS

Practitioners should address family dynamics when working with custodial grandfamilies before, during, and after a reunification.

Use of puppets to teach resourcefulness skills to women who self-injure: An exploratory study

BACKGROUND

Self-injurious behavior (SIB), when frequent and repetitive, can lead to risk behaviors resulting in accidental or intentional suicide. Psychoeducation about resourcefulness can be critical to interrupt the cycle of self-injury. Therapeutic puppetry provides a safe and secure vehicle for expressing feelings without fear of retaliation.

OBJECTIVES

Determine the outcome of a resourcefulness psychoeducation program, utilizing hand puppets as a teaching tool, on the measure of resourcefulness for adult women who self-injure.

METHODS

A psychoeducation program, utilizing hand puppets as a teaching tool, was offered to women during psychiatric hospitalization. Participants completed the Resourcefulness Scale (RS) pre and post intervention. A program evaluation to determine the effectiveness of hand puppets was completed. Acceptability and feasibility of the program was evaluated.

RESULTS

Sixteen participants completed the program. Results showed a statistically insignificant increase in scores. The program evaluation revealed agreement that resourcefulness learning was accomplished. Participants reported that hand puppets were helpful in practicing resourcefulness skills. Majority of participants recommended continuation of the program.

Maternal Stress and Mental Health Prior to Their Technology-Dependent Infant's Discharge Home From the NICU

Mothers of infants in the neonatal intensive care unit (NICU) face stressors including turbulent emotions from their pregnancy/unexpected preterm delivery and their infant's unpredictable health status. The study purpose was to examine the psychological state of mothers prior to the discharge of their technology-dependent infants (eg, feeding tubes, supplemental oxygen) from the NICU to home. The study sample consisted of mothers (N = 19) of infants dependent on medical technology being discharged from a large Midwest NICU. A descriptive, correlational design using convenience sampling was employed to recruit mothers to examine associations of infant and maternal factors, resourcefulness, and stress with psychological state (depressive symptoms, posttraumatic stress symptoms). Forty-two percent of mothers were at high risk for clinical depression, with 37% in the clinical range for posttraumatic stress disorder. Increased maternal depressive symptoms were significantly associated with the increased frequency and perceived difficulty of their stress and posttraumatic stress symptoms. Increased posttraumatic stress symptoms were significantly associated solely with elevated depressive symptoms. This study identified factors associated with the mothers' increased psychological distress, providing beginning evidence for future interventions to employ prior to their technology-dependent infant's NICU discharge.

Grandchildren's Depressive Symptoms and Perceptions of Family Functioning: Protective and Influencing Factors

A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children's living situation, parental monitoring, child's resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insight into factors influencing children's depressive symptoms and perceived family functioning, and provides direction for the development of future interventions.

Trauma-Informed Parenting Classes Delivered to Rural Kinship Parents: A Pilot Study

BACKGROUND

Without an informed approach, kinship parents, often grandparents, may struggle to effectively interact with their children who have experienced trauma.

OBJECTIVES

The purpose of this pilot study was to describe the overall impact and acceptability of a trauma-informed parenting curriculum delivered to 16 rural-dwelling kinship parents. Nursing faculty partnered with Cooperative Extension Educators to deliver this curriculum, developed by the National Child Traumatic Stress Network. Semistructured interviews, an acceptability survey, and measures of parent, child, and family environment were used.

DESIGN

This pilot, multisite, mixed-methods, intervention study employed a pre-post, paired test design.

RESULTS

Significant differences were revealed on select items that measured parent-child nurturing and the families' cultural, political, and intellectual activities with posttest scores lower than pretest scores. Themes revealed processing the aftermath of child trauma and being a kinship parent.

CONCLUSIONS

Although quantitative measures failed to demonstrate the impact of the curriculum, qualitative and satisfaction data provide preliminary evidence to support this intervention.

Does grandchild care influence grandparents' self-rated health? Evidence from a fixed effects approach

The present study aims to identify, whether and how supplementary grandchild care is causally related to grandparents' self-rated health (SRH). Based on longitudinal data drawn from the German Aging Survey (DEAS; 2008-2014), I compare the results of pooled OLS, pooled OLS with lagged dependant variables (POLS-LD), random and fixed effects (RE, FE) panel regression. The results show that there is a positive but small association between supplementary grandchild care and SRH in POLS, POLS-LD, and RE models. However, the fixed effects model shows that the intrapersonal change in grandchild care does not cause a change in grandparents' SRH. The FE findings indicate that supplementary grandchild care in Germany does not have a causal impact on grandparents' SRH, suggesting that models with between-variation components overestimate the influence of grandchild care on grandparents' health because they do not control for unobserved (time-constant) heterogeneity.

