Appraisal, coping, and social support as mediators of well-being in black and white family caregivers of patients with Alzheimer's disease

Reflections on Dementia-Related Stigma and Direct Support Seeking by Family Caregivers as Mediating Associations Between Caregiver Stress, Burden, and Well-Being

The demanding nature of caring for relatives with Alzheimer's disease and related dementias (ADRD) can lead to family caregiver burden and poor health. The stigmatization of people with ADRD can also impact caregivers' stress, while their support-seeking strategies may mitigate negative impacts of burden on their health. To examine hypothesized relationships, the present study considered whether different dimensions of ADRD family stigma influenced the association between a care recipient's behavioral symptoms and their family caregiver's perceived burden and if direct support seeking explained a connection between caregiver burden and well-being. Family caregivers (n = 375) completed a Qualtrics survey. Path analysis revealed ADRD behavioral symptoms predicted both caregiver and layperson forms of stigma. Layperson stigma also intervened between behavioral symptoms and caregiver burden. Direct support seeking mediated the association between caregiver burden and well-being. Findings underscore the utility of including stigma within ADRD caregiver stress models and studying caregiver health from network and communication perspectives.

A modified transactional model of stress and coping on depressive symptoms among informal caregivers of persons with dementia

Informal caregivers are crucial to the care of persons with dementia (PWD), but their role is often reported as challenging. This study aims to examine caregiver stress and depressive symptoms among informal caregivers of PWD using a modified transactional stress and coping model. Path analysis was conducted among a sample of informal caregivers of PWD in Singapore (n = 281) using information on functional dependence and memory and behavioral problems of PWD, and self-reported measurements on caregivers' knowledge of dementia, perceived positive aspects of caregiving, social support, coping patterns, caregiving self-efficacy, caregiving burden and depressive symptoms. The initial model reflecting our assumptions for the transactional stress and coping model showed a poor fit (model 1 - CFI = 0.858, TLI = 0.665, RMSEA = 0.118). Logical modifications were made until sufficient model fit was achieved (model 2 - CFI = 0.987, TLI = 0.955, RMSEA = 0.043). We then removed the insignificant paths in model 2 and obtained our final model (model 3 - CFI = 0.990, TLI = 0.974, RMSEA = 0.033). The final model supported our hypotheses, with some adjustments. This study advances our understanding of caregiver distress by modifying the transactional stress and coping model, including (1) the key role of caregiver self-efficacy in the primary appraisal process, (2) the dynamic assessment of coping resources across all stages of the model, and (3) the importance of coping patterns. Future studies could explore the generalizability of these findings.

Race Differences in Purpose in Life Among Family Caregivers: Findings From the Caregiving Transitions Study

Family caregiving may affect purpose in life, defined as the sense that life has meaning and intentionality. Few studies have compared caregivers to non-caregivers or examined the characteristics of caregivers associated with purpose in life. Using data from the Caregiving Transitions Study (n = 486), we conducted multiple linear regression analyses to test the effects of caregiver status, age, gender, social network, and physical and mental health on purpose in life. We also tested whether the effect of caregiver status differed by race and, among caregivers (n = 241), the associations between caregiving characteristics and purpose in life. Caregivers did not differ significantly from non-caregivers in purpose in life in adjusted analysis. Among caregivers, significantly greater purpose of life was observed among Black caregivers and those reporting higher positive aspects of caregiving. Future research should examine these issues longitudinally, and caregiver interventions should consider addressing purpose in life and positive aspects of caregiving.

Recognising the Parental Caregiver Burden of Children With Mental Disorders: A Systematic Mixed-Studies Review

This review aims to consolidate and appraise evidence exploring the caregiver burden of parents of children with mental disorders. A mixed-studies review structure was adopted and six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until September 2023. Thomas & Harden's thematic analysis framework was utilised for data analysis. Twenty-three studies were included in this review. The results-based convergent integration method identified an overarching theme titled 'hiding behind the walls on fire, engulfed in chaos: dark and alone', three main themes named 'Invisible scars': role of psychological factors on caregiver burden, navigating through social and economic influences on caregiving burden, and influence of illness-related variables and nine subthemes. This review highlighted that the parents perceived insufficient support from healthcare providers and a lack of insight regarding their children's medical condition as the primary contributors to the burden experienced. It is imperative for healthcare professionals to collaboratively engage with parental caregivers, offering accessible treatment options for their children with mental disorders and providing comprehensive educational resources to facilitate a profound understanding of their children's mental health conditions. In addition to addressing caregivers' informational needs, the establishment of an integrated support system is advocated, one involving active participation from healthcare professionals, healthcare institutions, community resources, social services and policymakers. This holistic approach could better meet the multifaceted needs of caregivers, encompassing psychosocial, emotional and financial aspects. Trial Registration: International Prospective Register of Systematic Reviews: PROSPERO ID: CRD42022363420.

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.

Capturing the perspectives of African American informal dementia caregivers: a phenomenological study

Dementia can be overwhelming to families and their caregivers. Informal caregiving is a widespread mode of providing dementia care in African American communities, yet impact of caregiving on informal or family caregivers in African American communities is burdensome. This study aimed to describe the lived experiences of informal caregivers of African American People Living with Dementia (PLWD) to understand their perceptions of dementia and dementia care, caregiver support needs, and service needs. Interpretive phenomenological qualitative inquiry guided this study to understand caregivers' experiences and needs. Ten family caregivers of African American PLWD in the community participated in this study. Data were collected through in-depth interviews and a diary study approach to document and interpret caregivers' experiences. The data analysis was based on procedures of content analysis. Four major themes emerged from the in-depth interviews: caregiver burden, familism, lack of information and community-based resources, and desire and need for culturally appropriate community-based resources. Triangulated diary entry data complemented the in-depth interviews with similar themes. This study highlights how African American informal caregivers of PLWD face various caregiving needs and challenges in dementia care including lack of culturally appropriate community resources and information. The study illustrates that African American cultural beliefs of familism are significant aspects of their caregiving experience and their coping strategies. These study results provide a useful foundation for various stakeholders to develop culturally targeted interventions and programs to support African American informal caregivers and their family members with dementia.

