Structural Equation Modeling of Parkinson's Caregiver Social Support, Resilience, and Mental Health: A Strength-Based Perspective

The influence of resilience and social support on mental health of older adults living in community: a cross-sectional study

BACKGROUND

Mental health is an important fundamental element of health that influences different dimensions of an older individual's life. There are various factors that affect the mental health of older adults, such as resilience and social support. However, the relationship between various factors and mental health is unclear. Purposes of the study were to investigates whether resilience and social support affect the mental health of older adults and to analyze the structural equation model of mental health among the older adults with resilience as a mediating variable.

METHODS

A cross-sectional study was conducted among 964 older adults by multi-stage random sampling. The data were collected using the following questionnaires: Thai Elderly Resilience Scale, Social Support Scale, and Thai Geriatric Mental Health Assessment. Data analysis used descriptive statistics, Pearson's correlation, and Path analysis.

RESULTS

The older adults had a high level of resilience, social support, and mental health (MH). The best model we obtained demonstrated that social support and resilience had directly statistically significant influences the MH. Social support also had statistically significant indirect effect via resilience to the MH.

CONCLUSION

Understanding the factors that influence mental health of older adults can be beneficial for health professionals to provide appropriate social support and resilience, including helping the older adult can join with others, be confident in life, have necessities, live with spiritual security, and be able to de-stress and management problems were recommended.

Resilience as a protective factor against depression in informal caregivers

Introduction

Although previous research has demonstrated that resilience can be protective against various mental health conditions such as depression, existing studies examining the relationship between resilience and depression have limitations. To our knowledge, the moderators of the relationship have not been examined. The aim of this study was to determine whether resilience acts as a protective factor against depression in informal caregivers and to examine potential moderators of the relationship between these variables.

Methods

In this cross-sectional study, 554 randomly selected informal caregivers participated (86.8% women, average age = 55.3 years). Major depressive episode, depressive symptomatology, resilience, positive environmental reward, negative automatic thoughts, self-efficacy, and personality were assessed.

Results

A total of 16.1% of informal caregivers met criteria for a depressive episode and 57.4% were at risk of developing depression. The average resilience score was 26.3 (SD = 7.6); 62.6% of participants were in the lower quartile of the resilience scale. The gender of the informal caregiver and self-efficacy acted as moderating variables in the relationship between resilience and depression. The impact of resilience on depressive symptoms was more pronounced in female informal caregivers, and increased as self-efficacy increased.

Discussion

Based on these findings, programs aimed at preventing depression in informal caregivers should focus on promoting resilience, especially in women, and introduce strategies to enhance self-efficacy to increase their impact.

Caregiver Burden in Parkinson Disease: A Scoping Review of the Literature from 2017-2022

Caregiver burden is a term that refers to the adverse effect of caregiving on the physical, emotional, social, spiritual, and financial well-being of the caregiver. Caregiver burden is associated with providing care to an individual with a chronic illness or disability, and the unique symptoms of Parkinson disease (PD) can amplify a patient's needs and reliance on others, leading to adverse outcomes for patients and their caregivers. In this scoping review of the literature from January 2017 through April 2022 that included 114 studies, we provide an updated, evidence-based summary of patient and caregiver-related factors that contribute to caregiver burden in PD. We also describe the impact of caregiver stress and burden on caregivers based on qualitative research studies and review recent interventions to mitigate burden. By providing clinical updates for practitioners, this review is designed to improve recognition of caregiver burden in the post-pandemic era and foster the development of targeted interventions to reduce caregiver burden in PD.

Pathobiology of Cognitive Impairment in Parkinson Disease: Challenges and Outlooks

Cognitive impairment (CI) is a characteristic non-motor feature of Parkinson disease (PD) that poses a severe burden on the patients and caregivers, yet relatively little is known about its pathobiology. Cognitive deficits are evident throughout the course of PD, with around 25% of subtle cognitive decline and mild CI (MCI) at the time of diagnosis and up to 83% of patients developing dementia after 20 years. The heterogeneity of cognitive phenotypes suggests that a common neuropathological process, characterized by progressive degeneration of the dopaminergic striatonigral system and of many other neuronal systems, results not only in structural deficits but also extensive changes of functional neuronal network activities and neurotransmitter dysfunctions. Modern neuroimaging studies revealed multilocular cortical and subcortical atrophies and alterations in intrinsic neuronal connectivities. The decreased functional connectivity (FC) of the default mode network (DMN) in the bilateral prefrontal cortex is affected already before the development of clinical CI and in the absence of structural changes. Longitudinal cognitive decline is associated with frontostriatal and limbic affections, white matter microlesions and changes between multiple functional neuronal networks, including thalamo-insular, frontoparietal and attention networks, the cholinergic forebrain and the noradrenergic system. Superimposed Alzheimer-related (and other concomitant) pathologies due to interactions between α-synuclein, tau-protein and β-amyloid contribute to dementia pathogenesis in both PD and dementia with Lewy bodies (DLB). To further elucidate the interaction of the pathomechanisms responsible for CI in PD, well-designed longitudinal clinico-pathological studies are warranted that are supported by fluid and sophisticated imaging biomarkers as a basis for better early diagnosis and future disease-modifying therapies.

