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Mavragani A, Tan JHY, Kosasih FR, Sündermann O. Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up. JMIR Form Res 2022; 6:e40723. [PMID: 36515984 PMCID: PMC9798264 DOI: 10.2196/40723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/20/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. OBJECTIVE In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). METHODS University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. RESULTS The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta-squared [ηp2]=0.018; P=.03) and anxiety (ηp2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (ηp2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (β=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. CONCLUSIONS This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. TRIAL REGISTRATION ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896.
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Affiliation(s)
| | - Jessalin Hui Yan Tan
- Department of Psychology, National University of Singapore, Singapore, Singapore
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Wai Wa Chan E, Liang L, Huinan Liu N, Hou WK. The moderated associations of self-compassion with physiological and psychological stress responses: Comparisons between cancer caregivers and non-caregivers. J Health Psychol 2021; 27:2318-2329. [PMID: 34281426 DOI: 10.1177/13591053211030994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Self-compassion has been shown to be protective against stress. Whether its stress buffering effect differs between cancer caregivers and non-caregivers is unknown. This study examined the moderating effect of self-compassion among cancer caregivers relative to non-caregivers by recruiting cancer caregivers from the hospital and a community sample matching on sex and age. Participants completed a questionnaire which comprised the self-reported anxiety (STAI-6) and self-compassion (SCS-SF) measures, and administered cortisol sample collections with Salivette tubes at home. Whereas caregivers experienced higher diurnal cortisol level, the differential protective effects of self-compassion were only present against anxiety symptoms but not physiological stress.
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Affiliation(s)
- Edward Wai Wa Chan
- Centre for Psychosocial Health, The Education University of Hong Kong, China
| | - Li Liang
- Centre for Psychosocial Health, The Education University of Hong Kong, China
| | - Nancy Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, China.,Department of Psychology, The Education University of Hong Kong, China
| | - Wai-Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, China.,Department of Psychology, The Education University of Hong Kong, China
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Ye B, Wu D, Im H, Liu M, Wang X, Yang Q. Stressors of COVID-19 and stress consequences: The mediating role of rumination and the moderating role of psychological support. CHILDREN AND YOUTH SERVICES REVIEW 2020; 118:105466. [PMID: 32994656 PMCID: PMC7515821 DOI: 10.1016/j.childyouth.2020.105466] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUNDS AND AIMS As COVID-19 spreads rapidly, this global pandemic has not only brought the risk of death but also spread unbearable psychological pressure to people around the world. The aim of this study was to explore (a) the mediating role of rumination in the association between stressors of COVID-19 and stress consequences of college students, and (b) the moderating role of psychological support in the indirect relationship between stressors of COVID-19 and stress consequences of college students. METHODS Eight hundred and forty-one Chinese college students (Mage = 19.50 years, SD = 1.580) completed the measures of stressors of COVID-19, stress consequences, rumination, and psychological support. RESULTS Stressors of COVID-19 were significantly positively associated with stress consequences, and mediation analyses indicated that rumination partially mediated this association. Moderated mediation analysis further revealed that psychological support buffered the relation between stressors of COVID-19 and rumination, as well as the relation between rumination and stress consequences. DISCUSSION AND CONCLUSION Findings of this study demonstrated that stressors associated with COVID-19 is positively related to rumination, which in turn, is related to stress consequences in college students. However, psychological support buffered this effect at both indirect mediation paths, suggesting that college students with greater psychological support may be better equipped to prevent negative stress consequences.
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Affiliation(s)
- Baojuan Ye
- Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang 330022, China
| | - Dehua Wu
- Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang 330022, China
| | - Hohjin Im
- Department of Psychological Science, University of California, Irvine, 4201 Social & Behavioral Sciences Gateway, Irvine 92617, United States
| | - Mingfan Liu
- Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang 330022, China
| | - Xinqiang Wang
- Center of Mental Health Education and Research, School of Psychology, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang 330022, China
| | - Qiang Yang
- School of Education, Jiangxi Normal University, 99 Ziyang Avenue, Nanchang 330022, China
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Sanches Slusarski Martins R, Pipek LZ, Mesquita GHAD, Nii F, Medeiros KADA, Carvalho BJ, Martines DR, D'Albuquerque LAC, Meyer A, Andraus W. The impact of stressors and overload on informal caregivers of patients with cirrhosis: The first use of the Burden Scale for Family Caregivers in Brazil. J Health Psychol 2020; 27:408-421. [PMID: 32927996 DOI: 10.1177/1359105320953464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cirrhosis affects liver functions and compromises much of the body's organs. The significant increase in chronic diseases, including cirrhosis, has led to changes in medical practice and health systems, leading the informal caregiver to play a major role because of family ties or some level of proximity to the patient, assuming daily care function. However, the burden generated by informal caregivers for uninterrupted care is present at different levels (physical, mental, social, professional, and financial) and even in the prognosis of the patient. OBJECTIVE The present study aims to evaluate the impact of stressors and overload on informal caregivers of cirrhosis patients. METHOD Cross-sectional study, conducted with 54 informal caregivers of cirrhosis patients, followed up at the Liver Transplant Service Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas, where they had access to a sociodemographic questionnaire, history of the patient's disease and the scale Burden Scale for Family Caregivers. RESULTS It was observed that higher levels of education and income of the caregiver correlates with a lower degree of stress. In addition, there is a significant difference found in the caregiver's age variable, which indicates that the youngest are those who have the highest degree of stress. The variable Na mEg/l of the patient also presents a statistically significant difference. CONCLUSION Our study was a precursor using the BSFC scale of worldwide coverage and that had not yet been applied in any study in Brazil, thus allowing a look at the various aspects that affect the quality of life of caregivers of patients with cirrhosis. Our results and the literature corroborate the importance not only of the patient, but also the informal caregiver's health.
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Affiliation(s)
- Raquel Sanches Slusarski Martins
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | | | - Fernanda Nii
- Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brazil
| | | | | | | | | | - Alberto Meyer
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Wellington Andraus
- Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Self-esteem, self-efficacy, and optimism as psychological resources among caregivers of people with dementia: findings from the IDEAL study. Int Psychogeriatr 2019; 31:1259-1266. [PMID: 34658313 DOI: 10.1017/s1041610219001236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Being a family caregiver, and in particular giving care to someone with dementia, impacts mental and physical health and potentially reduces the ability of caregivers to "live well." This paper examines whether three key psychological resources-self-efficacy, optimism, and self-esteem-are associated with better outcomes for caregivers of people with dementia. DESIGN AND PARTICIPANTS Caregivers of 1,283 people with mild-to-moderate dementia in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) project responded to measures of self-efficacy, optimism, and self-esteem, and "living well" (quality of life, life satisfaction, and well-being). Multivariate linear regression was used to examine the association between psychological resources and "living well". RESULTS Self-efficacy, optimism, and self-esteem were all independently associated with better capability to "live well" for caregivers. This association persisted when accounting for a number of potential confounding variables (age group, sex, and hours of caregiving per day). CONCLUSIONS Low self-efficacy, optimism, and self-esteem might present a risk of poor outcomes for caregivers of people with dementia. These findings encourage us to consider how new or established interventions might increase the psychological resilience of caregivers.