Burden and positive aspects of caregiving: cluster profiles of dementia caregiving experiences

OBJECTIVES

Although caregiver burden is common in the context of dementia caregiving, the caregiving role is linked to beneficial outcomes too. Individuals reporting higher positive aspects of caregiving tend to exhibit lower burden relative to those reporting few. The goal of this retrospective review of outpatient memory clinic medical records was to demonstrate whether and how constructs of burden and positive aspects of caregiving coexist within individual caregivers, and to explore potential contributors to caregiver profiles created based upon these constructs.

METHOD

Cluster analyses were conducted on 1160 caregivers from an initial intake interview meeting criteria on primary measures of Positive Aspects of Caregiving and the Zarit Burden Interview and repeated with 225 caregivers meeting inclusion criteria on all measures. Samples were compared for similarity, and the smaller sample (n = 225) was deemed appropriately representative. Multinomial logistic regressions examined cluster predictors in sample with 225 caregivers.

RESULTS

Results suggested a three-cluster solution: a High Burden group, a High Positive Experiences group, and a Low-Moderate Experiences group showing low burden and moderate positive experiences. Greater behavioral problems predicted belonging to the High Burden cluster. Greater care recipient dependence predicted belonging to the High Positive Experiences cluster while greater independence predicted the Low-Moderate Experiences cluster.

CONCLUSION

Findings suggest that burden and positive aspects of caregiving do not simultaneously present in caregivers at high levels. Supportive caregiver interventions might be tailored to profiles demonstrated here. Future research should investigate other potential contributors to experiences of burden and positive aspects of caregiving.

Through the Eyes of a Young Carer: A Photo Elicitation Study of Protective Resilience

Caregiving is recognised as a source of stress with potential for negative health impacts as well as positive outcomes and development of resilience. For young carers, children, and adolescents providing care for close family members, adaptation through resilience is crucial, yet work using a resilience approach is limited. This study explored protective factors and pathways to resilience in a sample of young carers, through application of the socioecological model in caring relationships. An in-depth qualitative approach was used, with in-person interviews facilitated by auto-driven photo elicitation. Deductive thematic analysis was applied, framed by three levels (individual, community, and society) of the socioecological model of resilience. Twelve participants (nine girls and three boys) aged 5-18 years, each providing care to a family member, were recruited using opportunity and volunteer sampling via carers' centres in the southwest of England. Ten key themes were identified, four at the individual level: pre-empting challenges and planning, cognitive strategies, emotional strategies, and seeking solitude; three at the community level: family support, friendships, and pets and inanimate objects; and three at the society level: professional support, access to caregiver activities and community, and being outdoors. The location of themes at each level indicated relevance of the socioecological model to identification of protective factors in a young carer population. These findings have important applications for guidance to charities and organisations supporting young carers. Identification of factors that promote resilience offers support for the development of well-informed interventions, which harness these protective factors to develop resilience and improve health for young carers.

Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period

OBJECTIVES

Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance.

METHOD

Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive).

RESULTS

During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear.

CONCLUSION

It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.

Trends in prevalence of short sleep duration and trouble sleeping among US adults, 2005-2018

STUDY OBJECTIVES

To determine trends in prevalence of short sleep duration and trouble sleeping among US adults from 2005 to 2018, and to assess how sleep trends vary by sex and race/ethnicity.

METHODS

Seven cycles of the National Health and Nutrition Examination Survey data between 2005-2006 and 2017-2018 were analyzed. Trouble sleeping and sleep duration were self reported. Short sleep duration was defined as sleep duration ≤6 hr. Age-standardized prevalence of reporting trouble sleeping to a health care provider and short sleep duration were estimated among the overall US adult population, and by sex and race/ethnicity.

RESULTS

From 2005 to 2014, the age-adjusted prevalence of short sleep duration remained similar in the overall population (p for trend >0.05). Non-Hispanic Black people had the highest prevalence of short sleep duration among all race/ethnicity groups in all seven cycles. The prevalence of short sleep duration appears lower in 2015-2018 than in 2005-2014 due to different measurement methods applied. However, from 2005 to 2018, there were increasing trends in age-adjusted prevalence of reporting trouble sleeping to a health care provider in the overall population, among both men and women, and all race/ethnicity groups (p for trend <0.05). Among all the race/ethnicity groups, non-Hispanic White people had the highest prevalence of reporting trouble sleeping to a healthcare provider.

CONCLUSION

Findings depict the persistence of sleep-related issues in the United States and possible risk factors, as well as racial disparities.

Parental resilience and psychological distress in the neonatal intensive care unit

OBJECTIVE

To evaluate the associations between parental resilience and psychological distress during the neonatal intensive care unit (NICU) hospitalization.

STUDY DESIGN

Observational cohort study of parents of preterm infants (n = 45) admitted to a NICU between December 2017-October 2019. Data on resilience and psychological distress were collected using validated scales. Regression analysis was used to evaluate associations.

RESULT

One-third of NICU parents screened positive for depression or anxiety. There were no identified sociodemographic factors or parental engagement activities associated with resilience. Parents with higher resilience had lower scores on depression and anxiety screens. However, resilience alone was not a predictor for a positive depression or anxiety screen (aOR 0.93, CI 0.86-1.00; aOR 0.95, CI 0.89-1.02, respectively).

CONCLUSION

Resilience may be associated with lower scores on depression and anxiety screens but is not an independent predictor for a positive screen during the early NICU hospitalization.

Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.

Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes

OBJECTIVES

The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics.

METHODS

Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden.

RESULTS

African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans' endorsement of familism predicted more positive caregiving appraisals. African Americans also reported greater levels of social support, which in turn predicted lower burden and depressive symptoms when compared with Whites. Exploratory analyses demonstrated significant associations between familism and self-efficacy. In the Hispanic subgroup, familism varied as a function of acculturation.

DISCUSSION

Results indicate that greater levels of familism and social support may exert a protective influence against adverse psychosocial caregiving outcomes. These findings can be used to inform intervention efforts targeting culturally congruent, family-centered approaches.