The Relationship between Social Support and Anxiety Symptoms in Informal Carers: A Systematic Review and Meta-Analysis

BACKGROUND

Providing care can be challenging for informal carers and increases the risk of mental health problems, such as experiencing clinical symptoms of anxiety. While strengthening social support for informal carers is a common recommendation to reduce this risk, no systematic review or meta-analysis to date has examined the relationship between social support and anxiety symptoms in informal carers. The aim of our study was to systematically review the current evidence on the association between perceived and received social support and anxiety symptoms in informal carers of dependent adults and older people, and to comment on the quality of the evidence.

METHODS

We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), Scopus, and LILACS up to 31 March 2021 for articles reporting on the association between caregiver anxiety symptoms and social support. A random-effects model was used to pool estimates, and each study was rated for quality using pre-specified criteria. Publication bias was assessed using a funnel plot and Egger's regression test, which was adjusted using trim and fill analysis.

RESULTS

From the 2180 identified articles, 35 studies met our inclusion criteria, reporting on 5036 informal carers in total. We found a moderate negative association between perceived social support and caregiver anxiety symptoms (r = -0.31, 95% CI = -0.35, -0.27) and a small, negative association between received social support and caregiver anxiety (r = -0.15, 95% CI = -0.22, -0.08).

CONCLUSION

The levels of perceived social support showed a significant negative association with caregiver anxiety symptoms. Policymakers and those working directly with informal carers should consider the development of targeted social support interventions that specifically enhance the levels of perceived social support to reduce symptoms of anxiety in informal carers.

Resilience in People with Lewy Body Disorders and Their Care Partners: Association with Mental Health, Relationship Satisfaction, and Care Burden

The emergence of cognitive impairment and dementia in people with Lewy body spectrum disorders (LBS) significantly impacts the quality of life of the individual and their care partner. Coping well with the condition may depend, in part, on the degree of psychological resilience or capacity to 'bounce back' from adversity. We explored resilience in people with Parkinson's disease mild cognitive disorder or dementia, or dementia with Lewy bodies, and their care partners, and its relation to outcomes related to their mental well-being and quality of life. This exploratory, cross-sectional study recruited 76 participant-dyads. Resilience, quality of life, depression, anxiety, and relationship satisfaction were evaluated in both members of the dyad. In care partners, care burden and stress were also assessed. Over 70% of both care partners and recipients reported high levels of resilience. Lower resilience in both members of the dyad was associated with higher anxiety and lower quality of life. Additionally, lower resilience in care partners was associated with lower well-being, relationship satisfaction, and higher burden and stress. Resilience in persons with LBS and their care partners is important to consider when assessing mental health, relationship, and care burden outcomes, acting as a focus of intervention to support positive outcomes.

Perceived social support and distress in carers of people with lung cancer: The serial mediation of resilience and positive aspects of caregiving

PURPOSE

To determine the mediating roles of resilience and positive aspects of caregiving (PAC) in the effect of perceived social support (PSS) on distress.

METHODS

This study, with a cross-sectional design, was conducted in a Chinese hospital. Instruments included the Multidimensional Scale of Perceived Social Support, Chinese version Connor-Davidson Resilience Scale, Positive Aspects of Caregiving, and the Depression, Anxiety, Stress Scales-21. Descriptive analysis and serial mediation analysis were conducted by SPSS 22.0.

RESULTS

Data from 300 Chinese carers of people with lung cancer was used. The correlation analysis showed that PSS, resilience, and PAC were protective factors of distress. The mediation analysis revealed that resilience and PAC separately and serially mediated the effect of PSS on distress.

CONCLUSION

Carers of people with lung cancer perceived positive and negative caregiving experiences simultaneously. PSS could alleviate distress by enhancing resilience and promoting PAC. Multicomponent interventions integrating PSS, resilience, and PAC should be designed to alleviate distress among Chinese carers of people with lung cancer.

Towards conceptual convergence: A systematic review of psychological resilience in family caregivers of persons living with chronic neurological conditions

Background

The demand for family caregiving in persons with chronic neurological conditions (CNCs) is increasing. Psychological resilience may empower and protect caregivers in their role. Thus, a synthesis of resilience evidence within this specific population is warranted.

