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López-Martínez C, Orgeta V, Frías-Osuna A, Del-Pino-Casado R. Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden. J Nurs Scholarsh 2024; 56:371-381. [PMID: 38282022 DOI: 10.1111/jnu.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time. DESIGN Prospective longitudinal study. METHODS We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time. RESULTS Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping. CONCLUSIONS Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers. CLINICAL RELEVANCE Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.
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Affiliation(s)
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Antonio Frías-Osuna
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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Cardile D, Corallo F, Ielo A, Cappadona I, Pagano M, Bramanti P, D’Aleo G, Ciurleo R, De Cola MC. Coping and Quality of Life Differences between Emergency and Rehabilitation Healthcare Workers. Healthcare (Basel) 2023; 11:2235. [PMID: 37628433 PMCID: PMC10454017 DOI: 10.3390/healthcare11162235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Audit and Feedback (A&F) is a systematic process involving the collection of data, which are subsequently compared with the established reference standards and then subsequently disseminated to healthcare providers through feedback meetings. This allows continuous improvement to be ensured in the quality of care processes. Often, the parameters taken into account concern only the patient and the treatment processes, neglecting other variables. Quality of life in the workplace and coping skills are determining variables for the clinical performance of all healthcare professionals. For this reason, in this study, these variables were investigated and differences were highlighted in two different role categories and context: cardiovascular emergency and neurological rehabilitation. A psychological screening was carried out by sending the computerized Coping Orientation to Problems Experienced-Nuova Versione Italiana (COPE-NVI) and Professional Quality of Life Scale-5 (ProQoL) questionnaires to all healthcare workers involved. Ninety-five healthcare providers (mean ± SD age: 47 ± 10.4 years; 37.9% male) answered the questionnaire and were assigned into two groups (G1 and G2) based on the ward in which they worked. These were further divided into two subgroups (R1 and R2) based on their role. The obtained results show that avoidance strategies are used more by health professionals working in rehabilitation (G2) wards than in intensive-care units (G1). Moreover, in G1 nurses, physical therapists and speech therapists (R2) obtained higher scores in terms of turning to religion (TR) and compassion satisfaction (CS), while physicians and psychologists (R1) obtained higher scores on the burnout scale (BO). The TR score for R2 was found to be higher, even in G2. The response trend of the two groups in the different departments was analyzed and commented on.
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Affiliation(s)
- Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Augusto Ielo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Irene Cappadona
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Maria Pagano
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
- Faculty of Psychology, Università degli Studi eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
| | - Giangaetano D’Aleo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Rosella Ciurleo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (D.C.); (A.I.); (I.C.); (M.P.); (P.B.); (G.D.); (R.C.); (M.C.D.C.)
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Fauth EB, Novak JR, Levin ME. Outcomes from a pilot online Acceptance and Commitment Therapy program for dementia family caregivers. Aging Ment Health 2022; 26:1620-1629. [PMID: 34233133 DOI: 10.1080/13607863.2021.1942432] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Psychosocial and cognitive-behavioral dementia caregiver interventions are effective, yet accessing counselor/therapist-led programs can be costly and difficult. Face-to-face therapist-led Acceptance and Commitment Therapy (ACT) is highly effective in dementia caregivers, as established by two different randomized control trials. The current study evaluates a pilot ACT for Caregivers program, which is a community-based, self-guided, online adaptation of ACT. METHOD Participants (N = 51; Mage=66.0 S. D =11.7, 80% women) completed 10 self-guided sessions teaching ACT, along with accessing an online dementia education library. RESULTS Repeated measures ANOVA from pre-, posttest, and 4-week follow-up demonstrated decreased depressive symptoms, burden, and stress reactions to behavioral symptoms, and increased positive aspects of caregiving and quality of life. ACT-specific measures improved, with decreases in cognitive fusion and psychological inflexibility (AAQ-II), and improvements in living according to personal values (ValuingProgress increased; ValuingObstruction decreased). All outcomes were statistically significant (at p < .01) and sustained over 4-week follow-up. Although this was a non-clinical sample, the program demonstrated clinical significance, as average depressive symptoms were at the clinical cutoff at baseline, but one standard deviation below clinical cut-off at post-test and 4-week followup. Use of education materials was low (29% of participants used these, albeit rating them helpful), suggesting that ACT likely contributed more to overall improvements. CONCLUSION The online ACT for Caregivers pilot program offers an empirically supported translation of traditional ACT, improving accessibility, and affordability for family dementia caregivers.