African American Family Caregivers Share How they Prepared for the Death of an Older Adult with Dementia: A Pilot Study of Hospice Care in A Nursing Home

The focus of this pilot study was to ascertain how bereaved African American caregivers prepared for the death of an older family member who died from a dementia-related diagnosis and the role of hospice care; an area with little research to date. Because African American older adults in the United States are at greater risk than Caucasian older adults for dementia-related health problems though less likely to be diagnosed, treated, or to enroll in hospice services, this exploratory study asked questions of the family caregivers' experiences in preparing for the death. Purposive criterion sampling was used to identify six African American bereaved caregivers whose family member lived in a nursing home (five who were enrolled in hospice services) who were extensively interviewed, with the use of conventional content analysis of the transcripts to identify the findings. Because of the limited sample size, themes identified were considered preliminary and may help guide ongoing and further research. Five primary themes revealed ways caregivers prepared: accepting reality; "I just kind of knew;" person with dementia "was ready;" "spending time;" and, getting your "business in order." All caregivers believed it was important to be prepared for the death, with the five who received hospice services reporting that they were prepared. Further research is needed to explore these preliminary findings of African American caregivers of family members with dementia at end-of-life to further inform social work and hospice team care.

Depression among caregivers of patients with dementia: Associative factors and management approaches

As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.

Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model

OBJECTIVES

To examine the mediation role of self-care between stress and psychological well-being in the general population of four countries and to assess the impact of sociodemographic variables on this relationship.

DESIGN

Cross-sectional, online survey.

PARTICIPANTS

A stratified sample of confined general population (N=1082) from four Ibero-American countries-Chile (n=261), Colombia (n=268), Ecuador (n=282) and Spain (n=271)-balanced by age and gender.

PRIMARY OUTCOMES MEASURES

Sociodemographic information (age, gender, country, education and income level), information related to COVID-19 lockdown (number of days in quarantine, number of people with whom the individuals live, absence/presence of adults and minors in charge and attitude towards the search of information related to COVID-19), Perceived Stress Scale-10, Ryff's Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14.

RESULTS

Self-care partially mediates the relationship between stress and well-being during COVID-19 confinement in the general population in the total sample (F (3,1078)=370.01, p<0.001, R²=0.507) and in each country. On the other hand, among the evaluated sociodemographic variables, only age affects this relationship.

CONCLUSION

The results have broad implications for public health, highlighting the importance of promoting people's active role in their own care and health behaviour to improve psychological well-being if stress management and social determinants of health are jointly addressed first. The present study provides the first transnational evidence from the earlier stages of the COVID-19 lockdown, showing that the higher perception of stress, the less self-care activities are adopted, and in turn the lower the beneficial effects on well-being.

Longitudinal study: understanding the lived experience of couples across the trajectory of dementia

Background

The longitudinal study, “Couples Lived Experiences,” focuses on whether and how relationship characteristics of older couples change with the cognitive decline of one member of the couple, and how these changes affect each individual’s emotional and physical health outcomes. Until now, most psychosocial research in dementia has focused either on the person with dementia (PWD) or the caregiver separately. The previous literature examining relationship characteristics and their role in outcomes for the caregiver and PWD is scant and suffers from methodological issues that limit the understanding of which relationship characteristics most influence outcomes for caregivers and care-receivers and what other factors may mitigate or exacerbate their effects.

Methods

We will enroll 300 dyads and collect information via online interviews of each member of the couple, every 6 months for 3 years. Relationship characteristics will be measured with a set of short, well-validated, and reliable self-report measures, plus the newly developed “Partnership Approach Questionnaire.” Outcomes include global quality of life, subjective physical health, mental health (depression and anxiety), and status change (transitions in levels of care; i.e., placement in a nursing home). Longitudinal data will be used to investigate how relationship characteristics are affected by cognitive, functional, and behavioral changes, and the impact of these changes on health outcomes. Qualitative data will also be collected to enrich the interpretation of results of quantitative analyses.

Discussion

Psychosocial interventions have demonstrated effectiveness in promoting the wellbeing of PWD and their caregivers. The knowledge gained from this study can lead to the development or enhancement of targeted interventions for older couples that consider the impact of cognitive and functional decline on the relationship between members of a couple and thereby improve their wellbeing.

Trial registration

This study has been registered with ClinicalTrials.gov. ClinicalTrials.gov Identifier is: NCT04863495.

Evaluating racial disparities in healthcare system utilization and caregiver burden among older adults with dementia

OBJECTIVE

To evaluate racial differences in healthcare utilization and caregiver burden in a culturally diverse population of older adults with dementia.

METHOD

One hundred and thirty-three dyads (person with dementia, PWD and caregiver, CG), with at least one emergency department (ED) visit or hospitalization 12 months prior, were enrolled. Independent sample t-tests and chi-squared analyses were performed to compare racial groups on healthcare utilization and CG burden. Mann-Whitney U test was used for item-level analyses, principal component analysis was used to examine relationships among outcomes, and regressions were used to identify the relationship between race and potential covariates.

RESULTS

PWD sample mean age was 79 years, predominantly female, and with high school education. Racial distribution was 65% White and 35% Black. CG sample mean age was 64 years, predominantly female, with more than 12 years of education. No differences were found for age or dementia severity across racial groups. Black PWD experienced more ED and ambulance utilization when compared to White counterparts. Non-emergency hospitalization rates were higher for White PWD. No significant differences were found by race for CG burden total score; however, item-level analysis suggested more anger, reduced social life, uncertainty, and inadequacy in White CGs. Regressions demonstrated a positive relationship between Black race and adult-child CGs with increased ED visits, while dyad educational attainment was associated with hospitalizations independent of race.

CONCLUSIONS

Healthcare utilization disparities extend to older adults with dementia diagnoses. Our findings suggest that culturally tailored interventions may be appropriate. Future research is encouraged to explore the effect of other covariates.

