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Mohammadi A, Ghazavi Z, Moghadam MF. The Effect of a Happiness Education Program on the Expressed Emotion and Quality of Life of Mothers of Children with Autism Spectrum Disorder. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:446-451. [PMID: 39205830 PMCID: PMC11349155 DOI: 10.4103/ijnmr.ijnmr_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/20/2024] [Accepted: 03/02/2024] [Indexed: 09/04/2024]
Abstract
Background The mental health of the parents of Autism Spectrum Disorder (ASD), particularly the mothers, is poor due to the severity and complex nature of this condition, and they encounter numerous issues. This investigation aimed to determine whether happiness education affected mothers of children with ASD's Expressed Emotions (EE) and Quality of Life (QoL). Materials and Methods A total of 70 mothers of children with ASD aged 3 to 13 years participated in this clinical trial study research. The experimental group received the Fordyce happiness training program once every 6 weeks via WhatsApp. In three stages, data were collected using a demographic form, the Family Questionnaire (FQ), and the World Health Organization Quality Of Life Instrument, Short Form (WHOQOL-BREF) (before the intervention, immediately afterward, and 1 month later). In the Statistical Package for Social Sciences (SPSS) software, the acquired data were analyzed using independent-sample t-tests, Chi-square tests, and repeated-measures Analysis of Variance (ANOVA). Results There was no significant difference in EE and QoL mean scores between the two groups before the intervention, but after, the intervention group's mean score of EE (20.91 (4.355)) was substantially lower than the control group's (44.74 (4.77)) (p < 0.001). In comparison, the intervention group's mean score of QoL and its dimensions was more significant than the control group's (p < 0.001). Conclusions Given the efficacy of the happiness education program in reducing EE and enhancing QoL in mothers of children with ASD, such treatment strategies should be developed and used.
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Affiliation(s)
- Atiyeh Mohammadi
- MScN, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ghazavi
- MScN, BSN, Nursing and Midwifery Care Research Canter, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Malek Fereidooni Moghadam
- Bsc, MSc, MSN, PhD, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Shi Y, Dong S, Liang Z, Xie M, Zhang H, Li S, Li J. Affiliate Stigma among family caregivers of individuals with dementia in China: a cross-sectional study. Front Public Health 2024; 12:1366143. [PMID: 38873291 PMCID: PMC11169882 DOI: 10.3389/fpubh.2024.1366143] [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: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Background Affiliate stigma experienced by family caregivers of individuals with dementia may seriously affect home care and prognosis of these patients. This study aimed to explore the levels of perceived affiliate stigma and its influencing factors among family caregivers of patients with dementia in mainland China, which remains a relatively unexplored topic. Methods In this cross-sectional study, purposive sampling was used to recruit dementia family caregivers from an online communication group between April and May 2022. A total of 727 eligible caregivers were included and asked to complete the demographic questionnaire, the affiliate stigma scale, and the caregiver burden inventory. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression were used to explore the factors that influence perceived affiliate stigma among dementia family caregivers. Results The mean score for affiliate stigma of dementia family caregivers was 48.09 ± 16.38 (range: 22-86). Whether there were regular breaks during patient care, time-dependent burden, developmental burden, physical burden, and social burden were significant factors influencing the affiliate stigma of dementia family caregivers. Conclusion Dementia family caregivers showed a moderate to high level of affiliate stigma. Those who had regular breaks during patient care, higher time-dependent burden, developmental burden, and physical burden and lower social burden exhibited higher levels of affiliate stigma.
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Affiliation(s)
- Yingying Shi
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Shishi Dong
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Zhiqi Liang
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Mengting Xie
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Hanyi Zhang
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Sixie Li
- School of Nursing, Wenzhou Medical University, Zhejiang, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Zhejiang, China
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Duodu PA, Simkhada B, Okyere J, Akrong R, Barker C, Gillibrand W, Simkhada P. Primary caregivers' experiences of caring for people living with dementia in Ghana: a phenomenological study. BMC Geriatr 2024; 24:304. [PMID: 38561684 PMCID: PMC10985993 DOI: 10.1186/s12877-024-04894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Dementia is often associated with functional impairments that limit the independence of persons living with dementia (PwD). As such, many PwD often require a higher level of support provided by persons referred to as caregivers. Such caregiving activities tend to strain and stress the caregiver. Nonetheless, Ghana lacks empirical evidence and understanding of the effects of caring for PwD on the lives of primary caregivers. To help narrow this knowledge gap, we explored the perspectives of primary caregivers about the impacts of caring for PwD in Ghana. METHODS Using a descriptive phenomenological design, we conducted in-depth interviews with primary caregivers in the Ashanti region, Ghana. A semi-structured interview guide was used as the data collection instrument. The data analysis followed Collazi's thematic analysis framework. All coding and categorization were done in NVivo-12. RESULTS Five themes emerged from the analysis. These themes included (a) sacrifice of personal interests, and time commitments; (b) financial strain and negative impact on job; (c) feelings of stress and burnout; (d) experience of abuse and stigma; and (e) perceived blessing of caregiving. CONCLUSION The study's findings resonate with existing literature, highlighting the consistent struggles faced by caregivers. Sacrificing personal interests, navigating financial strains, and grappling with stress and burnout emerged as pervasive themes. We conclude that despite the negative impacts of caring for PwD, caregivers perceived their role as associated with blessings, deriving positive meaning and fulfilment from their caregiving journey. This study underscores a need to build more compassionate communities in rural settings of Ghana.