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Affiliation(s)
- Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, AL, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT, USA
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Cheng HL, Lin TC, Tan WK, Chiu CM. Understanding employees' response to work-related after-hours use of instant messaging apps: a stress and coping perspective. ONLINE INFORMATION REVIEW 2021. [DOI: 10.1108/oir-06-2020-0214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to examine the complex relationships between permeability, work-family conflict, moral disengagement, behavioral disengagement, job strain and job engagement. In addition, this study aims to determine whether moral disengagement acts as a moderator and mediator in the relationship between work-family conflict and behavioral disengagement.Design/methodology/approachThe authors apply partial least squares structural equation modeling to test the hypotheses, using a sample of 176 valid responses.FindingsThe results indicate that permeability is likely to promote work-family conflict, which in turn may trigger moral disengagement. Moral disengagement may lead to behavioral disengagement, which in turn may increase job strain and decrease job engagement. The findings also show that work-family conflict does not have a significant effect on behavioral disengagement, suggesting that moral disengagement fully mediates the influence of work-family conflict on behavioral disengagement. In addition, the moderating effect of moral disengagement is not significant.Originality/valueApplying the transactional model of stress and coping theory and the moral disengagement theory, this study contributes to a better understanding of employees' experience of job strain caused by work-family conflict (induced by permeability of IM usage), as well as the employee's coping response.
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Fowler NR, Judge KS, Lucas K, Gowan T, Stutz P, Shan M, Wilhelm L, Parry T, Johns SA. Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer's disease and related dementias. BMC Geriatr 2021; 21:127. [PMID: 33593296 PMCID: PMC7885205 DOI: 10.1186/s12877-021-02078-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Caregivers of patients with Alzheimer’s disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility. Methods ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor’s-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire–9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE). Results All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as “completely satisfied.” At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased. Conclusions Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach. Trial registration Institutional Review Board (IRB) protocol #1904631305 version 05-14-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019.
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Affiliation(s)
- Nicole R Fowler
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA. .,Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA.
| | - Katherine S Judge
- Department of Psychology, College of Sciences and Health Professions, Cleveland State University, 1836 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Kaitlyn Lucas
- Department of Psychology, College of Sciences and Health Professions, Cleveland State University, 1836 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Tayler Gowan
- Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA
| | - Patrick Stutz
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA
| | - Mu Shan
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Department of Biostatistics, School of Medicine, Indiana University, 410 W. 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Laura Wilhelm
- Department of Behavioral Medicine and Psychiatry, West Virginia University, 3200 MacCorkle Ave., SE, Charleston, WV, 25304, USA
| | - Tommy Parry
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 N Blackford St, Indianapolis, IN, 46202, USA
| | - Shelley A Johns
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 N Blackford St, Indianapolis, IN, 46202, USA.,IUPUI Research in Palliative and End-of-Life Communication and Training Center, Indiana University-Purdue University Indianapolis, Indianapolis, USA
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Lam TP, Sun KS, Chan HY, Lau CS, Lam KF, Sanson-Fisher R. Perceptions of Chinese Towards Dementia in Hong Kong-Diagnosis, Symptoms and Impacts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010128. [PMID: 30621271 PMCID: PMC6339208 DOI: 10.3390/ijerph16010128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/16/2022]
Abstract
The increasing prevalence of dementia has become a public health issue worldwide including China. This study aims to explore the perception of Chinese in Hong Kong towards the diagnosis, symptoms and impacts of dementia. A cross-sectional survey was conducted among outpatients (without diagnosed dementia) attending a regional public hospital using a standard questionnaire. The results from 290 respondents showed that most preferred to be told about the diagnosis of dementia as soon as possible if they got it, in order to deal with the news and to access treatment and support early. Nearly two thirds of the respondents perceived practical issues (61.3%), physical health (61.0%), and emotional distress (58.4%) as their most fearful impacts, while legal issues (7.4%) were their least concerns. Family history/genes (79.1%) and brain injury (75.9%) were the most commonly perceived causes of dementia. For symptoms, respondents were more likely to identify cognitive impairments than undesirable behaviours. The accepting and proactive attitudes of the public indicate that there is a timely need of more public education about the disease, early screening and better continuity of care to fulfil the anticipated increase of the dementia patient population.
