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Debnar C, Peter C, Morselli D, Michel G, Bachmann N, Carrard V. Reciprocal association between social support and psychological distress in chronic physical health conditions: A random intercept cross-lagged panel model. Appl Psychol Health Well Being 2024; 16:376-394. [PMID: 37740583 DOI: 10.1111/aphw.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
The onset of a chronic physical health condition (CHC) can highly impact individuals' well-being and mental health. Social support has been shown to help people rebound after the onset of a CHC. Nonetheless, little is known about the longitudinal pattern of social support and its reciprocal association with mental health in CHC. This study aimed to illustrate the longitudinal pattern of perceived social support and to examine the reciprocal association between perceived social support and psychological distress across 6 years. Two random intercept cross-lagged panel models were conducted, one for emotional and one for practical support, using yearly assessments of 582 Swiss Household Panel's participants reporting a CHC. A reciprocal association was found, with psychological distress 1 year after the onset being linked to less emotional support in the following year and vice versa, more emotional support being linked to less psychological distress the following year. A unidirectional association was found for practical support, with more psychological distress 1 year before the CHC onset being linked to more practical support at the onset year. This study underlines the importance of involving the social environment of individuals living with a CHC, especially around the first year after the onset.
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Affiliation(s)
- Caroline Debnar
- Empowerment, Participation and Social Integration Unit, Swiss Paraplegic Research, Nottwil, Switzerland
- Swiss National Centre of Competence in Research LIVES, University of Lausanne, Lausanne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Claudio Peter
- Empowerment, Participation and Social Integration Unit, Swiss Paraplegic Research, Nottwil, Switzerland
- Swiss National Centre of Competence in Research LIVES, University of Lausanne, Lausanne, Switzerland
- Swiss Health Observatory (OBSAN), Neuchâtel, Switzerland
| | - Davide Morselli
- Swiss National Centre of Competence in Research LIVES, University of Lausanne, Lausanne, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Nicole Bachmann
- School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Valerie Carrard
- Empowerment, Participation and Social Integration Unit, Swiss Paraplegic Research, Nottwil, Switzerland
- Swiss National Centre of Competence in Research LIVES, University of Lausanne, Lausanne, Switzerland
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Rapelli G, Giusti EM, Tarquinio C, Varallo G, Franceschini C, Musetti A, Gorini A, Castelnuovo G, Pietrabissa G. Psychological couple-oriented interventions for patients with heart disease and their partners: a scoping review and guidelines for future interventions. Front Psychol 2023; 14:1194767. [PMID: 37842689 PMCID: PMC10570454 DOI: 10.3389/fpsyg.2023.1194767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective This scoping review aims to provide an accessible summary of available evidence on the efficacy of psychological couple-based interventions among patients with heart disease and their partners focusing on specific aspects and strategies by assessing different emotional and physical cardiac-related outcome measures. Methods A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the keywords "heart diseases" and "couple-based intervention." A literature search using systematic methods was applied. Data were extracted to address the review aims and were presented as a narrative synthesis. Results The database search produced 11 studies. Psychological couple-based interventions varied in terms of the type of intervention, personnel, format (group or individual, phone or in person), number of sessions, and duration. Most of the contributions also lacked adequate details on the training of professionals, the contents of the interventions, and the theoretical models on which they were based. Finally, although partners were involved in all the treatment, in most studies, the psychological strategies and outcomes were focused on the patient. Conclusion The variability of the psychological couple-based interventions of included studies represents a challenge in summarizing the existing literature. Regarding their impact, psychological interventions for patients with cardiovascular disease and their partners were found to moderately improve patients' and partners' outcomes.