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Del-Pino-Casado R, Serrano-Ortega N, López-Martínez C, Orgeta V. Coping strategies and psychological distress in family carers of frail older people: A longitudinal study. J Affect Disord 2019; 256:517-523. [PMID: 31280075 DOI: 10.1016/j.jad.2019.06.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/03/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Carers of dependent older people experience high levels of psychological distress. However, little is known about the effects of coping on carer distress over time. In this one year longitudinal study we investigated the relationship between distress, and coping strategies in a representative sample of family carers living in Spain. METHODS Primary carers of older people were recruited (N = 200). We used probability sampling and collected data via individual interviews from 2013 to 2015. Variables investigated included psychological distress, coping, and levels of objective and subjective burden. Panel data analysis was used to test a model of association of psychological distress, and coping strategies controlling for key confounders. RESULTS Acceptance and emotional support were the most frequently used strategies, whereas behavioural disengagement and humour were the least used. In the panel data regressions, positive reframing (B = -0.79, p < 0.001), self-distraction (B = -0.46, p = 0.034), substance use (B = 0.57, p < 0.001) and denial (B = 0.57, p = 0,049) were significantly related to psychological distress at one year follow-up. LIMITATIONS Limitations include participant drop out and assessing substance use coping via a brief measure. CONCLUSIONS Positive reframing and self-distraction were longitudinally associated with lower levels of carer psychological distress. Using denial and substance use coping increased distress long-term. Our results suggest that interventions that focus on positive reframing and assisting carers in decreasing dysfunctional coping may be useful therapeutic targets mitigating carer psychological morbidity.
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Jenkins Y. Caregivers for the Elderly: Clinical Issues and Intervention. WOMEN & THERAPY 2019. [DOI: 10.1080/02703149.2019.1622905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yvonne Jenkins
- Boston College, University Counseling Services, Private Practice, Brookline, Massachusetts
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Rodríguez-Madrid MN, Del Río-Lozano M, Fernandez-Peña R, Jiménez-Pernett J, García-Mochón L, Lupiañez-Castillo A, García-Calvente MDM. Gender Differences in Social Support Received by Informal Caregivers: A Personal Network Analysis Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010091. [PMID: 30602656 PMCID: PMC6339235 DOI: 10.3390/ijerph16010091] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
Abstract
Social support is an important predictor of the health of a population. Few studies have analyzed the influence of caregivers’ personal networks from a gender perspective. The aim of this study was to analyze the composition, structure, and function of informal caregiver support networks and to examine gender differences. It also aimed to explore the association between different network characteristics and self-perceived health among caregivers. We performed a social network analysis study using a convenience sample of 25 female and 25 male caregivers. A descriptive analysis of the caregivers and bivariate analyses for associations with self-perceived health were performed. The structural metrics analyzed were density; degree centrality mean; betweenness centrality mean; and number of cliques, components, and isolates. The variability observed in the structure of the networks was not explained by gender. Some significant differences between men and women were observed for network composition and function. Women received help mainly from women with a similar profile to them. Men’s networks were broader and more diverse and they had more help from outside family circles, although these outcomes were not statistically significant. Our results indicate the need to develop strategies that do not reinforce traditional gender roles, but rather encourage a greater sharing of responsibility among all parties.
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Affiliation(s)
- María Nieves Rodríguez-Madrid
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), 18012 Granada, Spain.
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
| | - María Del Río-Lozano
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Biomedical Research Centre (ibs.GRANADA), 18080 Granada, Spain.
| | - Rosario Fernandez-Peña
- Department of Nursing, SALBIS Research Group, Nursing Research Group IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - Jaime Jiménez-Pernett
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Public Health Research Institute (IRSPUM), University of Montreal, Montreal, QC H3N 1X7, Canada.
| | - Leticia García-Mochón
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Biomedical Research Centre (ibs.GRANADA), 18080 Granada, Spain.
- CIBER en Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain.
| | - Amparo Lupiañez-Castillo
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
| | - María Del Mar García-Calvente
- Andalusian School of Public Health, Consejería de Salud, Junta de Andalucía, 18080 Granada, Spain.
- Biomedical Research Centre (ibs.GRANADA), 18080 Granada, Spain.
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Howland LC, Jallo N, Connelly CD, Pickler RH. Feasibility of a Relaxation Guided Imagery Intervention to Reduce Maternal Stress in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46:532-543. [DOI: 10.1016/j.jogn.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 10/19/2022] Open
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10
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Huang T, Tworoger SS, Hecht JL, Rice MS, Sood AK, Kubzansky LD, Poole EM. Association of Ovarian Tumor β2-Adrenergic Receptor Status with Ovarian Cancer Risk Factors and Survival. Cancer Epidemiol Biomarkers Prev 2016; 25:1587-1594. [PMID: 27587791 DOI: 10.1158/1055-9965.epi-16-0534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The β2-adrenergic signaling pathway mediates the effects of chronic stress on ovarian cancer progression in mouse models. The relevance of this pathway to human ovarian cancer remains unknown. METHODS We assessed tumor expression of β2-adrenergic receptor (ADRB2) using tissue microarrays in 237 ovarian cancer cases from the Nurses' Health Studies (NHS/NHSII). Competing risks Cox regression was used to evaluate whether associations of reproductive, hormonal, and psychosocial factors with ovarian cancer risk differed by ADRB2. We also examined the association between tumor ADRB2 expression and ovarian cancer survival. RESULTS Forty-five (19%) cases were positive for ADRB2 staining. High levels of anxiety symptoms were positively associated with ADRB2-positive tumors (HR, 2.59; 95% confidence interval [CI], 1.15-5.84) but not with ADRB2-negative tumors (HR, 1.16; 95% CI, 0.81-1.66; Pheterogeneity = 0.07). We observed similar results for depression. No associations were observed for job strain, caregiving stress, or widowhood for either positive or negative ADRB2 status. Lifetime ovulatory years were more strongly associated with ADRB2-positive tumors (HR per 5 years, 1.60; 95% CI, 1.15-2.21) compared with ADRB2-negative tumors (HR, 1.11; 95% CI, 0.96-1.27; Pheterogeneity = 0.04). Significant heterogeneity by ADRB2 was also observed for parity (Pheterogeneity = 0.01), oral contraceptive use (Pheterogeneity = 0.03), and age at menopause (Pheterogeneity = 0.04). Tumor expression of ADRB2 was not associated with ovarian cancer mortality (HR, 1.05; 95% CI, 0.69-1.59). CONCLUSIONS Several stress- and ovulation-related factors were differentially associated with ovarian tumors responsive to β2-adrenergic signaling. IMPACT Replication in larger studies is warranted to confirm the role of β2-adrenergic signaling in ovarian cancer etiology. Cancer Epidemiol Biomarkers Prev; 25(12); 1587-94. ©2016 AACR.
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Megan S Rice
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anil K Sood
- Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Davis LL, Weaver M, Zamrini E, Stevens A, Kang DH, Parker CR. Biopsychological Markers of Distress in Informal Caregivers. Biol Res Nurs 2016; 6:90-9. [PMID: 15388906 DOI: 10.1177/1099800404267353] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Thirty caregiving wives participated in a study of caregiving distress and negative mood (depressive symptoms) by making diary entries on stressful caregiving situations and collecting saliva samples 4 times a day. At the end of the 7-day study period, caregivers’ salivary cortisol production was compared with their diary entries and correlated with pencil and paper self-report scores of caregiver distress and depressive symptoms. Findings. Despite the inability to control a number of factors thought to confound cortisol production (exercise, smoking, alcohol ingestion, and prescription medications), there was a statistically significant difference between No Caregiving and Caregiving cortisol, F( 1,739) = 7.67, P = 0.006, with cortisol production higher when caregiving events occurred. However, efforts to code specific types of caregiving situations (e.g., 1 = indirect care; 4 = AD problem behavior care) did not further differentiate cortisol production. Although caregivers’ self-reports for the same 7-day period indicated they were depressed, pencil-and-paper measures of distress and negative affect were not significantly correlated with cortisol production. Conclusions and Recommendations. The finding that this caregiving group was significantly stressed by caregiving, as evidenced by increased cortisol production during caregiving episodes, verifies the importance of further exploration of specific caregiving situations as contributory factors in caregiver health and well-being. In that saliva is a relatively economical and comparatively noninvasive biological data source for community-based stress studies, methodological limitations of the study are identified and 5 recommendations are made for future biological marker studies of caregiver distress in community-based settings.