Stress, Burden, and Well-Being in Dementia and Nondementia Caregivers: Insights From the Caregiving Transitions Study

BACKGROUND AND OBJECTIVES

Few population-based studies have directly compared caregivers of persons with dementia to caregivers of persons with other disabilities (nondementia caregivers). We enrolled dementia and nondementia caregivers who were providing substantial and sustained care and compared these groups on measures of caregiver stressors, appraisals of burden, and well-being.

RESEARCH DESIGN AND METHODS

Caregivers (N = 251) who provided continuous care for at least 1 year and at least 5 h per week were recruited from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Caregivers reported on dementia caregiving status, stressors, burden, and well-being.

RESULTS

Forty-seven percent (n = 117) reported caring for a person with dementia. Dementia caregivers reported more stressors, providing more care for self-care and behavioral problems than nondementia caregivers. Dementia caregivers also reported higher appraisals of stress and burden, and more depressive symptoms, but did not differ from nondementia caregivers on mental and physical health quality of life. In multivariable-adjusted models, adjustment for the total number of care recipient problems attenuated differences between dementia and nondementia caregivers on burden and depression measures.

DISCUSSION AND IMPLICATIONS

Dementia and nondementia caregivers showed relatively few differences in indicators of overall well-being in this population-based sample, perhaps because both groups of caregivers in this study were providing substantial care. Dementia caregivers may require special assistance with dementia-specific problems such as behavioral problems. Clinical interventions and policy changes targeting highly burdened caregivers are needed to support them in allowing their care recipients to age in place at home.

Coping Patterns Among Primary Informal Dementia Caregivers in Singapore and Its Impact on Caregivers-Implications of a Latent Class Analysis

BACKGROUND AND OBJECTIVES

Existing studies typically explore the factor structure of coping strategies among dementia caregivers. However, this approach overlooks the fact that caregivers often use different coping strategies simultaneously. This study aims to explore the coping patterns of primary informal dementia caregivers in Singapore, examine their significant correlates, and investigate whether different patterns would affect the depressive symptoms of caregivers.

RESEARCH DESIGN AND METHODS

Two hundred eighty-one primary informal caregivers of persons with dementia (PWD) were assessed. Coping strategies were measured by the Brief Coping Orientation to Problem Experienced inventory. A latent class analysis was performed to explore caregivers' coping patterns, followed by logistic regressions to identify the significant correlates and the relationships between coping patterns and caregiver depression.

RESULTS

The latent class analysis suggested a three-class solution that was featured by the frequency and variety of coping strategies used by caregivers-high coping (36.3%), medium coping (37.7%), and low coping (26.0%). Factors influencing the coping patterns of our sample were mainly related to caregivers' individual resources such as personal characteristics and caregiving stressors like PWD's problematic behaviors and caregiving burden. Compared to caregivers in the low coping group, those in the medium coping group had significantly higher risks of potential depression.

DISCUSSION AND IMPLICATIONS

The current study confirmed that there are distinct coping patterns among primary informal dementia caregivers, and caregivers with the low coping pattern had fewer depressive symptoms. Future research is needed to explore if coping patterns from our sample are generalizable to dementia caregivers elsewhere.

Systematic Review and Meta-Analysis of Racial and Ethnic Differences in Dementia Caregivers' Well-Being

BACKGROUND AND OBJECTIVES

Studies comparing racial/ethnic differences on measures of psychological and physical well-being for dementia caregivers have reported differences between minority and white caregivers. Recruitment methods often differ for minority and white participants due to enrollment targets and may lead to biased comparisons, especially in convenience samples. We aimed to examine racial/ethnic differences in dementia caregiver outcomes and to determine whether differences vary between studies with population-based or convenience samples.

RESEARCH DESIGN AND METHODS

We systematically reviewed articles with primary data from PubMed, Google Scholar, and PsycINFO. We included studies comparing African American or Hispanic/Latino to white dementia caregivers on measures of psychological well-being or physical well-being. Reviewers screened titles and abstracts, reviewed full texts and conducted risk-of-bias assessments. Meta-analyses were conducted to assess effects by race/ethnicity and study bias.

RESULTS

A total of 159 effects were extracted from 38 studies, 2 of which were population based. Random-effects models revealed small but statistically significant effects with better psychological well-being in African American caregivers compared with white caregivers in both population-based (d = -0.22) and convenience sample studies (d = -0.21). Hispanics/Latino caregivers reported lower levels of physical well-being than white caregivers (d = 0.12), though these effects varied by level of rated study bias.

DISCUSSION AND IMPLICATIONS

Consistency across study methods raises confidence in the validity of previous reports of better psychological well-being in African American caregivers. Future studies should use population-based samples with subgroups of Hispanic/Latino, Asian American, and American Indian caregivers that are culturally distinct on factors such as country of origin and tribe.

Surviving and Thriving: Qualitative Results from a Multi-Year, Multidimensional Intervention to Promote Well-Being among Caregivers of Adults with Dementia

(1) Introduction: Caring for an adult with dementia is both challenging and rewarding. Research indicates that community-based, social support, and/or arts engagement interventions can play a key role in ameliorating the negative outcomes associated with caregiving while enhancing its more positive attributes. This study explores the psychosocial outcomes experienced by dementia caregivers who participated in a multi-year, multidimensional intervention aimed at promoting caregiver and care recipient well-being. This intervention included bringing caregivers and people with Alzheimer’s disease or related dementias (ADRD) to local symphony performances, hosting a social reception prior to the performance, and assessing the outcomes of participation for both caregiver and the care recipient. (2) Materials, Methods, and Analysis: Qualitative data from participant phone interviews (n = 55) as well as focus groups are analyzed using thematic analysis from a phenomenological perspective. (3) Results: Across three years of participation, caregivers reported three main program benefits: relationship building (both with other participants as well as within the broader community); restored humanity (experiencing a greater sense of personal dignity and momentary return to normalcy), and positivity (experiencing positive emotions during the program). (4) Discussion: These findings point to the value of creating caregiver programming that brings together multiple dimensions of successful interventions in order to enhance caregiver experiences and positive intervention outcomes.