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Affiliation(s)
- Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
| | - Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
| | - Hoi Yan Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China.
| | - Robert Sanson-Fisher
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia.
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Stressors and anxiety in dementia caregiving: multiple mediation analysis of rumination, experiential avoidance, and leisure. Int Psychogeriatr 2016; 28:1835-1844. [PMID: 27457894 DOI: 10.1017/s1041610216001009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the robust associations between stressors and anxiety in dementia caregiving, there is a lack of research examining which factors contribute to explain this relationship. This study was designed to test a multiple mediation model of behavioral and psychological symptoms of dementia (BPSD) and anxiety that proposes higher levels of rumination and experiential avoidance and lower levels of leisure satisfaction as potential mediating variables. METHODS The sample consisted of 256 family caregivers. In order to test a simultaneously parallel multiple mediation model of the BPSD to anxiety pathway, a PROCESS method was used and bias-corrected and accelerated bootstrapping method was used to test confidence intervals. RESULTS Higher levels of stressors significantly predicted anxiety. Greater stressors significantly predicted higher levels of rumination and experiential avoidance, and lower levels of leisure satisfaction. These three coping variables significantly predicted anxiety. Finally, rumination, experiential avoidance, and leisure satisfaction significantly mediated the link between stressors and anxiety. The explained variance for the final model was 47.09%. Significant contrasts were found between rumination and leisure satisfaction, with rumination being a significantly higher mediator. CONCLUSIONS The results suggest that caregivers' experiential avoidance, rumination, and leisure satisfaction may function as mechanisms through which BPSD influence on caregivers' anxiety. Training caregivers in reducing their levels of experiential avoidance and rumination by techniques that foster their ability of acceptance of their negative internal experiences, and increase their level of leisure satisfaction, may be helpful to reduce their anxiety symptoms developed by stressors.
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Yang H, Jung S, Seo J, Khalid A, Yoo JS, Park J, Kim S, Moon J, Lee ST, Jung KH, Chu K, Lee SK, Jeon D. Altered behavior and neural activity in conspecific cagemates co-housed with mouse models of brain disorders. Physiol Behav 2016; 163:167-176. [DOI: 10.1016/j.physbeh.2016.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
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Lau Y, Wang Y, Kwong DHK, Wang Y. Testing direct and moderating effects of coping styles on the relationship between perceived stress and antenatal anxiety symptoms. J Psychosom Obstet Gynaecol 2015; 36:29-35. [PMID: 25541216 DOI: 10.3109/0167482x.2014.992410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to test the direct and moderating effects of different coping styles in mitigating perceived stress associated with antenatal anxiety symptoms among 755 pregnant women in Chengdu. METHODS A cross-sectional study using a questionnaire survey was carried out. The Perceived Stress Scale, the Trait Coping Style Questionnaire and the Zung Self-rating Anxiety Scale were used to measure stress, coping and anxiety symptoms, respectively. Hierarchical regression analysis was used to test the direct and moderating effects of coping styles in the relationship between perceived stress and antenatal anxiety symptoms. RESULTS Direct effects of negative coping (NC) styles were found. Women with higher NC scores were more likely to have anxiety symptoms. Positive coping (PC) styles had moderating effects on perceived stress, whereas NC styles did not. CONCLUSION The findings of this study highlight the direct and moderating effects of coping styles. This knowledge is important to healthcare professionals in planning health service provision. Health services should dedicate resources to teaching pregnant women how to enhance PC styles, alter NC styles and cultivate optimistic thinking to alleviate anxiety symptoms.
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Affiliation(s)
- Ying Lau
- School of Health Sciences, Macao Polytechnic Institute , Macao , China
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Geiger JR, Wilks SE, Lovelace LL, Chen Z, Spivey CA. Burden among male Alzheimer's caregivers: effects of distinct coping strategies. Am J Alzheimers Dis Other Demen 2015; 30:238-46. [PMID: 25267930 PMCID: PMC10852689 DOI: 10.1177/1533317514552666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Focusing on the understudied, increasing population of male Alzheimer's disease (AD) caregivers, the purpose of this study was to identify their likelihood of utilizing 3 coping strategies (task focused, emotion focused, and avoidance focused) and to examine the effects of each coping strategy on caregiving burden. Data were collected from 138 male AD caregivers in southern United States, including geographically proportional representation of African Americans in the sample. Stepwise regression revealed effects of each coping strategy on caregiving burden, controlling for demographics. The sample reported high burden. Task focused was the highest reported coping strategy. Yet, regression models indicated no significant effect of task-focused coping on burden outcomes. Emotion-focused and avoidance-focused coping each showed significant proportional effects on burden. Implications suggest that emotion- and avoidance-focused coping among male AD caregivers may be maladaptive, that is, reinforcing burden. Male AD caregivers may benefit from more task-focused coping, such as planning and active problem solving.
