The social networks of Hong Kong Chinese family caregivers of Alzheimer's disease: correlates with positive gains and burden

Factors influencing the ability of family caregivers of Alzheimer's patients within Iranian families to continue and persist in their caregiving roles: a qualitative study

BACKGROUND

Understanding the motivations driving family members to continue caring for individuals with Alzheimer's disease is crucial for enhancing social support programs within community health systems. This study specifically explores the factors influencing Iranian family caregivers' ability to persist in their caregiving roles.

METHODS

This qualitative study was conducted using conventional content analysis with 22 participants in 2022 in Babol (a city in northern Iran). The inclusion criteria for the study included caregivers of Alzheimer's patients who had been the primary caregivers for at least one year for patients with a confirmed diagnosis of Alzheimer's disease. The sampling method was purposive, ensuring maximum variation in social position, demographic status, and stages of Alzheimer's disease after the onset of symptoms. In this research, data were collected from caregivers of Alzheimer's patients through semi-structured interviews and in-depth individual interviews. The data were analyzed using MAXQDA software.

RESULTS

One category and four subcategories were identified to explain the continuity of the caring role in family caregivers of Alzheimer's patients. The category was "on the Fence of the Caring Role." The subcategories included Commitment to Care (Being Determined, Being Indebted, Feeling Dutiful), Coercion to Care (Giving in to the Caring Role Due to Family Requirements, Patient Care Due to Financial Problems), Socio-Cultural Beliefs and Concerns (Spiritual and Religious Tendencies, Social Stigma and Social Fears), and Attachment and Love for the Patient (Feeling Pity, Feeling Nostalgia for Kinship).

CONCLUSION

Family caregivers are deeply engaged in their roles, often feeling trapped by various pressures. Recognizing these dimensions can inform policymakers and health practitioners in developing targeted interventions, such as respite care programs, financial support, and community resources, aimed at alleviating caregiver burden and enhancing the quality of care for patients. By addressing the complexities of the caregiver experience, effective strategies can be implemented to support both patients and their caregivers, ultimately improving health outcomes within the community.

Validation of the Perceived Community Support Questionnaire for Older Chinese

BACKGROUND AND OBJECTIVES

Community support has a profound positive impact on older people's health and plays a crucial role in facilitating aging in place. This impact is particularly significant in the Chinese context, where community support can alleviate the pressure on traditional family caregiving. This study translated, adapted, and validated the perceived community support questionnaire (PCSQ) for use with older Chinese.

RESEARCH DESIGN AND METHODS

Data for this validation study were collected from a cross-sectional survey of 1,064 Chinese aged 65 years and above. Following the cultural adaptation of the PCSQ-14, confirmatory factor analysis (CFA) was conducted to examine its factor structure. Criterion validity, convergent and discriminant validity, internal consistency reliability, and test-retest reliability of the scale were also assessed.

RESULTS

Based on the CFA results, the adapted PCSQ-14 was found to have a 3-factor solution for community integration, community participation, and community organizations. The criterion-related validity was supported by its significant correlation with depression. Convergent and discriminant validity were established, with the internal consistency of the scale being 0.90. The test-retest reliability intraclass correlation coefficient for the scale was 0.78.

DISCUSSION AND IMPLICATIONS

The adapted version of the PCSQ-14 demonstrated promising psychometric properties in assessing perceived community support in older Chinese. The adapted PCSQ-14 could assist researchers in determining older Chinese adults' perceptions of community support, and could also assist practitioners and policymakers in developing targeted services for older people and allocating resources more effectively.

The quality of family relationships in dementia: Mixed methods to unravel mixed feelings

Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches.Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis.Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship.Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements.

Examining Online Behaviors of Adult-Child and Spousal Caregivers for People Living With Alzheimer Disease or Related Dementias: Comparative Study in an Open Online Community

BACKGROUND

Alzheimer disease or related dementias (ADRD) are severe neurological disorders that impair the thinking and memory skills of older adults. Most persons living with dementia receive care at home from their family members or other unpaid informal caregivers; this results in significant mental, physical, and financial challenges for these caregivers. To combat these challenges, many informal ADRD caregivers seek social support in online environments. Although research examining online caregiving discussions is growing, few investigations have distinguished caregivers according to their kin relationships with persons living with dementias. Various studies have suggested that caregivers in different relationships experience distinct caregiving challenges and support needs.

OBJECTIVE

This study aims to examine and compare the online behaviors of adult-child and spousal caregivers, the 2 largest groups of informal ADRD caregivers, in an open online community.

METHODS

We collected posts from ALZConnected, an online community managed by the Alzheimer's Association. To gain insights into online behaviors, we first applied structural topic modeling to identify topics and topic prevalence between adult-child and spousal caregivers. Next, we applied VADER (Valence Aware Dictionary for Sentiment Reasoning) and LIWC (Linguistic Inquiry and Word Count) to evaluate sentiment changes in the online posts over time for both types of caregivers. We further built machine learning models to distinguish the posts of each caregiver type and evaluated them in terms of precision, recall, F1-score, and area under the precision-recall curve. Finally, we applied the best prediction model to compare the temporal trend of relationship-predicting capacities in posts between the 2 types of caregivers.

RESULTS

Our analysis showed that the number of posts from both types of caregivers followed a long-tailed distribution, indicating that most caregivers in this online community were infrequent users. In comparison with adult-child caregivers, spousal caregivers tended to be more active in the community, publishing more posts and engaging in discussions on a wider range of caregiving topics. Spousal caregivers also exhibited slower growth in positive emotional communication over time. The best machine learning model for predicting adult-child, spousal, or other caregivers achieved an area under the precision-recall curve of 81.3%. The subsequent trend analysis showed that it became more difficult to predict adult-child caregiver posts than spousal caregiver posts over time. This suggests that adult-child and spousal caregivers might gradually shift their discussions from questions that are more directly related to their own experiences and needs to questions that are more general and applicable to other types of caregivers.