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Zauszniewski JA, Picot SJF, Roberts BL, Debanne SM, Wykle ML. Predictors of Resourcefulness in African American Women. J Aging Health 2016; 17:609-33. [PMID: 16177453 DOI: 10.1177/0898264305279871] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. Objective: Using Rosenbaum’s theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. Methods: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. Results: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. Discussion: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.
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Välimäki TH, Martikainen JA, Hallikainen IT, Väätäinen ST, Koivisto AM. Depressed Spousal Caregivers Have Psychological Stress Unrelated to the Progression of Alzheimer Disease: A 3-Year Follow-Up Report, Kuopio ALSOVA Study. J Geriatr Psychiatry Neurol 2015; 28:272-80. [PMID: 26251107 DOI: 10.1177/0891988715598229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore family caregiver (FC) long-term psychological distress after Alzheimer disease (AD) diagnosis in a family member. METHODS FC (n = 236) and patients with AD were prospectively followed up to 36 months after AD diagnosis. FC psychological distress was evaluated using the General Health Questionnaire (GHQ). Furthermore, caregiver depressive symptoms and sense of coherence, along with AD patient measurements, were measured at baseline and annually. Generalized estimating equation models were applied to study associations of these baseline factors to caregiver GHQ. RESULTS After 36 months of follow-up, spousal caregivers (SCs) GHQ was significantly higher (P < .001) than in the nonspousal caregivers (NSCs). The difference in GHQ scores was associated by depressive symptoms (P < .001) at baseline, and the depressed SCs have more severe distress than NSCs over the observation period. CONCLUSION During longitudinal caregiving, spousal and depressed caregivers of patients with AD report higher and increasing psychological stress than nonspousal and nondepressed caregivers. Spousal relationship, caregivers' depressive symptoms, and the severity of patients' neuropsychological symptoms at the time of AD diagnosis predict the trajectory of psychological distress. The current study highlights the need for evaluating AD caregiver mental health and level of coping.
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Affiliation(s)
- Tarja H Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland Unit of Nursing Development, Clinical Education and Research, Kuopio University Hospital, Kuopio, Finland
| | - Janne A Martikainen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Ilona T Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
| | - Saku T Väätäinen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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Parenting stress, salivary biomarkers, and ambulatory blood pressure: a comparison between mothers and fathers of children with autism spectrum disorders. J Autism Dev Disord 2015; 45:1084-95. [PMID: 25287900 DOI: 10.1007/s10803-014-2263-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Parents of children with autism spectrum disorders (ASD) may experience higher levels of stress and health problems than parents of children with typical development. However, most research has focused on mothers, with emphasis on parent-reported stress and wellbeing. This study compared parenting responsibility, distress, anxiety, depression, cortisol, alpha-amylase, and cardiovascular activity between 19 mother-father dyads of children with ASD. Mothers reported higher parenting responsibility, distress, anxiety, and depression than fathers, while fathers had higher blood pressure and heart rate variability. Mothers and fathers had lower than average morning cortisol levels, suggesting stress effects on the hypothalamic-pituitary-adrenal-axis. Parents of children with ASD may benefit from routine health screening (particularly adrenal and cardiovascular function) and referral for stress reduction interventions or supports.
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15
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Martin AC, Keats MR. The impact of yoga on quality of life and psychological distress in caregivers for patients with cancer. Oncol Nurs Forum 2014; 41:257-64. [PMID: 24769590 DOI: 10.1188/14.onf.257-264] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the effects of a six-week Vinyasa yoga (VY) intervention on caregivers' overall quality of life (QOL) and psychological distress. DESIGN A single-group, pre- and post-test pilot study. SETTING University public recreational facility. SAMPLE 12 informal caregivers for patients with cancer. METHODS Caregivers participated in a six-week VY intervention and completed measures of QOL and psychological distress pre- and postintervention. Program satisfaction was measured with open-ended survey questions. MAIN RESEARCH VARIABLES QOL, psychological distress, and program satisfaction. FINDINGS Significant improvements were found in the mental component score of overall QOL and in overall psychological distress. Several subdomains of QOL and psychological distress were also improved significantly. Open-ended survey question responses revealed participants perceived physical and mental benefit from the intervention, highlighting improvements in flexibility, core and upper-body strength, balance, breathing, and energy. CONCLUSIONS Informal caregivers may benefit mentally and physically from participating in VY. IMPLICATIONS FOR NURSING Caregivers of patients with cancer characterize a group worthy of attention, research, and interventions focusing on their healthcare needs.
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Affiliation(s)
- Andi Céline Martin
- Faculty of Kinesiology and Health Studies, University of Regina, Saskatchewan, Canada
| | - Melanie R Keats
- School of Health and Human Performance and the School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
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Stansfeld S, Smuk M, Onwumere J, Clark C, Pike C, McManus S, Harris J, Bebbington P. Stressors and common mental disorder in informal carers--an analysis of the English Adult Psychiatric Morbidity Survey 2007. Soc Sci Med 2014; 120:190-8. [PMID: 25259657 PMCID: PMC4224501 DOI: 10.1016/j.socscimed.2014.09.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/18/2014] [Accepted: 09/14/2014] [Indexed: 11/19/2022]
Abstract
This study investigates potential explanations of the association between caring and common mental disorder, using the English Adult Psychiatric Morbidity Survey 2007. We examined whether carers are more exposed to other stressors additional to caring--such as domestic violence and debt--and if so whether this explains their elevated rates of mental disorder. We analysed differences between carers and non-carers in common mental disorders (CMD), suicidal thoughts, suicidal attempts, recent stressors, social support, and social participation. We used multivariate models to investigate whether differences between carers and non-carers in identifiable stressors and supports explained the association between caring and CMD, as measured by the revised Clinical Interview Schedule. The prevalence of CMD (OR=1.64 95% CI 1.37-1.97), suicidal thoughts in the last week (OR=2.71 95% CI 1.31-5.62) and fatigue (OR=1.33 95% CI 1.14-1.54) was increased in carers. However, caring remained independently associated with CMD (OR=1.58 1.30-1.91) after adjustment for other stressors and social support. Thus caring itself is associated with increased risk of CMD that is not explained by other identified social stressors. Carers should be recognized as being at increased risk of CMD independent of the other life stressors they have to deal with. Interventions aimed at a direct reduction of the stressfulness of caring are indicated. However, carers also reported higher rates of debt problems and domestic violence and perceived social support was slightly lower in carers than in non-carers. So carers are also more likely to experience stressors other than caring and it is likely that they will need support not only aimed at their caring role, but also at other aspects of their lives.