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Grants
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
- HHS013-01 Strategic Research Investment Seed Funding, School of Human and Health Sciences, University of Huddersfield
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Affiliation(s)
- Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Bibha Simkhada
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ransford Akrong
- Educational Assessment and Research Center, Osu, Accra, Ghana
| | - Caroline Barker
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Warren Gillibrand
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
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Liu X, Mo W, Takiue K, Kanaya R, Takeya Y, Koujiya E, Yamakawa M. Expressed Emotion in Families of People With Dementia: A Review of Scale-Based Measures. J Gerontol Nurs 2024; 50:17-25. [PMID: 38290096 DOI: 10.3928/00989134-20240110-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE Research on the concept of expressed emotion (EE) has expanded in recent years but its role in dementia still requires elucidation. Understanding the role of EE in the dementia context could help in the development of appropriate interventions. METHOD The current review synthesized relevant literature to investigate the prevalence and correlates of EE status in families of people with dementia. A comprehensive search of four databases from inception to 2022 produced 2,683 papers; 18 studies met inclusion criteria. RESULTS The use of EE criteria differed not only across cultural contexts, but even within the same cultural context. Overall, the prevalence of EE in families with dementia compared with other psychiatric conditions was not high. CONCLUSION Specific changes in EE over time remain to be explored, and findings emphasize the need to carefully discriminate High EE status based on the cultural background of family members with dementia. [Journal of Gerontological Nursing, 50(2), 17-25.].
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Peng Y, Xu R, Li Y, Li L, Song L, Xi J. Dyadic effects of stigma on quality of life in people with schizophrenia and their family caregivers: Mediating role of patients' perception of caregivers' expressed emotion. FAMILY PROCESS 2024. [PMID: 38282434 DOI: 10.1111/famp.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
Schizophrenia, as a stressful diagnosis, profoundly impacts the whole family, especially people with schizophrenia and their caregivers. This study tested the potential mediating role of expressed emotion in the association between mental health stigma and quality of life in caregiver-patient dyads. Using a 2-wave longitudinal design with a 6-month interval between assessments, 161 dyads of patients with schizophrenia and their family caregivers (one patient and one caregiver) completed measures of mental health stigma, expressed emotion, and quality of life. The results showed that patients' self-stigma had no significant actor or partner effect on expressed emotion or quality of life. In contrast, caregivers' stigmatizing attitudes toward patients had a significant partner effect on patients' perception of caregivers' expressed emotion and quality of life. The mediating effect of patients' perception of caregivers' expressed emotion in the association between caregivers' stigmatizing ideas toward patients and patients' quality of life was significant. By focusing on the interdependence of patients and their caregivers, this study highlights the role of caregivers' stigmatizing attitudes toward patients and patients' perception of caregivers' expressed emotion on patients' quality of life. Psychoeducation and interventions should not only aim to reduce the self-stigma of people with schizophrenia but also their caregivers' stigmatizing ideas toward patients. Family interventions targeted at reducing the EE level of caregivers and patients' perception of caregivers' EE would also benefit the adaptation and quality of life of people with schizophrenia and their caregivers.
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Affiliation(s)
- Yanan Peng
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), Positive Education China Academy (PECA) of Han-Jing Institute for Studies in Classics, Juzhe Xi's Master Workroom of Shanghai School Mental Health Service, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Ronghua Xu
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), Positive Education China Academy (PECA) of Han-Jing Institute for Studies in Classics, Juzhe Xi's Master Workroom of Shanghai School Mental Health Service, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yan Li
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), Positive Education China Academy (PECA) of Han-Jing Institute for Studies in Classics, Juzhe Xi's Master Workroom of Shanghai School Mental Health Service, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Ling Li
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), Positive Education China Academy (PECA) of Han-Jing Institute for Studies in Classics, Juzhe Xi's Master Workroom of Shanghai School Mental Health Service, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Lanjun Song
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), Positive Education China Academy (PECA) of Han-Jing Institute for Studies in Classics, Juzhe Xi's Master Workroom of Shanghai School Mental Health Service, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Changning Mental Health Center, Shanghai, China
| | - Juzhe Xi
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), Positive Education China Academy (PECA) of Han-Jing Institute for Studies in Classics, Juzhe Xi's Master Workroom of Shanghai School Mental Health Service, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- China Research Institute of Care and Education of Infants and Young Children, East China Normal University, Shanghai, China
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Bjørge H, Kvaal K, Ulstein I. Quality of Life and Relationships in Caregivers of People With Dementia. A Gender Perspective. Am J Alzheimers Dis Other Demen 2024; 39:15333175241276404. [PMID: 39159602 PMCID: PMC11334129 DOI: 10.1177/15333175241276404] [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: 04/18/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Home-dwelling people with dementia rely on their family members to be able to stay at home. This affects the family caregivers' quality of life (QoL). However, less is known about how male and female caregivers differ in their QoL. Our study aimed to investigate gender differences in caregivers' quality of life (QoL), whether emotional relationships influence QoL, and how their QoL changes over time. The study applied a cross-sectional and a longitudinal design to examine a total of 208 caregivers, 158 female and 50 male caregivers, and their family member with dementia. Regression analysis and t-tests were performed to identify what characteristics about caregivers and care receivers influence male and female QoL, and whether caregivers' QoL developed after one year. Both male and female caregivers' depression influenced their QoL. For females, their own social distress influenced their QoL, and for males, their experience of their care receivers' overemotional attitude influenced their QoL. From baseline to one-year follow-up their QoL decreased while their distress and experience of care receivers' emotional attitudes was stable. Significant gender-specific differences were found, indicating that gender must be considered when approving caregivers' needs and planning interventions for caregivers.
