Self-esteem, self-efficacy, and optimism as psychological resources among caregivers of people with dementia: findings from the IDEAL study

Care burden and associated factors among caregivers of patients with bipolar type I disorder

BACKGROUND

Family caregivers play a significant role in providing care for these people at home and need new evidence on the outcomes of their caregiving. Caregiving for people with chronic psychiatric disorders, especially Bipolar type I Disorder (BD-I), is a major challenge in the healthcare system. This study aimed to examine the relationship between caregiver burden, resilience and optimism in family caregivers of patients with BD-I.

METHODS

This study used a cross-sectional design and involved 209 family caregivers of people with BD-I by convenience sampling method. Data were collected using the Zarit Burden Inventory (ZBI), Connor-Davidson Resilience Scale (CD-RISC), and Revised Life Orientation Test (LOT-R). The participants were selected from the list of family caregivers covered by the Ibn Sina Hospital's health clinic in Mashhad, Iran. The data were analyzed using descriptive statistics and multiple regression analysis with a significance level of 0.05.

RESULTS

The average ages of the caregivers and their patients were 45.43 (13.34) and 36.7 (14.05), respectively. The average caregiver burden score was 41.92 (19.18), which was moderate (31 to 60). The predictors of caregiver burden in this study were caregiver-related factors such as optimism (p < 0.001, β = 0.25) and employment status (housewife: p = 0.038, β = 0.43; self-employed: p = 0.007, β = 0.12; retired: p < 0.001, β = 0.23), and patient-related factors such as the presence of psychotic symptoms (p < 0.001, β = 0.33), daily caregiving hours (p < 0.001, β = 0.16), history of suicide attempts (p = 0.035, β = 0.43), and alcohol consumption (p < 0.001, β = 0.85). These variables explained 58.3% of the variance in caregiver burden scores.

CONCLUSION

The study concluded that family caregivers of people with BD-I had moderate levels of caregiver burden and low resilience, influenced by various factors related to themselves and their patients. Psychological education interventions within the framework of mental health support systems are recommended to reduce caregiver burden in these people.

Factors Associated With Working Caregivers' Well-Being: Comparisons Between Black and White Working Caregivers in the United States

This study investigated stressors and strains, resources, and well-being among Black working caregivers (BWC) and White working caregivers (WWC) who participated in the Midlife in the United States study (Black: n  =  49, White: n  =  250). Comparisons were made between BWC and WWC for primary caregiving stressors, secondary strains, resources, and well-being, and hierarchical regression models tested associations among these factors. BWC reported less negative work-to-family spillover, more perceived control and religious/spiritual coping, and higher positive affect than WWC, complementing existing evidence of greater resilience among BWC. Secondary strains stemming from the workplace had stronger associations with well-being than primary caregiving stressors, confirming that the workplace deserves greater attention in stress research and interventions for working caregivers. Finally, perceived control, optimism, and family support were important resources for well-being for both BWC and WWC, substantiating their valuable role in interventions for working caregivers.

Felt Age and Its Psychological Correlates in Dementia Spousal Caregiving Dyads: Findings From the IDEAL Programme

OBJECTIVES

Evidence suggests spouses influence each other's subjective views on aging. Aligned with the Theory of Dyadic Illness Management, we investigated for the first time similarities in felt age (how old people feel relative to their chronological age) between people with dementia and their spousal caregivers, and how each partner's felt age was related to psychological correlates in the other partner.

METHODS

We used baseline (2014-2016) data from 1,001 people with dementia and their spousal caregivers who participated in the British Improving the experience of Dementia and Enhancing Active Life study. We ran linear regressions to analyze the extent to which the felt age of people with dementia and their caregivers were similar, and whether relationship quality was associated with the similarity. We utilized actor-partner interdependence models to analyze whether the felt age of people with dementia and their caregivers were associated with each other's well-being, satisfaction with life, and self-efficacy.