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Affiliation(s)
- Stephen Stansfeld
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK.
| | - Melanie Smuk
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AZ UK
| | - Charlotte Clark
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Cleo Pike
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, UK
| | - Sally McManus
- NatCen Social Research, 35 Northampton Square, London EC1V 0AX UK
| | - Jenny Harris
- Florence Nightingale School of Nursing and Midwifery, Kings College, London, UK
| | - Paul Bebbington
- UCL Mental Health Sciences Unit, 2nd Floor, Charles Bell House 67-73, Riding House Street, London W1W 7EJ, UK
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Abstract
One in 15 Australians over 65 experience dementia, and are commonly supported by spouses. Evidence demonstrates declining wellbeing for these caregivers as their role continues. There are indications of improvement once caregivers transition out of the role (recovery) but alternate suggestions that caregiving stress may be too damaging to be appeased (wear and tear). It seems plausible that reason for transition (care recipient's move into residential care or death) will affect caregivers' outcomes. A synthetic cohort method compared caregivers' stress and wellbeing prior to, and one and two years post-transition. There was evidence of wear and tear for physical wellbeing but recovery for psychological wellbeing over time; with little difference based on reason for transition. Caregiver outcomes seem to be a function of the action rather than the reason for transition, but factors such as age must be considered when designing methods to support post-transition wellbeing.
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Affiliation(s)
- Lynsey J Brown
- Discipline of General Practice, Flinders University, Australia
| | - Malcolm J Bond
- Discipline of General Practice, Flinders University, Australia
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18
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Llanque S, Savage L, Rosenburg N, Caserta M. Concept Analysis: Alzheimer's Caregiver Stress. Nurs Forum 2014; 51:21-31. [PMID: 24787468 DOI: 10.1111/nuf.12090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this article was to analyze the concept of caregiver stress in the context of caring for a person with Alzheimer's disease and related dementias. BACKGROUND Currently, there are more than 15 million unpaid caregivers for persons suffering from Alzheimer's disease and related dementias. This unpaid care can be stressful for caregivers due to the chronic nature of the disease process, as well as other factors. METHOD The paper incorporates the modified method of Wilson's concept analysis procedure to analyze the concept of caregiver stress. DATA SOURCES A review of the literature was undertaken using the Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and PubMed. RESULTS A theoretical definition of caregiver stress is provided, and the defining attributes, related concepts, antecedents, and consequences of caregiver stress are proposed, and case studies are presented. CONCLUSIONS The analysis demonstrates that caregiver stress is the unequal exchange of assistance among people who stand in close relationship to one another, which results in emotional and physical stress on the caregiver. Implications for future nursing research and practice conclude the paper.
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Rote S, Angel JL, Markides K. Health of elderly Mexican American adults and family caregiver distress. Res Aging 2014; 37:306-31. [PMID: 25651573 DOI: 10.1177/0164027514531028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using newly available data on family caregivers from a large epidemiological study of elderly Mexican-origin adults (Hispanic Established Population for the Epidemiologic Study of the Elderly [HEPESE], 2010/2011), we identify which types of impairment (functional, psychological, and cognitive) in the elderly individual are associated with family caregiver depressive symptoms. Results from ordinary least squares regressions using 626 caregiver-care recipient dyads demonstrate that more severe mobility limitations (Performance-Oriented Mobility Assessment), social disability (instrumental activities of daily living), neuropsychiatric disturbances related to cognitive decline (Neuropsychiatric Inventory), and depressive symptoms in the elderly subject are positively associated with caregiver psychological distress. Perceived social stress partially accounts for these associations. We also identify certain segments of this caregiver population that are especially vulnerable to burden when caring for a family member with high levels of impairment, namely female and low-income caregivers. These vulnerabilities should be the focus of intervention efforts to reduce stress and improve the emotional and psychological well-being of Mexican-origin caregivers.
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Affiliation(s)
- Sunshine Rote
- Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jacqueline L Angel
- LBJ School of Public Affairs and Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Kyriakos Markides
- Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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20
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Abstract
Objective: Cancer is a disease that not only affects the individual's mental and physical integrity but also affects the functionality of the family system. Caregivers experience stress when patients cannot cope with the symptoms they are experiencing. The stress experienced by caregivers gives rise to psychological and physical symptoms. The purpose of this study is to determine the attitude of coping with stress of family caregivers of cancer patients. Methods: This study was conducted as a descriptive research at the Medical Oncology Clinic. The study sample group comprised of 127 family caregivers. In the collection of the data, the Personel Information Form and Attitude of Coping with Stress Inventory were used. Results: The coping attitude used most frequently by family caregivers was active planning, and the least used coping attitude was avoidance isolation (biochemical). There was no significant statistical difference between the coping attitude depending on the descriptive characteristics of the family caregivers (P > 0.05). Conclusion: Results show that family caregivers of cancer patients tend to choose effective coping methods. However, there were still caregivers that displayed ineffective coping attitudes. Therefore, it is important to support the effective coping attitudes of caregivers and intervene in order to change the ineffective coping attitudes.
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Puterman E, Epel E. An intricate dance: Life experience, multisystem resiliency, and rate of telomere decline throughout the lifespan. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2012; 6:807-825. [PMID: 23162608 PMCID: PMC3496269 DOI: 10.1111/j.1751-9004.2012.00465.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Accumulation of life stressors predicts accelerated development and progression of diseases of aging. Telomere length, the DNA-based biomarker indicating cellular aging, is a mechanism of disease development, and is shortened in a dose response fashion by duration and severity of life stressor exposures. Telomere length captures the interplay between genetics, life experiences and psychosocial and behavioral factors. Over the past several years, psychological stress resilience, healthy lifestyle factors, and social connections have been associated with longer telomere length and it appears that these factors can protect individuals from stress-induced telomere shortening. In the current review, we highlight these findings, and illustrate that combining these `multisystem resiliency' factors may strengthen our understanding of aging, as these powerful factors are often neglected in studies of aging. In naturalistic studies, the effects of chronic stress exposure on biological pathways are rarely main effects, but rather a complex interplay between adversity and resiliency factors. We suggest that chronic stress effects can be best understood by directly testing if the deleterious effects of stress on biological aging processes, in this case the cell allostasis measure of telomere shortening, are mitigated in individuals with high levels of multisystem resiliency. Without attending to such interactions, stress effects are often masked and missed. Taking account of the cluster of positive buffering factors that operate across the lifespan will take us a step further in understanding healthy aging. While these ideas are applied to the telomere length literature for illustration, the concept of multisystem resiliency might apply to aging broadly, from cellular to systemic health.
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Ishii Y, Miyashita M, Sato K, Ozawa T. A family's difficulties in caring for a cancer patient at the end of life at home in Japan. J Pain Symptom Manage 2012; 44:552-62. [PMID: 22575721 DOI: 10.1016/j.jpainsymman.2011.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 09/30/2011] [Accepted: 10/10/2011] [Indexed: 11/24/2022]
Abstract
CONTEXT Most people hoped for home care at the end of life and death at home in Japan. However, the rate for death at home from cancer in Japan is less than 10% of the total deaths of cancer patients. OBJECTIVES The aim of this study was to investigate circumstances, difficulties, and correlated factors for family caregivers who provided care at home for a family member with terminal cancer. METHODS The Family's Difficulty Scale for end-of-life home care questionnaire was sent to 395 bereaved family caregivers who had cared for a terminal cancer patient with the assistance of home services. RESULTS We obtained 306 responses for a response rate of 81%. The results showed that family caregivers had a high rate of difficulties related to "Patient's pain and condition" (64%~90%) and "Burden of care" (61%~78%). A logistic regression analysis was performed on the data to examine factors related to the difficulties. More difficulties occurred for male caregivers (odds ratio [OR]=0.39, P=0.04) who did not prefer for the patient to die at home (OR=0.42, P=0.01). CONCLUSION This study indicates that it is important for home care providers to introduce services to reduce care burden. In addition, a thorough explanation of the patient's symptoms and condition is necessary to reduce distress and anxiety for family caregivers.
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Affiliation(s)
- Yoko Ishii
- Ohtawara Red Cross Hospital, 2-7-3 Sumiyoshi-chou, Ohtawara-shi, Tochigi, Japan.
