Factors Associated With Caregiver Depressive Symptoms, Outcomes, and Perceived Physical Health After Coronary Artery Bypass Surgery

Relationship between mutuality and depression in patients with chronic heart failure and caregivers in China: An actor-partner interdependence model analysis

Background

Patients with chronic heart failure and their family caregivers may experience adverse emotional problems, such as depression. Mutuality, which refers to the relationship between caregivers and those they care for, is an important factor affecting depression in the dyads. The purpose of this study was to investigate the relationship between mutuality and depression in patients with CHF and their caregivers in China.

Methods

In this cross-sectional study, we used the Mutuality Scale and the Self-Rating Depression Scale to measure mutuality and depression of patients and caregivers. We used SPSS version 26.0 and AMOS version 21.0 to analyze the data. An APIM was established to analyze the actor-partner effects of patient-caregiver mutuality and depression.

Results

A total of 250 dyads of patients and caregivers were included in the study. There were statistically significant differences in mutuality and depression between CHF patients and caregivers. The 4 dimensions of patients' mutuality all have the actor effect on depression. There were 3 partner effects of caregivers' "pleasurable activities", "shared values", and "reciprocity" on depression. Regarding caregiver depression, we only found an actor effect of caregivers' "shared values" on depression.

Conclusion

The relationship between patients and caregivers should be evaluated in the clinical setting, and it is very important to develop intervention measures to improve the adverse emotional problems affecting both patients and their caregivers.

A framework for assessing food-energy-water security: A FEW case studies from rural Alaska

Food, energy, and water (FEW) are basic needs for well-being and quality of life. Assessing FEW security allows residents, communities, and policy makers to make informed decisions about how to sustain and improve well-being. We have developed a FEW security assessment framework that examines four components of security: availability, access, quality, and preference. With the help of local community members, we interviewed 114 households in three rural Alaska communities to assess FEW security, drivers and outcomes of FEW security, and potential interactions among FEW components and with renewable energy (RE) developments. While FEW security was high overall, preference and quality, especially for food, was lower. Food harvested from the local environment (i.e. subsistence) was necessary to include in security assessments given that 24% of participants reported insecurity when asked about contemporary sources (i.e. purchased) versus 5% reporting insecurity for subsistence food sources (i.e., harvested). The major influences on FEW security tended to originate from outside the community, including factors such as transportation, income, fuel prices, and weather. One internal factor, health, was both a driver and an outcome of FEW security. Satisfaction with RE varied (42%-68%) with dissatisfaction due to unreliability, uncertainty of the economic benefit, desire for other types of RE, or wanting more RE (n = 6). Communication about RE projects was key to managing expectations, promoting knowledge, and identifying benefits for residents. Participants did not identify linkages between RE and FEW security. Our assessment tool can be used by communities and policy makers to contextualize FEW security into more insightful and specific components, allowing for identification of attainable actions to improve FEW security and thus individual and community well-being.

Influence of mutuality on quality of life in heart failure patient with inadequate self-care and caregiver dyads: an actor-partner interdependence model analysis

AIMS

Mutuality, a positive quality of the relationship between patients and their informal caregivers characterized by love and affection, shared pleasurable activities, shared values, and reciprocity, influences several patient-caregiver outcomes in chronic-condition cases, but it remains unknown whether it influences the heart failure (HF) patient-caregiver dyad quality of life (QOL). The aim of this study was to evaluate the influence of mutuality and its four dimensions (love and affection, shared pleasurable activities, shared values, and reciprocity) on QOL in HF patient-caregiver dyads.

METHODS AND RESULTS

Cross-sectional study: Using the actor-partner interdependence model, we examined how an individual's mutuality influenced his/her own QOL (actor effect) and his/her partner's QOL (partner effect). Mutuality and physical and mental QOL were measured with the Mutuality Scale and Short Form 12, respectively. A total of 494 HF patient-caregiver dyads were enrolled in the study. Mutuality showed strong evidence of caregiver partner effects on the HF patients' physical QOL (total score B = 2.503, P = 0.001; shared pleasurable activities B = 2.265, P < 0.001; shared values B = 1.174, P = 0.420 and reciprocity B = 1.888, P = 0.001). For the mental QOL, mutuality and its four subscales had actor effects only on the patients' mental health (total mutuality B = 2.646, P = 0.003; love and affection B = 1.599, P = 0.360; shared pleasurable activities B = 2.599, P = 0.001; shared values B = 1.564, P = 0.001 and reciprocity B = 1.739, P = 0.020). In caregivers, mutuality had an actor effects on mental QOL (total score B = 1.548, P = 0.041 and reciprocity B = 1.526, P = 0.009).