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Affiliation(s)
- Giada Rapelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emanuele Maria Giusti
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Claudia Tarquinio
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giorgia Varallo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural, University of Parma, Parma, Italy
| | - Alessandra Gorini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
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Liljeroos M, Ågren S, Jaarsma T, Stromberg A. Dialogues between nurses, patients with heart failure and their partners during a dyadic psychoeducational intervention: a qualitative study. BMJ Open 2017; 7:e018236. [PMID: 29247098 PMCID: PMC5736023 DOI: 10.1136/bmjopen-2017-018236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To describe nurses' documentation of the content in a psychoeducational intervention inspired by Stuifbergen's model addressing cognitive, supportive and behavioural needs of patient-partner dyads affected by heart failure. DESIGN A descriptive qualitative design was used analysing nurses' documentation in a dialogue guide based on a health promotion model. SETTINGS The dialogue guide was used during three nurse-led sessions at two heart failure clinics in Sweden with patients affected with heart failure and their partners during the years 2005-2008. PARTICIPANTS The dialogue guides from 71 patient-partner dyads were analysed using direct deductive content analyses. Patients' mean age was 69 years and 31% were female, partners' mean age was 67 years and 69% were female. RESULTS The findings supported the conceptual health promotion model and identified barriers, recourses and self-efficacy described by the dyads within each category. CONCLUSION The dyads described that during the sessions, they had gained enhanced knowledge and greater confidence to handle their life situation and expressed that they needed psychoeducational support during the whole illness trajectory. The results may guide and help to improve content and quality when caring for patients affected with heart failure and their partners and also when designing new interventions. TRIAL REGISTRATION NUMBER NCT02398799; Post-results.
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Affiliation(s)
- Maria Liljeroos
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Susanna Ågren
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiothoracic Surgery, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Anna Stromberg
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, USA
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Liljeroos M, Ågren S, Jaarsma T, Årestedt K, Strömberg A. Long-term effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure: a randomized controlled trial. Qual Life Res 2016; 26:367-379. [PMID: 27631892 DOI: 10.1007/s11136-016-1400-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role. OBJECTIVE Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden. DESIGN A randomized controlled study design, with a follow-up assessment after 24 months. SETTING AND PARTICIPANTS Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden. INTERVENTION A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners' physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity. RESULTS One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time. DISCUSSION AND CONCLUSION Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial. REGISTERED ON CLINICALTRIALS. GOV IDENTIFIER NCT02398799.
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Affiliation(s)
- Maria Liljeroos
- Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden. .,Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden.
| | - Susanna Ågren
- Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiothoracic Surgery, County Council of Östergötland, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,School of Health and Caring Sciences, Faculty of Health, Social Work and Behavioral Sciences, Linnaeus University, Kalmar, Sweden
| | - Anna Strömberg
- Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, County Council of Östergötland, Linköping, Sweden
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Evangelista LS, Strömberg A, Dionne-Odom JN. An integrated review of interventions to improve psychological outcomes in caregivers of patients with heart failure. Curr Opin Support Palliat Care 2016; 10:24-31. [PMID: 26716392 PMCID: PMC4760617 DOI: 10.1097/spc.0000000000000182] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article examines interventions aimed at improving psychological outcomes (e.g., caregiver burden, quality of life, anxiety, depression, perceived control, stress mastery, caregiver confidence and preparedness, and caregiver mastery) in family caregivers of patients with heart failure. RECENT FINDINGS Eight studies meeting the inclusion criteria were included in the review. The most common intervention involved psychoeducation facilitated by a nurse (6/8) and supplemented with a combination of follow-up face-to-face sessions (2/6), home visits (2/6), telephone calls (3/6), and telemonitoring (3/6). Two studies used a support group intervention of four to six sessions. Half of the interventions reported a significant effect on one or more primary outcomes, including caregiver burden (n = 4), depressive symptoms (n = 1), stress mastery (n = 1), caregiver confidence and preparedness (n = 1), and caregiver mastery (n = 1). SUMMARY Compared with dementia and cancer family caregiving, few interventions have been evaluated in caregivers of patients with heart failure. Of the existing interventions identified in this review, considerable variability was observed in aims, intervention content, delivery methods, duration, intensity, methodological rigor, outcomes, and effects. Given this current state of the science, direct comparison of heart failure caregiver interventions and recommendations for clinical practice are premature. Thus, research priority is strongly warranted for intervention development and testing to enhance heart failure caregiver support and education.