CONCLUSIONS

Our findings suggest that it is important for researchers and community organizers to consider the heterogeneity of caregiving experiences and subsequent online behaviors among different types of caregivers when tailoring online peer support to meet the specific needs of each caregiver group.

Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature

Over 55 million people reportedly suffer from dementia worldwide. In Japan, it is estimated that 1 in 5 people over 65 years old will have dementia by 2025, of which more than 20% will live with symptoms that require home/nursing care. Given the lack of effective medical treatments for dementia, informal caregivers play essential roles in allowing dementia patients to live with dignity. Our review focusing on caregiver burden showed that this burden has not been sufficiently addressed, despite having negative effects on caregivers' health, employment, and finances. It is important to consider non-pharmacological interventions that contribute to effective coping strategies for mitigating the caregiver burden. Online communication tools may be a viable intervention measure to educate caregivers on the importance of sharing resilient coping strategies to reduce their stress so that they can continue to provide care for their loved ones.

Changes in Network Size, Quality, and Composition among Informal Caregivers in Different Welfare Clusters: Longitudinal Analyses Based on a Pan-European Survey (SHARE)

INTRODUCTION

This study analyzed the association between transitions into informal caregiving, inside and outside their own household, and changes in network size, quality, and composition among older adults (≥50 years) in four different welfare systems in Europe.

METHODS

Data from waves 4, 6, and 8 of the Survey of Health, Ageing and Retirement in Europe was used and included up to 110,823 participants (aged ≥50 years) from 12 countries. Participants were asked about informal caregiving inside and outside the household and their network size, quality (emotional closeness, contact frequency), and composition (family, friends, men, women). Adjusted linear and Poisson fixed effects regression analyses were conducted.

RESULTS

Participants transitioning into any caregiving (inside or outside the household) had a larger network. More women and family members were found among all those transitioning into caregiving, but only outside caregiving was associated with more men and friends in the network. Transitioning into caregiving outside was associated with reduced network closeness and contact. Changes among caregivers outside were similar in all welfare states but were more pronounced among caregivers inside the household of Eastern Europe.

CONCLUSION

Different patterns of changes in network size, quality, and composition were found among adults transitioning into caregiving inside and outside the household. All parameters changed among caregivers outside the household. However, the welfare system played a key role in the network changes among inside household caregivers. Thus, the micro as well as the macro context of caregiving is important for the support network of informal caregivers.

Social Networks Effects on Spouse and Adult-Child Dementia Caregivers' Experiences: A Cross-Sectional Study

OBJECTIVES

A large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers' experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China.

METHODS

Data collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables.

RESULTS

Spouses had weaker social network strength (β = -0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the "positive aspects": a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003).

CONCLUSIONS AND IMPLICATIONS

Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.

Empirical Analysis of Preferences of Older Adults for Care Facilities in Japan: Focusing on Household Structure and Economic Status

Japan is advancing into a super-aged society at an unprecedented speed, and the proportion of the elderly population will continue to rise. The number of older adults needing nursing care will also increase with the aging population. We used a cross-sectional dataset of older Japanese adults to examine their future preferences for care facilities and their relationship with individual characteristics, household structure, and economic status. We further focused on a subgroup of those who lived alone and were experiencing poverty and examined their care needs through their choice of care facilities. We found the following results from multinomial logit and probit regressions. First, compared with living alone, older adults who live with their spouses or other members prefer to live in their own houses. Second, older adults experiencing poverty preferred to choose facilities geared towards low-income groups, while wealthy older adults preferred to choose fee-based nursing homes/nursing homes with diverse services and high costs. Third, single older adults in poverty were less likely to choose to live in facilities. Covariates such as sex, age, and health status also mattered in their choices. Therefore, tailoring the formal care services to the preferences and actual needs of older adults is imperative.

Burden of Family Caregivers of Patients with Oral Cancer in Home Care in Taiwan

Oral cancer is currently the fourth leading cause of cancer-related death in Taiwan. The complications and side effects of oral cancer treatment cause a tremendous burden on patients' family caregivers. This study explored the burden on primary family caregivers of patients with oral cancer and its related factors. One hundred and seven patients with oral cancer and their primary family caregivers were included through convenience sampling. The Caregiver Reaction Assessment (CRA) scale was employed as the primary research instrument. The primary factors of caregiver burden, in descending order, were disrupted schedules (M = 3.19, SD = 0.84), a lack of family support (M = 2.82, SD = 0.85), health problems (M = 2.67, SD = 0.68), and financial problems (M = 2.59, SD = 0.84). The CRA scores of the caregivers differed significantly in terms of education level (t = 2.57, p < 0.05) and household income (F = 4.62, p < 0.05), which significantly predicted caregiver burden (R2 = 0.11, F = 4.32, p = 0.007). The study results provide a reference for healthcare professionals to identify the factors for family caregiver burden, as well as the characteristics of patients and family caregivers particularly vulnerable to caregiver burden, thus improving family-centred care.

Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders

BACKGROUND

One in four families has at least one member with a mental disorder and families are the main caregivers in most patients in low and middle-income countries. Caregivers experience disruption in their routine lives, increased responsibilities, increased need for support, and changes in their network. The role of personal support networks in the health and burden of the caregivers is complex and depends on the context, cultural and socioeconomical variables. In this study, we aimed to investigate the personal support network of caregivers of patients with severe mental illness in Iran.

METHODS

By using a mixed-methods design, we focused on the structure and composition of caregiver networks, as well as self-perceived caregiver support.

RESULTS

We found that the support network of caregivers was mostly composed of immediate family members whom themselves were selectively chosen as a result of the multidimensional process of interaction between stigma, availability, and the perceived needs of caregivers. The participants mentioned economic and instrumental supports more frequently than emotional support, probably reflecting their unmet basic needs. Advocacy for providing formal systemic supports to caregivers, as well as interventions that expand caregivers personal support network is recommended.

CONCLUSIONS

Most participants of the study were relatively isolated and had a small network of support, mostly composed of immediate family members. Stigma was a serious source of family distress for caregivers and a limiting factor in social relationships.