CONCLUSION

Our results confirm the important role of mutuality in determining the physical and mental QOL in HF patient-caregiver dyads. Interventions aimed at improving the relationships within HF patient-caregiver dyads may have an impact on HF patients' and caregivers' QOL.

Self-Report and Caregiver Proxy-Report Agreement of Perceived Chronic Stress and Mutuality in Poststroke Aphasia

Background People with aphasia (PWA) report higher levels of stress in comparison to stroke survivors without aphasia. If untreated, chronic stress is known to have detrimental effects to the body and brain and can negatively impact health and well-being. According to extant literature, self- and proxy-report agreement on objective domains is higher than on subjective domains, like chronic stress. In addition, high levels of mutuality, also known as shared feelings between two people, have been strongly associated with low levels of stress in stroke survivors. Little is known, however, of the agreement between self-report and caregiver proxy-report on perceived chronic stress or mutuality in PWA. Purpose The proposed study sought to examine (a) the degree of agreement between caregiver proxy-report and PWA self-report on perceived stress and (b) the relationship between perceived stress and mutuality between PWA and their caregivers. Method The Modified Perceived Stress Scale and the Mutuality Scale were administered to 21 PWA/caregiver dyads. An independent-samples t test was conducted to determine if there were significant differences in perceived stress and mutuality as reported by PWA, their caregiver, and their caregiver's proxy-report. A Pearson correlation was performed to determine the level of agreement across questionnaires. Results There was a moderate correlation between the proxy-report and self-report for perceived stress. On average, proxy-reports for perceived stress were significantly higher than PWA self-reports. Overall, mutuality was high among the dyads. There was moderate agreement between caregiver's mutuality and proxy-report agreement on perceived stress. Lastly, our findings do not indicate that caregiver's perceived stress influenced their perception of the PWA's perceived stress. Conclusion The results of this study provide support for the use of proxy-derived information in perceived stress with the use of a mutuality scale.

The Impact of Caregiving Burden on Mental Well-Being in Coronary Artery Bypass Graft Surgery Caregivers: The Mediatory Role of Perceived Social Support

An increase in caregiver burden and a decrease in social support have both been identified as predictors of poor caregiver psychological distress. However, little is known about the role of these factors in coronary artery bypass graft (CABG) caregivers. The purpose of this study was to investigate whether change in perceived social support from pre to post surgery mediated the relationship between change in caregiver burden and caregiver depressive symptoms and subjective well-being post surgery. A sample of 101 caregivers of elective CABG patients were assessed 28 days before and 62 days after patients' surgery. Caregivers completed the Oberst Burden Scale, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, the Beck Depression Inventory, and the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Simple mediation analyses showed that change in social support significantly mediated both the relationship between change in caregiver burden and post-surgery depressive symptoms (unstandardised β = 0.041, 95% CI (0.005, 0.112)) and the relationship between change in caregiver burden and post-surgery subjective well-being (unstandardised β = 0.071, 95% CI (0.001, 0.200)). Psychological interventions aimed at the CABG caregiver population should promote social support to deal with the increase of caregivers' tasks and demands after the patients' surgery.

The Association Between Mutuality, Anxiety, and Depression in Heart Failure Patient-Caregiver Dyads: An Actor-Partner Interdependence Model Analysis

BACKGROUND

Heart failure (HF) patient-caregiver dyads experience severe psychological problems, such as anxiety and depression. A variable that has been found to be associated with anxiety and depression in patients and caregivers in severe chronic conditions is mutuality. However, this association has not been explored in HF patient-caregiver dyads to date.

OBJECTIVE

The aim of this study was to evaluate the associations among mutuality, anxiety, and depression in HF patient-caregiver dyads.

