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Kum C, Miller EL, Jones H, Kean EB, Kreitzer N, Bakas T. Theoretically Based Factors Affecting Stroke Family Caregiver Health: An Integrative Review. West J Nurs Res 2021; 44:338-351. [PMID: 34636275 DOI: 10.1177/01939459211050955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke family caregivers often neglect their own health while providing care. Rigorous reviews have focused on stroke caregiver needs and outcomes; however, a comprehensive review of stroke caregiver health is lacking. The purpose of this integrative review was to determine factors associated with stroke family caregiver health. Using a PRISMA flow diagram and Rayyan software, 41 studies were identified published from January 2000 to December 2020. Databases included Cochrane Reviews, Cochrane Trials, PsycINFO, Ovid MEDLINE, PubMed, EBSCOhost MEDLINE, Embase, and CINAHL. Rigorous guidelines were used to critique the 41 articles. Health measures were global in nature, lacking details regarding health promotion activities important to stroke family caregiver health. Common factors associated with caregiver health were depressive symptoms and burden. Further research is needed to design more situation-specific instruments to measure stroke family caregiver health, as well as interventions to reduce depressive symptoms and burden while promoting caregiver health.
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Affiliation(s)
- Cleopatra Kum
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Elaine L Miller
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Holly Jones
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, Cincinnati, OH, USA
| | - Natalie Kreitzer
- University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
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2
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Wang S, Cheung DSK, Leung AYM, Davidson PM. Bibliotherapy for improving caregiving appraisal of informal caregivers of people with dementia: A pilot randomized controlled trial. Res Nurs Health 2021; 44:692-703. [PMID: 34002406 DOI: 10.1002/nur.22143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/12/2021] [Accepted: 05/05/2021] [Indexed: 11/06/2022]
Abstract
Caregiving appraisal is a key driver to moderating caregiving outcomes. The caregiving appraisal of informal caregivers of people with dementia requires increased attention. This study aimed to explore the feasibility and acceptability of an evidence-based bibliotherapy protocol, and test the efficacy on improving caregiving appraisal. A two-arm pilot randomized controlled trial was adopted. Sixty informal caregivers were randomized to either the intervention group, receiving eight weekly professional-guided bibliotherapy sessions in addition to usual care; or the usual care group. The professional-guided bibliotherapy sessions were weekly sessions in which caregivers self-read the designated chapter and then received telephone coaching. Caregiving appraisal, coping, psychological well-being, positive aspects of caregiving, knowledge of dementia, and attitude toward dementia were assessed both at baseline and immediately after the intervention. Assessors were blinded to group allocation. Individual interviews among 10 participants from the intervention group were conducted to explorecaregivers' acceptance of the intervention. Descriptive statistics, χ 2 test, Mann-Whitney U test, independent t test, generalized estimating equation, and content analysis were used for data analysis. This study pioneered the use of bibliotherapy among informal caregivers of people with dementia. The participant recruitment rate was 69.8%. The attrition rate of the intervention group was 20%. Bibliotherapy had a significant time-by-group interaction effect on caregiving appraisal (p < 0.001), coping (p = 0.003), positive aspects of caregiving (p = 0.001), knowledge of dementia (p = 0.017), and attitude toward dementia (p < 0.001). The effect on psychological well-being, however, was only significant on the personal growth subscale (p = 0.025). The acceptability was also confirmed. No adverse event was documented.