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Affiliation(s)
- Lorraine S Evangelista
- aUCI Program in Nursing Science, University of California Irvine, Irvine, California bDepartment of Medical and Health Sciences and Department of Cardiology, Linköping University, Linköping, Sweden cSchool of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
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Liljeroos M, Agren S, Jaarsma T, Strömberg A. Perceived caring needs in patient-partner dyads affected by heart failure: a qualitative study. J Clin Nurs 2014; 23:2928-38. [PMID: 24698101 DOI: 10.1111/jocn.12588] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the perceived caring needs in patient-partner dyads affected by heart failure to develop an understanding of potential areas of support. BACKGROUND Being affected by heart failure has a great impact on both the patient and the partner but until now contemporary care has remained patient focused. DESIGN A qualitative study design was used. METHODS Eight focus group interviews were performed, which included nineteen patients diagnosed with heart failure and their cohabiting partner. Patients were aged between 55-89 years and partners' ages ranged from 48-87 years. Data were analysed using qualitative content analyses. RESULTS The dyads perceived that caring needs could be summarised in two themes 'Dyads perceive a need for continuous guidance through the different phases of the illness trajectory' and 'Dyads perceive a need to share burden and support with each other and others'. The dyads described a need to learn more about heart failure to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital, and having someone who cared about the well-being of the partners was perceived as comforting. Both the patient and the partner need to be present at the clinic visits. Receiving the same information and being able to ask questions reduce insecurity. Meeting others in the same situation and sharing the burden in group sessions were proposed as an opportunity to support each other and others. CONCLUSIONS There is a need to improve education and support for patient-partner dyads affected by heart failure. RELEVANCE TO CLINICAL PRACTICE The result shows the importance to provide continuous healthcare contacts throughout the illness trajectory. Furthermore, partners should be included at follow-up, and support groups should be organised so that dyads can meet and support each other.
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Affiliation(s)
- Maria Liljeroos
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden
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Compare A, Zarbo C, Manzoni GM, Castelnuovo G, Baldassari E, Bonardi A, Callus E, Romagnoni C. Social support, depression, and heart disease: a ten year literature review. Front Psychol 2013; 4:384. [PMID: 23847561 PMCID: PMC3696881 DOI: 10.3389/fpsyg.2013.00384] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/10/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronary heart disease is the major cause of morbidity and mortality in the world. Psychosocial factors such as depression and low social support are established risk factors for poor prognosis in patients with heart disease. However, little is known about the hypothetical relationship pattern between them. PURPOSE The purposes of this narrative review are (1) to appraise the 2002-2012 empirical evidence about the multivariate relationship between depression, social support and health outcomes in patients with heart disease; (2) to evaluate the methodological quality of included studies. METHOD PubMed and PsychINFO were searched for quantitative studies assessing the multiple effects of low social support and depression on prognosis outcomes in patients with heart disease. The following search terms were used: social relation(*), cardiac disease, support quality, relationship, and relational support. RESULTS Five studies (three prospective cohort studies, one case-control study, and one randomization controlled trial) were selected and coded according to the types of support (social and marital). The majority of findings suggests that low social support/being unmarried and depression are independent risk factors for poor cardiac prognosis. However, all analyzed studies have some limitations. The majority of them did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship. Moreover, some of them present methodological limitations. CONCLUSION Depressive symptoms and the absence of social or marital support are significant risk factors for poor prognosis in cardiac patients and some evidence supports their independence in predicting adverse outcomes. Cardiac rehabilitation and prevention programs should thus include not only the assessment and treatment of depression but also a specific component on the family and social contexts of patients.