METHODS

This was a cross-sectional study. Mutuality, anxiety, and depression in HF patient-caregiver dyads were assessed using the Mutuality Scale (MS) total and 4 dimension scores and the Hospital Anxiety and Depression Scale, respectively. Data were analyzed using the actor-partner interdependence model to examine how mutuality of patients and caregivers was associated with both the patients' own (actor effect) and their partners' anxiety and depression (partner effect).

RESULTS

A sample of 366 dyads of patients with HF (mean age, 72 years; 56% male) and caregivers (mean age, 54 years; 73.3% female) was enrolled. Regarding patient anxiety, we observed only an actor effect between the MS dimension scores of "love and affection" and "reciprocity" and anxiety in patients (B = -1.108, P = .004 and B = -0.826, P = .029, respectively). No actor and partner effects were observed concerning caregiver anxiety. Regarding depression, we observed that only the MS dimension of "love and affection" in patients had both an actor (patient: B = -0.717, P = .032) and a partner (caregiver: B = 0.710, P = .040) effect on depression.

CONCLUSIONS

The assessment of MS in HF patient-caregiver dyads is important to formulate interventions aimed at improving anxiety and depression in patients and caregivers.

Mediating effect of mutuality on caregiver burden in Parkinson's disease partners

Objectives: Parkinson's disease (PD) is a complex neurodegenerative disorder with a broad list of motor and non-motor symptoms (NMS) that has been shown to affect the relationship quality (mutuality) and caregiver burden. However, little is known if the effect of motor and NMS on caregiver burden is mediated by mutuality. Therefore, the aim of this study was to explore if perceived mutuality by patients and partners mediates the effect of motor and NMS on caregiver burden.Methods: Data were collected from 51 dyads with one PD patient, including measures of motor signs, NMS, impaired cognition, patients' and partners' perceived mutuality, caregiver burden and dependency in activities in daily life (ADL). Structural equation model with manifest variables were applied to explore if patients' and partners' mutuality score mediated the effect of motor signs, NMS, ADL or impaired cognition on caregiver burden.Result: Our results suggest that having a partner with PD who is dependent in ADL or has impaired cognition decreases partners' mutuality which leads to elevated burden. Motor symptoms or other NMS were not associated with partners' mutuality or caregiver burden. Instead, increasing severity of motor symptoms decrease patients' mutuality in turn leading to lower level of partners' mutuality.Conclusion: Our findings enhance the understanding of the complexity of living with PD for the partner and suggest that clinical assessment should include evaluation of how PD symptoms influence the quality of the relationship between partners and patients.

Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies

OBJECTIVES

To provide a comprehensive synthesis of informal caregivers' experiences of caring for a significant other following discharge from cardiac surgery.

DESIGN

Systematic integrated review without meta-analysis.

DATA SOURCES

A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies).

RESULTS

Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6-734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress.

CONCLUSION

Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions.

PROSPERO REGISTRATION NUMBER

CRD42018096590.

The influence of relational mutuality on dyadic coping among couples facing breast cancer

OBJECTIVE

The study examined how a couple's capacity for mutuality as conceptualized by the Relational-Cultural Theory plays a role in their managing the stresses accompanying breast cancer.

METHODS

Eighty-six women treated for a primary, non-metastatic breast cancer and their partners completed measures of quality of life, relational mutuality, and dyadic coping. Demographic and clinical factors were self-reported. The relationship between mutuality and dyadic coping was evaluated using the Actor-Partner Interdependence Model (APIM).

RESULTS

Relational mutuality was positively associated with both the patients' and the caregivers' scores on common and positive dyadic coping. Similarly, relational mutuality was associated with both patients' and caregivers' reduced scores on avoidance of dyadic coping.

CONCLUSIONS

Relational mutuality emerges as a significant factor in our understanding about dyadic coping in the context of cancer and this study highlights the role it plays in dyadic coping behaviors.

IMPLICATIONS

The promotion of relational mutuality in couples coping with cancer-related stress should be a major focus in couple-based interventions.

'Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review

OBJECTIVE

To assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD). Design Mixed methods systematic review including qualitative and quantitative studies. Data sources Databases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors.

DATA ANALYSIS/SYNTHESIS

A results-based convergent synthesis was conducted.

RESULTS

Searches returned 8026 titles and abstracts. 54 studies-21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time.