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Affiliation(s)
- Heidi Bjørge
- OsloMet – Oslo Metropolitan University, Faculty of Health, Institute of Nursing and Health Promotion, Oslo, Norway
| | - Kari Kvaal
- Inland Norway University of Applied Sciences, Faculty of Health and Social Sciences, Elverum, Norway
| | - Ingun Ulstein
- The Memory Clinic, Department of Geriatric Medicine, Oslo University Hospital Trust, Oslo, Norway
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Warren A. The relationship between perceived stigma and perceived stress in cognitive decline: a survey of persons with mild cognitive impairment and their caregivers. Front Psychol 2023; 14:1293284. [PMID: 38144994 PMCID: PMC10740212 DOI: 10.3389/fpsyg.2023.1293284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction While Alzheimer's disease and other causes of dementia have rapidly become a global health crisis with growing incidence that is unabated, the incidence of Mild Cognitive Impairment (MCI) far exceeds that of Alzheimer's disease. Persons with MCI demonstrate some level of cognitive impairment, but daily functions remain intact and there is no certainty that they will develop dementia. Yet, the possibility conjures a considerable amount of fear and anxiety, further fueled by a vast array of misconceptions and stigma. The pervasive nature of this stigma permeates society and culture at many levels. Persons with MCI who are at higher risk for development of dementia may be especially vulnerable to fear and stigma associated with the diagnosis. Based on this premise, the primary aim of this study was to examine the relationship between perceived stigma and perceived stress in persons with MCI and their care partners, including the relationship between income and the study variables. The secondary aim was to examine the effect of a combined cognitive rehabilitation and wellness program on these perceptions. Methods Thirty participants were recruited from Mayo Clinic's Health Action to Benefit Independence and Thinking (HABIT) program. MCI (n = 15) and care partner (n = 15) participants completed the Stigma Impact Scale (SIS) and the Perceived Stress Scale (PSS) before and after the HABIT program. Results Average SIS and PSS scores decreased in the MCI, care partner, and combined groups, both pre- and post-HABIT. Linear regression was used to assess the relationship between perceived stigma and stress, controlling for income. A significant relationship was found between perceived stigma and perceived stress both pre and post-HABIT. Discussion The results suggest a relationship exists between perceived stigma and perceived stress in persons with MCI and their care partners, and an educational program such as HABIT may strengthen this relationship by informing participants of potential challenges that occur in cognitive decline. Understanding these relationships may provide an opportunity to provide tools for this vulnerable population.
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Affiliation(s)
- Alison Warren
- The Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Brinkman AH, Barry TD, Lindsey RA. The Relation of Parental Expressed Emotion, Parental Affiliate Stigma, and Typically-developing Sibling Internalizing Behavior in Families with a Child with ASD. J Autism Dev Disord 2023; 53:4591-4603. [PMID: 36180666 DOI: 10.1007/s10803-022-05760-3] [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] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
Caregivers of children with autism spectrum disorder (ASD) experience greater stress, expressed emotion (EE), and affiliate stigma than caregivers of children without ASD. Siblings of children with ASD often experience greater negative functioning than siblings of individuals without ASD. The current study found significant interrelations among symptom severity and externalizing behavior in children with ASD; parental stress, affiliate stigma, and EE; and TD sibling internalizing behavior. In addition, certain subcomponents of affiliate stigma predicted unique variance in EE and TD sibling internalizing behavior. Findings may increase understanding of psychosocial functioning in families with children with ASD and allow clinicians to improve outcomes for all family members. Limitations of the study included self-report data, limited sample diversity, and a cross-sectional design.
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Affiliation(s)
- Aurora H Brinkman
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, 99164-4820, Pullman, WA, USA
| | - Tammy D Barry
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, 99164-4820, Pullman, WA, USA.
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Zhang Q, Deng J, Luo H, Wang L. Senile dementia and psychiatric stigma among community health service providers and relatives of diagnosed and suspected dementia patients: a cross-sectional study. PeerJ 2023; 11:e14613. [PMID: 36647450 PMCID: PMC9840390 DOI: 10.7717/peerj.14613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023] Open
Abstract
Background The number of people suffering from dementia is increasing rapidly in China. Early identification, referral, and intervention for dementia patients within communities are important to public health. However, these measures could be impacted by misconceptions about dementia and associated psychiatric stigma from community health professionals and relatives of dementia patients. Methods A cross-sectional survey was conducted on 249 participants, which included community doctors, community nurses, and relatives of diagnosed and suspected dementia patients in Guiyang, China. Participants were recruited through convenient sampling. The Chinese version of Dementia Knowledge Assessment Scale (DKAS) and the Perceived Psychiatric Stigma Scale (PPSS) were used to evaluate the participants' knowledge of dementia and dementia-related psychiatric stigma. Results A total of 249 participants completed the questionnaire. The participants had moderate overall knowledge of dementia and the associated psychiatric stigma. Participants who were ≥45 years old, had a low level of education, had a low monthly income, or gained knowledge of dementia through non-media channels had lower awareness of dementia and stronger psychiatric stigma. In the "Communication & behavior" subscale of DKAS, all participants had a low level of awareness. Relatives of diagnosed and suspected dementia patients had higher total PPSS and "Marital preclusion" subscale scores than community doctors and nurses but lower psychiatric stigma based on the PPSS "Self-deprecation" subscale score. Conclusions Despite their profession, community doctors and nurses did not show an absolute advantage over relatives of diagnosed and suspected dementia patients in the dementia knowledge, and they even showed higher psychiatric stigma in some subscales. The self-deprecation subscale is related to the identification with negative labels such as "people with a mental illness are the weak". This study shows that reducing stigma on the "Self-deprecation" subscale should be a core component of training and educational programs targeted at improving dementia knowledge among community health service providers.