Biofeedback in Grandmothers Raising Grandchildren: Evaluating Intervention Parameters

This study examined the six critical parameters for evaluating interventions, including necessity, acceptability, feasibility, safety, fidelity, and effectiveness, of a heart rate variability (HRV) biofeedback training intervention in a sample of 20 grandmothers who were the primary caregivers of their grandchildren. After the grandmothers completed the HRV biofeedback training, they answered open-ended questions to provide data on the six parameters during face-to-face interviews. The findings of the study provided evidence for the necessity, acceptability, feasibility, safety, fidelity, and effectiveness of the HRV biofeedback intervention for reducing the stress experienced by grandmothers in raising their grandchildren.

Mental Health Stress, Family Resources and Psychological Distress: A Longitudinal Mediation Analysis in African American Grandmothers Raising Grandchildren

OBJECTIVES

This study examines the effectiveness of a multidisciplinary intervention for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources.

METHOD

A nonrandom sample of African American grandmothers (N = 679) was assessed to test the predictive relations among study constructs in the context of a prospective mediational model.

RESULTS

Perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between the 2 mental health stress groups.

CONCLUSION

The findings suggest appropriate resource-focused interventions can enhance grandmothers' subjective assessments of family resources and reduce psychological distress. However, additional research is needed to ascertain the consistency and generalizability of findings.

Evaluating an Online Resourcefulness Training Intervention Pilot Test Using Six Critical Parameters

Few resources are available to help grandmother caregivers to grandchildren manage their complex family situations that may have immediate and long-term consequences for themselves and their families. Resourcefulness training is an intervention designed to help grandmothers improve their ability to deal with these problems. The purpose of this pilot study was to evaluate the necessity, feasibility, acceptability, fidelity, safety, and effectiveness (i.e., effect sizes) of an online, computer-based resourcefulness training intervention that was adapted from a face-to-face intervention. Twelve grandmothers raising or living with grandchildren participated in the pilot intervention that included (a) watching an instructional video on resourcefulness, (b) completing two online questionnaires over a 6-week time period, and (c) writing in an online journal every day for 4 weeks. Data are evaluated within the context of the six parameters important to intervention development. Qualitative and quantitative results provide initial support for all six parameters. Recommendations to improve aspects of the intervention are discussed.

Resourcefulness Training for Women Dementia Caregivers: Acceptability and Feasibility of Two Methods

Almost 10 million women in the United States are caregivers for elders with dementia and many experience extreme stress that compromises their health. Acceptable and feasible interventions to teach them resourcefulness skills for managing stress may improve their health and facilitate continued caregiving. This study examined two commonly used methods for practicing skills taught during resourcefulness training (RT) to women caregivers of elders with dementia (n=63): journaling and digital voice recording. It also explored whether providing caregivers a choice between the two methods made it more acceptable or feasible. Qualitative and quantitative data were collected before, during, and after RT. Caregivers who recorded used more words (M=5446) but recorded fewer days (M=17) than those who journaled (M=2792 words and M=27 days). Similar concerns in relation to time management and practice method were expressed by women caregivers irrespective of practice method (journal versus recorder) or random versus choice condition. While journaling was more frequent than recording, more words were expressed during recordings. Perceived stress and depressive symptoms were unrelated to the number of practice days or word counts, suggesting RT acceptability and feasibility even for highly stressed or depressed caregivers. Because intervention feasibility is important for RT effectiveness testing, alternatives to the journaling and recording methods for practicing RT skills should be considered.

Biofeedback in Grandmothers Raising Grandchildren: Correlations Between Subjective and Objective Measures

Research shows that 20% of grandmothers raising grandchildren experience stress and depression. Heart rate variability (HRV) biofeedback may help grandmothers track and regulate their physiological response to stress. This study therefore examined correlations between coherence scores reflecting HRV and self-report measures of stress, negative emotions, and depressive cognitions in 20 grandmothers raising grandchildren. Higher coherence scores were inversely and significantly correlated with self-report measures, suggesting the need to examine the effects of HRV biofeedback on biomarkers reflecting stress and depression.