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23
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Coping strategies and psychological morbidity in family carers of people with dementia: a systematic review and meta-analysis. J Affect Disord 2012; 139:1-11. [PMID: 21723617 DOI: 10.1016/j.jad.2011.05.055] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/27/2011] [Accepted: 05/27/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression. METHOD We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses. RESULTS We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC=0.39, 95% CI 0.28-0.50; N=688) and depression (0.46, 0.36-0.56; N=1428) cross-sectionally, and with depression 6 and 12months later (0.32, 0.10-0.54; N=143). Emotional support and acceptance-based coping correlated with less anxiety (-0.22, 95% CI -0.26 to -0.18; N=628) and depression (-0.20, -0.28 to -0.11; N=848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity. LIMITATIONS Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies. CONCLUSIONS There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style.
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Hoffman GJ, Lee J, Mendez-Luck CA. Health behaviors among Baby Boomer informal caregivers. THE GERONTOLOGIST 2012; 52:219-30. [PMID: 22391873 DOI: 10.1093/geront/gns003] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY This study examines health-risk behaviors among "Baby Boomer" caregivers and non-caregivers. DESIGN AND METHODS Data from the 2009 California Health Interview Survey of the state's non-institutionalized population provided individual-level, caregiving, and health behavior characteristics for 5,688 informal caregivers and 12,941 non-caregivers. Logistic regression models were estimated separately for four individual health-risk behaviors-smoking, sedentary behavior, and regular soda and fast-food consumption-as well as a global health-risk measure. RESULTS Controlling for psychological distress and personal characteristics and social resources such as age, gender, income and education, work and marital status, and neighborhood safety, caregivers had greater odds than non-caregivers of overall negative health behavior and of smoking and regular soda and fast-food consumption. We did not observe significant differences in odds of negative behavior related to stress for spousal caregivers and caregivers in the role for longer periods of time or those providing more hours of weekly care compared with other caregivers. IMPLICATIONS Our study found evidence that Baby Boomer caregivers engage in poor health behaviors that are associated with exposure to caregiving. Baby Boomer caregivers may be at risk for certain behavioral factors that are associated with disability and chronic illness.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Health Services, School of Public Health, University of California at Los Angeles, CA 90095-1772, USA.
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25
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Molloy GJ, Johnston DW, Johnston M, Gao C, Witham MD, Struthers AD, McMurdo MET. Using the demand-control model of job strain to predict caregiver burden and caregiver satisfaction in the informal caregivers of heart failure patients. Br J Health Psychol 2010; 13:401-17. [PMID: 17535502 DOI: 10.1348/135910707x203363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The demand-control (D-C) model of job strain has generated a considerable body of empirical support in predicting psychological health outcomes in the context of work. This study aimed to extend previous work using the D-C model of job strain to predict caregiver burden and satisfaction in the informal caregivers of patients with heart failure. DESIGN AND METHOD Data were gathered from 60 caregiver/patient dyads in a cross-sectional design. Patients with chronic stable heart failure were recruited from out-patient clinics. The dependent variables were caregiver burden and satisfaction. Demand and control were measured using both patient- and caregiver-derived measures. RESULTS The D-C model accounted for 15 and 19% of the variance in caregiver burden, after controlling for age, gender and relationship to the patient. Lower control was associated with higher burden. The D-C model did not predict caregiver satisfaction. CONCLUSION The D-C model was associated with caregiver burden, but not satisfaction in caregivers, with control being the dominant predictor. Research linking the theory and findings from job strain and informal caregiving studies may elucidate both fields of research. Using the demand-control model of job strain to predict caregiver burden and caregiver satisfaction in the informal caregivers of heart failure patients.
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Affiliation(s)
- Gerard J Molloy
- Department of Epidemiology & Public Health, University College London, UK.
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Ostlund U, Wennman-Larsen A, Persson C, Gustavsson P, Wengström Y. Mental health in significant others of patients dying from lung cancer. Psychooncology 2010; 19:29-37. [PMID: 19253315 DOI: 10.1002/pon.1433] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Definitions and measures of significant others' mental health vary, but stress processes have been associated with caregiver outcomes of this kind. Thus, various mental health outcomes probably appear, either as specific responses to particular types of caregiver stressors, or as part of a general response resulting from an accumulation of various stressors. The present study explores the occurrence of symptoms of strain with regard to depression, exhaustion, and emotional well-being in significant others of patients dying from lung cancer, and how these symptoms coexist. METHODS Measures used were the Montgomery Asberg Depression Rating Scale, the OLdenburg Burnout Inventory, and the Swedish Health-Related Quality of Life Survey. Data from 84 significant others of patients dying from lung cancer were collected at a time-point during the last 4 months before the patients died and subsequently analysed. The occurrence of symptoms of strain was established by creating cut-off scores from the general population. To explore how the different symptoms coexisted, hierarchical agglomerative cluster analyses were conducted using Ward's method. RESULTS Approximately 40% of the significant others reported symptoms of strain for each of the three outcomes, and a coexistence was found since the significant others clustered as subgroups, ranging from 'high on all scales' to 'low on all scales'. CONCLUSION A considerable proportion of the significant others were thus negatively affected in terms of mental health. We conclude that being a significant other of a person dying from lung cancer most likely results in a general response to this major life event.
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Affiliation(s)
- Ulrika Ostlund
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
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27
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Abstract
PURPOSE/OBJECTIVES To describe the quality of life (QOL) and well-being of caregivers of patients receiving outpatient chemotherapy for leukemia and to identify strategies to promote the best possible QOL and well-being for the caregivers. DESIGN Descriptive, cross-sectional study. SETTING Ambulatory treatment center of a major comprehensive cancer center in the southern United States. SAMPLE Convenience sample of 194 caregivers of patients receiving chemotherapy for leukemia. METHODS Participants completed the Caregiver Quality-of-Life-Cancer Scale, the Caregiver Well-Being Scale, and the Learning Needs Questionnaire developed by the authors. Descriptive statistics were used to summarize the demographic characteristics of the caregivers, and exploratory factor analysis was performed to identify meaningful factors. MAIN RESEARCH VARIABLES QOL, well-being, and learning needs. FINDINGS Caregivers identified burden as their most important concern for QOL. Key factors identified with caregivers' well-being were expression of feelings and household maintenance. Caregivers identified giving medications and managing the side effects as crucial to learning needs. Communication, positive attitudes, support, and education were important in promoting QOL for the caregivers. CONCLUSIONS Caregiving for a patient receiving chemotherapy for leukemia influences the QOL and well-being of the caregiver. IMPLICATIONS FOR NURSING This study highlights the need for better nurse-caregiver communication and education, particularly in the areas of symptom management and medication administration. Additional research should focus on factors that affect caregivers' QOL, their educational needs, and improved interventions for delivering new information or reinforcing old information.
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Affiliation(s)
- Geline Joy Tamayo
- Thoracic/Head and Neck Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, USA.
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Phillips AC, Gallagher S, Hunt K, Der G, Carroll D. Symptoms of depression in non-routine caregivers: the role of caregiver strain and burden. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2009; 48:335-46. [PMID: 19159507 DOI: 10.1348/014466508x397142] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The origins and persistence of psychological morbidity in caregivers are not fully understood. The present analysis examined the relationship between the strain and burden of caregiving and depression and anxiety in a large community sample. Social support and sleep quality were investigated as potential mediators. DESIGN Cross-sectional and prospective observational study. METHOD Individuals caring for someone other than their own child (N=393) were identified from a population of 2,079. Caregiving strain and burden, social support, and sleep quality were assessed. Participants completed the hospital anxiety and depression scale at the same time and 5 years later. RESULTS Caregiving strain and burden were associated with depression and anxiety symptoms cross-sectionally, and with a worsening of symptoms 5 years later. Sleep quality appeared to mediate the cross-sectional relationships. CONCLUSIONS The demands of caregiving and associated sleep disruption contribute to symptoms of depression and anxiety in caregivers.