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Affiliation(s)
- Qiwen Zhang
- Department of Geriatric Psychiatry, The Second People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
| | - Jing Deng
- Department of Psychiatry, The Second People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
| | - Huanyue Luo
- Department of VIP Clinic, The Second People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
| | - Li Wang
- Department of Geriatric Psychiatry, The Second People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
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Analysis of family stigma and socioeconomic factors impact among caregivers of patients with early- and late-onset Alzheimer's disease and frontotemporal dementia. Sci Rep 2022; 12:12663. [PMID: 35879380 PMCID: PMC9314345 DOI: 10.1038/s41598-022-16400-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
To the best of our knowledge, there are no research studies about socioeconomic factors, family stigma, and their psychological impact on early-onset dementia caregivers. We assessed the impact of family stigma and socioeconomic factors on psychological outcomes, quality of life (QoL), and caregiver burden among 150 caregivers of patients with early-onset Alzheimer’s disease due to E280A mutation in presenilin 1 (EOAD), frontotemporal dementia (FTD), and late-onset Alzheimer’s disease (LOAD). Caregivers of patients with EOAD presented a higher frequency of socioeconomic risk factors. Caregivers of FTD presented higher levels of family stigma and a higher prevalence of negative outcomes. We found family stigma to be a more suitable predictor of all outcomes. After adjusting for the type of dementia, dementia stage and behavioral changes, and caregiver age and education, family stigma was the most important factor associated with a higher risk of caregiver burden and a reduction in QoL in terms of energy fatigue and emotional wellbeing among early-onset dementia caregivers.
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Aurooj A, Mahmood Z. Subjective Experiences of Alzheimer's Disease in the Pakistani Cultural Context: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2022; 61:125-138. [PMID: 34250570 DOI: 10.1007/s10943-021-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Studying Alzheimer's disease with the fluctuating environmental, individual, and cultural factors in pertinence to the Diagnostic Statistical Manual (DSM-5) requires information, awareness, and understanding of the disease. Studies have calibrated sociocultural factors to be imperative in the expression of functional symptomology of Alzheimer's disease. Pakistan as a sociocentric, predominantly Muslim country, calls for such efforts. The current research was conducted to study the functional symptomology and experiences of Alzheimer's disease. A qualitative approach was adopted in which in-depth interviews of three dyads of patients with Alzheimer's disease and their caregivers (N = 6) were conducted. Interpretative Phenomenological Analysis was applied to acquire the thematic analysis of data. Results showed sociocentricism as a forefront factor. Cognition, behavior, and emotions were found to be functionally expressed by religion, unawareness, respect of older people, stigmatization, and isolation within family dynamics. The study could be an instigator for further culture-oriented assessment and management providing services.
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Affiliation(s)
- Amna Aurooj
- University of Management and Technology, Lahore, Pakistan.
| | - Zahid Mahmood
- University of Management and Technology, Lahore, Pakistan
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Chang CC, Yeh TY, Su JA. Factors associated with the quality of life in family caregivers of people with dementia in Taiwan. TAIWANESE JOURNAL OF PSYCHIATRY 2022. [DOI: 10.4103/tpsy.tpsy_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Epps F, Foster K, Alexander K, Brewster G, Chester M, Thornton J, Aycock D. Perceptions and Attitudes Toward Dementia in Predominantly African American Congregants. J Appl Gerontol 2021; 40:1511-1516. [PMID: 33487058 PMCID: PMC8302664 DOI: 10.1177/0733464820987350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to identify the perceptions and attitudes of African American congregants toward dementia before and after attending a dementia-focused workshop. Six churches in Metropolitan Atlanta, Georgia, hosted the workshops. Attendees (N = 171) participated in a free association exercise to evaluate their perceptions and attitudes toward dementia. Before and after the workshop, participants wrote words and phrases that occurred to them when they thought of dementia. Content analysis was used to identify themes. Before the workshop, participants' responses tended to include negative language (e.g., fear, memory loss, sadness). After the workshop, participants expressed more positive words (e.g., support, hopefulness, caring). These findings suggest that education can change congregants' perceptions about dementia and potentially reduce dementia-associated stigma. This change will allow families to feel comfortable both interacting with and seeking help from those in their faith communities.