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Affiliation(s)
- Shanshan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.,WHO Collaborating Center for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Angela Yee Man Leung
- WHO Collaborating Center for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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3
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López-Martínez C, Orgeta V, Frías-Osuna A, Del-Pino-Casado R. The mediating role of sense of coherence on mental health outcomes in carers of older dependent relatives: A longitudinal study. Int J Geriatr Psychiatry 2021; 36:722-730. [PMID: 33184903 DOI: 10.1002/gps.5472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sense of coherence (SOC) is an important protective factor for carer well-being but research to date remains cross-sectional, focusing primarily on the direct effects of SOC on carers' mental health. The study's aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers' psychological health, and its stability over time. METHODS Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at 1-year follow-up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care-recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. RESULTS SOC was significantly negatively longitudinally associated with both anxiety (β = -0.38, p = 0.001) and depressive symptoms (β = -0.28, p = 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety, and caregiver strain and depressive symptoms (Sobel test: p < 0.001 for anxiety and p < 0.001 for depressive symptoms). Differences between baseline and 1-year follow-up SOC scores were not statistically significant (p = 0.617). CONCLUSIONS SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non-experimental conditions over a period of 1 year in this sample. The findings suggest that interventions aimed at strengthening SOC may protect carer psychological well-being.
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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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Tsai SJ, Li CC, Tsai SM, Kao SC, Chen HM, Pai HC. Illness Representation and Self-Efficacy: An Exploration of Fatigue Factors in Middle-Aged Stroke Survivors. Clin Nurs Res 2021; 30:1030-1037. [PMID: 33629607 DOI: 10.1177/1054773821997134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients' illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients' self-efficacy, promote patients' resilience, and better function.
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Affiliation(s)
- Su-Ju Tsai
- Chung Shan Medical University Hospital, Taichung, Taiwan.,Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Chi Li
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Mei Tsai
- Chung Shan Medical University Hospital, Taichung, Taiwan.,Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Chuan Kao
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | | | - Hsiang-Chu Pai
- Chung Shan Medical University Hospital, Taichung, Taiwan.,Chung Shan Medical University, Taichung, Taiwan
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5
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Gonçalves-Pereira M, Zarit SH, Papoila AL, Mateos R. Positive and negative experiences of caregiving in dementia: The role of sense of coherence. Int J Geriatr Psychiatry 2021; 36:360-367. [PMID: 32944997 DOI: 10.1002/gps.5433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Sense of coherence (SOC) is increasingly recognized as an important health determinant, particularly for mental health. Part of the evidence comes from informal caregivers in diverse clinical conditions. The extent to which SOC influences caregiving outcomes, however, is relatively under-researched in dementia, particularly regarding positive experiences. We analysed the association of SOC with dementia caregivers' subjective burden, psychological distress and positive aspects of care. METHODS/DESIGN This is a secondary analysis of cross-sectional data from the Lisbon study of Families of Persons with Dementia, involving a convenience sample of 99 primary caregivers of community-dwelling patients of neurology and psychiatry services. SOC was assessed with the Orientation for Life Scale. Measures of caregivers' outcomes were: the Zarit Burden Interview, the General Health Questionnaire for psychological distress and the Positive Aspects of Caregiving scale. Analyses controlled for demographics, caregiving arrangements, objective burden, social support, patients' neuropsychiatric symptoms and dementia stage. RESULTS Lower SOC was associated with higher psychological distress (p = 0.001). No significant associations were found for subjective burden (p = 0.081) or positive aspects of caregiving (p = 0.688). Additional analyses showed that lower SOC was associated with less emotional support (p < 0.001) and past psychiatric illness (p = 0.044). CONCLUSIONS These findings support previous research suggesting that SOC is protective for psychological distress, and extend evidence to the positive aspects of care in dementia. The cross-sectional design and small-scale convenience sampling preclude both causality presumptions and generalizability. SOC assessments may be useful to define subgroups of dementia caregivers at risk for anxiety and depression.