CONCLUSION

Caregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required.

TRIAL REGISTRATION NUMBER

CRD42016053412.

The Relationship Between Mutuality and Health-Related Quality of Life in Adult Child Caregivers in China

The strain inherent in caregiving relationships between adult children and aging parents is a prominent issue in contemporary China due to a combination of demographic and socioeconomic changes. The purpose of this study was to explore how mutuality, a positive quality of caregiving relationships, contributes to the physical health and mental health (health-related quality of life [HRQoL]) of adult child caregivers [ACCs] of parent stroke survivors. A cross-sectional correlational study was conducted on a nonproportional quota sample of 126 ACCs, using questionnaires of demographics, the 15-item Mutuality Scale, and the Second Version of the Standard 12-Item Health Survey (SF-12v2). Higher mutuality was found to be correlated with better caregiver physical health and mental health. However, after adjusting for the covariates, mutuality significantly explained 4.6% of the variance of caregiver physical health (β = .22, ΔR² = .046, p < .01) but it did not significantly explain the variance of caregiver mental health. Although multiple factors correlate with Chinese family caregivers' HRQoL, this was the first study exploring the impact of caregiver-care receiver dyadic relationships on caregiver HRQoL in mainland China by using a mutuality scale with SF-12v2. Despite the fact that the Chinese tradition of filial piety can facilitate mutuality, socioeconomic changes and legislation that require adult children to care for aging parents appear to create high stress among family caregivers. Higher levels of mutuality contribute to better physical health in Chinese family caregivers. Therefore, culturally appropriate family nursing strategies and social policies in China could enhance caregiver mutuality and potentially promote their HRQoL, in particular physical health.

Psychometric properties of the mutuality scale in Swedish dyads with Parkinson's disease

OBJECTIVES

The 15-item mutuality scale (MS) has been used in several neurological conditions assessing the quality of relationship associations with negative effects of the caregiving situation. The aim of this study was to translate the original MS into Swedish and assess its psychometric properties in Parkinson's disease (PD).

MATERIALS AND METHODS

Following the forward-backward translation method, the scale was evaluated regarding linguistic correctness at a conceptual level and user-friendliness. The scale was filled out by a sample of 50 care dyads where one was having PD. Scale assumptions and scale structure were evaluated using floor/ceiling effect and principal component analyses (PCA) with promax rotation. Internal consistency was evaluated using Cronbach's alpha and mean inter-item correlation coefficients.

RESULTS

The Swedish MS was evaluated as user-friendly and relevant by the participants. The scale demonstrated no floor/ceiling effect and showed high internal consistency (α≥0.93) with a mean inter-item correlation coefficient of ≥0.5. Through the PCA, a two factor solution emerged, which accounted for 67% and 64% of the variance of the MS score by PD-partners and PD-patients, respectively. However, some variables were complex and discarded in the final solution.

CONCLUSION

Our findings provide initial support of the Swedish MS as a user-friendly and useful instrument with acceptable psychometric properties even though more research is needed to evaluate the existence of subscales.

Spousal Caregivers of Coronary Artery Bypass Surgery Patients: Differences between Caregivers with Low vs. High Caregiving Demands

PURPOSE

Compared to non-caregivers, caregivers have higher rates of depressive symptoms, caregiver strain, less mutuality, and health care visits. However, few investigators have examined family caregivers after coronary artery bypass (CAB) surgery. The purpose of this study was to examine differences in caregiving difficulties, mutuality (i.e., open communication; avoiding sad thoughts), and depressive symptoms based on low vs. high caregiving demands among spousal caregivers.

DESIGN

A descriptive, comparative design was used to examine 33 spousal caregivers of CAB surgery patients (16 in low and 17 in high caregiving demand groups).

METHODS

Measures included: Caregiving Burden Scale, Mutuality and Interpersonal Sensitivity Scale, and Patient Health Questionnaire-9. Groups were compared using Mann-Whitney U statistics.

FINDINGS

It was found that caregivers with high caregiving demands reported more caregiving difficulties and more open communication about the surgery compared to caregivers with low demands.

CONCLUSION

Caregivers with greater caregiving demands may need additional support to assist them with the caregiving situation.