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Affiliation(s)
- Anna C Phillips
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK.
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29
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Lucini D, Cannone V, Malacarne M, Bruno D, Beltrami S, Pizzinelli P, Piazza E, Fede GD, Pagani M. Evidence of autonomic dysregulation in otherwise healthy cancer caregivers: A possible link with health hazard. Eur J Cancer 2008; 44:2437-43. [DOI: 10.1016/j.ejca.2008.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 07/29/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
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Bristow M, Cook R, Erzinclioglu S, Hodges J. Stress, distress and mucosal immunity in carers of a partner with fronto-temporal dementia. Aging Ment Health 2008; 12:595-604. [PMID: 18855175 DOI: 10.1080/13607860802343076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study investigates the psychological and physiological impact of caring for a partner with fronto-temporal dementia (FTD). Carers were expected to exhibit greater stress and poorer psychological well-being in comparison with non-carers, and suppressed mucosal immunity. METHOD Twenty-five carers and 36 non-carers completed standardised psychological assessments of perceived stress, psychological well-being, coping and social support. Levels of mucosal immunity were assessed in saliva samples collected over the 3 days of the study, alongside daily assessments of stress, arousal and mood. RESULTS Informal carers as a group reported greater stress and poorer psychological well-being, but there was considerable variation, with some carers reporting better psychological functioning than non-carers. Immune levels were not suppressed in carers compared with non-carers; counter to hypothesis, there was a positive correlation between immunity and poorer psychological well-being. CONCLUSIONS This research suggests that caring for a partner with FTD increases distress and carers might benefit from psychological intervention. However, the variation in psychological well-being requires explanation. Furthermore, this first examination of mucosal immunity employing participants experiencing enduring stress suggests that, in contrast to previous research, enduring stress does not lead to suppression of mucosal immunity and may actually enhance it.
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Affiliation(s)
- Matt Bristow
- Department of Psychology, Anglia Ruskin University, Cambridge, UK.
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31
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Gallagher S, Phillips AC, Evans P, Der G, Hunt K, Carroll D. Caregiving is associated with low secretion rates of immunoglobulin A in saliva. Brain Behav Immun 2008; 22:565-72. [PMID: 18178376 DOI: 10.1016/j.bbi.2007.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 11/13/2007] [Accepted: 11/22/2007] [Indexed: 11/30/2022] Open
Abstract
Although the chronic stress of caring for a sick/disabled relative has been associated with poorer immunity using a range of outcomes, its impact on secretory immunoglobulin A (S-IgA) in saliva has yet to be examined. Three hypotheses were tested in analyses of data from a large community sample: first, caregivers would have lower S-IgA secretion rates than non-caregivers; second, the impact of caregiving on S-IgA would be particularly apparent in older participants; third, for caregivers, caregiving burden would be negatively associated with S-IgA. The sample comprised three distinct age cohorts, one young (N=623), one middle aged (N=639), and the other elderly (N=582). Participants were classified as caregivers if they regularly cared for somebody other than routine childcare. Caregiving strain was measured and a caregiving burden index was then derived as the composite of the number of people being cared for, the type of care provided, and the residential status of the person being cared for. From 2-min saliva samples, S-IgA secretion rate was measured. There was a significant caregiver status by age cohort interaction; caregivers in the eldest cohort had lower S-IgA secretion rates than their non-caregiving counterparts. Caregiving strain and burden and S-IgA were related, such that caregivers who experienced greater strain and burden had lower S-IgA secretion rates. These findings resonate with those from other studies using different immune outcomes. Considered together, it is clear that that the chronic stress of caregiving has widespread effects on immunity.
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Affiliation(s)
- Stephen Gallagher
- School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, England, United Kingdom
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Dorn T, Yzermans JC, Spreeuwenberg PM, van der Zee J. Physical and mental health problems in parents of adolescents with burns--a controlled, longitudinal study. J Psychosom Res 2007; 63:381-9. [PMID: 17905046 DOI: 10.1016/j.jpsychores.2007.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 01/22/2007] [Accepted: 02/06/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Caregiving has been described in the literature as a risk factor for ill health in the carer. This controlled, prospective study examines the course of physical and mental health problems in parents of adolescent survivors of a mass burn incident. METHODS Health information was extracted from electronic medical records. Continuous data were available for 1 year before and 4 years after the fire. Cohorts comprised 273 parents of survivors with burns, 199 parents of survivors without burns, and 1756 controls. Post-fire increases in health problems were compared by means of logistic regression. RESULTS Parents of burn victims were more likely to present mental health problems during the first 2 years after the incident, when compared to the baseline. Moreover, they were more likely to present cardiovascular health problems in every year following the disaster, compared to the baseline. Increases observed in mental and cardiovascular health problems were significantly larger in parents of burn victims compared to controls. Risk factors for presenting mental health problems were female gender of the parent and a large burn size in the child. Lower socioeconomic status and female gender of the parent predicted cardiovascular health problems. CONCLUSION Evidence gained in longitudinal studies informs on which health problems are most likely to develop in parental caregivers. In the interest of both parent and child, a family-oriented approach is proposed.
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Affiliation(s)
- Tina Dorn
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Thomas P, Hazif-Thomas C, Delagnes V, Bonduelle P, Clément JP. Environnement contenant chez la personne âgée démente – Étude Pixel. Encephale 2007; 33:317-25. [PMID: 17675929 DOI: 10.1016/s0013-7006(07)92045-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Caregivers of demented outpatients can suffer from poor health, are often anguished and unable to cope with the cared patient, and this burden can generate frailty. OBJECTIVES This survey attempted to determine the psychological parameters and effective capability influence of the caregiver's Quality of Life (QoL) and vulnerability, and measured the consequences of their alteration. METHODS 4 categories of situations were studied, according to the angst and coping capability of caregivers. Caregiver's QoL and vulnerability were assessed in these situations. Data were related to the socio-demographic data of both patients and their principal caregivers, and to the patients' medical and therapeutic data. RESULTS 1,410 and 10 patients diagnosed with dementia who lived at home with their principal caregivers were recruited for this survey. Angst and inability to cope with patients alter caregivers' QoL and was correlated to their vulnerability. Female caregivers were often in these situations, had a poorer QoL and were more vulnerable than men. Caregivers anguished and/or nab to cope with the cared patient were less satisfied with their own care and did not enjoy their relationships with their patients. Caregivers with psychological difficulties and failure to cope had to deal with nutritional difficulties with the demented patient. DISCUSSION Caregivers' QoL and vulnerability, are related to angst and inability to cope with patients. We could imagine that both patients and caregivers would benefit by taking care of carers.