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Zwar L, Angermeyer MC, Matschinger H, Riedel-Heller SG, König HH, Hajek A. Are informal family caregivers stigmatized differently based on their gender or employment status?: a German study on public stigma towards informal long-term caregivers of older individuals. BMC Public Health 2021; 21:1868. [PMID: 34656105 PMCID: PMC8520205 DOI: 10.1186/s12889-021-11955-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Stigma and informal caregiving are determinants for health and wellbeing, but few studies have examined stigma towards informal caregiving. Public stigma may be expressed differently towards caregivers depending on their gender and employment status due to societal norms. Therefore, this study analyzes if there is a difference in public stigma shown by the general population toward informal caregivers of care recipients aged 65 years or older based on the observed caregiver’s gender or working status. Methods A cross-sectional study was conducted in Germany. Data from 1038 adult participants from the general population in Germany were assessed with an Online-Survey. They were recruited with a quota-system based on the German micro census. Participants were randomly assigned to one of 16 vignettes describing a caregiving situation, which varied in the caregiver’s gender and working status, and care recipient’s gender and type of impairment. After reading the vignette, they were asked to provide sociodemographic information and complete three questionnaires on public stigma assessing their emotional (Emotional Reactions), behavioral (Social Distance) and cognitive reaction (Statements on informal caregivers) to the caregiver described in the vignette. Regression analyses, adjusted for sociodemographic data of the participants, were conducted. Results Findings indicated an association between reading about male caregivers and increased social distance, compared with reading about female caregivers. Reading about working caregivers was associated with decreased social distance and increased appreciative statements, compared to reading about non-working caregivers. Analyses after stratifying by gender of the caregiver in the vignette indicated an association between reading about female working caregivers and increased appreciative statements, compared to reading about female non-working caregivers. When stratifying by working status, an association was found between reading about male working caregivers and increased social distance, when compared to reading about female working caregivers. Conclusions This study’s findings indicate that gender and working status of the perceived informal caregivers are of relevance to the public stigma directed towards these caregivers. Male and non-working informal caregivers were shown more public stigma than female and working informal caregivers. Thus, interventions to reduce public stigma, in particular towards male and non-working caregivers, are recommended.
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Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | | | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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15
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Tan EY, de Vugt ME, Deckers K, Schols JM, Verhey FR. Interaction of caregiver-expressed emotions and neuropsychiatric symptoms in persons with dementia: a longitudinal cohort study. BMJ Open 2021; 11:e046869. [PMID: 34588239 PMCID: PMC8480002 DOI: 10.1136/bmjopen-2020-046869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) have a major impact in persons with dementia (PwD). The interaction between the caregiver and the person with dementia may be related to the emergence of NPS. The concept of expressed emotion (EE) is used to capture this dyadic interaction. The aim of the present study is to examine longitudinally the association between EE in caregivers and NPS in PwD living at home. DESIGN A longitudinal cohort study with 2 years of follow-up. SETTING PwD and their informal caregivers living at home in the south of the Netherlands. PARTICIPANTS 112 dyads of PwD and their caregivers from the MAAstricht Study of BEhavior in Dementia. MAIN OUTCOME MEASURES EE was measured at baseline with the Five-Minute Speech Sample and was used to classify caregivers in a low-EE or high-EE group. Associations between EE and neuropsychiatric subsyndromes (hyperactivity, mood and psychosis) measured with the Neuropsychiatric Inventory (NPI) were analysed over time. RESULTS Seventy-six (67.9%) caregivers were classified in the low-EE group and 36 (32.1%) in the high-EE group. There was no difference between the EE groups in mean NPI scores over time. In the high-EE group, hyperactivity occurred more frequently than in the low-EE group at baseline (p=0.013) and at the other time points, but the mean difference was not always significant. There were no differences for the mood and psychosis subsyndromes. PwD with caregivers scoring high on the EE subcategory critical comments had an increased risk of institutionalisation (OR 6.07 (95% CI 1.14 to 32.14, p=0.034)) in comparison with caregivers scoring low on critical comments. CONCLUSIONS High EE in informal caregivers is associated with hyperactivity symptoms in PwD. This association is likely to be bidirectional. Future studies investigating this association and possible interventions to reduce EE are needed.
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Affiliation(s)
- Eva Yl Tan
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Reinier van Arkel Group, s-Hertogenbosch, Netherlands
| | - Marjolein E de Vugt
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Kay Deckers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jos Mga Schols
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Frans Rj Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Altamirano O, Weisman de Mamani A. Risk and Resiliency Factors Related to Dementia Caregiver Mental Health. FAMILY PROCESS 2021; 60:904-919. [PMID: 32619332 DOI: 10.1111/famp.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prevalence rates for dementia are expected to rise exponentially as the elderly population rises. With this comes a corresponding increase in the number of family members who will become dementia caregivers. Caregivers of people with dementia often experience a deterioration in mental health. Identifying factors that relate to caregiver mental health is necessary to develop appropriate interventions. The current study explored how family functioning (measured with a latent variable that includes family cohesion, family balance, and family communication), caregiver expressed emotion (EE), and patient symptom severity related to caregiver mental health (measured with a latent variable that includes depression, anxiety, and stress). Participants included 107 dementia caregivers. The following specific hypotheses were tested: lower levels of both (1) EE and (2) patient symptom severity, and (3) higher levels of family functioning would be related to better caregiver mental health. Results produced a well-fitting model: X2 (18) = 14.858, p = .672; CFI = 1.00; RMSEA = .00; SRMR = .037. Moreover, results indicated that better family functioning (Ɣ = -3.54, SE = 1.34, p = .008), lower levels of caregiver EE (β = .36, SE = 0.07, p < .01), and higher patient symptom severity (β = -3.03, SE = 0.88, p = .001) were related to better caregiver mental health. Results from this study suggest that efforts to bolster family functioning (i.e., enhance communication, promote cohesion, encourage flexibility) could help improve caregiver mental health.