RESULTS

The felt age of people with dementia was associated with the felt age of their caregivers (β = 0.10; p = .001). Caregivers and people with dementia reported a more similar felt age when caregivers rated the caregiving relationship more positively (β = 0.07; p = .04). Caregivers' felt age was associated with well-being (β = 0.07; p = .02) and satisfaction with life (β = 0.06; p = .04), but not with self-efficacy, in people with dementia.

DISCUSSION

Felt age in caregivers and people with dementia may be interwoven, and important psychological variables in people with dementia are related to caregivers' felt age. Findings offer empirical evidence on dementia caregiving dynamics and how family relationships are related to views on aging.

Caregiving and all-cause mortality in postmenopausal women: Findings from the Women's Health Initiative

BACKGROUND

Caregiving is commonly undertaken by older women. Research is mixed, however, about the impact of prolonged caregiving on their health, well-being, and mortality risk. Using a prospective study design, we examined the association of caregiving with mortality in a cohort of older women.

METHODS

Participants were 158,987 postmenopausal women aged 50-79 years at enrollment into the Women's Health Initiative (WHI) who provided information on current caregiving status and caregiving frequency at baseline (1993-1998) and follow-up (2004-2005). Mortality was ascertained from baseline through March of 2019. Cox regression with caregiving status defined as a time-varying exposure was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality, adjusting for sociodemographic factors, smoking, and history of diabetes, hypertension, cardiovascular disease (CVD), and cancer. Stratified analyses explored whether age, race-ethnicity, depressive symptoms, frequency of caregiving, optimism, and living status modified the association between caregiver status and mortality.

RESULTS

At baseline, 40.7% of women (mean age 63.3 years) self-identified as caregivers. During a mean 17.5-year follow-up, all-cause mortality (50,526 deaths) was 9% lower (multivariable-adjusted HR = 0.91, 95% CI: 0.89-0.93) in caregivers compared to non-caregivers. The inverse association between caregiving and all-cause mortality did not differ according to caregiving frequency or when stratified by age, race-ethnicity, depressive symptoms, optimism, or living status (interaction p > 0.05, all). Caregiving was inversely associated with CVD and cancer mortality.

CONCLUSION

Among postmenopausal women residing across the United States, caregiving was associated with lower mortality. Studies detailing the type and amount of caregiving are needed to further determine its impact on older women.

Resilience in caregivers of people with mild-to-moderate dementia: findings from the IDEAL cohort

OBJECTIVES

A novel model of resilience was tested in caregivers of people with mild-to-moderate dementia and was extended to explore whether including self-efficacy, optimism, and self-esteem improved its predictive value.

DESIGN

Cross-sectional.

SETTING

Data from the IDEAL cohort were used.

PARTICIPANTS

The study comprised 1222 caregivers of people with dementia.

MEASUREMENTS

A composite resilience score was calculated from five measures. Multivariable regressions were used to investigate factors associated with resilience.

RESULTS

Greater resilience was associated with being older, being male, and caregiving for older people with dementia. Greater resilience was also observed when people with dementia had fewer functional difficulties and/or fewer neuropsychiatric symptoms, there was a stronger dyadic relationship, and the caregiver had fewer social restrictions, less neuroticism, and greater perceived competence. Surprisingly, caregiver self-efficacy, optimism, and self-esteem were unrelated to resilience.

CONCLUSION

Caregivers of people with mild-to-moderate dementia generally scored well for resilience. Resilience was associated with both the personal characteristics of caregivers and level of care need among people with dementia. Future work is needed to determine whether the caregivers in this cohort appeared resilient because the care recipients had relatively low care needs and consequently placed fewer demands on caregiver well-being than would be the case where dementia is more advanced.

Psychobiological effects of an eHealth psychoeducational intervention to informal caregivers of persons with dementia: a pilot study during the COVID-19 pandemic in Italy

BACKGROUND

The workload associated with caring for a person with dementia (PwD) could negatively affect informal caregivers' physical and mental health. According to the recent literature, there is a need for studies testing the implementation of affordable and accessible interventions for improving caregivers' well-being.