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Affiliation(s)
- Angelo Compare
- Department of Human and Social Sciences, University of Bergamo Bergamo, Italy
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Ågren S, Evangelista LS, Hjelm C, Strömberg A. Dyads affected by chronic heart failure: a randomized study evaluating effects of education and psychosocial support to patients with heart failure and their partners. J Card Fail 2012; 18:359-66. [PMID: 22555264 PMCID: PMC3381875 DOI: 10.1016/j.cardfail.2012.01.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) causes great suffering for both patients and their partners. The aim of this study was to evaluate the effects of an integrated dyad care program with education and psychosocial support to patients with CHF and their partners during a postdischarge period after acute deterioration of CHF. METHODS One hundred fifty-five patient-caregiver dyads were randomized to usual care (n = 71) or a psychoeducation intervention (n = 84) delivered in 3 modules through nurse-led face-to-face counseling, computer-based education, and other written teaching materials to assist dyads to develop problem-solving skills. Follow-up assessments were completed after 3 and 12 months to assess perceived control, perceived health, depressive symptoms, self-care, and caregiver burden. RESULTS Baseline sociodemographic and clinical characteristics of dyads in the experimental and control groups were similar at baseline. Significant differences were observed in patients' perceived control over the cardiac condition after 3 (P < .05) but not after 12 months, and no effect was seen for the caregivers.No group differences were observed over time in dyads' health-related quality of life and depressive symptoms, patients' self-care behaviors, and partners' experiences of caregiver burden. CONCLUSIONS Integrated dyad care focusing on skill-building and problem-solving education and psychosocial support was effective in initially enhancing patients' levels of perceived control. More frequent professional contact and ongoing skills training may be necessary to have a higher impact on dyad outcomes and warrants further research.
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Affiliation(s)
- Susanna Ågren
- Division of Nursing Science, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Chung ML, Lennie TA, Dekker RL, Wu JR, Moser DK. Depressive symptoms and poor social support have a synergistic effect on event-free survival in patients with heart failure. Heart Lung 2011; 40:492-501. [PMID: 21453972 DOI: 10.1016/j.hrtlng.2010.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 08/25/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depressive symptoms and poor social support are predictors of increased morbidity and mortality in patients with heart failure (HF). However, the combined contribution of depressive symptoms and social support event-free survival of patients with HF has not been examined. OBJECTIVE To compare event-free survival in 4 groups of patients with HF stratified by depressive symptoms and perceived social support (PSS). METHOD A total of 220 patients completed the Beck Depression Inventory-II and the Multidimensional Perceived Social Support Scale and were followed for up to 4 years to collect data on death and hospitalizations. RESULTS Depressive symptoms (hazard ratio = 1.73, P = .008) and PSS (hazard ratio = 1.51, P = .048) were independent predictors of event-free survival. Depressed patients with low PSS had 2.1 times higher risk of events than non-depressed patients with high PSS (P = .003). CONCLUSION Depressive symptoms and poor social support had a negative additive effect on event-free survival in patients with HF.
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Affiliation(s)
- Misook L Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky 40536-0232, USA.
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Agren S, Evangelista L, Strömberg A. Do partners of patients with chronic heart failure experience caregiver burden? Eur J Cardiovasc Nurs 2010; 9:254-62. [PMID: 20598946 DOI: 10.1016/j.ejcnurse.2010.03.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/03/2010] [Accepted: 03/05/2010] [Indexed: 11/27/2022]
Abstract
AIMS To describe the levels and identify independent predictors of caregiver burden in partners of patients with heart failure. BACKGROUND Care and support from a partner are important for the well-being of patients with heart failure and may potentially delay disease progression. However, caregiving may be associated with burden and stress and it is therefore important to understand which factors that influence caregiver burden. Theoretical models of caregiving describe the concept of burden as an outcome variable, including decreased well-being and health. METHODS Data for this descriptive cross-sectional study were collected between January 2005 and September 2008. The dependent variable consisted of the Caregiver Burden Scale total score index. Socio-demographic and clinical characteristics, health-related quality of life, symptoms of depression, perceived control, and knowledge on heart failure were included in a regression analysis to determine independent predictors of caregiver burden. RESULTS The 135 partners had a mean-age of 69 years and 75% were females. Caregiver burden was perceived as medium in 30% of the partners. The patients' Physical Component Score of SF-36 (p<0.001), partners' Mental Component Score of SF-36 (p<0.001) and perceived control (p<0.01) accounted for 39% of the variance in caregiver burden. CONCLUSION Caregiver burden was lower when the mental health of the partner and the physical health of the patient were better and the partner experienced higher control over the heart disease. A partner-centered approach to educate and support partners of patients with heart failure is essential to improve the life situation for patient-partner dyads.
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Affiliation(s)
- Susanna Agren
- Department of Medical and Health Sciences, Linköping University, Sweden.