The Impact of Risk and Resistance Factors on Quality of Life in Caregivers of Individuals with Dementia

OBJECTIVES

The present study investigates the effect of caregiver and care recipient risk and resistance factors on caregiver quality of life (QOL). Risk factors are those characteristics that contribute to psychosocial maladjustment of the caregiver and reduce QOL, while resistance factors promote caregiver adjustment and improve QOL.

METHODS

One-hundred and three caregiver/care recipient dyads were recruited from a memory assessment clinic in Midwestern United States. Caregivers completed questionnaires estimating perceived social support, spirituality, social problem-solving, and care recipient functional dependence. Care recipients' results from the Mini-Mental State Examination and Animal Naming task were also collected.

RESULTS

In the final model, caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence each accounted for a significant portion of variance in caregiver QOL. The final model accounted for 46.1% of the variance in caregiver QOL.

CONCLUSION

Caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence are important contributors to caregiver QOL. Further research is needed to specify which caregiver and care recipient characteristics are most important to caregiver QOL.

CLINICAL IMPLICATIONS

Health professionals should assess caregiver problem-solving skills, social support, and care recipient functional dependence, as these may provide important information about caregiver QOL. Study results also suggest that caregiving has more of a negative impact on caregiver QOL for midlife adult caregivers compared to older adult caregivers, and appears to have a greater negative effect on spouses than on children.

Caregiver Well-Being and Burden: Variations by Race/Ethnicity and Care Recipient Nativity Status

BACKGROUND AND OBJECTIVES

Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others).

RESEARCH DESIGN AND METHODS

The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (N = 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver's outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts of the inclusion of caregiving factors (background factors, primary stressors, secondary stressors, and resources).

RESULTS

Regression analyses showed that only care burden significantly varied by care recipient nativity status after controlling for covariates. Caregivers of foreign-born care recipients reported a higher burden. However, when interactions of care recipient nativity status × caregiver race/ethnicity were introduced, non-Hispanic black and Hispanic caregivers of foreign-born care recipients were more likely to report better psychological well-being and self-rated health compared to their counterparts. Across caregiver groups, better caregiver-care recipient relationship quality and less caregiver chronic conditions were associated with less burden and better caregiver psychological well-being and self-rated health.

DISCUSSION AND IMPLICATIONS

Care recipient nativity status and caregiver race/ethnicity may have complex effects on caregiving experiences. Given the observed significant interaction effects for caregiver psychological well-being and self-rated health, cultural factors may affect the extent to which these caregivers appraise their caregiving. Future research should delve into the appropriate ways to assess care stress as well as resilience among each caregiver group. Our results indicate the need for research, education, and practice that assess cultural and within-group differences among caregivers and inform needed changes to structural barriers.

Spirituality and resilience among family caregivers of survivors of stroke: A scoping review

BACKGROUND

Stroke is the leading cause of disability in Australia and the third-leading cause of disability worldwide and a significant burden on caregivers.

OBJECTIVE

To map the extent, range and nature of the literature investigating spirituality and resilience among family caregivers of survivors of stroke.

METHOD

A scoping review.

RESULTS

Six studies were identified, conducted in the United States, United Kingdom, China and Turkey. These included two quantitative, one experimental and three qualitative designs. No studies linked spirituality to resilience. For the qualitative studies, spirituality was the primary focus of one, and the secondary focus of two others. Qualitative data reflected the lived experience of caregivers drawing upon spirituality to help cope with the burden of caregiving. For the two quantitative studies, spirituality was measured as a secondary focus and showed no significant links between spirituality or adjustment in caregivers. The one experimental study comprised a psycho-educational intervention focused on building resilience, finding a significant increase in social support not reflected in a matched control group. Clinical implications suggested the need for strength-based interventions, including spiritual needs and religious beliefs of the family caregiver.

CONCLUSIONS

Spirituality and resilience following stroke are essential factors in caregiver adjustment following stroke. Further research with a focus on causality and the link between spirituality, resilience and adjustment in this population is needed.

A Comprehensive Model of Factors Associated With Capability to "Live Well" for Family Caregivers of People Living With Mild-to-Moderate Dementia: Findings From the IDEAL Study

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Introduction:

Understanding key influences on outcomes for caregivers of people with dementia is hampered by inconsistent conceptualization and measurement of outcomes and limited evidence about the relative impact of different variables. We aimed to address these issues.

Methods:

We analyzed data from 1283 caregivers of community-dwelling individuals with mild-to-moderate dementia in the Improving the experience of Dementia and Enhancing Active Life cohort study. We generated a “living well” latent factor from measures of quality of life, satisfaction with life, and well-being. We used structural equation modelling to derive latent variables for 7 domains reflecting caregivers’ perceptions of their personal resources and experiences, and to examine the associations with caregivers’ perceptions of their capability to “live well.”

Results:

The domain of psychological characteristics and psychological health was most strongly related to living well [2.53; 95% confidence interval (CI), 2.08-2.97], followed by physical fitness and physical health (1.48; 95% CI, 1.04-1.91) and experiencing caregiving (1.34; 95% CI, 0.99-1.70). Social capitals, assets and resources (0.68; 95% CI, 0.35-1.00) and relationship with the person with dementia (−0.22; 95% CI, −0.41 to −0.03) had smaller, significant associations. Social location (0.28; 95% CI, −0.33 to 0.89) and managing everyday life with dementia (0.06; 95% CI, −0.15 to 0.28) were not significantly associated with living well.

Discussion:

These findings demonstrate the importance of supporting caregivers’ psychological and physical health and their ability to develop and maintain positive coping strategies, as well as enabling them to maintain vital social capitals, assets and resources.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Perceived stress, resilience, and health-related quality of life among Parkinson's disease caregivers in Mexico

The stress process model of caregiving posits that caregivers' internal psychosocial resources may serve as buffers between the stress associated with caregiving and well-being. Empirical support for the stress process model exists for several caregiving contexts, but little research has investigated the Parkinson's disease caregiving experience in Mexico. Using a cross-sectional, correlational design, the objective of this study was to examine whether resilience moderates the relation between perceived stress and health-related quality of life (HRQOL) among Parkinson's disease caregivers in Mexico. Data were collected from April 2015 to February 2016 during outpatient neurology appointments in Mexico City, Mexico. Participants included informal caregivers (N = 95) for a family member with Parkinson's disease. Participants completed a battery of questionnaires assessing their level of perceived stress, resilience, and HRQOL. Regression analyses indicated that resilience moderated the inverse relation between perceived stress and mental HRQOL. However, contrary to hypotheses, resilience did not moderate the relation between stress and physical HRQOL. Findings shed light on resilience as a potential protective factor for mental HRQOL among Parkinson's disease caregivers in Mexico and indicate that resilience may be beneficial to target in mental health promotion interventions.