Positive aspects of caregiving in incident and long-term caregivers: Role of social engagement and distress

OBJECTIVES

Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress.

METHODS

Participants included 283 African American or White caregivers from the Caregiving Transitions Study with a wide range of caregiving durations. PAC are defined as positive appraisals that caregivers report about their role, such as feeling appreciated or confident. We fit multivariable linear models with the total PAC score as the outcome to assess its association with years of caregiving and social engagement (social network, monthly social contact). Models were adjusted for age, sex, race, marital status, relationship to care recipient, care recipient's dementia status, perceived stress and caregiving strain.

RESULTS

Caregivers with higher social engagement reported significantly higher PAC. A non-significant trend was found in most analytic models for caregivers with longer duration of care to report higher PAC. African American caregivers reported higher PAC compared to White caregivers. Dementia caregivers reported lower PAC than non-dementia caregivers in models adjusting for demographics and social network size, but the association was attenuated with the addition of caregiving strain.

DISCUSSION

Higher social engagement and longer duration of care tend to be associated with higher PAC after adjusting for demographics and measures of distress. Future studies should aim to leverage longitudinal data to understand whether caregivers shift appraisal to positive aspects of their role and explore implementation of caregiving interventions targeting PAC in order to improve the caregiving experience.

Lonely in a Crowd: Social Isolation Profiles and Caregiver Burden Among Family Caregivers of Community-Dwelling Older Adults With Cognitive Impairment

Objectives

This study identified distinct social isolation profiles among caregivers, each formed by varied combinations of social disconnectedness and loneliness, and examined if and how the profiles were associated with caregiver burden.

Methods

Latent class analysis and multivariable regression were applied to data from 266 caregivers of community-dwelling older Singaporeans with cognitive impairment.

Results

Two caregiver social isolation profiles were identified: strongly connected, not lonely (86%), and moderately connected, lonely (14%). Moderately connected and lonely caregivers tended to perceive a higher level of burden than strongly connected and not lonely caregivers. Moderately connected and lonely caregivers were also more likely to be burdened by their care recipients’ poor health than their connected and not lonely counterparts.

Discussion

Caregivers who feel “lonely in a crowd” are vulnerable to caregiving stress and burden. Tailored interventions, such as cognitive behavioral therapy, are needed to reduce the loneliness of moderately connected caregivers.

Public long-term care insurance scheme and informal care use among community-dwelling older adults in China

The public long-term care insurance (LTCI) scheme has been implemented in a few countries. Although the hypotheses of crowding-out, crowding-in and specialisation can facilitate our understanding of the relationship between LTCI and informal care use, existing studies may suffer from reverse causality. Employing a quasi-experimental design, this study examined the policy effect of LTCI on informal care use among community-dwelling older adults in China. Based on the data from three waves of the Chinese Longitudinal Healthy Longevity Survey, a staggered difference-in-differences (DID) with propensity score matching (PSM) approach was used to analyse the impact of LTCI on probability and hours of informal care use. The results showed that, for disabled older adults, LTCI reduced 43.3% of the probability and 82.4% of the weekly hours of informal care. LTCI also exhibited a spillover effect among nondisabled older adults through reducing the probability and weekly hours of informal care by 5.2% and 12.2%, respectively. Therefore, we argue that policymakers can consider rolling out the scheme for the entire country. Meanwhile, measures are needed to avoid a sharp decrease in informal care provision.

Impact of confinement measures due to the COVID-19 pandemic on people living with dementia and their caregivers in Spain

The COVID-19 pandemic has particularly affected people living with dementia (PLWD) and their caregivers, who have seen their access to social support services and opportunities for socialisation limited. The objective of the study was to explore the impact of COVID-19 on PLWD and their caregivers in Spain. An online survey was conducted between November 27, 2020, and January 19, 2021, that explored compliance with prevention guidelines, changes at the family level and in access to social support services. Instruments were included to estimate levels of anxiety and depression. The survey was answered by 229 people (161 current caregivers, 54 former caregivers, 13 formal caregivers and 1 person with dementia). Analysis of the current and former caregivers showed that they felt well informed, although they find it difficult for PLWD to comply with prevention guidelines. The use of social support services was reduced and the difficulty of access to social and health services increased, there was a negative impact on the economic situation and family relationships, with an increase in perceived overload. In addition, caregivers of PLWD scored above the cut-off points in the tests used to assess depression and anxiety, although the results of the multiple regression analysis do not allow us to conclude that the loss of resources influences the anxiety and depression scores. The negative impact of the pandemic on caregivers of PLWD is verified. It is necessary to adapt social support services and design strategies to maintain the provision of support to these vulnerable groups.

Factors associated with positive aspects of caregiving experiences among family caregivers of persons living with dementia in Taiwan: A cross-sectional study

This study examined the associated factors of positive aspects of caregiving experience among family caregivers of persons living with dementia in Taiwan. This cross-sectional correlational study recruited dyads of primary family caregivers of persons living with dementia by convenience sampling from dementia care centers in northern Taiwan from September 9, 2020, to June 20, 2021. A total of 100 dyads who met inclusions criteria agreed to participate in the study. Significant predictors of positive aspects of caregiving experience were scores of dementia behavior disturbance (t=-3.63, p =<.001), a spousal caregiver (t=2.83, p =.006), and the subscale score for satisfaction on the functional social support (t=2.62, p =.01). Our findings suggest prevention and treatment of dementia behavior disturbance for persons living with dementia, improving satisfaction with functional social support, and focusing on non-spousal caregivers could enhance experiences of positive caregiving for family caregivers.

Assessment of the Psychological Burden Among Family Caregivers of People Living with Alzheimer's Disease Using the Zarit Burden Interview

BACKGROUND

In China, family caregivers play a major role in caring for people living with Alzheimer's disease (PLWAD), but little is known about the burden this creates.

OBJECTIVE

This study aimed to investigate the burden among family caregivers of PLWAD and the factors influenced it.