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Affiliation(s)
- Manuel Gonçalves-Pereira
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - Steven H Zarit
- Department of Human Development and Family Studies, Penn State University, University Park, Pennsylvania, USA
| | - Ana L Papoila
- Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Centre of Statistics and its Applications, University of Lisbon (CEAUL), Lisbon, Portugal
| | - Raimundo Mateos
- Department of Psychiatry, University of Santiago de Compostela (USC), Santiago de Compostela, Spain.,Psychogeriatric Unit, CHUS University Hospital, Santiago de Compostela, Spain
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Seixas AA, Chung DP, Richards SL, Madhavaram S, Raghavan P, Gago J, Casimir G, Jean-Louis G. The impact of short and long sleep duration on instrumental activities of daily living among stroke survivors. Neuropsychiatr Dis Treat 2019; 15:177-182. [PMID: 30655670 PMCID: PMC6324604 DOI: 10.2147/ndt.s177527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Stroke survivors generally have problems completing instrumental activities of daily living (IADL; eg, preparing meals, chores, taking a bath, and managing finances). However, it is unclear how stroke survivors might stave off IADL issues. Studies indicating that sleep has restorative neurological effects provide potential mechanisms to address issues with IADL. The aim of this study was to ascertain the association between sleep duration (short or long sleep duration) and IADL among stroke survivors and those without a stroke history. METHODS Data of 486,619 participants were analyzed from the 2000 to 2015 National Health Interview Survey (NHIS), a nationally representative sample. Measures of self-reported stroke, sociodemographic variables, sleep duration, and IADL problems were collected. Binary logistic regression was utilized to analyze the relationship of short (≤6 hours) and long (≥9 hours) sleep duration with limitations to IADL. RESULTS Of the sample, 3% reported a physician-diagnosed stroke event. The mean age was 45.73 years; 52.7% were female; 77.4% were White; 14.2% were Black; 41.3% were married, 62.7% were employed; 31.1% reported that annual family income was less than $35,000; 87% reported good-to-excellent health; and 29.7% reported short sleep (≤6 hours). Approximately 30% of stroke survivors reported IADL problems, and 34.4% who reported IADL problems were short sleepers. Among stroke survivors, long sleepers were 97% more likely than average sleepers to report IADL problems (OR =1.97, 95% CI =1.71-2.26, P<0.001) adjusting for age, sex, race, marital status, poverty, and health. CONCLUSION Findings from our study indicate that, among stroke survivors, long sleepers were more likely to report IADL problems compared to average sleepers (7-8 hours). Future studies should investigate other potential mediators such as severity of stroke, medication, comorbidities, level of impairment, and whether improving sleep among stroke survivors may improve IADL.
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Affiliation(s)
- Azizi A Seixas
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
- Department of Psychiatry, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
| | - Debbie P Chung
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
| | - Shannique L Richards
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
| | - Shreya Madhavaram
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
| | - Preeti Raghavan
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
- Department of Rehabilitation Medicine, NYU Langone Health, NY, New York, USA
| | - Juan Gago
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
- Cervical Cancer Prevention Program, National Cancer Institute of Argentina, Buenos Aires, Argentina
| | - George Casimir
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
- Department of Psychiatry, Center for Healthful Behavior Change, NYU Langone Health, NY, New York, USA,
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Del-Pino-Casado R, Espinosa-Medina A, López-Martínez C, Orgeta V. Sense of coherence, burden and mental health in caregiving: A systematic review and meta-analysis. J Affect Disord 2019; 242:14-21. [PMID: 30170234 DOI: 10.1016/j.jad.2018.08.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/17/2018] [Accepted: 08/01/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Informal caregiving is associated with a number of negative effects on carers' physical and psychological well-being. The salutogenic theory argues that sense of coherence (SOC) is an important factor in psychological adjustment to stress. The main aim of this study was to systematically review current evidence on the association between SOC, burden and mental health outcomes in informal carers. METHOD A systematic search was carried out up to September 2017 in the following databases: PubMed, CINAHL (EBSCO), PsychInfo (OVID) and Scopus. Studies were included if they evaluated the relationship between sense of coherence and subjective caregiver burden and/or mental health outcomes, specifically symptoms of depression and anxiety. Meta-analyses were performed and subgroup analyses were carried out to explore if methodological factors influenced findings. RESULTS Thirty-five studies were included in the meta-analysis, which provided 40 independent samples with 22 independent comparisons for subjective caregiver burden, 26 for symptoms of depression and 7 for symptoms of anxiety. Higher levels of SOC were associated with lower levels of subjective caregiver burden and better mental health outcomes. Publication bias did not change the estimate of the effect. LIMITATIONS Most of the studies included in this review were cross-sectional. CONCLUSIONS Findings suggest that SOC is an important determinant of carer well-being and may protect carers from high levels of psychological distress and caregiver burden.