AIMS

This study aimed to explore the feasibility and effectiveness of an 8 week eHealth psychoeducation intervention held during the COVID-19 pandemic in Italy in reducing the psychological burden and neuroendocrine markers of stress in caregivers of PwD.

METHODS

Forty-one informal caregivers of PwD completed the eHealth psychoeducation intervention. Self-reported (i.e., caregiver burden, anxiety symptoms, depressive symptoms, and caregiver self-efficacy) and cortisol measurements were collected before and after the intervention.

RESULTS

Following the intervention, the caregivers' self-efficacy regarding the ability to respond to disruptive behaviours improved (t = - 2.817, p = 0.007), anxiety and burden levels decreased (state anxiety: t = 3.170, p = 0.003; trait anxiety: t = 2.327, p = 0.025; caregiver burden: t = 2.290, p = 0.027), while depressive symptoms and cortisol levels did not change significantly. Correlation analyses showed that the increase in self-efficacy was positively associated with the improvement of caregiver burden from pre- to post-intervention (r = 0.386, p = 0.014). The intervention had a low rate of dropout (n = 1, due to the patient's death) and high levels of appreciation.

DISCUSSION

The positive evidence and participation rate support the feasibility and effectiveness of the proposed eHealth psychoeducational intervention to meet the need for knowledge of disease management and possibly reduce detrimental effects on caregivers' psychological well-being.

CONCLUSION

Further placebo-controlled trials are needed to test the generalizability and specificity of our results.

Self-esteem and optimism in patients with major depression disorder: a cross-sectional study

Background

Depressive disorders are common mental illnesses characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities. Self-esteem refers to the appraisal of one's worth and personality, whereas optimism reflects a positive attitude and the expectation of positive outcomes. Therefore, the present study aims to determine the average self-esteem and optimism of patients with depression in 2022.

Methods

The present study is a single center and prospective descriptive-analytical study in which 121 patients out of 154 participants with major depression using convenience sampling were studied. Recruitment started on 10 June 2022 and ended on 12 July 2022. Data were collected using a demographic questionnaire, the Rosenberg Self-Esteem Scale (RSES), and the Revised Life Orientation Test (LOT -R). Data analysis was performed using statistical tests and the Pearson correlation coefficient with SPSS software version 21.

Results

The mean and SD of patients' self-esteem scores were 14.68±1.30, and the mean and SD for optimism scores were 9.90±1.68. Pearson correlation analysis showed that educational level had a significant inverse relationship with patients' self-esteem scores (r=-0.009, P=0.03), and sex had a significant relationship with patients' optimism scores (r=0.175, P=0.008).

Conclusion

Considering the importance of self-esteem and optimism in the recovery and return to society of patients with major depression, it is necessary to take measures to strengthen and increase self-esteem and optimism in these patients.

Perceived Caregiving Trajectories and their Relationship with Caregivers' Burdens and Gains

The study explores the meanings that family caregivers of people with dementia ascribe to the past, present, and future of their role as a caregiver, and how their integration into caregiving trajectories is related to caregivers' burdens and gains. The sample was made up of 197 family caregivers (M_age = 62.1, SD = 12.3, 70.1% females). They completed three incomplete sentences regarding their past, present, and future caring role, the Zarit Burden Interview and the Gains Associated with Caregiving scale. Sentence completions were content analyzed, and the associations between the resulting trajectories and burdens and gains were studied by means of a one-way ANOVA. Caregivers differed in the meanings ascribed to past, present, and future of their role. Stable-negative (M = 43.6, SD = 13.3), regressive (M = 43.3, SD = 12.7), and present-enhancing (M = 37.4, SD = 13.7) trajectories showed higher levels of burdens than progressive (M = 31.3, SD = 12.3) and/or stable-positive trajectories (M = 26.1, SD = 13.7). Progressive trajectories (M = 38.9, SD = 15.7) were related to more gains than regressive trajectories (M = 28.6, SD = 12.7). Family caregivers' evaluations of their past, present, and future are not only important separately, but their combination into caregiving trajectories is also relevant. Such trajectories might be relevant when designing interventions to help caregivers reduce their burden levels and increase the benefits ascribed to their experience. The most adaptive trajectory identified was the progressive one, whereas the regressive trajectory was the most dysfunctional.