METHODS

Family caregivers of PLWAD were recruited from a hospital in China from January 2018 to July 2018. All data were collected online using the Chinese version of the Zarit Burden Interview (ZBI), and the participants' sociodemographic and caregiving details were obtained. T-tests and Kruskal-Wallis H (K) tests were used to compare ZBI scores between groups. Factors related to the caregiver psychological burden were analyzed using multiple linear regression analysis.

RESULTS

A total of 300 participants were assessed, of which 213 (71.00%) were female. More than half of the caregivers were the patient's daughter (51.0%, n = 153). The average ZBI score of the caregivers was 43.05 (13.42). The level of burden was influenced by age, the relationship of the caregiver to the patient, the severity of AD, the caregiver's retirement status, the income level of the caregiver, and the caring time. Regression analysis showed that retired caregivers were more likely to have higher levels of burden and that burden increased with AD severity.

CONCLUSION

Most family caregivers of PLWAD have a considerable caregiver psychological burden. The findings increase the understanding of factors that influence family caregiver burden, and pave the way for potential interventions, such as social support and caregiver empowerment, to reduce their burden.

Source of Social Support and Caregiving Self-Efficacy on Caregiver Burden and Patient's Quality of Life: A Path Analysis on Patients with Palliative Care Needs and Their Caregivers

Few studies have explored the inter-relationships of sources of social support and caregiving self-efficacy with caregiver burden and patient’s quality of life among patients with palliative care needs and their caregivers. This study tested the associations of two sources of social support (family and friends) and the mediating role of caregiving self-efficacy on caregiver burden and patient’s quality of life. A convenience sample of 225 patient–caregiver dyads recruited between September 2016 and May 2017 from three hospitals in Hong Kong was included in the current analysis. Results showed that the final model provided a satisfactory fit (SRMR = 0.070, R-RMSEA = 0.055 and R-CFI = 0.926) with the data, as good as the hypothesized model did (p = 0.326). Significant associations were detected. Family support had a significant negative indirect effect on caregiver burden and a significant positive indirect effect on patient’s quality of life through caregiving self-efficacy, whereas friend support had a significant positive direct effect on caregiver burden but a minimal effect, if any, on patient’s quality of life. These findings emphasized (1) the importance of caregiving self-efficacy in improving caregiver burden and patient’s quality of life and that (2) sources of social support may be an important dimension moderating the associations of caregiving self-efficacy with caregiver burden and patient’s quality of life.

Quality of life, burden, family emotional support: a model for older adults who are caregivers

OBJECTIVE

To investigate associations between quality of life, sex, age, burden, and nature of emotional support available in the family in older adults who are caregivers of older relatives.

METHOD

Cross-sectional and correlational study on 148 caregivers gathered in public and private healthcare services, who were subjected to psychological measures of quality of life, burden, exchange of emotional support, sex, and age. Data were analyzed using Chi-square, Fisher's exact test and path analyses (p < 0.05).

RESULTS

A total of 77% women, average age of 69.7 years. There were significant associations between exchange of support and burden due to the provided assistance, being a woman and satisfaction with the received support, satisfaction with the received support and burden, burden and quality of life, and satisfaction with the received support and feeling of burden due to the provided support.

CONCLUSION

Satisfaction with the received emotional support moderate the association between sex and burden, and such moderate the association between satisfaction with emotional support and perceived quality of life.

The Effect of Negative Aging Self-Stereotypes on Satisfaction With Social Support

OBJECTIVES

Previous studies have demonstrated a relationship between negative age self-stereotypes and social support satisfaction. This study examined whether negative age stereotype plays a causal role, and whether health anxiety is a possible mediator, in this relationship.

METHODS

A total of 114 Chinese older persons were randomly assigned into three experimental conditions. In two of the conditions, participants were primed with either negative or positive age stereotypes using a sentence unscrambling task, before responding to measures of self-perception of aging, health anxiety, and satisfaction with family and nonfamily support. Those in the control condition responded to the same questions without priming.

RESULTS

Main effects of priming were found across the board except for satisfaction with nonfamily support. In general, participants primed with negative age stereotypes reported more negative self-perception of aging, higher health anxiety, and lower satisfaction with family support, compared with control or those primed with positive age stereotypes. However, the effect on family support satisfaction could not be explained by concomitant experimental effect on health anxiety.

DISCUSSION

The central role of the family as a support provider might be the reason why the activation of negative age stereotypes led to less satisfaction with family, but not nonfamily.

Predicting self-esteem in informal caregivers of people with dementia: Modifiable and non-modifiable factors

While informal caregivers often feel burdened by the care for a person with dementia, they can also experience positive consequences due to caregiving; caregiver gains. One of these, relatively overlooked, caregiver gains is heightened self-esteem. We assessed the predictive ability of non-modifiable (caregiver sociodemographic- and dementia related-) and modifiable (psychological-) factors for caregiver self-esteem). A cross-sectional study in which 201 caregivers, who spent at least eight hours a week on caring for a community-residing person with dementia, completed a semi-structured interview and five questionnaires. One two-block (1: non-modifiable-; 2: modifiable variables) hierarchic multiple regression analysis was used to assess which variables predicted self-esteem. None of the non-modifiable variables significantly predicted self-esteem. Regarding the modifiable variables, depression and relationship quality with the person with dementia significantly predicted self-esteem (adjusted R² = .460, β = -.207, p = .015 and β = .632, p < .001 respectively). Caregivers who experience a better relationship quality with the person with dementia, and fewer depression symptoms, experience a higher level of self-esteem. Interventions focused on heightening self-esteem should strive to optimize these factors to enhance the lives of informal dementia caregivers.

Parent perceptions of mental illness in Chinese American youth

BACKGROUND

Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth.

METHODS

Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking.

RESULTS

While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences.

DISCUSSION

These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study

OBJECTIVES

The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers.

METHODS

Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention.

RESULTS

Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported.

CONCLUSION

This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.