CLINICAL RELEVANCE

Priority should be given to family caregivers, who take care of patients in cardiac rehabilitation, with higher caregiving demand.

Relationship Quality in Non-Cognitively Impaired Mother-Daughter Care Dyads: A Systematic Review

More than 60 million Americans provide care to a family member; roughly two thirds are women providing care to aging mothers. Despite the protective nature of relationship quality, little attention has been given to its role in mother-daughter care dyads, particularly in mothers without cognitive impairment. A systematic appraisal of peer-reviewed, English language research was conducted. Nineteen articles met criteria. When relationship quality is positive, mother-daughter dyads enjoy rewards and mutuality, even when conflict occurs. Daughters grow more emotionally committed to mothers' over the care trajectory, despite increasing demands. Daughters' commitment deepens as mothers physically decline, and mothers remain engaged, emotional partners. When relationship quality is ambivalent or negative, burden, conflict, and blame conspire, creating a destructive cycle. Avenues for continuing study, including utilizing the dyad as the unit of analysis, troubled dyads, longitudinal assessment, and end of life context, are needed before interventions to improve mother-daughter relationship quality may be successfully implemented.

Why does placement of persons with Alzheimer's disease into long-term care improve caregivers' well-being? Examination of psychological mediators

Caregiving for individuals with Alzheimer's disease is associated with chronic stress and elevated symptoms of depression. Placement of the care receiver (CR) into a long-term care setting may be associated with improved caregiver well-being; however, the psychological mechanisms underlying this relationship are unclear. This study evaluated whether decreases in activity restriction and increases in personal mastery mediated placement-related reductions in caregiver depressive symptoms. In a 5-year longitudinal study of 126 spousal Alzheimer's disease caregivers, we used multilevel models to evaluate placement-related changes in depressive symptoms (short form of the Center for Epidemiologic Studies Depression scale), activity restriction (Activity Restriction Scale), and personal mastery (Pearlin Mastery Scale) in 44 caregivers who placed their spouses into long-term care relative to caregivers who never placed their CRs. The Monte Carlo method for assessing mediation was used to evaluate the significance of the indirect effect of activity restriction and personal mastery on postplacement changes in depressive symptoms. Placement of the CR was associated with significant reductions in depressive symptoms and activity restriction and was also associated with increased personal mastery. Lower activity restriction and higher personal mastery were associated with reduced depressive symptoms. Furthermore, both variables significantly mediated the effect of placement on depressive symptoms. Placement-related reductions in activity restriction and increases in personal mastery are important psychological factors that help explain postplacement reductions in depressive symptoms. The implications for clinical care provided to caregivers are discussed.

Patients' and partners' health-related quality of life before and 4 months after coronary artery bypass grafting surgery

BACKGROUND

Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients' physical and mental health usually improves after surgery little is known about the partners' health-related quality of life (HRQoL) in CABG. If the partners' physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients' and partners' HRQoL before and after CABG; to explore whether patients' and partners' pre-operative socio-demographics and HRQoL predict their own, and also partners' HRQoL 4 months after CABG.

METHODS

This prospective study recruited 84 dyads (patients 84% males, aged 64.5 years; partners 94% females, aged 61.05 years). Patients' and partners' perceived health status was assessed using the Short-Form 12 Health Survey. Patients' physical limitation, angina symptoms and treatment satisfaction were assessed using the Seattle Angina Questionnaire. Partners' emotional, physical and social functioning was assessed using the Quality of Life of Cardiac Spouses Questionnaire. Data were analysed using hierarchical multiple (logistic) regressions, repeated measures analysis of variance, paired t test and Chi square.

RESULTS

Patients most likely to have poorer physical health post-operatively were associated with partners who had poorer pre-operative physical health. Partners most likely to have poorer emotional, physical and social functioning post-operatively were associated with patients who had poorer pre-operative mental health. Patients" and partners' poorer post-operative HRQoL was also explained by their poorer pre-operative HRQoL.

CONCLUSION

The partners' involvement should be considered as part of patients' pre-operative assessment. Special attention needs be paid to patients' pre-operative mental health since it is likely to impact on their post-operative mental health and the partner's emotional, physical and social functioning.

