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Aljunaid MA, Alosaimi RM, Alazmi EA, Afandi AA, Musslem MT, Aljarameez MM, Alzobaidi HH. Determinants of Depression in Caregivers of Geriatric Patients in Jeddah, Saudi Arabia: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1368. [PMID: 39202649 PMCID: PMC11356660 DOI: 10.3390/medicina60081368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Caregiving for geriatric patients is essential for ensuring the well-being and quality of life of older adults. Family caregivers play a crucial role, but they often face a significant burden that can lead to adverse mental health outcomes, including depression. This study aimed to estimate the prevalence of depression among caregivers of geriatric patients in Jeddah, Saudi Arabia, and to analyze its association with caregiver burden and various socio-demographic and caregiving parameters. Methods: A cross-sectional study was conducted in Jeddah, Saudi Arabia, between January and March 2024. Adult caregivers of geriatric patients were recruited through various social media platforms. Data were collected via an electronic questionnaire that included demographic information, caregiving parameters, the Patient Health Questionnaire-9 (PHQ-9) for depression screening, and the Zarit Burden Interview (ZBI-12) for caregiver burden assessment. Data were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression. Results: Of the 269 participants, the average age was 32 years, and the gender distribution was nearly balanced. The prevalence of depression (PHQ-9 score ≥ 10) among caregivers was 45.4% (95% CI: 39.3, 51.5%). Significant factors associated with higher depression scores included younger age, female gender, single status, being a student, low income, and caregiving burden. In the multivariate analysis, female gender (OR 2.50, 95% CI 1.30-4.80) and caregiving burden (mild-to-moderate burden: OR 6.18, 95% CI 2.94-13.00; high burden: OR 22.75, 95% CI 8.75-59.13) were independent predictors of depression. Conclusions: The study highlights the high prevalence of depression among caregivers of geriatric patients in Jeddah and underscores the significant impact of caregiving burden on mental health. These findings emphasize the need for targeted interventions, such as mental health support, respite care programs, and culturally sensitive educational training, to mitigate caregiver burden and enhance the well-being of caregivers.
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Affiliation(s)
- Mohammed A. Aljunaid
- Department of Family and Community Medicine, University of Jeddah, Jeddah 21589, Saudi Arabia
| | | | - Essa Ahmed Alazmi
- Faculty of Medicine, University of Jeddah, Jeddah 21589, Saudi Arabia (M.M.A.)
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Levenson RW, Chen KH, Levan DT, Chen Y, Newton SL, Paul D, Yee CI, Brown CL, Merrilees J, Moss D, Wang G. Evaluating In-home Assistive Technology for Dementia Caregivers. Clin Gerontol 2024; 47:78-89. [PMID: 36732317 PMCID: PMC10394113 DOI: 10.1080/07317115.2023.2169652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Dementia caregivers (CGs) are at heightened risk for developing problems with anxiety and depression. Much attention has been directed toward developing and deploying interventions designed to protect CG health, but few have been supported by rigorous empirical evidence. Technology-based interventions that are effective, scalable, and do not add greatly to the CG burden are of particular interest. METHODS We conducted a nine-month randomized controlled trial in 63 homes evaluating People Power Caregiver (PPCg), a system of sensors in the home connected to cloud-based software that alerts CGs about worrisome deviations from normal patterns (e.g., falls, wandering). RESULTS CGs in the active condition had significantly less anxiety than those in the control condition at the six-month assessment. Greater anxiety reduction in the active condition at the six-month assessment was associated with greater interaction with PPCg via SMS text messages. There were no differences in anxiety at the three-month or nine-month assessments or in depression at any assessment. CONCLUSIONS PPCg shows promise for reducing anxiety associated with caring for a =person with dementia. CLINICAL IMPLICATIONS Technology-based interventions can help reduce CG anxiety, a major adverse consequence of caregiving that may be difficult to treat due to other demands on caregiver time and energy.