Telephone-based behavioral activation intervention for dementia family caregivers: Outcomes and mediation effect of a randomized controlled trial

OBJECTIVES

The study examined the effects of a telephone-administered psycho-education with behavioral activation intervention (TBA) for family caregivers of person's with Alzheimer's dementia to reduce levels of depressive symptoms and burden and to enhance relationship satisfaction with the care-recipient METHODS: A double-blinded randomized trial compared TBA with telephone-based psycho-education with general monitoring (TGM). Ninety-six dementia caregivers were randomized. Both conditions received four weekly psycho-education sessions led by a social worker. TBA participants then received eight bi-weekly behavioral activation practice sessions delivered by paraprofessionals. TGM participants received eight bi-weekly monitoring sessions by paraprofessionals.

RESULTS

As compared to TGM, TBA participants reported significantly larger reductions in depressive symptoms and burden and larger improvement in relationship satisfaction. Self-efficacy for controlling upsetting thoughts was found to have a partial meditation effect between TBA and the reduction of depressive symptoms. Qualitative feedback suggested that TBA participants expressed unique gains in awareness and developing new ways of reappraising the caregiving situation.

CONCLUSION

TBA was an effective intervention to reduce depressive symptoms and burden as well as to enhance relationship satisfaction in dementia caregivers.

PRACTICE IMPLICATIONS

The use of telephone and trained paraprofessionals can enhance the accessibility and sustainability of behavioral activation intervention for dementia family caregivers.

Qualitative exploration of emotional and social changes from diagnosis to bereavement for spousal caregivers of persons with dementia

OBJECTIVES

To understand how bereaved spousal caregivers of persons with dementia perceive and respond to changes over the course of their spouse's disease, from diagnosis into bereavement.

DESIGN

Qualitative interview study with convenience sampling and thematic analysis approach.

PARTICIPANTS

Participants included eight women and two men (n=10) who had been spousal caregivers for a person with dementia prior to his/her death. Participants were older adults who self-reported good health and were bereaved longer than a year.

SETTING

Data collected in a small Canadian prairie city between fall 2014 and winter 2015.

FINDINGS

Two overarching themes were developed as important components of participants' caregiving journey: emotional reactions to change and variation in social connectedness throughout the caregiving and bereavement journey. Four key sub-themes developed through the analysis of emotional reactions to events: memorable grief overshadows persistent grief, a progressive feeling of hopelessness and overwhelmed, relief is common but hidden and gratitude is a milestone in a constructive bereavement. Three key variations of social connectedness throughout the caregiving and bereavement journey were developed: the importance of social inclusion throughout a caregiving and bereavement journey, the repeated loss of companionship and withdrawing from social interactions is contingent on needs.

CONCLUSIONS

The findings suggest that emotional changes throughout caregiving and bereavement are not linear. The need for support from family, friends and new social supports is influential in enabling the caregiver to move forward during caregiving and bereavement.

Community Social Capital and Positive Caregiving Experiences Among Adult-Children Caregivers of Older Adults With Disabilities in Urban China

The present study aimed to examine the association between community social capital and positive caregiving experiences among adult-children caregivers of disabled older adults in urban China. Data for this study were derived from the 2016 wave of the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai. The final analysis featured 440 disabled older adult and adult-children caregiver dyads. Multiple indicators and multiple causes modeling was used to test the proposed model from a structural equation modeling perspective. Provision of support to others was significantly associated with self-affirmation. Citizenship activity was significantly associated with life enrichment. Support of units (i.e., employers) was significantly associated with self-affirmation and life enrichment. The findings support the integration of the stress process model and social capital theory and highlight the important role of community social capital in enhancing the subdimensions of positive caregiving experiences. Policy and intervention implications are discussed.

Long-Term Outcomes of the Benefit-Finding Group Intervention for Alzheimer Family Caregivers: A Cluster-Randomized Double-Blind Controlled Trial

OBJECTIVES

To examine the effects of the group benefit-finding therapeutic intervention (BFT) for Alzheimer family caregivers up to 10-month follow-up.

METHODS

This was a cluster-randomized double-blind controlled trial in social centers and clinics. Participants included 129 caregivers. Inclusion criteria were 1) primary caregiver aged 18 years and older and without cognitive impairment, 2) providing 14 or more care hours per week to a relative with mild-to-moderate Alzheimer disease, and 3) scoring 3 or more on the Hamilton Depression Rating Scale. Exclusion criterion was care-recipient having parkinsonism or other forms of dementia. BFT (using cognitive reappraisal to find positive meanings) was evaluated against two forms of psychoeducation as controls-standard and simplified (lectures only) psychoeducation. All interventions had eight weekly sessions of 2 hours each. Primary outcome was depressive symptoms, whereas secondary outcomes were global burden, role overload, and psychological well-being. Measures were collected at baseline, postintervention, and 4- and 10-month follow-up.

RESULTS

Mixed-effects regression showed that BFT's effect on depressive symptoms conformed to a curvilinear pattern, in which the strong initial effect leveled out after postintervention and was maintained up to 10-month follow-up; this was true when compared against either control group. The effect on global burden was less impressive but moderate effect sizes were found at the two follow-ups. For psychological well-being, there was an increase in the BFT group at 4-month follow-up and a return to baseline afterward. No effect on role overload was found.

CONCLUSION

Benefit-finding reduces depressive symptoms as well as global burden in the long-term and increases psychological well-being in the medium-term.

A "separation of worlds": The support and social networks of family carers of people with dementia at the end of life, and the possible role of the internet

Caring for someone with dementia is one of the most challenging caring roles; however, the demands of the role towards the end of life often mean carers are unable to maintain face-to-face support. The aim of this study was to: (a) Explore the experiences of older (over 65 years) family carers of people with dementia of support towards the end of life; (b) Explore with family carers the role of the internet as a support for them at the end of life. Semi-structured interviews were conducted, with purposive sampling from general practice and research networks to recruit 20 current and former family carers aged 65 and over in England (2016-2017). Interviews were audio-recorded, transcribed, and analysed using thematic analysis. An overarching theme of the "separation of worlds" (the internal caring world and the outside world of society) was identified, with four sub themes: (a) the support role of relationships and social networks; (b) loss as a consequence of caring; (c) reconstruction of life as a carer; and finally; (d) life within and beyond the computer screen. This study demonstrates the complexity of social support at the end of life for family carers depicted in a model of two worlds. The internet can be seen as a viable approach to help carers maintain existing networks, reconstruct networks they have lost or developing new networks to meet their new needs and circumstances as a carer. Future support interventions should focus on a mixed model of technology and human interaction.