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

OBJECTIVES

Being a family caregiver, and in particular giving care to someone with dementia, impacts mental and physical health and potentially reduces the ability of caregivers to "live well." This paper examines whether three key psychological resources-self-efficacy, optimism, and self-esteem-are associated with better outcomes for caregivers of people with dementia.

DESIGN AND PARTICIPANTS

Caregivers of 1,283 people with mild-to-moderate dementia in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) project responded to measures of self-efficacy, optimism, and self-esteem, and "living well" (quality of life, life satisfaction, and well-being). Multivariate linear regression was used to examine the association between psychological resources and "living well".

RESULTS

Self-efficacy, optimism, and self-esteem were all independently associated with better capability to "live well" for caregivers. This association persisted when accounting for a number of potential confounding variables (age group, sex, and hours of caregiving per day).

CONCLUSIONS

Low self-efficacy, optimism, and self-esteem might present a risk of poor outcomes for caregivers of people with dementia. These findings encourage us to consider how new or established interventions might increase the psychological resilience of caregivers.

Compassion fatigue among oncologists: the role of grief, sense of failure, and exposure to suffering and death

Purpose

Oncologists cope with unique work characteristics that increase their risk of developing compassion fatigue—that is, burnout and secondary traumatic stress—and can result in reduced capacity and interest in being empathetic to the suffering of others (Stamm B. The concise ProQOL manual, 2010). At the same time, oncologists can experience compassion satisfaction—that is, the positive aspects of caring. This study explored the associations of compassion fatigue and compassion satisfaction with oncologists’ grief and sense of failure beyond their reported exposure to suffering and death.

Methods

Seventy-four oncologists completed self-administered questionnaires examining compassion fatigue, compassion satisfaction, grief, exposure to suffering and death, and sense of failure.

Results

The oncologists reported that they face the loss of approximately 50% of their patients, and that their patients suffer from profound emotional and physical pain. High levels of compassion fatigue and grief, and moderate levels of sense of failure, were reported. Findings showed a lack of association between exposure to suffering and death and compassion fatigue and satisfaction. However, grief and sense of failure were found to predict both aspects of compassion fatigue: secondary traumatic stress (p < 0.001, p < 0.003, respectively) and burnout (p < 0.002, p < 0.025, respectively).

Conclusions

These results highlight the importance of the oncologists’ subjective experiences of grief and sense of failure, beyond their reports of exposure to suffering and death, in terms of their levels of compassion fatigue. Implications of these findings include the need to develop interventions for oncologists that will allow them to acknowledge, process, and overcome negative experiences of failure and grief.

Association of physical functioning of persons with dementia with caregiver burden and depression in dementia caregivers: an integrative data analysis

OBJECTIVES

To determine whether caregiver relationship and race modify associations between physical functioning of persons with dementia (PWD) and their caregiver's burden and general depressive symptoms.

METHOD

We pooled data from four behavioral intervention trials (N = 1,211). Using latent growth modeling, we evaluated associations of PWD physical functioning with the level and rate of change in caregiver burden and caregivers' general depressive symptoms and stratified these associations by caregiver relationship and race.

RESULTS

PWD were, on average, 81 years old (68% female) with mean follow-up of 0.5 years. More baseline PWD physical impairment was associated with less worsening in caregiver burden over time (β = -0.23, 95% CI: -0.29, -0.14), but this relationship was not modified by caregiver characteristics. More impaired baseline PWD physical functioning was not associated with changes in depressive symptoms (β = -0.08, 95% CI: -0.17, 0.00), but was associated with less worsening in depressive symptoms among spousal (β = -0.08, 95% CI: -0.17, 0.00) and non-white (β = -0.08, 95% CI: -0.17, 0.00) caregivers.

CONCLUSIONS

Dementia caregivers may experience reduced caregiver-related burden because of adjustment to PWD functional status, while spousal and non-white caregivers may experience less depressive symptoms resultant of adjustment to functional status.

Caregiving Across Diverse Populations: New Evidence From the National Study of Caregiving and Hispanic EPESE

BACKGROUND AND OBJECTIVES

The current study employs population-based data to determine the extent to which stress and coping factors are related to self-rated health and distress for informal caregivers (CGs) from the 3 largest racial/ethnic groups in the United States (non-Latino White, African American, and Mexican American).

RESEARCH DESIGN AND METHODS

Data on primary, informal CGs are obtained from the 2015 National Study of Caregiving (NSOC) (n = 667) and the 2016 Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE) CG supplement (n = 287). Logistic regression models of health are presented for all CGs and specifically for dementia CGs.

RESULTS

Caregiving intensity is related to health for non-Latino White CGs and African American dementia CGs. Support from family and friends is related to better self-rated health, but only for African American dementia CGs. While better relationship quality is related to better health for African American CGs and White dementia CGs, formal support utilization is related to worse CG health for Mexican American dementia CGs.

DISCUSSION AND IMPLICATIONS

Findings emphasize the importance of earlier detection and intervention with CGs at the beginning in the caregiving career, the interplay of formal and informal support, and appropriate ways to intervene with dementia CGs. Culturally tailored home- and community-based care options are needed to supplement the low levels of CG support, especially for the Mexican American population.

Coping Resources, Loneliness, and Depressive Symptoms of Older Women With Chronic Illness

Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women (N = 138) with at least one chronic illness (M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.

Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver's ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.