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Gupta T, Osborne KJ, Nadig A, Haase CM, Mittal VA. Alterations in facial expressions in individuals at risk for psychosis: a facial electromyography approach using emotionally evocative film clips. Psychol Med 2023; 53:5829-5838. [PMID: 36285533 PMCID: PMC10130238 DOI: 10.1017/s0033291722003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Negative symptoms such as blunted facial expressivity are characteristic of schizophrenia. However, it is not well-understood if and what abnormalities are present in individuals at clinical high-risk (CHR) for psychosis. METHODS This experimental study employed facial electromyography (left zygomaticus major and left corrugator supercilia) in a sample of CHR individuals (N = 34) and healthy controls (N = 32) to detect alterations in facial expressions in response to emotionally evocative film clips and to determine links with symptoms. RESULTS Findings revealed that the CHR group showed facial blunting manifested in reduced zygomatic activity in response to an excitement (but not amusement, fear, or sadness) film clip compared to controls. Reductions in zygomatic activity in the CHR group emerged in response to the emotionally evocative peak period of the excitement film clip. Lower zygomaticus activity during the excitement clip was related to anxiety while lower rates of change in zygomatic activity during the excitement video clip were related to higher psychosis risk conversion scores. CONCLUSIONS Together, these findings inform vulnerability/disease driving mechanisms and biomarker and treatment development.
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Affiliation(s)
- Tina Gupta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - K. Juston Osborne
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ajay Nadig
- Harvard/MIT MD-PhD Program, Harvard Medical School, Boston, MA, 02115
| | - Claudia M. Haase
- Department of Psychology, Northwestern University, Evanston, IL, USA
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Brown CL, Grimm KJ, Wells JL, Hua AY, Levenson RW. Empathic Accuracy and Shared Depressive Symptoms in Close Relationships. Clin Psychol Sci 2023; 11:509-525. [PMID: 37206479 PMCID: PMC10193708 DOI: 10.1177/21677026221141852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Empathic accuracy, the ability to accurately understand others' emotions, is typically viewed as beneficial for mental health. However, empathic accuracy may be problematic when a close relational partner is depressed because it promotes shared depression. Across two studies, we measured empathic accuracy using laboratory tasks that capture the ability to rate others' emotional valence accurately over time: first, in a sample of 156 neurotypical married couples (Study 1; Total N=312), and then in a sample of 102 informal caregivers of individuals with dementia (Study 2). Across both studies, the association between empathic accuracy and depressive symptoms varied as a function of a partner's level of depressive symptoms. Greater empathic accuracy was associated with (a) fewer depressive symptoms when a partner lacked depressive symptoms, but (b) more depressive symptoms when a partner had high levels of depressive symptoms. Accurately detecting changes in others' emotional valence may underpin shared depressive symptoms.
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Affiliation(s)
- Casey L. Brown
- Department of Psychology, Georgetown University
- Department of Psychology, University of California, Berkeley
| | | | - Jenna L. Wells
- Department of Psychology, University of California, Berkeley
| | - Alice Y. Hua
- Department of Psychology, University of California, Berkeley
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Pressman PS, Chen KH, Casey J, Sillau S, Chial HJ, Filley CM, Miller BL, Levenson RW. Incongruences Between Facial Expression and Self-Reported Emotional Reactivity in Frontotemporal Dementia and Related Disorders. J Neuropsychiatry Clin Neurosci 2022; 35:192-201. [PMID: 35989572 PMCID: PMC10723939 DOI: 10.1176/appi.neuropsych.21070186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Emotional reactivity normally involves a synchronized coordination of subjective experience and facial expression. These aspects of emotional reactivity can be uncoupled by neurological illness and produce adverse consequences for patient and caregiver quality of life because of misunderstandings regarding the patient's presumed internal state. Frontotemporal dementia (FTD) is often associated with altered social and emotional functioning. FTD is a heterogeneous disease, and socioemotional changes in patients could result from altered internal experience, altered facial expressive ability, altered language skills, or other factors. The authors investigated how individuals with FTD subtypes differ from a healthy control group regarding the extent to which their facial expressivity aligns with their self-reported emotional experience. METHODS Using a compound measure of emotional reactivity to assess reactions to three emotionally provocative videos, the authors explored potential explanations for differences in alignment of facial expressivity with emotional experience, including parkinsonism, physiological reactivity, and nontarget verbal responses. RESULTS Participants with the three main subtypes of FTD all tended to express less emotion on their faces than they did through self-report. CONCLUSIONS Exploratory analyses suggest that reasons for this incongruence likely differ not only between but also within diagnostic subgroups.