Social support and self-rated health among caregivers of people with dementia: The mediating role of caregiving burden

The purpose of this study was to examine the associations between three indicators of social support and self-rated health among caregivers of people with dementia, and whether caregiving burden mediated such associations. Data from the Resources for Enhancing Alzheimer's Caregiver Health II (REACH II; N = 637) was used and multivariate analyses were conducted to test the mediation effects of caregiving burden by PROCESS for v3.2.03. The results revealed that three indicators of social support (received support, social network, and negative interactions) were all significantly associated with self-rated health. Findings also showed that caregiving burden acted as a mediator mechanism through which the associations between social network and self-rated health, negative interactions and self-rated health occurred. Results suggest that there is a need for more comprehensive caregiving assessments as well as multicomponent interventions that include improving and expanding social networks for caregivers of people with dementia. Findings also highlight the importance of minimizing interpersonal conflicts with others and providing more multicomponent programs aimed at reducing caregiving burden.

Geographical proximity and depressive symptoms among adult child caregivers: social support as a moderator

OBJECTIVES

This study examined whether geographical proximity is a predictor of depressive symptoms, and whether family and friend support can moderate the relationship between geographical proximity and depressive symptoms.

METHOD

A survey of 557 adult child primary caregivers was conducted in Shanghai, China in 2013. Geographical proximity was measured as a categorical variable: coresidence, short distance (less than 30 minutes' travel time), and long distance (more than 30 minutes' travel time). Family and friend support were assessed using the Multidimensional Scale of Perceived Social Support. Depressive symptoms were evaluated using the Center on Epidemiologic Studies Depression Scale. Multiple regression analyses and interaction terms were used to test the moderating roles of family and friend support.

RESULTS

Adult child caregivers who live more than 30 minutes away from care recipients experienced higher depressive symptoms than coresiding caregivers (β = .114, p < .01). Family support (β = -.408, p < .05) and friend support (β = -.235, p < .05) were protective factors that lessened depressive symptoms for long-distance adult child caregivers.

CONCLUSION

This study adds spatial dimension to caregiving literature and extends stress process theory. These findings have important implications for service planning and social support for adult child caregivers.

Risky wandering behaviors of persons with dementia predict family caregivers' health outcomes

OBJECTIVES

To examine the relationships between dementia persons' risky wandering behaviors and family caregivers' physical and mental health.

METHODS

A secondary analysis was conducted using the original cross-sectional data from180 dyads. The Risky Wandering and Adverse Outcome model assessed behaviors of eloping and getting lost outside the house for dementia persons. Data were analyzed using descriptive statistics, Pearson's correlation coefficient and hierarchical regressions.

RESULTS

The mean age of caregivers was 56.01 years (SD = 13.8); 65% were female. Younger caregivers experienced greater physical fatigue and sleep disturbance. Presence of foreign helpers predicted a reduction in mental and physical fatigue of caregiver (β = -0.186, p < .05; β = 0.198, p < .05, respectively). Getting lost outside of the house influenced caregivers' mental fatigue (β = 0-0.215, p < .05); eloping behavior influenced caregivers' sleep disturbance (β = 0.231, p < .05). Care-receivers' activities of daily living affected caregivers' depressive symptoms (β = -0.179, p < .05).

CONCLUSIONS

Dementia family caregiver physical and mental health problems have distinct predictors. Employing the Risky Wandering and Adverse Outcome model could inform policy makers regarding long-term care resources to improve dementia care.

The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator

OBJECTIVES

The aim of this study was to explore caregiving self-efficacy as a mediator for the association between family functioning and caregiving appraisal of dementia family caregivers in Taiwan.

METHOD

This study adopted a cross-sectional correlational design. Purposive sampling was used to recruit 115 dyads of dementia patients and family caregivers from the outpatient neurological clinics of two hospitals in northern Taiwan. Data were gathered through interviews with a structured questionnaire, which included demographic characteristics for caregivers and patients, family functioning, caregiving self-efficacy, as well as positive and negative aspects of caregiving appraisal.

RESULTS

Family functioning, patients' activities of daily living score, Neuropsychiatric Inventory caregiver distress, and three domains of self-efficacy were significantly associated with caregiver burden. Hierarchical multiple regression analyses indicated that self-efficacy for obtaining respite (SE-OR) significantly explained 20.5% of the variance in caregiver esteem. Caregiver perceived worsened health status, family functioning, and SE-OR significantly explained 59% of the variance in caregiver burden. The mediation test only supported the partially mediating role of SE-OR on the relationship between family functioning and caregiver burden, while the mediating effect of self-efficacy for responding to disruptive behaviours and controlling upsetting thoughts were insignificant.

CONCLUSION

Our findings provided preliminary evidence for health professionals recommending that future studies should assess the family dynamic and health problems of caregivers, and develop appropriate family-centred interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden.

Social support and subjective burden in caregivers of adults and older adults: A meta-analysis

BACKGROUND

Despite the generally accepted belief that social support improves caregiver adjustment in general and subjective burden in particular, the literature shows mixed findings, and a recent review concluded that the predictive strength of caregiver social support in determining caregiver burden is less evident, due to the conceptual diversity of this determinant.

OBJECTIVE

The purpose of this review is to analyse the relationship of perceived and received social support with subjective burden among informal caregivers of an adult or older adult.

METHODS

A systematic search was carried out up to September 2017 in the following databases: MEDLINE (PubMed), CINAHL, EMBASE, PsycINFO), Scopus and ISI Proceedings, and a meta-analysis was performed with the results of the selected and included studies.

RESULTS

Fifty-six studies were included in the meta-analysis, which provided 46 independent comparisons for perceived support and 16 for received support. Most of these studies were cross-sectional. There was a moderate, negative association of perceived social support on subjective burden (r = -0.36; CI 95% = -0.40, -0.32) and a very small, negative association of received support on subjective burden (r = -0.05; CI 95% = -0.095, -0.001).