Evaluation of a therapeutic education program for French family caregivers of elderly people suffering from major neurocognitive disorders: Preliminary study

The pertinence of a therapeutic program of education has been studied with regard to carers of patients suffering from major neurocognitive disorders. The program, adapted to the needs expressed by the carers, consisted of three workshops with a view to supplying general information about the pathologies, specific information on behavioral disorders, and specific aids to identify and manage their emotional reactions. The results of this preliminary study show a moderate significant benefit to the level of anxiety in the participants, taking into account the specific expectations of the carers and bringing to light further needs.

Associations of knowledge of Alzheimer’s disease and memory loss and employment status with burden in African American and Caucasian family caregivers

Caring for an individual living with Alzheimer’s disease and other forms of dementia is especially challenging and impacts every aspect of the lives of the family caregivers. Family caregiving is defined as informal, unpaid care provided by family or friends to people with a chronic illness or disability. Caregiver burden, often experienced by a caregiver for a cognitively impaired family member, is multifaceted involving physical, psychological, social, and emotional problems. To date, little has been done to examine the relationship between the knowledge of Alzheimer’s disease and memory loss and caregiver burden. To fill this gap, a cross sectional, correlational design was employed to collect data from a convenience sample ( N = 104) of African American and Caucasian dementia family caregivers. For this study, caregivers ranged from 25 to 89 years of age with African American caregivers possessing significantly lower levels of knowledge about Alzheimer’s disease and other dementias compared to Caucasian caregivers, p < .001. There were 44 caregivers who scored 41 or greater on the Caregiver Burden Inventory corresponding to moderate to severe and higher levels of burden. Results of hierarchical multiple regression models indicated that higher levels Alzheimer’s disease knowledge was significantly associated with lower caregiver burden for all caregivers, B = −0.294, p < .01. Additionally, employment status was significantly associated with caregiver burden. This study highlights the benefits of including disease specific knowledge within educational components of dementia related interventions and programs involving families.

Coping and adjustment in caregivers: A systematic review

This systematic review assessed coping and adjustment in caregivers of all ages to provide a synthesis of existing literature in the context of methodological approaches and underlying theory. Four databases were searched. Reference lists, citations and experts were consulted. In total, 27 studies (13 quantitative and 14 qualitative) were included. Coping factors associated with adjustment (problem- versus emotion-focussed coping and cognitive strategies) and psychosocial factors associated with physiological adjustment (trait anxiety, coping style and social support) were identified. Results raised methodological issues. Future research requires physiological adjustment measures and longitudinal assessment of the long-term impact of childhood caregiving. Findings inform future caregiver research and interventions.

Psychological status and coping styles of caregivers of individuals with intellectual disability and psychiatric illness

BACKGROUND

The psychological status of caregivers of individuals with intellectual disability and psychiatric illness (PI) is important for effective management. The aim of this study was to examine the psychological status and its relationship with coping styles among these caregivers.

MATERIALS & METHODS

Caregivers (N = 80) of individuals with intellectual disability (n = 40) and PI (n = 40) were administered a socio-demographic questionnaire, depression, anxiety and stress scale and COPE Inventory.

RESULTS

Caregivers experienced depression, anxiety and stress symptoms. These symptoms were found to be significantly higher among caregivers of individuals with intellectual disability than those with PI. The most common coping style used was religious coping. Use of positive reinterpretation and growth was associated with lower levels of depression and stress symptoms.

CONCLUSION

Caregivers' mental health plays an important role in the quality of care delivery and outcome. Use of appropriate coping styles can reduce the impact of these symptoms.

Relationships among Symptom Management Burden, Coping Responses, and Caregiver Psychological Distress at End of Life

BACKGROUND

Family caregivers (FCGs) face numerous stressors and are at heightened risk of psychological distress. While theoretical explanations exist linking caregiving stressors with outcomes such as anxiety and depression, limited testing of these theories has occurred among FCGs of patients nearing the end of life.

OBJECTIVE

Researchers sought to evaluate mediational relationships among burden experienced by hospice FCGs because of symptom management demands, caregivers' coping responses, and caregivers' psychological distress.

DESIGN

Quantitative data for this descriptive exploratory study were collected through survey. Hypothesized relationships among caregiver variables were examined with structural equation modeling.

SETTING/SUBJECTS

Respondents were FCGs (N = 228) of hospice patients receiving services from a large, non-profit community hospice in the Mid-Southern United States.

RESULTS

Burden associated with managing hospice patients' psychological symptoms was shown to predict psychological distress for FCGs. Caregivers' use of escape-avoidance coping responses mediated this relationship.

CONCLUSIONS

Results suggest that FCGs would benefit from additional tools to address patients' psychological symptoms at end of life. When faced with psychological symptom management burden, caregivers need a range of coping skills as alternatives to escape-avoidance coping.

Resilience and burden in caregivers of older adults: moderating and mediating effects of perceived social support

BACKGROUND

The burden of caring for an older adult can be a form of stress and influence caregivers' daily lives and health. Previous studies have reported that resilience and social support play an important role in reducing physical and psychological burden in caregivers. Thus, the present study aimed to examine whether perceived social support served as a possible protective factor of burden among caregivers of older adults in Singapore using moderation and mediation effects' models.

METHODS

We conducted a cross-sectional study with 285 caregivers providing care to older adults aged 60 years and above who were diagnosed with physical and/or mental illness in Singapore. The Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience and burden was measured by the Zarit Burden Interview (ZBI). The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure perceived social support. Hayes' PROCESS macro was used to test moderation and mediation effects of perceived social support in the relationship between resilience and burden after controlling for sociodemographic variables. Indirect effects were tested using bootstrapped confidence intervals (CI).

RESULTS

The mean scores observed were CD-RISC: 70.8/100 (SD = 15.1), MSPSS: 62.2/84 (SD = 12.2), and ZBI: 23.2/88 (SD = 16.0) respectively. While perceived social support served as a full mediator between resilience and caregiver burden (β = - 0.14, 95% CI -0.224 to - 0.072, p < 0.05), it did not show a significant moderating effect.