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Affiliation(s)
- Peter S Pressman
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - Kuan Hua Chen
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - James Casey
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - Stefan Sillau
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - Heidi J Chial
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - Christopher M Filley
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - Bruce L Miller
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
| | - Robert W Levenson
- Department of Neurology Behavioral Neurology Section (Pressman, Filley), Alzheimer's and Cognition Center (Pressman, Sillau, Chial), Linda Crnic Institute for Down Syndrome (Chial), and Marcus Institute for Brain Health (Filley), University of Colorado Anschutz Medical Campus, Aurora; Berkeley Psychophysiology Laboratory, University of California, Berkeley (Chen, Casey, Levenson); Memory and Aging Center, University of California, San Francisco (Miller)
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Chen KH, Casey JJ, Connelly DE, Merrilees J, Yang CM, Miller BL, Levenson RW. Lower activity linkage between caregivers and persons with neurodegenerative diseases is associated with greater caregiver anxiety. Psychophysiology 2022; 59:e14040. [PMID: 35315937 DOI: 10.1111/psyp.14040] [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: 05/22/2021] [Revised: 10/24/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
Physiological linkage refers to the degree to which two individuals' central/peripheral physiological activities change in coordinated ways. Previous research has focused primarily on linkage in the autonomic nervous system in laboratory settings, particularly examining how linkage is associated with social behavior and relationship quality. In this study, we examined how linkage in couples' daily somatic activity (e.g., synchronized movement measured from wrist sensors)-another important aspect of peripheral physiology-was associated with relationship quality and mental health. We focused on persons with neurodegenerative diseases (PWNDs) and their spousal caregivers, whose linkage might have direct implications for the PWND-caregiver relationship and caregiver's health. Twenty-two PWNDs and their caregivers wore wristwatch actigraphy devices that provided continuous measurement of activity over 7 days at home. PWND-caregiver activity linkage was quantified by the degree to which activity was "in-phase" or "anti-phase" linked (i.e., coordinated changes in the same or opposite direction) during waking hours, computed by correlating minute-by-minute activity levels averaged using a 10-min rolling window. Caregivers completed well-validated surveys that assessed their mental health (including anxiety and depression) and relationship quality with the PWND. We found that lower in-phase activity linkage, but not anti-phase linkage, was associated with higher caregiver anxiety. These dyad-level effects were robust, remaining significant after adjusting for somatic activity at the individual level. No effects were found for caregiver depression or relationship quality. These findings suggest activity linkage and wearables may be useful for day-by-day monitoring of vulnerable populations such as family caregivers. We offered several possible explanations for our findings.