CONCLUSIONS

1) perceived and received support are not redundant constructs, 2) the relationships between social support and subjective burden depend on whether the social support is measured as perceived or received, 3) the relationship of perceived social support with subjective burden has a bigger effect size than that of received social support, the relation between received support and subjective burden being clinically irrelevant, 4) perceived social support may be a good predictor of subjective burden.

IMPLICATIONS OF KEY FINDINGS

Our findings broadly support interventions promoting social support in caregivers to prevent or alleviate subjective burden, and specifically, to intervene on the promotion of perceived social support more than on the promotion of received social support when preventing or alleviating burden.

Unravelling positive aspects of caregiving in dementia: An integrative review of research literature

BACKGROUND

Family caregiving is the crucial informal care resource to lessen the burdens associated with dementia. Research in this field has focused on reducing the caregiver's burden, but little attention has been given to promoting the positive aspects of caregiving.

OBJECTIVES

To conduct a systematic critical review of research on the nature of positive aspects of caregiving, and the factors predicting this phenomenon among family caregivers of dementia patients, with the ultimate purpose of gaining insights to explain how and why it emerges.

REVIEW METHODS

A systematic search of the literature was undertaken in the databases OvidMedline, CINAHL, PsycINFO, Web of Science and Scopus, using the keywords 'care* AND Alzheimer OR dementia AND 'positive aspect' OR 'positive experience' OR 'positive perceptions' OR reward OR gain OR 'satisfaction with care*' OR 'care* satisfaction' OR benefit OR uplift OR meaning OR enjoyment OR pleasure OR growth OR hope OR gratification. The Critical Appraisal Skills Programme checklists for qualitative and cohort studies were used to evaluate data quality. Narrative data synthesis was undertaken using the five-stage Whittermore and Knafl method.

RESULTS

A total of 3862 articles were identified, of which 41 were included in this review. The key findings are that positive aspects of caregiving among family caregivers of dementia patients form a multi-dimensional construct which covers four key domains: a sense of personal accomplishment and gratification, feelings of mutuality in a dyadic relationship, an increase of family cohesion and functionality, and a sense of personal growth and purpose in life. By integrating the findings about the nature and conditions predicting positive aspects of caregiving, the presence of three conditions was identified as promoting the emergence of such qualities i) personal and social affirmation of role fulfilment, ii) effective cognitive emotional regulation and iii) contexts which favour finding meaning in the caregiving process.

CONCLUSION

The findings of this review provide insight into catalysing the paradigm shift from 'reducing stress' to 'optimising positive experience' in developing caregiving support services for dementia, and may guide future empirical study to explain this unique dimension of caregiving experience.

Middle-Aged Offspring's Support to Aging Parents With Emerging Disability

Purpose of the Study

A vast literature has examined family caregivers, but few studies explore transitions from providing ordinary support to parents to situations involving increasing dependency. Using 2 waves of data, we examined how parents' increasing disability in activities of daily living (ADL) is associated with changes in everyday support patterns, relationship quality, and psychological well-being of middle-aged offspring, taking into account other informal and paid help to the parent.

Design and Methods

Three hundred and eighty middle-aged adults reported on everyday support they provided to each parent (N = 487) and parent's ADL at baseline and 5 years later.

Results

Increased parents' disability led to increases in offspring's support, in particular tangible support. Support given by offspring was lower when parents received paid help but was not affected by help from other informal members (e.g., family members, friends). Increased disability was associated with decreases in positive relationship quality with parents; as well, offspring who provided actual help with ADL reported increases in negative relationship quality.

Implications

The effects of increasing parents' disability on relationship quality and involvement of other informal and paid help may have implications for the longer-term impact of care on both offspring and their parents.

Effects of psychosocial interventions on self-efficacy of dementia caregivers: a literature review

INTRODUCTION

Self-efficacy plays an important role in mediating stressors and physical and psychological outcomes in dementia caregiving.

OBJECTIVES

This literature review aims to identify, summarize, and critically appraise current evidence on the psychosocial interventions used for enhancing the self-efficacy of caregivers of patients with dementia (PWD).

METHODS

A database search from two major web gateways was conducted to identify relevant research articles with an intervention for caregivers of patients with any type of dementia that included self-efficacy as an outcome measure.

RESULTS

A total of 14 studies met the criteria. The key findings and characteristics of the interventions were summarized and analyzed. The results showed that caregivers' self-efficacy and other aspects could be improved by psychosocial interventions.

CONCLUSION

The efficacy of the interventions for self-efficacy and other outcomes for caregivers and PWD were explored. Recommendations on the effects and significance of various psychosocial interventions for caregivers of PWD in enhancing self-efficacy were discussed.

Functional social support in family caregivers of elderly adults with severe dependence

OBJECTIVE

This work sought to determine functional social support in family caregivers of severely dependent elderly adults and its relationship with sociodemographic characteristics.

METHODS

This was a cross-sectional study. The Duke-UNC-11 Functional Social Support questionnaire was applied to 67 family caregivers from Family Healthcare Centers in Valdivia (Chile) in 2012.

RESULTS

Family caregivers perceived low levels of affective social support (49.3%) and of trust (98.5%); considering insufficient the information and advice they receive related, principally, to the scarce number of people who help, they need to establish communication to share their feelings and problems derived from the task of caring. These caregivers recognize the support from community healthcare centers. Functional social support is correlated to the following variables: number of people who live in the home, years of study, age of the caregiver, and number of people who help; with this last variable predicting the level of social support in its two dimensions.

CONCLUSION

Family caregivers of severely dependent elderly adults perceive a level of functional social support, especially in the dimension of trust. Community nurses must increase the number of home visits, evaluate the needs for social support perceived in caregivers, and teach coping strategies to mitigate problems that emerge in this work.