Physical health, mental health, and life changes among family caregivers of patients with lung cancer

PURPOSE/OBJECTIVES

To describe physical health, mental health, and life changes among family caregivers of patients with lung cancer.

DESIGN

Cross-sectional quantitative study.

SETTING

A university outpatient oncology center, two Veterans Affairs outpatient clinics, and a private outpatient oncology practice in Indianapolis, IN.

SAMPLE

91 family caregivers of patients with lung cancer.

METHODS

Data were collected using standardized instruments and analyzed using descriptive statistics and hierarchical multiple regression.

MAIN RESEARCH VARIABLES

Demographic and medical factors, physical health, mental health, and life changes from caregiving.

FINDINGS

Caregivers' physical health and mental health were below population norms, whereas social functioning did not differ from norms. More than 50% of caregivers reported negative emotional effects of caregiving, and more than 33% reported negative physical health effects of caregiving. About 40% of caregivers, however, reported positive changes in their relationships with the patients with lung cancer and other family members as a result of caregiving. Caregivers' mental health was more strongly associated with life changes than physical health.

CONCLUSIONS

Findings suggest that many family caregivers of patients with lung cancer experience negative physical and mental health effects of caregiving, whereas relations with family members improve for a substantial minority of caregivers. These positive and negative consequences of caregiving should be jointly considered when developing self-report measures and interventions for this population.

IMPLICATIONS FOR NURSING

Nurses can conduct brief screening assessments to identify caregivers with probable distress and can provide practical and psychosocial support, as well as referrals to support services.

KNOWLEDGE TRANSLATION

Findings suggest that interventions are needed to address the negative physical and emotional health consequences of caring for family members with lung cancer. Such interventions could build on the relational benefits of caregiving to improve the patient-caregiver relationship and expand caregivers' support system.

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population.

Long-term health-related quality of life of stroke survivors and their spousal caregivers

Because treatment for stroke has improved, individuals are living longer with the effects of a stroke. The resulting long-term impairment can affect both stroke survivors' and their caregivers' health-related quality of life (HRQOL). Few studies have examined the HRQOL of stroke survivors and their caregivers greater than 2 years poststroke. The stroke survivors and their spousal caregivers (n = 30 dyads) who had previously completed a 12-month study after discharge from inpatient rehabilitation were assessed at 3-5 years poststroke. The HRQOL and related outcomes were measured for stroke survivors and caregivers. Data from baseline to 12 months were used in conjunction with data from this study. Linear mixed models were used to analyze the change in repeated measures over time. Multiple linear regression was used to analyze the relationship of generic HRQOL to related psychosocial outcomes. The stroke survivors were an average of 4.68 years poststroke. The mean age for stroke survivors and caregivers was 70.8 and 64.9 years, respectively. Most stroke survivors were men (80%) and non-Hispanic White (70%). Among stroke survivors, depression decreased from baseline to 12 months (p = .04) but increased from 12 months to the end of follow-up (p = .003). The caregivers' depression decreased from baseline to all time points (p = .015). Stroke-specific HRQOL showed statistically significant (p < .03) decreases between 12 months and end of follow-up. Increased number of illnesses and older age were associated with caregivers' lower physical HRQOL score (p = .004). Higher depression was associated with lower mental HRQOL score for both caregivers and stroke survivors (p = .003 and p = .011, respectively). Both stroke survivors and caregivers continue to experience negative stroke-related health outcomes for many years after the initial stroke; some of these outcomes even worsen over time. These findings illustrate the need for ongoing psychological and medical evaluation for both long-term stroke survivors and caregivers. Development and testing of targeted behavioral interventions are also warranted.

The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers

OBJECTIVE

Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers' and stroke survivors' mutuality and caregivers' and stroke survivors' perceived stress.

METHOD

This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor-partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation.

RESULTS

Caregivers' mutuality showed an actor effect (β = -3.82, p < 0.0001) but not a partner effect. Thus, caregivers' mutuality influenced one's own perceived stress but not the stroke survivors' perceived stress. Stroke survivors' perceived stress showed a partner effect and affected caregivers' perceived stress (β = 0.13, p = 0.047). Caregivers' perceived stress did not show a partner effect and did not significantly affect stroke survivors' perceived stress.

CONCLUSION

These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.