Aim

In this systematic review we aimed to: (1) examine the origins and conceptualizations of resilience; (2) summarize current resilience measurement tools; and (3) synthesize correlates, predictors and outcomes of resilience in family caregivers of persons with CNCs.

Design

We sourced English articles published up to July 2020 across five databases using search terms involving CNCs, family caregivers and resilience.

Results

A total of 50 studies were retained. Nearly half (44%) of the studies used trait‐based resilience definitions, while about one third (36%) used process‐based definitions. Twelve different resilience scales were used, revealing mostly moderate to high‐resilience levels. Findings confirmed that resilience is related to multiple indicators of healthy functioning (e.g., quality of life, social support, positive coping), as it buffers against negative outcomes of burden and distress. Discordance relating to the interaction between resilience and demographic, sociocultural and environmental factors was apparent.

Conclusions

Incongruity remains with respect to how resilience is defined and assessed, despite consistent definitional concepts of healthy adaptation and equilibrium. The array of implications of resilience for well‐being confirms the potential for resilience to be leveraged within caregiver health promotion initiatives via policy and practice.

Patient or Public Contribution

The findings may inform future recommendations for researchers and practitioners to develop high‐quality resilience‐building interventions and programmes to better mobilize and support this vulnerable group.

A dyadic study of psychological well-being of individuals with Parkinson's disease and their caregivers

Parkinson's disease (PD) is an incapacitating neurodegenerative disease. Patients with PD and their caregivers may have interactive effects on each other’s psychological well-being. This study aimed to assess the dyadic dynamics of resilience, fatigue, and suicidal ideation on the depression severity of PD patients and their caregivers. In total, 175 PD patients and 175 caregivers were recruited at a medical center from August 2018 to May 2020. Structural equation modeling (SEM) was used to examine the actor/partner effects on the psychological well-being of both the PD patients and their caregivers. The most common psychiatric diagnoses of both the PD patients (28.6%) and their caregivers (11.4%) were depressive disorders. The PD patients’ and their caregivers’ fatigue, suicidal ideation, and lack of resilience were significantly associated with the severity of their depression, respectively. Interactive effects existed between psychological well-being of individuals with PD and their caregivers. Clinicians must be aware of, and manage, these contributing factors between PD patients and their caregivers in order to prevent them from worsening each other’s depression.

Parkinson's Disease Caregiver Strain in Singapore

Background: Caregiver strain is recognized globally with Parkinson's disease (PD). Comparatively little is understood about caregiver burden and strain in Asia.

Objective: To investigate caregiver strain for families living with PD in Singapore, in light of international data.

Methods: Ninety-four caregivers were recruited via people living with idiopathic PD in Singapore. Caregiver strain was assessed using the Zarit Burden Interview (ZBI); health status was assessing using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). PD disability measures were the Unified Parkinson's Disease Rating Scale (UPDRS) and modified Hoehn and Yahr (1967) Scale.

Results: Primary caregivers of people living with PD in Singapore were mostly cohabiting spouses, partners or offspring. Around half employed foreign domestic helpers. Mean caregiving duration was 5.9 years with an average of eight hours per day spent in caregiving roles. Most care providers were comparatively healthy. Caregivers reported significant levels of strain which increased with greater level of disability (r = 0.36, n = 94, p < 0.001). Associations were significant between caregiver strain and scores on the UPDRS mentation, behavior, and mood subscales [r = 0.46, n = 94, p < 0.001, 95% CI (0.28, 0.60)]. High scores on the UPDRS activities of daily living subscale were associated with caregiver strain [r = 0.50, n = 94, p < 0.001, CI (0.33, 0.64)].

Conclusion: Most caregivers in this Singapore sample reported high levels of strain, despite comparatively good physical function. Caregiver strain in PD spans geopolitical and cultural boundaries and correlates with disease severity. These results support the need for better early recognition, education, and support for caregivers of people living with PD.

Relationship of Perceived Social Support with Mental Health in Older Caregivers

Background: Elderly caregivers present increased physical and mental health problems. These factors can lead to a lack of autonomy and a need for social support. This study aims to analyse the relationships between perceived social support and mental health status in elderly caregivers aged 65 and older. Methods: a cross-sectional study based on data from the Spanish National Health Survey (ENSE-17) carried out on 7023 people. The study population was restricted to 431 caregivers aged ≥65 years. A study of the correlation between the mental health state and the perceived social support was carried out. Both variables were related to the sex of the caregiver. Results: Perceived social support by older caregivers is significantly related to mental health (p = 0.001), and stress (p < 0.001). Also, there is a significant relationship between perceived social support and mental well-being (p = 0.001), self-esteem (p = 0.005) and stress (p = 0.001) in older women caregivers. Conclusions: Older caregivers have adequate mental well-being and perceive high social support. Perceived social support can contribute to improving the mental well-being of older caregivers.