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Affiliation(s)
- Kuan-Hua Chen
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - James J Casey
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Dyan E Connelly
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Jennifer Merrilees
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Chien-Ming Yang
- Department of Psychology/The Research Center for Mind, Brain & Leaning, National Chengchi University, Taipei, Taiwan
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, USA
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
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Wolff JL, Benge JF, Cassel CK, Monin JK, Reuben DB. Emerging topics in dementia care and services. J Am Geriatr Soc 2021; 69:1763-1773. [PMID: 34245585 DOI: 10.1111/jgs.17341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The National Institute on Aging (NIA), in conjunction with the Department of Health and Human Services as part of the National Alzheimer's Project Act (NAPA), convened a 2020 Dementia Care, Caregiving, and Services Research Summit Virtual Meeting Series. This review article summarizes three areas of emerging science that are likely to grow in importance given advances in measurement, technologies, and diagnostic tests that were presented at the Summit. RESULTS Dr. Cassel discussed novel ethical considerations that have resulted from scientific advances that have enabled early diagnosis of pre-clinical dementia. Dr. Monin then summarized issues regarding emotional experiences in persons with dementia and their caregivers and care partners, including the protective impact of positive emotion and heterogeneity of differences in emotion by dementia type and individual characteristics that affect emotional processes with disease progression. Finally, Dr. Jared Benge provided an overview of the role of technologies in buffering the impact of cognitive change on real-world functioning and their utility in safety and monitoring of function and treatment adherence, facilitating communication and transportation, and increasing access to specialists in underserved or remote areas. CONCLUSIONS National policy initiatives, supported by strong advocacy and increased federal investments, have accelerated the pace of scientific inquiry and innovation related to dementia care and services but have raised some new concerns regarding ethics, disparities, and attending to individual needs, capabilities, and preferences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jared F Benge
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Christine K Cassel
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David B Reuben
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Brown CL, Wells JL, Hua AY, Chen KH, Merrilees J, Miller BL, Levenson RW. Emotion Recognition and Reactivity in Persons With Neurodegenerative Disease Are Differentially Associated With Caregiver Health. THE GERONTOLOGIST 2021; 60:1233-1243. [PMID: 32293012 DOI: 10.1093/geront/gnaa030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Motivated by the high rates of health problems found among caregivers of persons with neurodegenerative disease, we examined associations between deficits in two aspects of care recipients' socioemotional functioning and their caregivers' health. RESEARCH DESIGN AND METHODS In 2 studies with independent samples (N = 171 and 73 dyads), caregivers reported on care recipients' emotion recognition and emotional reactivity. Caregiver health was assessed using both self-report measures (Studies 1 and 2) and autonomic nervous system indices (Study 2). RESULTS Lower emotion recognition in care recipients was linearly associated with worse self-reported health, faster resting heart rate, and greater physiological reactivity to an acoustic startle stimulus in caregivers. These effects held after accounting for a variety of risk factors for poor caregiver health, including care recipients' neuropsychiatric symptoms. Emotional reactivity showed a quadratic association with health, such that the lowest and highest levels of emotional reactivity in care recipients were associated with lower self-reported health in caregivers. DISCUSSION AND IMPLICATIONS Results shed light on the unique associations between two aspects of care recipients' emotional functioning and caregivers' health. Findings suggest potential ways to identify and help caregivers at heightened risk for adverse health outcomes.
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Affiliation(s)
- Casey L Brown
- Department of Psychology, University of California, Berkeley
| | - Jenna L Wells
- Department of Psychology, University of California, Berkeley
| | - Alice Y Hua
- Department of Psychology, University of California, Berkeley
| | - Kuan-Hua Chen
- Department of Psychology, University of California, Berkeley
| | - Jennifer Merrilees
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Pelit Aksu S, Şentürk Erenel A. Caregiver Burden and the Level of Perceived Social Support of Caregivers Helping with Inpatient Care of Patients with Gynecologic Cancer. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2021; 29:113-123. [PMID: 34263229 PMCID: PMC8137736 DOI: 10.5152/fnjn.2021.19085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/09/2020] [Indexed: 11/22/2022]
Abstract
AIM This study aimed to determine the caregiver burden and the level of perceived social support of caregivers helping with inpatient care of patients with gynecologic cancer. METHOD This was a descriptive study. The research sample included 227 caregivers. These caregivers, whose informed consent was obtained, assisted in the inpatient care in gynecologic oncology clinics of 3 hospitals in Ankara, Turkey. The research data were collected using an information form developed to define the characteristics of patients and their caregivers. The Zarit Caregiver Burden Scale and the Multidimensional Scale of Perceived Social Support were used. RESULTS The average caregiving duration of the caregivers was 8.63±13.06 days. Their age, educational status, income, employment status, the number of children and duration of caregiving, sharing the caregiving, the difficulties faced during the caregiving significantly affected the caregiver burden and the perceived social support. It was found that there is a moderate, negative, and significant relationship between the scores of caregiver burden and perceived social support. CONCLUSION On the basis of these results, the nurses should adopt an integrated approach while providing care for patients with gynecologic cancer and plan the care by including the caregivers.