The state of the science of family caregiver-care receiver mutuality: a systematic review

This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.

Living kidney donors and their family caregivers: developing an evidence-based educational and social support website

CONTEXT

Although graft and patient survival rates for living kidney donation are improved, some healthcare providers question whether volunteer donors and their informal caregivers are fully informed of the donation process and the risks involved. Donors and their family caregivers have reported that they receive limited information about the predonation and donor recovery process. Offering web-based information and social support is one way to address this gap.

STRATEGY

Living kidney donor candidates and their family caregivers participating in the Living Donor Information Network for Caregiving (LINC) have access to a variety of online informational resources and a social support discussion forum throughout their living kidney donation experience. Strategies in the development and implementation of an online information and social-support resource are presented.

CONCLUSIONS

Use of the LINC website for information and support may assist health care providers in identifying potential barriers in the current donation process and provide direction for enhancing knowledge and confidence among donors and family caregivers.

A systematic review of psychosocial interventions to improve cancer caregiver quality of life

OBJECTIVE

To evaluate and estimate the effect of psychosocial interventions on improving the quality of life (QoL) of adult cancer caregivers.

METHODS

We conducted a systematic review of randomized controlled trials among adult cancer caregivers published from 1947 to 2011. Rigorous inclusion criteria included randomization of caregivers, use of control groups, and at least one active psychosocial intervention where caregiver QoL was measured. A pair of raters independently reviewed all abstracts, and studies were assessed for quality using an 11-item PEDro coding scale. Data were extracted, examined, and synthesized using a narrative approach.

RESULTS

Six randomized controlled trials met inclusion criteria out of 1066 identified abstracts. Studies were rejected because of methodological flaws and failure to report a measure of caregiver QoL. A total of 1115 caregivers were included at baseline measurements. Estimated effect sizes for included studies were nil to small ranging from 0.048 to 0.271. Studies with larger effect sizes targeted caregivers' problem-solving and communication skills.

CONCLUSIONS

Interventions targeting problem-solving and communication skills may ease the burdens related to patient care and role changes associated with care while improving caregiver's overall QoL. Further research is needed to establish efficacy of interventions across all stages of the 2cancer caregiving experience, especially focusing on issues of caregiver retention, caregiver relationships to the cancer patient, and individual differences in caregiver experiences with different types of cancer.

Difficulty assisting with health care tasks among caregivers of multimorbid older adults

BACKGROUND

Family caregivers provide assistance with health care tasks for many older adults with chronic illnesses. The difficulty they experience in providing this assistance, and related implications for their well-being, have not been well described.

OBJECTIVE

The objectives of this study are: (1) to describe caregiver's health care task difficulty (HCTD), (2) determine the characteristics associated with HCTD, and (3) explore the association between HCTD and caregiver well-being.

DESIGN

This is a cross-sectional study.

PARTICIPANTS

Baseline sample of caregivers to older (aged 65+ years) multimorbid adults enrolled in an ongoing cluster-randomized controlled trial (N = 308).

MAIN MEASURES

The HCTD scale (0-16) is comprised of questions measuring self-reported difficulty in assisting older adults with eight health care tasks, including taking medication, visiting health care providers, and managing medical bills. Caregivers were categorized using this scale into no, low, medium, and high HCTD groups. We used ordinal logistic regression and multivariate linear regression analyses to examine the relationships between HCTD, caregiver self-efficacy, caregiver strain (Caregiver Strain Index), and depression (Center for Epidemiological Studies Depression Scale), controlling for patient and caregiver socio-demographic and health factors.

KEY RESULTS

Caregiver age and number of health care tasks performed were positively associated with increased HCTD. The quality of the caregiver's relationship with the patient, and self-efficacy were inversely associated with increased HCTD. A one-point increase in self-efficacy was associated with a significant lower odds of reporting high HCTD (OR, 0.64; 95% CI, 0.54, 0.77).Adjusted linear regression models indicated that high HCTD was independently associated with significantly greater caregiver strain (B, 2.7; 95% CI, 1.12, 4.29) and depression (B, 3.01; 95% CI, 1.06, 4.96).

CONCLUSIONS

This study demonstrates that greater HCTD is associated with increased strain and depression among caregivers of multimorbid older adults. That caregiver self-efficacy was strongly associated with HCTD suggests health-system-based educational and empowering interventions might improve caregiver well-being.