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Affiliation(s)
- Ph Thomas
- Gériatre, Centre Mémoire de Ressources et de Recherche du Limousin, Pôle Universitaire de Psychiatrie du sujet âgé, CH Esquirol, 87025 Limoges
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Shi HJ, Nakamura K, Shimbo M, Takano T. Dietary supplement consumption among urban adults influenced by psychosocial stress: its pronounced influence upon persons with a less healthy lifestyle. Br J Nutr 2005; 94:407-14. [PMID: 16176612 DOI: 10.1079/bjn20051494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In order to examine the consumption of dietary supplements among urban adults and the impact of psychological stress on supplement use in relation to lifestyle, 375 interviews of a population-based sample of urban Japanese in 2002 were analysed. The usage of various supplements, stress process (daily stressors, psychological moderators, stress outcomes), personal health practices (smoking, alcohol drinking, physical exercise, fruit and vegetable juice consumption, health-conscious eating habits) and other background factors were measured. We examined the impacts of stress on the use of vitamin tablets and capsules, vitamin-enriched health drinks and health drinks for intestinal adjustment. The percentages of these three categories of supplement user were 26.9, 18.7 and 35.7%, respectively. After adjusting for potential confounders, subjects with 'two or more' daily stressors out of the eight stressors investigated consistently showed 2-fold higher levels of consumption of either vitamin tablets and capsules or vitamin-enriched drinks compared with their counterparts with 'one or less' daily stressors. Stress-outcome indicators also related, to a greater or less extent, to the elevated consumption of various supplements. Further lifestyle-stratified analyses revealed that the stress-supplementation relationships were weaker in subjects fulfilling more than three of the five investigated health practices (i.e. the healthy lifestyle group), but stronger in subjects with fewer than two healthy practices (i.e. the less healthy lifestyle group). In conclusion, dietary supplement consumption is independently associated with stress in urban adults. The uncontrolled use of supplements for the self-medication of stress or to compensate for unhealthy behaviour represents a health concern for the general population.
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Affiliation(s)
- Hui-Jing Shi
- Department of Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
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Lavretsky H. Stress and depression in informal family caregivers of patients with Alzheimer’s disease. ACTA ACUST UNITED AC 2005. [DOI: 10.2217/1745509x.1.1.117] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Family caregiving of older individuals with Alzheimer’s disease is becoming widespread in the USA and around the world because of the aging of the population. As a result, family members are increasingly being asked to perform complex tasks similar to those carried out by paid health or social service providers. Dementia caregiving presents unique and extreme challenges associated with caring for someone with cognitive and behavioral impairment. This article summarizes the extensive literature on dementia caregiving, identifies key issues and major findings regarding the definition and prevalence of caregiving, and reviews the epidemiological, cultural, individual and biological factors contributing to caregiver stress and depression. The author describes the psychiatric and physical health effects of caregiving and reviews various intervention approaches to improving caregiver burden, depression and quality of life. The author offers a perspective on future directions in dementia caregiver research and development of more effective interventions.
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Affiliation(s)
- Helen Lavretsky
- University of California, Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute and Hospital, 760 Westwood Pl., Los Angeles, CA 90095, USA
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Davis LL, Weaver M, Habermann B, Buckwalter K. Participant-centered adaptations in caregiver trials: strategies for managing confounds. Nurs Outlook 2005; 53:73-8. [PMID: 15858525 DOI: 10.1016/j.outlook.2004.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Randomized trials have been criticized for being more protocol than participant-centered, with concerns raised about higher subject attrition and limited generalizability under controlled conditions. Informal caregivers are similar to other participants in community-based trials: many are unlikely to remain in a trial without procedural adaptations to meet some of their needs. PURPOSE This article discusses design and statistical strategies for tracking potential confounds associated with 3 participant-centered adaptations that may be made in community-based caregiver trials: tailoring multi-component interventions, using interpersonal contacts for participant maintenance, and non-blinding of trial participants. The intent of the article is to initiate dialogue on the seldom-discussed issue of participant-centered adaptations in community-based trials. CONCLUSIONS Participant-centered adaptations may reduce subject attrition and enhance generalizability, but protocol adaptation can compromise trial integrity. The challenge for investigators is to develop scientifically sound methods for tracking / controlling potential confounds associated with each adaptation.
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Tsai PF, Jirovec MM. The relationships between depression and other outcomes of chronic illness caregiving. BMC Nurs 2005; 4:3. [PMID: 15725346 PMCID: PMC554787 DOI: 10.1186/1472-6955-4-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 02/22/2005] [Indexed: 11/16/2022] Open
Abstract
Background Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction). Methods The sample for this secondary data analysis consisted of 236 and 271 subjects from the Americans' Changing Lives, Wave 1, 1986, and Wave 2, 1989, data sets. Measures were constructed from the original study. Structural equation modeling was used to test the hypothesized model, and an exploratory structural modeling method, specification search, was used to develop a data-derived model. Cross-validation was used to verify the paths among variables. Results Hours of care, age, and gender predicted caregivers' outcomes directly or through perceived caregiver stress (p < .01). Depression mediated the relationship between perceived stress and psychological outcomes and explained 40% and 11% of the variance in self-esteem and marital satisfaction, respectively. Conclusion Depression predicted psychological outcomes. Whether depression predicts physical health outcomes needs to be further explored.
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Affiliation(s)
- Pao-Feng Tsai
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary M Jirovec
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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Osuch E, Engel CC. Research on the Treatment of Trauma Spectrum Responses: The Role of the Optimal Healing Environment and Neurobiology. J Altern Complement Med 2004. [DOI: 10.1089/acm.2004.10.s-211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elizabeth Osuch
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Charles C. Engel
- Deployment Health Clinical Center, Walter Reed Army Center, Washington, DC
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Lim JW, Zebrack B. Caring for family members with chronic physical illness: a critical review of caregiver literature. Health Qual Life Outcomes 2004; 2:50. [PMID: 15377384 PMCID: PMC521496 DOI: 10.1186/1477-7525-2-50] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 09/17/2004] [Indexed: 11/10/2022] Open
Abstract
This article reviews 19 studies (1987-2004) on quality of life for family caregivers helping those with chronic physical illness. Here we explore the concepts of and instruments used to measure caregivers' quality of life. We were particularly interested in understanding stress-related variables and documenting factors influencing quality of life based on family stress theory. Findings show that various positive and negative terms equated with quality of life were used to measure them. Results indicate that stress-related variables as possible predictors influencing caregivers' quality of life include: patient and caregiver characteristics, stressors, stress appraisal, stress coping methods, and social support. Our recommendations touch upon applying theory for intervention, developing measurement, making operable the concepts for measuring, and the need for longitudinal and comprehensive study.
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Affiliation(s)
- Jung-won Lim
- School of Social Work, University of Southern California, 669 MRF Building, West 34Street, & 102W, Los Angeles, CA 90089-0411, USA
| | - Brad Zebrack
- School of Social Work, University of Southern California, 669 MRF Building, West 34Street, & 102W, Los Angeles, CA 90089-0411, USA
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Gothelf D, Aharonovsky O, Horesh N, Carty T, Apter A. Life events and personality factors in children and adolescents with obsessive-compulsive disorder and other anxiety disorders. Compr Psychiatry 2004; 45:192-8. [PMID: 15124149 DOI: 10.1016/j.comppsych.2004.02.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The association among life events, personality factors, and anxiety disorders in children and adolescents was assessed in 28 children with obsessive-compulsive disorder (OCD), 28 children with other anxiety disorders (AD), and 24 normal controls using the Life Events Checklist (LEC) and the Junior Temperament and Character Inventory (JTCI). No significant differences were found among the groups for demographic and clinical characteristics. Children with OCD had significantly more total life events and more negative life events in the year before onset than normal controls, and they perceived the life events as having more impact. Scores for children with other AD fell between the other two groups for most of the life event parameters. The only specific life event that distinguished children with AD from normal controls was major illness or injury of a relative. High anxiety levels and older age--but not depression level--predicted a greater perceived impact of life events. Children with OCD and other AD both scored higher than normal controls on the harm avoidance parameter of the JTCI. Harm avoidance scores correlated positively and significantly with the reported occurrence of negative life events and their perceived impact. Thus, quantity, quality, and specificity of life events may be associated with AD in young people, especially OCD. This association may be related to the personality characteristic of harm avoidance.