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Affiliation(s)
- Sıdıka Pelit Aksu
- Department of Nursing, Gazi University Faculty of Health Science, Ankara, Turkey
| | - Ayten Şentürk Erenel
- Department of Nursing, Gazi University Faculty of Health Science, Ankara, Turkey
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Emotion Recognition and Traffic-Related Risk-Taking Behavior in Patients with Neurodegenerative Diseases. J Int Neuropsychol Soc 2021; 27:136-145. [PMID: 32812527 DOI: 10.1017/s1355617720000740] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Neurodegenerative diseases (NDDs), such as Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, and Huntington's disease, inevitably lead to impairments in higher-order cognitive functions, including the perception of emotional cues and decision-making behavior. Such impairments are likely to cause risky daily life behavior, for instance, in traffic. Impaired recognition of emotional expressions, such as fear, is considered a marker of impaired experience of emotions. Lower fear experience can, in turn, be related to risk-taking behavior. The aim of our study was to investigate whether impaired emotion recognition in patients with NDD is indeed related to unsafe decision-making in risky everyday life situations, which has not been investigated yet. METHODS Fifty-one patients with an NDD were included. Emotion recognition was measured with the Facial Expressions of Emotions: Stimuli and Test (FEEST). Risk-taking behavior was measured with driving simulator scenarios and the Action Selection Test (AST). Data from matched healthy controls were used: FEEST (n = 182), AST (n = 36), and driving simulator (n = 18). RESULTS Compared to healthy controls, patients showed significantly worse emotion recognition, particularly of anger, disgust, fear, and sadness. Furthermore, patients took significantly more risks in the driving simulator rides and the AST. Only poor recognition of fear was related to a higher amount of risky decisions in situations involving a direct danger. CONCLUSIONS To determine whether patients with an NDD are still fit to drive, it is crucial to assess their ability to make safe decisions. Measuring emotion recognition may be a valuable contribution to this judgment.
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Chen KH, Hua AY, Lwi SJ, Haase CM, Rosen HJ, Miller BL, Levenson RW. Smaller Volume in Left-Lateralized Brain Structures Correlates with Greater Experience of Negative Non-target Emotions in Neurodegenerative Diseases. Cereb Cortex 2021; 31:15-31. [PMID: 32820325 DOI: 10.1093/cercor/bhaa193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Abstract
Subjective emotional experience that is congruent with a given situation (i.e., target emotions) is critical for human survival (e.g., feeling disgusted in response to contaminated food motivates withdrawal behaviors). Neurodegenerative diseases including frontotemporal dementia and Alzheimer's disease affect brain regions critical for cognitive and emotional functioning, resulting in increased experience of emotions incongruent with the situation (i.e., non-target emotions, such as feeling happy when seeing someone grieving). We examined neuroanatomical correlates of subjective experience of non-target emotions in 147 patients with neurodegenerative diseases and 26 healthy individuals. Participants watched three films intended to elicit particular target emotions and rated their experience of negative and positive target and non-target emotions after watching each film. We found that smaller volume in left hemisphere regions (e.g., caudate, putamen, and dorsal anterior insula) was associated with greater experience of negative non-target emotions. Follow-up analyses confirmed that these effects were left-lateralized. No correlates emerged for positive non-target emotions. These findings suggest that volume loss in left-hemisphere regions produces a more diffuse, incongruent experience of non-target emotions. These findings provide a potential neuroanatomical basis for understanding how subjective emotional experience is constructed in the brain and how this can be disrupted in neurodegenerative disease.