Feeding the family during times of stress: experience and determinants of food insecurity in an Inuit community

This paper uses a mixed methods approach to characterise the experience of food insecurity among Inuit community members in Igloolik, Nunavut, and examine the conditions and processes that constrain access, availability, and quality of food. We conducted semi-structured interviews (n= 66) and focus groups (n= 10) with community members, and key informant interviews with local and territorial health professionals and policymakers (n= 19). The study indicates widespread experience of food insecurity. Even individuals and households who were food secure at the time of the research had experienced food insecurity in the recent past, with food insecurity largely transitory in nature. Multiple determinants of food insecurity operating over different spatial-temporal scales are identified, including food affordability and budgeting, food knowledge and preferences, food quality and availability, environmental stress, declining hunting activity, and the cost of harvesting. These determinants are operating in the context of changing livelihoods and climate change, which in many cases are exacerbating food insecurity, although high-order manifestations of food insecurity (that is, starvation) are no longer experienced.

Predictors of depressive symptoms in caregivers of patients with heart failure

BACKGROUND

Millions of family members deliver informal care and support to patients with heart failure (HF). Caregivers of patients with HF experience depressive symptoms, but factors associated with depressive symptoms are unknown. The purposes of this study were (1) to examine differences between caregivers with and without depressive symptoms in patients' characteristics and caregivers' functional status, caregiving burden (time devoted to caregiving, difficulty of caregiving tasks, and overall perceived caregiving distress), and perceived control; and (2) to determine predictors of depressive symptoms of caregivers.

METHOD

A total of 109 caregivers (mean age of 57 years; spousal caregiver, 79%) and patients with HF participated in this study. Depressive symptoms, perceived control, and functional status of both patients and caregivers were assessed using the Beck Depression Inventory II, the Control Attitudes Scale-Revised, and the Duke Activity Status Index, respectively. Caregivers' burden (time and difficulty of caregiving tasks and burden) were assessed using the Oberst Caregiving Burden Scale and the Zarit Burden Interview.

RESULTS

The 27.5% of HF caregivers with depressive symptoms (Beck Depression Inventory II score > or =14) had poorer functional status, lower perceived control, and higher perceived caregiving distress; experienced more caregiving difficulty; and spent more time in caregiving tasks than did caregivers without depressive symptoms. Controlling for age and sex in a multiple regression, caregivers' own functional disability (standard beta [sbeta] = -.307, P < .001), perceived control (sbeta = -.304, P < .001), and caregiver burden (sbeta = .316, P = .002) explained 45% of the variance in caregivers' depressive symptoms. Patients' New York Heart Association class and functional status did not predict caregivers' depressive symptoms.

CONCLUSION

Caregivers' poor functional status, overall perception of caregiving distress, and perceived control were associated with depressive symptoms. Depressed caregivers of patients with HF may benefit from interventions that improve caregivers' perceived control, address the caregiving burden, and improve or assist with caregivers' functional status.

Health-related quality of life after coronary artery bypass grafting

AIM

The purpose of this study was to monitor changes in health-related quality of life and to identify associated factors among patients having coronary artery bypass grafting and their significant others.

BACKGROUND

Heart disease and its treatment affects the lives of both patients and their significant others, and the early stage of recovery from surgery causes particular anxiety for both.

METHOD

In this longitudinal study, three sets of questionnaire data were collected 1, 6 and 12 months after coronary artery bypass grafting surgery from patients and significant others at one university hospital in Finland in 2001-2005. We recruited all patients who had been admitted for elective coronary artery bypass grafting surgery during the period specified. The data consisted of the responses from those patients and significant others who had completed all three questionnaires and for whom patient-significant other pairs existed (n = 163).

FINDINGS

Patients' and their significant others' health-related quality of life was at its lowest one month after the operation and improved during follow-up. The change in the mean health-related quality of life score differed between patients and significant others; the improvement in the patients' health-related quality of life was greater than that in the significant others. Neither the background variables used in the study nor social support were associated with change in health-related quality of life.

CONCLUSION

Further research is needed to identify factors explaining the change in health-related quality of life to develop interventions to support patients and significant others.