Dumela Mma: an examination of resilience among South African grandmothers raising grandchildren

Grandmothers serve as primary care-givers for a significant number of South African children. Previous research has documented that South African grandmothers experience physical, financial, emotional and social adversity. However, less attention has been given to South African grandmothers' resilience, or their capacity to respond to the challenges associated with raising their grandchildren. Utilising Walsh's (2003; 2012) family resilience model, this qualitative study examined resilience and resilient processes among 75 Black South African grandmothers raising grandchildren. Grandmothers participated in structured interviews during a weekly visit to a local luncheon (social) club. Results indicated that the grandmothers perceived themselves as engaging in a number of resilient processes, including relying on their spirituality, accessing sources of instrumental support, and seeking emotional support and companionship from their grandchildren and larger communities. Grandmothers also believed that focusing on their grandchildren contributed to their sense of resilience. This involved maintaining a sense of responsibility to their grandchildren, having hope for their grandchildren's futures and finding enjoyment in the grandmother–grandchild relationship. The findings reveal that, by engaging in various resilient processes, South African grandmothers raising grandchildren perceive themselves and their families as having strategies they can utilise in order to successfully cope with adversity. Findings also highlight the need for prevention and intervention efforts designed to promote grandmothers' resilience, as well as the resilience of their grandchildren.

Factors Related to Depressive Symptoms in Mothers of Technology-Dependent Children

Mothers caring for technology-dependent children at home often suffer clinically significant and unrecognized depressive symptoms. The study aim was to determine factors related to elevated depressive symptoms and provide information to target interventions that assists mothers in self-management of their mental health. Secondary data analysis from a descriptive, correlational study of 75 mothers was performed. Hierarchical multiple regression analysis results indicate that younger, unpartnered mothers with lower normalization efforts and personal resourcefulness, and less care hours, had increased depressive symptoms. The importance of personal resourcefulness and the potential for a resourcefulness training intervention to reduce depressive symptoms are discussed.

Grandparents and grandchildren: care and support in Myanmar, Thailand and Vietnam

Recent surveys in Myanmar, Thailand and Vietnam reveal that substantial proportions of persons aged 60 and older co-reside with grandchildren and commonly provide grandparental care. Usually the grandchildren's parents are also present. Situations in which the grandchildren's parents are absent are considerably less frequent. Parents are commonly the main source of the grandchildren's financial support even if absent. Most grandparents that provide care do not consider it a serious burden even when the grandchild's parents are absent. Moreover, grandparental care is not always one-directional as grandchildren can also be of help to grandparents. These features of grandchild care reflect a regional cultural context that views acceptance of reciprocal intergenerational obligations as normal and in which co-residence of older persons and adult children is still common. Differences in economic development and past fertility trends account for much of the observed differences in grandparental care among the three countries by affecting grandchildren availability and migration of adult children. In addition, economic development and demographic trends will continue to shape grandparental care in the coming decades. Despite the lack of attention to development and demographic context in previous studies, these aspects of the changing societal context deserve a prominent place within conceptual frameworks guiding comparative research on grandparenting.

Caregiver Burden, Health Status, and Learned Resourcefulness of Older Caregivers

As caregivers undertake caregiving responsibilities over a long period of time, the burdens placed on them could lead to undue stress and affect their health. This correlation study examined the current situations and relationships among caregiver burden, health status, and learned resourcefulness (LR) of older caregivers who care for disabled older adults, and predicted the important factors that affect their caregiver burden. In all, 108 older caregivers were recruited from home care services of two hospitals. Structured questionnaire interviews were applied to collect data: the Caregiver Burden Scale, the SF-36 Health Survey (SF-36), and the Rosenbaum’s Self-Control Schedule. Results indicated that the caregiver burden was negatively correlated with physical health, mental health, and LR. Physical and mental health were positively correlated with LR. The predictors of caregiver burden included LR, health status, economic status, and activities of daily living, which accounted for 58.60% of the total caregiver burden variance.

Psychometric properties of the resourcefulness scale among caregivers of persons with autism spectrum disorder

Caregiving for children with autism spectrum disorder (ASD) can be very costly to caregivers' well-being. Resourcefulness interventions have shown increases in positive health outcomes. However, before delivering the intervention, there should be a reliable and a valid measure to test resourcefulness. The psychometric properties of the Resourcefulness Scale (RS) have not been examined among ASD caregivers. This study examined the psychometrics of the 28-item RS in a convenience sample of 204 ASD caregivers. A Cronbach's alpha of .91 showed the internal consistency of the RS. Construct validity was supported by the emergence of two dimensions of resourcefulness (personal and social) in a confirmatory factor analysis and by substantial intercorrelations between the two subscales (r = .48, p < .001). Findings suggested the reliability and validity of RS among ASD caregivers, which is a necessary step toward implementing resourcefulness interventions to help ASD caregivers to deal with their stress and improve their quality of life.