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Affiliation(s)
- Olivia Altamirano
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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17
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Zwar L, Angermeyer MC, Matschinger H, Riedel-Heller SG, König HH, Hajek A. Public stigma towards informal caregiving in Germany: a descriptive study. Aging Ment Health 2021; 25:1515-1524. [PMID: 32347119 DOI: 10.1080/13607863.2020.1758913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aims to investigate the public stigma towards informal caregivers of individuals aged 65 years and older in the German population. METHOD In an Online-Survey 1038 participants (18 years and older and living in Germany) were sampled using a quota-system based on the German micro census data. To assess public stigma towards informal caregiving for individuals aged 65 years and older, three aspects of stigma were assessed: 1) emotional reactions (adapted Emotional Reaction to Mental Illness Scale), 2) behavioral reactions (adapted Social Distance Scale), and 3) cognitive reactions (newly developed List of Cognitions regarding informal caregiving). Exploratory and confirmatory factor analyses were conducted for the development and adaptation of the three instruments, and their composite reliability is provided. RESULTS Emotional reactions in terms of devaluing feelings and feelings of misery were low, while appreciative feelings were neither low nor high. Reported social distance was low. Agreement with cognitions towards informal care in terms of devaluing and accusative cognitions was on average low, but high regarding appreciative cognitions. CONCLUSION The results show that there is stigma towards informal caregiving for older individuals (65 years and older) in terms of emotional reactions, cognitions and social distance, although the magnitude of this stigma seems to be small. Knowledge regarding the occurrence and magnitude of stigma, as well as the processes that underlie this, is needed to prevent stigmatization and its negative outcomes, or at the very least, to enable the development of support for the affected individuals.
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Affiliation(s)
- L Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M C Angermeyer
- Center for Public Mental Health, Gösing am Wagram, Austria
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Meshkinyazd A, Bordbar MF, Heydari A. Experiences of Family Caregivers of Patients with Borderline Personality Disorder of Social Stigma. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:18-24. [PMID: 33954094 PMCID: PMC8074737 DOI: 10.4103/ijnmr.ijnmr_267_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/06/2020] [Accepted: 10/07/2020] [Indexed: 11/05/2022]
Abstract
Background: Social stigma is the most common and challenging burden of care on the family of people with Borderline Personality Disorder (BPD) In Iran, despite the cultural and social influences, this issue has been less studied. Therefore, present study was conducted to determine the lived experiences of caregivers of patients with BPD of social stigma. Materials and Methods: This qualitative study was performed at Ibn Sina hospital in Mashhad, Iran from 2017 to 2019. Participants were selected by purposive and snowball sampling method. Data were collected through semi-structured interviews. Data saturation was achieved after 16 interviews. Finally, the data were analyzed by the method proposed by Diekelmann (1989). Results: In data analysis, one main theme and two sub-themes emerged. The main themes include Black shadow. Two sub-themes consisted of society dagger and secrecy. The sub-theme of society dagger included the two common meanings (inner turmoil in response to the stigma of others and weakening of family status among relatives and acquaintances). The sub-theme of secrecy comprised of the three common meanings (concealment of disease, hide hospitalization, and seclusion). Conclusions: An understanding of the experience of family stigma can lead to the development of supportive strategies to manage this problem among caregivers of patients with BPD. Nurses can support caregivers by offering them opportunities to discuss how stigma is disrupting their caregiving roles. They can also support the caregivers in negotiating the experienced social and emotional distress and when necessary, refer them to the other members of healthcare teams.
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Affiliation(s)
- Ali Meshkinyazd
- PhD Student in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Abbas Heydari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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19
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Wong CSC, Zelman DC. Caregiver expressed emotion as mediator of the relationship between neuropsychiatric symptoms of dementia patients and caregiver mental health in Hong Kong. Aging Ment Health 2020; 24:1690-1699. [PMID: 31274003 DOI: 10.1080/13607863.2019.1636200] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Quality of life among Hong Kong's family dementia caregivers is a current heightened public health concern. This was one of the first East Asian studies to examine the role of family expressed emotion (EE) in the negative caregiver outcomes associated with dementia caregiving. EE comprises overinvolved and critical communications in families of people with mental illness. In this research, caregiver EE was evaluated as a mediator of the relationship between behavioral and psychological problems associated with dementia (BPSD) and negative caregiver outcomes.Method: Participants were 89 Hong Kong family caregivers (79% female, 84% married, 43% >50 years of age) of people with diagnosed dementia, recruited from elder day care centers. Caregivers completed the Neuropsychiatric Inventory (NPI), Cohen Mansfield Agitation Inventory (CMAI), Level of Expressed Emotion scale (LEE), Zarit Burden Interview, and Center for Epidemiological Studies Depression Scale (CES-D).Results: Agitation, delusions, hallucinations, aggression and irritability were BPSD most associated with caregiver burden and depression. EE significantly mediated the BPSD-negative caregiver outcome relationship. Among EE subscales, intrusiveness was significantly more common and less associated with negative caregiver outcomes. Caregiving hours, low family support, and religious nonaffiliation were associated with EE and poorer caregiver outcomes.Conclusions: The negative impact of BPSD on dementia caregivers in Hong Kong is influenced by EE. Higher scores on EE intrusiveness may be partly accounted for by filial piety, a strong sense of family responsibility characterized by high attentiveness to elderly family members. As EE is a potentially modifiable factor, interventions are considered.