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Ayers S, Joekes K, Copland C. Recognizing anxiety and post-traumatic stress disorder in cardiac patients. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjca.2010.5.3.46829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan Ayers
- School of Psychology, University of Sussex, Brighton, BN1 9QH, UK
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12
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Chung ML, Lennie TA, Riegel B, Wu JR, Dekker RL, Moser DK. Marital status as an independent predictor of event-free survival of patients with heart failure. Am J Crit Care 2009; 18:562-70. [PMID: 19880958 DOI: 10.4037/ajcc2009388] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Depressive symptoms are a well-known predictor of mortality in patients with heart failure, and positive spousal support is associated with improved outcomes in these patients. However, in the context of depressive symptoms, the effect on survival of having a spouse is unknown. OBJECTIVE To determine the effect of marital status on event-free survival in patients with heart failure who did or did not have depressive symptoms. METHODS Depressive symptoms were assessed by using the Beck Depression Inventory-II in patients with heart failure who were followed-up for up to 4 years to collect data on mortality and hospitalizations. Patients were grouped according to the presence and absence of depressive symptoms by using the standard cutoff score of 14 on the Beck Depression Inventory-II. Kaplan-Meier and Cox regression analyses were used to compare event-free survival for married and nonmarried patients who were stratified according to the presence or absence of depressive symptoms. RESULTS Of 166 patients, 56% were married, and 33% had depressive symptoms. Levels of depressive symptoms were similar between married and nonmarried patients (10.9 vs 12.1; P = .39). Married patients experienced longer event-free survival than did nonmarried patients (P = .009), even with stratification according to depressive symptoms (P = .01). CONCLUSIONS Patients with a spouse had longer event-free survival than nonmarried patients did, even in the context of depressive symptoms.
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Affiliation(s)
- Misook L Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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Nissen NK, Madsen M, Kjøller M, Waldorff SB, Olsen Zwisler AD. Are hospitals also for relatives? A survey of hospitals' activities regarding relatives of cardiac patients. Scand J Public Health 2009; 36:827-31. [PMID: 19004900 DOI: 10.1177/1403494808093330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Patients and their close relatives both feel the burden of cardiovascular disease. Relatives of heart patients experience lower quality of life and increased mortality than the general population and relatives of patients with other diseases. Nevertheless, knowledge on health services aimed at relatives of patients with cardiac diseases is sparse. This study aimed to survey the prevalence of health services for relatives of cardiac patients in Denmark. METHODS We surveyed activities offered by Danish hospitals to the relatives of cardiac patients. Data were obtained from an Internet-based survey and 50 of 55 invited hospital departments participated. RESULTS Almost all departments offer activities to relatives of cardiac patients, but only one-quarter have activities specifically aimed at supporting relatives. Large departments offer activities for relatives more often than smaller departments. Participation rates for relatives are generally low, and the departments experience numerous barriers in providing activities for relatives of heart patients. CONCLUSIONS Danish hospitals focus very little on relatives of cardiac patients, and this seems to be due to several factors, including lack of resources, lack of interest and knowledge among staff, and practical and psychological barriers among patients and relatives. More research is needed on health services concerning relatives of cardiac patients, regarding both the prevalence of activities and barriers to these.
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Nissen NK, Madsen M, Olsen Zwisler AD. Health service interventions targeting relatives of heart patients: A review of the literature. Scand J Public Health 2008; 36:818-26. [DOI: 10.1177/1403494808092249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Relatives of heart patients experience anxiety, uncertainty, and low quality of life, and the hospitalization of a heart patient is associated with increased risk of death for the partner. Relatives' physical and mental problems may be rectified by activities established by the health services to support relatives and to enable them to handle the situation. This study systematically reviewed the literature on the latest health service interventions targeting relatives of heart patients. Methods: The literature about interventions targeting relatives of heart patients has been systematically reviewed to clarify what the health services do for relatives of heart patients and to assess the effects of interventions. We searched Medline, EMBASE, PsycINFO, CINAHL database, CSA and the Cochrane Library from January 2000 to March 2006. Results: Only six scientific articles reported on interventions testing health service activities for relatives of heart patients, and one literature review scrutinized earlier studies within the field. All the interventions indicate positive effects on patients' and/or relatives' health and well-being, in accordance with nurses' assessments. Nevertheless, the few studies and their questionable quality means that full evidence on the effects of the interventions is lacking. Conclusions: Future research should clarify the evidence for health service interventions and draw up guidelines for activities for the relatives of heart patients.