Scalar Assessment of the Family Caregiver Activation in Transitions Tool: An Exploratory Factor Analysis

The Family Caregiver Activation in Transitions (FCAT) tool in its current, non-scalar form is not pragmatic for clinical use as each item is scored and intended to be interpreted individually. The purpose of the current study was to create a scalar version of the FCAT to facilitate better care communications between hospital staff and family caregivers. We also assessed the scale's validity by comparing the scalar version of the measure against patient health measures. Data were collected from 463 family caregiver-patient dyads from January 2016 to July 2019. An exploratory factor analysis was performed on the 10-item FCAT, resulting in a statistically homogeneous six-item scale focused on current caregiving activation factors. The measure was then compared against patient health measures, with no significant biases found. The six-item scalar FCAT can provide hospital staff insight into the level of caregiver activation occurring in the patient's health care and help tailor care transition needs for family caregiver-patient dyads. [Journal of Gerontological Nursing, 48(12), 35-42.].

Psychological Resources as a Buffer Between Racial/Ethnic and SES-based Discrimination and Adolescents' Academic Well-being

While the detrimental consequences of racial/ethnic discrimination for adolescent well-being are well-established, less is known about the impact of SES-based discrimination and the potential protective benefits of adolescents' intraindividual assets. The current study addressed these gaps by investigating the longitudinal associations between racial/ethnic and SES-based educator-perpetrated discrimination and adolescents' academic well-being and assessed whether psychological resources moderated these pathways. To do so, the study used longitudinal data from a diverse sample of 750 9th grade students (54% female; 41% White, 34% Latina/o/x, 8% Asian American, 6% African American, 11% biracial/other race/ethnicity; 43% had parents with an associate's degree or less) in the Southwestern U.S. who were subsequently surveyed one year later. Educator-perpetrated racial/ethnic discrimination was negatively associated with students' school engagement, and both psychological resilience and self-efficacy emerged as protective for students' educational expectations in the face of racial/ethnic and SES-based discrimination, respectively. The results of the current study highlight the role of discriminatory treatment in educational disparities and provide insights on effective coping strategies to combat the negative impacts of discrimination in academics.

Living with dementia under COVID-19 restrictions: coping and support needs among people with dementia and carers from the IDEAL cohort

Stringent social restrictions imposed during 2020 to counter the spread of the COVID-19 pandemic could significantly affect the wellbeing and quality of life of people with dementia living in the community and their family carers. We explored the impact of COVID-19 restrictions on people with dementia and family carers in England and considered how negative effects might be mitigated. We conducted semi-structured telephone interviews with 11 people with dementia and 11 family carers who were ongoing participants in the IDEAL cohort during the initial ‘lockdown’ period in May and June 2020, and follow-up interviews with five people with dementia and two carers as restrictions were eased in July. We analysed interview data and triangulated the findings with issues raised in dementia-specific online forums. Findings showed some people with dementia were coping well, but others experienced a range of negative impacts, with varying degrees of improvement as restrictions were eased. The need for clear personalised information relating to COVID-19 and the value of support in the form of regular ‘just checking’ phone calls was emphasised. This exceptional situation provides a natural demonstration of how social and psychological resources shape the potential to ‘live well’ with dementia. While some support is recommended for all, a personalised approach to determine needs and coping ability would ensure that further practical and emotional support is targeted effectively.

The changing self: The impact of dementia on the personal and social identity of women (findings from the Improving the Experience of Dementia and Enhancing Active Life programme)

This paper explores the impact of dementia on the selfhood of women, specifically the ways in which changes occur as a result of such a diagnosis. Interviews were conducted with 12 women (recruited from the Improving the Experience of Dementia and Enhancing Active Life programme dataset), and analysed using interpretative phenomenological analysis. Emergent themes concerned the process of receiving and adjusting to a dementia diagnosis, the emotional and psychological impact of dementia, self-presentation and stigma and the self-enforcement of new boundaries. The analysis showed that dementia had a wide-ranging impact on the selfhood and identity of women, with newfound characteristics associated with the disease leading to a loss of self-esteem, sadness and anger. The women subsequently engaged in the modification of their behaviour, as a means of coming to terms with the losses experienced.