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Affiliation(s)
| | - Diane C Zelman
- California School of Psychology, Alliant International University, Hong Kong SAR, China
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20
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Lopez RP, Rose KM, Kenney L, Sanborn V, Davis JD. Managing Shame: A Grounded Theory of How Stigma Manifests in Families Living With Dementia. J Am Psychiatr Nurses Assoc 2020; 26:181-188. [PMID: 30866693 DOI: 10.1177/1078390319832965] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND: Alzheimer's disease and related dementias are irreversible, progressive brain disorders that slowly destroy memory, language, problem solving, and cognition. In the United States, dementia is the fifth leading cause of death for people age 65 years and older. Early diagnosis could have important benefits stigma related to dementia remains a significant impediment to diagnosis, treatment, and accessing services. While a growing body of research documents the existence and negative outcomes of stigma, less is known about how dementia-related stigma produces ill effects. AIMS: The purpose of this study was to use qualitative methods to explore how stigma manifests within families from the perspective of family caregivers of people with dementia. METHOD: Using a grounded theory approach, we interviewed 13 family caregivers of people with dementia. RESULTS: Shame emerged as the central theme experienced by family caregivers of people with dementia. Attempting to manage shame, produced three categories of responses: (1) silencing and not calling attention to the symptoms, (2) concealing the diagnosis, and (3) shunning and avoiding contact. CONCLUSIONS: Shame may be an underlying mechanism by which stigma is enacted and perpetuated, resulting in caregivers' isolation and delay in access to diagnostic and supportive services. Efforts to dispel the misconception that dementia is a shameful disease may be one way to diminish stigma.
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Affiliation(s)
- Ruth Palan Lopez
- Ruth Palan Lopez, PhD, GNP-BC, FGSA FAAN, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Karen M Rose
- Karen M. Rose, PhD, RN, FGSA, FAAN, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Lauren Kenney
- Lauren Kenney, BS Rhode Island Hospital, Providence, RI, USA
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21
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Mar J, Arrospide A, Soto-Gordoa M, Iruin Á, Tainta M, Gabilondo A, Mar-Barrutia L, Calvo M, Mateos M, Ibarrondo O. Dementia-related neuropsychiatric symptoms: inequalities in pharmacological treatment and institutionalization. Neuropsychiatr Dis Treat 2019; 15:2027-2034. [PMID: 31413574 PMCID: PMC6657654 DOI: 10.2147/ndt.s209008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dementia-related neuropsychiatric symptoms (NPS) are the main determinant of family stress and institutionalization of patients. This study aimed to identify inequalities by gender and socioeconomic status in the management of NPS in patients diagnosed with dementia. METHODS An observational study was carried out to study all the cases of dementia in the corporate database of the Basque Health Service (29,864 patients). The prescription of antipsychotics and antidepressants and admission to a nursing home were used to establish the presence of NPS. The socioeconomic status of individuals was classified by a deprivation index. Logistic regressions were used to identify drivers for drug prescriptions and institutionalization. RESULTS NPS are poorly recorded in the clinical databases (12%). Neuropsychiatric symptoms were severe enough in two thirds of patients with dementia to be treated with psychoactive medication. Institutionalization showed an increase from those who did not receive medication to those who had been prescribed antidepressants (OR: 1.546), antipsychotics (OR: 2.075) or both (OR: 2.741). The resulting inequalities were the increased prescription of antidepressant drugs in women and more nursing-home admissions for women who were the least socioeconomically deprived and men who were the most deprived. CONCLUSIONS In large clinical databases, psychoactive drugs prescriptions can be useful to underscore the considerable burden of dementia-related NPS. Specific tools are needed to monitor social and health care programs targeted to dementia-related NPS from a population perspective. Programs aimed at reducing the family burden of care of dementia patients at home become the key elements in reducing inequalities in these patients' care. Socioeconomic status is the most important driver of inequality, and gender inequality may simply be hidden within the social environment. Integrated programs boosting the continuity of care are an objective for which compliance could be measured according to the NPS coding in the electronic health record.
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Affiliation(s)
- Javier Mar
- Clinical Management Unit, OSI Alto Deba, Arrasate-Mondragón, España
- AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, España
- Economic Evaluation Department, Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Arantzazu Arrospide
- AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, España
- Economic Evaluation Department, Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Myriam Soto-Gordoa
- Departamento de Ingeniería de Organización, Mondragón Unibertsitatea, Arrasate-Mondragón, España
| | - Álvaro Iruin
- Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- Psychiatry Service, Gipuzkoa Mental Health Network, Donostia-San Sebastián, España
| | - Mikel Tainta
- Psychiatry Service, CITA Alzheimer Foundation, Donostia-San Sebastián, España
- Neurology Service, OSI Goierri-Alto Urola, Zumárraga, España
| | - Andrea Gabilondo
- Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
- Psychiatry Service, Gipuzkoa Mental Health Network, Donostia-San Sebastián, España
| | - Lore Mar-Barrutia
- Psychiatry Service, Hospital Bellvitge, Hospitalet de Llobregat, España
| | | | - Maider Mateos
- Health Department, Basque Government, Vitoria-Gasteiz, España
| | - Oliver Ibarrondo
- AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, España
- Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
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22
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23
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Balouch S, Rifaat E, Chen HL, Tabet N. Social networks and loneliness in people with Alzheimer's dementia. Int J Geriatr Psychiatry 2019; 34:666-673. [PMID: 30706526 DOI: 10.1002/gps.5065] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/25/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Modifiable lifestyle risk factors are of great interest in the prevention and management of Alzheimer's disease (AD). Loneliness and social networks may influence onset of AD, but little is known about this relationship in people with AD. The current study aimed to explore the relationship between loneliness and social networks (social measures) and cognitive and psychopathology decline (AD outcomes) in people with AD. METHODS Ninety-three participants with mild to moderate AD were recruited from memory clinics, in a cross-sectional study. Social networks (measured by the Lubben Social Network Scale-6), feelings of loneliness (measured by De Jong Loneliness Scale), cognition (measured by the Standardized Mini-Mental State Examination), and psychopathology (measured by the Neuropsychiatric Inventory) were assessed in an interview setting. Two multiple regressions with bootstrap were conducted on cognition and psychopathology as outcome variables. Family and friends subsets of social networks and loneliness were entered as predictors and age, gender, and depression as covariates. RESULTS The friendship subset of social networks was significantly related to cognition (independent of age, gender, depression, loneliness, and family subset of social network): B = 0.284, P = 0.01. Neither loneliness nor social networks predicted psychopathology (Ps > 0.05). CONCLUSIONS Maintaining or developing a close friendship network could be beneficial for cognition in people with AD. Alternatively, greater dementia severity may lead to fewer friends. More research on the direction of this relationship in people with AD is needed.