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Affiliation(s)
| | - Mette Madsen
- Institute of Public Health, University of Copenhagen, Denmark
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Luttik ML, Jaarsma T, Moser D, Sanderman R, van Veldhuisen DJ. The Importance and Impact of Social Support on Outcomes in Patients With Heart Failure. J Cardiovasc Nurs 2005; 20:162-9. [PMID: 15870586 DOI: 10.1097/00005082-200505000-00007] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As advances in medical treatment of heart failure (HF) become limited, other factors are being studied to improve outcomes. There is much evidence that supportive social relations have a major impact on health outcomes and that social support is essential for adjustment to illness. This article describes current research on the influence of social support on outcomes in patients with HF. A computerized literature search in Medline, CINAHL, and PsychLit was performed on each of the different outcomes in relation to social support, covering the period 1993 to 2003. Seventeen studies were found that investigated the relationship between social support and different outcome measures in HF. Four studies found clear relationships between social support and rehospitalizations and mortality; the relationship between quality of life and depression was less clear. Up to now, limited research has been done on the impact of social support on outcomes in patients with HF. The available studies suggest that social support has an impact on HF outcomes but further research is necessary before firm conclusions about the nature of these relationships can be reached.
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Richards HL, Fortune DG, Chong SLP, Mason DL, Sweeney SKT, Main CJ, Griffiths CEM. Divergent Beliefs About Psoriasis Are Associated with Increased Psychological Distress. J Invest Dermatol 2004; 123:49-56. [PMID: 15191541 DOI: 10.1111/j.0022-202x.2004.22703.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The psychological adjustment of patients with psoriasis has been studied extensively. By comparison, no research has focused on their partners. We examined illness representations of psoriasis held by patients and their partners, and investigated whether divergent beliefs were associated with psychological distress. Fifty-eight patients with chronic plaque psoriasis and their partners completed a range of psychological assessments including beliefs about the condition, anxiety, depression, and worry. Patients also completed a self-assessment of psoriasis severity. Patients with psoriasis had significantly higher levels of anxiety, depression, and worry than their partners (t's > 2.53, p's < .05). Multiple regression analysis indicated that divergence in patients' and partners' beliefs about emotional impact of psoriasis and chronicity of timeline accounted for a statistically significant (21.3%) proportion of the variance in depression for partners. Differences in views on the consequences of having psoriasis and the cyclical nature of the condition were also significantly associated with increased levels of worry in partners. Dissimilarity in particular aspects of illness representations are associated with increased psychological distress in particular for the partners of patients with psoriasis. The results illustrate the importance of concordance between patients' and partners' models of illness in relation to adjustment, and highlight the need to consider and collaborate with both patients and their partners in managing this challenging condition.
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Affiliation(s)
- Helen L Richards
- Department of Behavioral Medicine, University of Manchester School of Medicine, Hope Hospital, Manchester, UK.
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Abstract
A 1-day point-prevalence study was conducted in our 141-bed tertiary cardiac care hospital in order to determine our patients' and their significant others' level of understanding of cardiac risk factors in general and of the patients' personal cardiac risk factors. There were 3 parts to the study: patient interviews, significant other (SO) interviews, and an audit of the participating patients' charts. Of the 87 patients who were able to participate, 71 completed the interviews as did 53 significant others. From recall, only 14 patients and 11 significant others were able to define what a cardiac risk factor was ("Habits or factors that contribute to heart disease") and they were unable to identify many general risk factors. However, when given a recognition task where cardiac risk factors were interspersed with sham factors, the overall mean general knowledge score was 13.6 for patients and 13.9 for significant others out of 16. The correlation between the patients' understanding of their cardiac risk factors and the significant others' understanding of them was reasonably good (r = 0.58, P < .0001), as was the correlation between the SOs' understanding and the charts (r = 0.58, P < .0001). There was less agreement between the patients' understanding and the chart documentation of cardiac risk factors (r = 0.36, P < .01). The findings of this study have implications for patient teaching as well as for documentation of cardiac risk factors.
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