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Affiliation(s)
| | | | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, United Kingdom
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Alenljung M, Ranada ÅL, Liedberg GM. Struggling with everyday life after mild stroke with cognitive impairments – The experiences of working age women. Br J Occup Ther 2018. [DOI: 10.1177/0308022618800184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The aim of this study was to explore how women of working age who have had a mild stroke resulting in cognitive impairment experience and manage their everyday lives. Method Data were collected using semi-structured interviews. The participants consisted of 10 women of working age who had sustained cognitive impairment after a mild stroke. The interviews were analysed using qualitative content analysis. Results Three main categories appeared: The everyday is affected by the symptoms, Living strategies, and The social environment effects and changes. Participants feel insecure about their abilities and capabilities, experience anxiety and fear in relation to work, and find it hard to live up to demands and expectations. They are required to plan their daily activities in a new way and to prioritise chores that benefit the family, rather than follow their own interests and social activities. In order to cope with everyday life, they need to allocate chores to other family members. Conclusions The constant impact of fatigue and cognitive impairments affects everyday life. The women said that they had to learn to continuously manage their limitations through their experience of everyday life, something that can be facilitated with occupational therapy.
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Affiliation(s)
- Maria Alenljung
- Occupational therapist, Department of Rehabilitation and Department of Social and Welfare Studies, Linköping University, Sweden
| | - Åsa Larsson Ranada
- Lecturer, Department of Social and Welfare Studies, Linköping University, Sweden
| | - Gunilla M Liedberg
- Associate Professor, Department of Social and Welfare Studies, Linköping University, Sweden
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Hutton L, Ownsworth T. A qualitative investigation of sense of self and continuity in younger adults with stroke. Neuropsychol Rehabil 2017; 29:273-288. [PMID: 28274180 DOI: 10.1080/09602011.2017.1292922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Younger adults are more likely to survive after stroke and their life trajectory is often disrupted. This qualitative study aimed to explore the experience of sense of self and continuity in younger adults after stroke. In-depth semi-structured interviews were conducted with 10 adults (3 male, 7 female) with stroke onset between 18 and 55 years of age. Their interview transcripts were analysed using a phenomenological approach that involved idiographic and nomothetic stages of analysis. Two major themes emerged: (1) centrality of stroke; and (2) impacts of stroke on self. The first theme relates to how central the stroke is in participants' lives. The second theme depicts ways in which stroke influences participants' sense of self. In general, participants who perceived their stroke as having lower centrality also experienced continuity of self, whereas participants who viewed their stroke as higher in centrality experienced interruption of self which often co-existed with growth of self. However, perceptions of stroke centrality and the impacts on self shifted over time and context. These findings extend conceptualisations of post-stroke adjustment by indicating that the impact of stroke on sense of self during early to middle adulthood is linked to how central people perceive their stroke to be within their life story. Younger adults may simultaneously experience their sense of self as continuous, interrupted, and grown after stroke.
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Affiliation(s)
- Lauren Hutton
- a School of Applied Psychology and Menzies Health Institute Queensland , Brisbane , Australia
| | - Tamara Ownsworth
- a School of Applied Psychology and Menzies Health Institute Queensland , Brisbane , Australia
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Garton ALA, Sisti JA, Gupta VP, Christophe BR, Connolly ES. Poststroke Post-Traumatic Stress Disorder: A Review. Stroke 2016; 48:507-512. [PMID: 27932604 DOI: 10.1161/strokeaha.116.015234] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/24/2016] [Accepted: 11/09/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew L A Garton
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.).
| | - Jonathan A Sisti
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - Vivek P Gupta
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - Brandon R Christophe
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - E Sander Connolly
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
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