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Affiliation(s)
- Sara Balouch
- Brighton and Sussex Medical School, Brighton, UK
| | - Enas Rifaat
- Brighton and Sussex Medical School, Brighton, UK
| | - Henglien Lisa Chen
- Department of Social Work and Social Care, University of Sussex, Brighton, UK
| | - Naji Tabet
- Brighton and Sussex Medical School, Brighton, UK
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Leggett A, Kales HC, Gitlin L. Finding fault: Criticism as a care management strategy and its impact on outcomes for dementia caregivers. Int J Geriatr Psychiatry 2019; 34:571-577. [PMID: 30556172 PMCID: PMC6420398 DOI: 10.1002/gps.5052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/09/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite a large literature on the stress process, little attention has focused on how caregivers for persons living with dementia (PLWDs) provide care and how this may impact care outcomes. Criticism is a management strategy caregivers may use to respond to behavioral symptoms. We consider whether criticism is associated with caregivers' mental health and service utilization. METHODS Data are drawn from the Advancing Caregiver Training intervention study including 256 informal caregivers living with a PLWD. In multiple linear regressions controlling for caregivers' demographics and PLWDs' clinical factors, we consider criticism (criticism subscale of the Dementia Management Strategies Scale) as a predictor of caregiver burden, depressive symptoms, desire to institutionalize the PLWD, level of frustration with care, and the number of home-based, social, and health services utilized. RESULTS On average, 15% of the sample sometimes reported using criticism as a management strategy to manage the challenges of care. Greater use of criticism was associated with significantly more caregiver burden (β = 0.26, P < 0.001) and frustration with caregiving (β = 0.66, P < 0.001), but not depressive symptoms or a desire to institutionalize the PLWD. Criticism was also associated with significantly greater utilization of home-based (β = 0.14, P < 0.05) and social services (β = 0.15, P < 0.05), but not health care services. CONCLUSION Criticism appears to be used by more burdened and frustrated caregivers. The association of criticism with social and home-based services potentially reflects a need for greater support among this group of caregivers. Behavioral interventions that can help caregivers manage behavioral symptoms with positive, empirically validated strategies may be helpful.
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Affiliation(s)
- Amanda Leggett
- Program for Positive Aging and Department of Psychiatry, University of Michigan
| | - Helen C. Kales
- Program for Positive Aging and Department of Psychiatry, University of Michigan
| | - Laura Gitlin
- Distinguished University Professor and Dean, Drexel University, Adjunct Professor, Johns Hopkins School of Nursing
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25
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Saffari M, Lin CY, Koenig HG, O'Garo KGN, Broström A, Pakpour AH. A Persian version of the Affiliate Stigma Scale in caregivers of people with dementia. Health Promot Perspect 2019; 9:31-39. [PMID: 30788265 PMCID: PMC6377701 DOI: 10.15171/hpp.2019.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Dementia is prevalent among older adults and frequently causes dependence on family caregivers. Caregivers may experience a form of stigmatization called affiliate stigma that negatively affects their mental health. The current study sought to establish the psychometric properties of a tool to measure affiliate stigma among Iranian caregivers. Methods: Overall, 541 caregivers of older people with dementia were included in this cross sectional study. Several measures were used to assess the psychometric properties of the Affiliate Stigma Scale (ASS) including the Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale (HADS), Short Form 12 (SF-12), Rosenberg Self-Esteem Scale (RSES), and Multidimensional Scale of Perceived Social Support (MSPSS). Convergent and discriminate validity were examined.Exploratory and confirmatory factor analyses were utilized to assess the factor structure of the Ass and a Rasch model was used to evaluate the measurement functioning of the scale. Results: Factor loadings ranged from 0.69 to 0.83 and test-retest reliability from 0.72 to 0.89.Item difficulty ranged widely from -0.66 to 0.89. No considerable differential item functioning (DIF) was found across gender. Confirmatory factor analysis confirmed the three cognitive,effective, and behavioral dimensions of the scale (comparative fit index [CFI]=0.931 to 0.995,root mean square error of approximation [RMSEA]=0.046 to 0.068). Internal consistency was acceptable (Cronbach’s α: 0.88 to 0.94). Significant and positive relationships were found between affiliate stigma and depression, anxiety, and care giving burden (β =0.35 to 0.46). Conclusion: The ASS is a psychometrically valid measure for assessing affiliate stigma in Iranian caregivers of people with dementia. Application of this tool among other caregivers, language sand cultures deserves further study.
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Affiliation(s)
- Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Harold G Koenig
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Adjunct Professor, King Abdulaziz University, Jeddah, Saudi Arabia.,Adjunct Professor, Ningxia Medical University, Yinchuan, China
| | - Keisha-Gaye N O'Garo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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