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Affiliation(s)
- Jennifer R Geiger
- Louisiana State University School of Social Work, Baton Rouge, LA, USA
| | - Scott E Wilks
- Louisiana State University School of Social Work, Baton Rouge, LA, USA
| | - Lauren L Lovelace
- Louisiana State University School of Social Work, Baton Rouge, LA, USA Baton Rouge General Medical Center, Baton Rouge, LA, USA
| | - Zibei Chen
- Louisiana State University School of Social Work, Baton Rouge, LA, USA
| | - Christina A Spivey
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
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Abstract
PURPOSE OF REVIEW Carers of people with dementia are at increased risk of experiencing psychological distress. This article reviews recent findings on the role of personality traits for psychological outcomes for carers of people with dementia. RECENT FINDINGS Several studies have now established that personality influences the caregiving experience, carer well-being and outcomes such as coping ability, burden and caregiving style. Several moderators of these associations have also been identified such as the effect of kinship and type of dementia. There is consistent evidence that carer personality characteristics influence the progression of the disease such as cognitive decline and severity. Most of the recent studies identified in this review are cross-sectional. SUMMARY Taken together, these results indicate that personality is an important psychological resource for carers. Recent findings indicate that personality traits are associated with and influence both carer and patient outcomes. Future research is necessary to guide interventions and to expand further on our understanding of how personality factors shape adjustment to the caregiving role and how these impact on the progression of the disease.
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Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D, Romeo R, Livingston D, Mummery C, Walker Z, Hoe J, Cooper C. Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. Lancet Psychiatry 2014; 1:539-48. [PMID: 26361313 DOI: 10.1016/s2215-0366(14)00073-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Two-thirds of people with dementia live at home supported mainly by family carers. These carers frequently develop clinical depression or anxiety, which predicts care breakdown. We aimed to assess the clinical effectiveness (long-term reduction of depression and anxiety symptoms in family carers) and cost-effectiveness of a psychological intervention called START (STrAtegies for RelaTives). METHODS We did a randomised, parallel-group trial with masked outcome assessments in three UK mental-health services and one neurological-outpatient dementia service. We included self-identified family carers of people with dementia who had been referred in the previous year and gave support at least once per week to the person with dementia. We randomly assigned these carers, via an online computer-generated randomisation system from an independent clinical trials unit, to either START, an 8-session, manual-based coping intervention delivered by supervised psychology graduates, or treatment as usual (TAU). The primary long-term outcomes were affective symptoms (Hospital Anxiety and Depression Scale total score [HADS-T]) 2 years after randomisation and cost-effectiveness (health and social care perspectives) over 24 months. Analysis was by intention to treat, excluding carers with data missing at both 12 and 24 months. This trial is registered ISCTRN70017938. FINDINGS From November 4, 2009, to June 8, 2011, we recruited 260 carers. 173 carers were randomly assigned to START and 87 to TAU. Of these 260 participants, 209 (80%) were included in the clinical efficacy analysis (140 START, 69 TAU). At 24 months, compared with TAU the START group was significantly better for HADS-T (mean difference -2·58 points, 95% CI -4·26 to -0·90; p=0·003). The intervention is cost effective for both carers and patients (67% probability of cost-effectiveness at the £20 000 per QALY willingness-to-pay threshold, and 70% at the £30 000 threshold). INTERPRETATION START is clinically effective, improving carer mood and anxiety levels for 2 years. Carers in the control TAU group were seven times more likely to have clinically significant depression than those receiving START. START is cost effective with respect to carer and patient outcomes, and National Institute for Health and Care Excellence (NICE) thresholds. The number of people with dementia is rapidly growing, and policy frameworks assume that their families will remain the frontline providers of (unpaid) support. This cost-neutral intervention, which substantially improves family-carers' mental health and quality of life, should therefore be widely available. FUNDING National Institute for Health Research Health Technology Assessment programme 08/14/06.