The Social Convoy for Family Caregivers Over the Course of Hospice

CONTEXT

Family caregivers play a central role in the care of those in hospice care. Little is known about the social support networks for those providing this day-to-day care without training.

OBJECTIVES

The purpose of this study was to explore changes in family and friend social networks among hospice caregivers over the course of the hospice stay.

METHODS

Data on social support networks were collected as part of a multisite randomized controlled trial and analyzed using structural equation modeling.

RESULTS

A statistically significant decline in the caregivers' family network subscale score was found over the four week period during which they received hospice services, reflecting a possible weakening of their family networks.

CONCLUSION

This result illustrates the potential importance of ongoing comprehensive assessment of caregiver networks and attention to interventions that may assist in capitalizing on both the quantity of support (numbers of individuals asked to help) and the quality of social support (attending to issues of support burden).

Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina

PURPOSE

This study examined the pattern of family dynamics of Argentinian individuals with dementia that most heavily influences the quality of care provided by family caregivers (CGs).

METHOD

One hundred and two CGs of individuals with Alzheimer's disease in Argentina participated in this study. The majority (75%) were female, with an average age of 57.8 years (standard deviation = 13.5) and had spent a median of 48 months (interquartile range [IQR]: 36.00-60.00) providing care to their family member with dementia, devoting a median of 60 hours (IQR: 50.00-80.00) per week to these duties. Caregivers completed Spanish versions of instruments assessing their family dynamics and quality-of-care provision.

RESULTS

Hierarchical regression analyses suggested that higher quality of informal care (Provide and Respect) was related to greater levels of empathy and reduced levels of overall dysfunction in CGs' families. Higher quality of care-Provide was also related to shorter duration of time (in months) spent providing care.

CONCLUSION

Dementia CG interventions in Latino populations would likely benefit from addressing difficulties experienced when providing care for a prolonged period of time, as well as programming or techniques to improve family dynamics, especially family empathy and general functioning, given the strong reciprocal influence of these factors on CG quality of care.

The Association of Satisfaction and Perceived Burden With Anxiety and Depression in Primary Caregivers of Dependent Elderly Relatives

Some researchers have viewed caregiver burden and satisfaction as two ends of the same continuum rather than as independent aspects of the caregiving experience. We conducted a cross-sectional study of primary caregivers of dependent elderly relatives in Spain (N = 200; probabilistic sample), to determine whether satisfaction and perceived burden coexisted in caregivers, and whether these variables, considered separately and in combination, were associated with anxiety and depression, while controlling for objective aspects of care recipients' needs. Data on satisfaction with care, perceived burden, objective burden, anxiety, and depression were gathered in 2013 by interviews in caregivers' homes. Descriptive, bivariate, and multivariate analyses were performed. Of the 200 primary caregivers, 12.5% reported both high satisfaction with care and high perceived burden. Anxiety and depression levels were lower in caregivers with high satisfaction and low perceived burden than in those with low satisfaction and high burden or with high satisfaction and high burden. Our findings support the following conclusions: (1) Satisfaction may be experienced despite the presence of stressful factors; (2) the combination of high satisfaction and low burden might have protective effects on anxiety and depression in caregivers.

Illness beliefs of Chinese American immigrants with major depressive disorder in a primary care setting

Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients' illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants' illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization.

Dimensionality of burden in Alzheimer caregivers: confirmatory factor analysis and correlates of the Zarit Burden interview

ABSTRACT Background: To investigate dimensions of caregiver burden through factor analysis of the Zarit Burden Interview (ZBI), and to examine predictors of different dimensions of burden. Methods: Confirmatory factor analyses were performed on 395 Hong Kong Chinese Alzheimer caregivers to examine whether several proposed factor structures fit the data well. Subsequently, participants were split into two roughly equal subsamples, for the purpose of identifying the most optimal factor structure through exploratory factor analysis in Sample A (n = 183) and an independent verification through confirmatory factor analysis in Sample B (n = 212). ZBI subscales representing the established factors were correlated with caregiver and care-recipient variables known to be associated with burden. Results: Confirmatory factor analyses showed that factor models reported elsewhere did not fit the data well. Subsequently, exploratory factor analysis in Sample A suggested a 4-factor structure. After dropping three items due to poor factor loadings, the 4-factor structure was found to fit the data moderately well in Sample B. The four factors tapped personal strain, captivity, self-criticism, and loss of control. However, self-criticism was basically unrelated to the other three factors and showed a rather different pattern of correlations with caregiver and care-recipient variables. Self-criticism was more common among child caregivers and those who did not live with the care-recipient and was less involved in day-to-day care, yet feeling obligated and close to the care-recipient. Conclusions: The dimensions of caregiver burden may be culturally specific. More research is needed to examine cultural considerations in measuring caregiver burden.

Benefit-finding intervention for Alzheimer caregivers: conceptual framework, implementation issues, and preliminary efficacy

PURPOSE

To describe an intervention promoting benefit-finding in Alzheimer caregivers, to discuss key issues in implementation and ways to resolve them, and to examine whether the intervention reduced burden and depression in a small randomized trial.

DESIGN AND METHODS

Twenty-five caregivers were randomized into benefit-finding and psychoeducation groups. Both groups had eight weekly sessions. Outcome measures including role overload, Zarit Burden Interview, and Hamilton depression scale were collected at baseline and after treatment. Results were analyzed using analysis of covariance. Additionally, the challenges of implementing such interventions, some of which related to cultural issues, were analyzed qualitatively.

RESULTS

Controlling for pretest, the benefit-finding group had lower depression than the psychoeducation group at post-test, despite the fact that some caregivers found benefit-finding challenging. The two groups did not differ on overload and burden. However, within-group analysis suggested that both groups showed significant reductions in overload from pretest to post-test. In addition, we discussed participants' difficulties in grasping the technique of thought modification for benefit-finding, recording such exercises at home, and sharing their thoughts and experiences in groups. We described measures undertaken in the main trial to overcome these issues.

IMPLICATIONS

Cognitive approaches focusing on benefit-finding are feasible among Chinese caregivers, with preliminary evidence suggesting an effect on alleviating depression.