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Affiliation(s)
- Doron Gothelf
- Richard E. Feinberg Department of Psychiatry, Schneider Children's Medical Center of Israel, Petah Tiqwa, and Sacker Faculty of Medicine, Tel Aviv University, Israel
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Roy M, Kirschbaum C, Steptoe A. Intraindividual variation in recent stress exposure as a moderator of cortisol and testosterone levels. Ann Behav Med 2003; 26:194-200. [PMID: 14644695 DOI: 10.1207/s15324796abm2603_04] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Intraindividual variation in recent stress exposure and its impact upon cortisol and testosterone was investigated. Over 1 year, 72 young male firefighters completed the Daily Stress Inventories, for 2 shift cycles (16 days), every 3 months. At the end of each 16-day period each participant attended a 1-hr morning assessment session. Saliva samples and blood pressure measurements were taken at 10-min intervals, and at 30 min, a blood sample was drawn. Across the year of assessment, there were significant linear relationships in reported stress and in neuroendocrine activity. In contrast to expectations, as daily stress decreased across the year (p <.008), salivary cortisol increased (p <.001) and testosterone levels decreased (p <.001). Within-subjects comparisons of the sessions with the highest and lowest stress confirmed these linear relationships: Lower stress prior to the assessment session was associated with higher cortisol levels (p <.01). These results, though in contrast to the orthodoxy concerning the association between stress and cortisol, are supported by findings in a number of other studies and may constitute down regulation of cortisol activity following an increment in stress exposure.
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Affiliation(s)
- Mark Roy
- University of Central Lancashire, UK.
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Hazif-Thomas C, Bouché C, Clément JP, Thomas P. Influence de la déambulation et des comportements moteurs inadéquats sur la prise en charge des déments à domicile par des aidants informels. L’étude PIXEL. ANNALES MEDICO-PSYCHOLOGIQUES 2003. [DOI: 10.1016/s0003-4487(03)00147-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Intensive care unit (ICU) survivors may experience deterioration in their quality of life for months following their return home, with families assuming a caregiving role. The aim of this study was to measure the burden associated with caring for a family member who had been critically ill. The study also sought to describe the relationship between three factors (filial obligation, social support, self-efficacy) and caregiver burden. Seventy-one family carers, 51 females (72%) and 20 (28%) males of long-term intensive care patients completed a mailed survey, after signing an informed consent form. Although the vast majority of the caregivers were providing substantial number of hours of care each week, they scored lower than the midpoint on all caregiver burden inventory subscales. Filial obligation was found to be positively associated with caregiver burden; however, there was no association between social support, self-efficacy and caregiver burden. Male caregivers experienced significantly more burden than female caregivers. The findings suggest that an understanding of the factors that impact on caregiver burden of families of ICU survivors is only beginning to emerge.
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Affiliation(s)
- Michelle Foster
- Intensive Care Unit, Gold Coast Hospital, Southport, Queensland, Australia.
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Abstract
The Roy adaptation model is a widely used nursing theory, but only a few studies have used it in the context of caregiving for the chronically ill. Many caregivers with chronically ill relatives suffer from stress and its consequences, and in an aging society, more and more people will be affected by stress. In this article, the author presents a middle-range theory of caregiver stress based on the Roy adaptation model as the first step in understanding the applicability of the Roy adaptation model in the context of stress in caregivers.
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Affiliation(s)
- Pao-Feng Tsai
- College of Nursing, University of Arkansas for Medical Sciences, USA
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Abstract
The current issue of Acta Neuropsychiatrica presents a series of papers which together provide a broad overview relating stress, immunity, cytokine activity and depressive illness, as well as the influence of cytokines on other neurological disorders. This introduction to the issue presents a broad perspective of the impact of stressors on immune functioning in animal studies and in humans, considering the potential effects of acute, subchronic and chronic stressors, as well as the contribution of previous stressor experience in promoting neurochemical and immunological alterations. Given the supposition that cytokines may act as immunotransmitters, and immune challenge may be viewed as a stressor, a brief review is provided concerning the impact of stressors and cytokine challenges on central neurochemical functioning, with particular emphasis on the commonalties between the effects of these treatments. It is suggested that by virtue of the neurochemical changes imparted by cytokines, a depressive affect may be instigated, just as it is in response to psychogenic stressors. To this end, an overview is presented concerning the relationship between cytokines and depression, as well as the influence of cytokine treatments on behavioral changes in animal studies and among patients receiving immunotherapy. Provisionally, the data support the view that activation of the inflammatory response system may contribute to affective illness, and that cytokines may act as signaling molecules to activate central nervous system processes regulating mood states.
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Affiliation(s)
- Hymie Anisman
- 1Institute of Neurosciences, Carleton University, Ottawa, Ontario, Canada
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Vedhara K, McDermott MP, Evans TG, Treanor JJ, Plummer S, Tallon D, Cruttenden KA, Schifitto G. Chronic stress in nonelderly caregivers: psychological, endocrine and immune implications. J Psychosom Res 2002; 53:1153-61. [PMID: 12479999 DOI: 10.1016/s0022-3999(02)00343-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This investigation examined whether the immune dysregulation that characterises elderly informal caregivers (e.g., spousal caregivers of dementia patients) extends to a younger caregiver population, specifically spousal carers of patients with multiple sclerosis (MS). METHOD MS spousal caregivers (n=41, mean age 43 years, 14 women, 27 men) and noncaregiving controls (n=62, mean age 33 years, 44 women, 18 men) were recruited. Psychological morbidity (i.e., self-reported stress, anxiety and depression), endocrine activity (i.e., salivary cortisol and DHEAs) and immunity (i.e., IgG and HAI responses to influenza vaccination and IFN-gamma and IL-4 levels) were assessed. RESULTS AND CONCLUSIONS MS caregivers and noncaregivers did not differ significantly in their IgG or HAI responses to influenza vaccination or in levels of IFN-gamma and IL-4. However, it remains unclear whether the "preserved" immune response of these younger caregivers was due to (1) an absence of immune senescence, (2) a relative absence of psychological morbidity, or both.
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Affiliation(s)
- Kavita Vedhara
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, UK.
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Adler KA, Mills PJ, Dimsdale JE, Ziegler MG, Patterson TL, Sloan RP, Grant I. Temporal stability of acute stress-induced changes in leukocyte subsets and cellular adhesion molecules in older adults. Brain Behav Immun 2002; 16:262-74. [PMID: 12009686 DOI: 10.1006/brbi.2001.0630] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the temporal stability of enumerative immune and catecholamine responses to acute psychosocial stress in 67 Alzheimer's caregivers ages 56-82 years (45 women and 22 men) who were required to prepare and deliver two 3-min speeches on three occasions at 2-week and 6-week intervals. All leukocyte subsets and adhesion molecules (CD62L and CD11a) changed significantly from rest to postspeak at each of the three testing sessions (p's <.0005). Responses showed moderate to high temporal stability across baseline and absolute task values (r's =.65-.96). Reliability was predictably lower for both forms of change scores (r's = -.16-.64). The level of temporal stability achieved is comparable to that seen previously in younger adults, indicating that acute psychosocial stress produces reliable changes in circulating leukocytes and cell adhesion molecules in older adults.
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Affiliation(s)
- Karen A Adler
- Department of Psychiatry, University of California-San Diego, La Jolla, CA 92093, USA
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Vedhara K, Bennett PD, Brooks E, Gale L, Munnoch K, Schreiber-kounine C, Fowler C, Sammon A, Rayter Z, Farndon J. Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. Psychol Health 2001. [DOI: 10.1080/08870440108405498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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