CONCLUSIONS

Perceived social support mediates the association between resilience and caregiver burden among caregivers of older adults in Singapore. It is crucial for healthcare professionals, particularly those who interact and deliver services to assist caregivers, to promote and identify supportive family and friends' network that may help to address caregiver burden.

Mediated Effects of Coping on Mental Health Outcomes of African American Women Exposed to Physical and Psychological Abuse

Few studies have assessed the individual symptoms of posttraumatic stress disorder (PTSD) as separate mental health consequences of intimate partner abuse (IPA). This study examined the role of coping strategies associated with symptoms of PTSD in a community sample of African American women who have experienced abuse ( N = 128). The results revealed that nonphysical abuse was more prevalent than physical abuse. Specific symptoms of PTSD expressed depended on the type of abuse experienced and the type of coping strategies utilized. The findings have multiple implications on how IPA is studied as well as its clinical screening and treatment processes.

Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment

BACKGROUND

Pediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program.

METHOD

The relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires.

RESULTS

Components of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL.

CONCLUSION

Ultimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.

Care Giving Offspring to Aging Parents: How it Affects Their Marital Relations, Parenthood, and Mental Health

The study examined the effect of direct and indirect stresses on the mental health of offspring caring for an aging parent. The study is based on Pearlin, Lieberman, Menaghan, and Mullan's (1981) Stress Development Model. The research examined 345 subjects, men and women aged 40-59 who filled a questionnaire sent by post within their workplace. The research findings show that the various stresses of the caregiver role are mutually connected and have a significant positive effect on the mental health of caregiving offspring. Another finding shows that the extended family support variable acts as a buffer on the caregiving burden on the adult child.

Socioecological factors and positive aspects of caregiving: findings from the REACH II intervention

OBJECTIVE

Taking a socioecological perspective, this study assessed the relationship of intrapersonal, interpersonal, and organizational factors to positive aspects of caregiving (PAC) for 642 dementia caregivers by racial/ethnic group from the baseline data of the multisite Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention.

METHODS

Nine intrapersonal indicators, 4 interpersonal indicators, and 12 organizational indicators were used. Blocked-multiple regression analyses by three racial/ethnic groups were computed to examine significant factors related to PAC among caregivers after controlling for memory and behavioral problems.

RESULTS

Data showed a significant difference in PAC and significantly different indicators of PAC by racial/ethnic group. Hispanic caregivers reported the highest level of PAC while White participants showed the lowest scores on the measure of PAC. Education, marital status, and using formal transportation services were significant predictors for PAC among Hispanic caregivers; age, education, caregiving duration, and received social support were significant for PAC among African American caregivers; and sex, education, being a spousal caregiver, satisfaction with social support, using help from homemaker and visiting nurse services, and participating in support groups were significant among White caregivers.

CONCLUSION

Findings indicate that PAC varies significantly across the three studied racial/ethnic groups of family caregivers and that intrapersonal, interpersonal, and organizational factors relate uniquely to PAC. Additional investigations of PAC could serve an important role in the development of family caregiving supports and services.

Strain in African American and White American Caregivers of Hospitalized Elderly

This study investigated the relationship between race and strain in family caregivers of hospitalized older patients. Data came from a sample of 176 African American and 194 White American caregivers who were identified as part of a prospective study of changes in functional status of older hospitalized patients. When interaction terms were added to a multivariate model assessing the relationship between race and strain, race lost its significant influence on strain. Instead, its combination with two other variables-being an adult child caregiver and being married-emerged as important correlates. Being an adult child had deleterious consequences for White caregivers, whereas being married had advantageous consequences for African American caregivers. Findings emphasize the need to reevaluate how the race variable is used in future research and the need for hospital staff to be sensitive to racial diversity when working with families to plan for older patients' discharge.

Childbearing History and Self-Reported Well-Being in Later Life

The authors examined how numbers of live births and pregnancy losses affected the self-rated health and depressive symptoms of women aged 50 years and older, contrasting African Americans and Whites. The authors used data from Atherosclerosis Risk in Communities, a large, prospective study with substantial minority representation. They tested hypotheses that childbearing-history variables would influence self-rated well-being among older women and that perceived social support would mediate the associations. The authors also tested whether these associations would be stronger among older African American versus White women. The results suggest that the impact of child-bearing history is greater among older African American than White women. Pregnancy loss worsened depressive symptoms and self-rated health among African American women; the effect was reduced by social-support variables. High parity was associated with worse self-rated health among African American women, mediated by social support. Having no live births was not associated with diminished well-being among older women of any race.

Issues in Caregivers' Stress and Providers' Support

This study examined whether support from care recipients' primary care providers affects the stress and health of caregivers. This two-year longitudinal study addressed changes in caregivers' mental and physical health, both self-assessed and evaluated by professional nurse practitioners in physical examinations, and the effects of provider support on caregivers' health. Randomly selected participants from three previous studies plus a group of volunteer Alzheimer's caregivers constituted the sample. Of 254 eligible individuals, 150 agreed to participate, but by time 2, care recipient deaths and other reasons had reduced the number of caregivers to 99. Participants showed significant increases in stress and service use but declines in all areas of health and in provider support. Provider support did not materially affect caregivers' health but had an indirect effect on caregivers' self-assessed health through rewards. Despite the need for bolstering caregivers' health, perceived support from care recipients' providers is limited.

Positive Aspects of Caregiving

The aim of this study was to assess a newly developed measure for the positive aspects of caregiving using a sample of dementia caregivers. The measure was developed and administered to 1,229 participants in a national collaborative Alzheimer’s disease caregiver study and evaluated for validity and reliability using standard psychometric analyses. Factor analysis identified two components in this nine-item measure: Self-Affirmation and Outlook on Life. Cronbach’s alphas for the components were .86 and .80, respectively. For the entire scale, Cronbach’s alpha was .89. The Positive Aspects of Caregiving measure, tested with a large, diverse, and well-characterized sample shows promise as a valid and reliable instrument. With additional implementation and testing, the measure has the potential to substantially increase our understanding of basic caregiving research and the outcomes of intervention efforts.