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Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
| | - Julie Barber
- Statistical Science and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Mark Griffin
- Statistical Science and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Derek King
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Renee Romeo
- Institute of Psychiatry, King's College London, London, UK
| | | | - Cath Mummery
- Institute of Neurology, University College London, London, UK
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK; North Essex Partnership University NHS Foundation Trust, Chelmsford, UK
| | - Juanita Hoe
- Division of Psychiatry, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Reevy GM, Deason G. Predictors of depression, stress, and anxiety among non-tenure track faculty. Front Psychol 2014; 5:701. [PMID: 25071667 PMCID: PMC4085875 DOI: 10.3389/fpsyg.2014.00701] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/18/2014] [Indexed: 11/26/2022] Open
Abstract
Nationwide in the United States, 70% of faculty members in higher education are employed off the tenure-track. Nearly all of these non-tenure-track (NTT) appointments share a quality that may produce stress for those who hold them: contingency. Most NTT appointments are contingent on budget, enrollment, or both, and the majority of contingent faculty members are hired for one quarter or semester at a time. Significant research has investigated the effects of contingency on teaching, students, departments, colleges, and universities; however, little research has focused on the psychological experiences of NTT faculty. The current study examined perceptions of workplace stressors and harm, organizational commitment, common coping mechanisms, and depression, anxiety and stress among NTT faculty using a longitudinal design that spanned 2-4 months. Results indicate that NTT faculty perceive unique stressors at work that are related to their contingent positions. Specific demographic characteristics and coping strategies, inability to find a permanent faculty position, and commitment to one's organization predispose NTT faculty to perceive greater harm and more sources of stress in their workplaces. Demographic characteristics, lower income, inability to find a permanent faculty position, disengagement coping mechanisms (e.g., giving up, denial), and organizational commitment were associated with the potential for negative outcomes, particularly depression, anxiety, and stress. Our findings suggest possibilities for institutional intervention. Overall, we argue that universities would be well-served by attending to the needs of NTT faculty on campus in order to mitigate negative outcomes for institutions, students, and faculty.
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Affiliation(s)
- Gretchen M Reevy
- Department of Psychology, California State University, East Bay Hayward, CA, USA
| | - Grace Deason
- Department of Psychology, University of Wisconsin-La Crosse La Crosse, WI, USA
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Sommerlad A, Manela M, Cooper C, Rapaport P, Livingston G. START (STrAtegies for RelaTives) coping strategy for family carers of adults with dementia: qualitative study of participants' views about the intervention. BMJ Open 2014; 4:e005273. [PMID: 24898089 PMCID: PMC4054623 DOI: 10.1136/bmjopen-2014-005273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To analyse the experience of individual family carers of people with dementia who received a manual-based coping strategy programme (STrAtegies for RelaTives, START), demonstrated in a randomised-controlled trial to reduce affective symptoms. DESIGN A qualitative study using self-completed questionnaires exploring the experience of the START intervention. Two researchers transcribed, coded and analysed completed questionnaires thematically. SETTING Three mental health and one neurology dementia clinic in South East England. PARTICIPANTS Participants were primary family carers of a patient diagnosed with dementia who provided support at least weekly to their relative. We invited those in the treatment group remaining in the START study at 2 years postrandomisation (n=132) to participate. 75 people, comprising a maximum variation sample, responded. PRIMARY AND SECONDARY OUTCOME MEASURES (1) Important aspects of the therapy. (2) Continued use of the intervention after the end of the therapy. (3) Unhelpful aspects of the therapy and suggestions for improvement. (4) Appropriate time for intervention delivery. RESULTS Carers identified several different components as important: relaxation techniques, education about dementia, strategies to help manage the behaviour of the person with dementia, contact with the therapist and changing unhelpful thoughts. Two-thirds of the participants reported that they continue to use the intervention's techniques at 2-year follow up. Few participants suggested changes to the intervention content, but some wanted more sessions and others wanted the involvement of more family members. Most were happy with receiving the intervention shortly after diagnosis, although some relatives of people with moderate dementia thought it should have been delivered at an earlier stage. CONCLUSIONS Participants' varied responses about which aspects of START were helpful suggest that a multicomponent intervention is suited to the differing circumstances of dementia carers, providing a range of potentially helpful strategies. The continued use of the strategies 2 years after receiving the intervention could be a mechanism for the intervention remaining effective.
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Affiliation(s)
| | - Monica Manela
- Division of Psychiatry, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
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