The Caregiver Identity in Context: Consequences of Identity Threat From Siblings

OBJECTIVES

Although siblings represent central members of the networks of caregivers and their parents, there has been limited attention to how siblings affect one another's well-being during caregiving. In this article, we draw from theories of identity and stress to examine the impact that siblings have on caregivers' psychological well-being. Specifically, we employ a mixed-methods approach to explore whether caregivers' perceptions that their siblings are critical of the care they provide their mother are associated with higher depressive symptoms and the mechanisms underlying this association.

METHODS

Using quantitative data collected from 404 caregivers nested within 231 families as part of the Within-Family Differences Study, we conduct mediation analyses to examine whether perceived sibling criticisms are associated with caregivers' depressive symptoms (a) directly and/or (b) indirectly through sibling tension. We then analyze qualitative data collected from the same caregivers to gain insight into the processes underlying statistical associations.

RESULTS

Quantitative analyses revealed that there was no direct relationship between perceived sibling criticisms and depressive symptoms; there was, however, an indirect relationship such that perceived sibling criticisms were associated with greater sibling tension, which in turn was associated with higher depressive symptoms. These quantitative findings were corroborated by qualitative analyses, which demonstrated that, in an effort to mitigate the negative impact of sibling criticisms, caregivers often employed strategies that may have fueled sibling tension.

DISCUSSION

These findings demonstrate how identity processes, as well as the family networks in which caregiving takes place, shape the experiences and consequences of parent care.

Emotion regulation and decision-making in persons with dementia: A scoping review

BACKGROUND AND OBJECTIVES

Emotion is integral to decision-making, and emotion regulation is associated with improved well-being in older age. Persons with dementia are likely to experience impairments in emotion regulation processes that can potentially contribute to differential decision-making and well-being outcomes. To promote the development of theoretical models of well-being in dementia, we review the quantitative evidence concerning the associations between emotion regulation and decision-making in dementia.

METHODS

Scoping review.

RESULTS

Seven studies of persons with dementia met our criteria. In persons with frontotemporal lobar degeneration, emotion regulation processes that precede the emotional experience were associated with decision-making in a moral (but not uncertainty) context. Independent of type of dementia, evidence concerning the associations between emotion regulation processes that occur after emotion is experienced and decision-making was mixed and drew on different methodologies. No studies relating to the associations between decision-making in dementia and several emotion regulation processes and strategies were found.

CONCLUSIONS

In this review, we sought to clarify the concept of everyday decision-making in dementia and map the current state of evidence concerning its associations with emotion regulation. Our findings show that emotion regulation processes are associated with decision-making in dementia, depending on type of decision-making assessment and emotional experience. We outline the gaps in the literature to set a research agenda for promoting our understanding of how emotion regulation processes can shape the various decisions that are made by persons with dementia on a daily basis.

Home-Based Care for People with Alzheimer's Disease and Related Dementias (ADRD) during COVID-19 Pandemic: From Challenges to Solutions

There has been supporting evidence that older adults with underlying health conditions form the majority of the fatal cases in the current novel coronavirus disease (COVID-19) pandemic. While the impact of COVID-19 is affecting the general public, it is clear that these distressful experiences will be magnified in older adults, particularly people living with Alzheimer's disease and related dementia (ADRD), making them the most vulnerable group during this time. People with differing degrees of ADRD are especially susceptible to the virus, not only because of their difficulties in assessing the threat or remembering the safety measures, but also because of the likelihood to be subject to other risk factors, such as lack of proper care and psychological issues. Therefore, in this article, we will discuss the challenges related to home-based care for people with ADRD during a pandemic and propose a formulation of systematic solutions to address these challenges and to alleviate the social and economic impact resulting from the crisis.