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Wells JL, Hua AY, Levenson RW. Poor Disgust Suppression Is Associated with Increased Anxiety in Caregivers of People with Neurodegenerative Disease. J Gerontol B Psychol Sci Soc Sci 2020; 76:1302-1312. [PMID: 32322886 DOI: 10.1093/geronb/gbaa056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Caregivers of persons with neurodegenerative disease have high rates of mental health problems compared to noncaregiving adults. Emotion regulation may play an important role in preserving caregivers' mental health. We examined the associations between caregivers' emotion regulation measured in several ways (ability, habitual use, and self-ratings) and their mental health symptoms. METHOD Ninety-one caregivers of persons with neurodegenerative disease participated in a laboratory-based assessment of emotion regulation. In two series of tasks, caregivers were given different instructions (no instruction, suppress) regarding altering their emotional behavioral responses to disgusting films and acoustic startle stimuli. Caregivers' emotional behavior was measured via behavioral coding and caregivers rated "how much emotion" they showed during each task. Anxiety, depression, and habitual use of expressive suppression were measured via questionnaires. RESULTS Poor emotion regulation in the disgust suppression condition (i.e., greater emotional behavior) was associated with greater anxiety. Associations were not found for the startle suppression condition, depression, or self-report measures of emotion regulation. DISCUSSION Findings suggest that caregivers who are unable to suppress emotional behavior in response to disgusting stimuli may be at greater risk for anxiety. Given high levels of anxiety in caregivers, it may be useful to evaluate interventions that improve ability to downregulate emotional behavior.
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Affiliation(s)
- Jenna L Wells
- Department of Psychology, University of California, Berkeley
| | - Alice Y Hua
- Department of Psychology, University of California, Berkeley
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13
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Connelly DE, Verstaen A, Brown CL, Lwi SJ, Levenson RW. Pronoun Use during Patient-Caregiver Interactions: Associations with Caregiver Well-Being. Dement Geriatr Cogn Disord 2020; 49:202-209. [PMID: 32610328 PMCID: PMC7805608 DOI: 10.1159/000508095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Caring for a spouse with dementia can be extremely challenging. Many caregivers experience profound declines in well-being; however, others remain healthy. OBJECTIVE This study determined whether the personal pronouns used in interactions between persons with dementia (PWDs) and their spousal caregivers were associated with caregiver well-being. METHODS Fifty-eight PWDs and their spousal caregivers engaged in a 10-min conversation about an area of disagreement in a laboratory setting. Verbatim transcripts of the conversation were coded using text analysis software, and caregivers and PWDs each received scores for (a) I-pronouns, (b) you-pronouns, and (c) we-pronouns. Caregivers' well-being was assessed using a composite measure of depression, anxiety, burden, and strain. RESULTS Results revealed that less use of we-pronouns by caregivers and PWDs and greater use of I-pronouns by PWDs were -associated with lower caregiver well-being. CONCLUSIONS These findings indicate that less use of pronouns that refer to the couple (we-pronouns used by either partner) and greater use of pronouns that refer to the PWD (I-pronouns used by the PWD) are indicative of caregivers at heightened risk for lower well-being.
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Affiliation(s)
- Dyan E. Connelly
- Department of Psychology, University of California, Berkeley, CA US
| | - Alice Verstaen
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA US
| | - Casey L. Brown
- Department of Psychology, University of California, Berkeley, CA US
| | - Sandy J. Lwi
- VA Northern California Health Care System, Martinez, CA US
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14
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Wells JL, Brown CL, Hua AY, Soyster PD, Chen KH, Dokuru DR, Coppola G, Haase CM, Levenson RW. Neurodegenerative Disease Caregivers' 5-HTTLPR Genotype Moderates the Effect of Patients' Empathic Accuracy Deficits on Caregivers' Well-Being. Am J Geriatr Psychiatry 2019; 27:1046-1056. [PMID: 31133468 PMCID: PMC6739173 DOI: 10.1016/j.jagp.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the hypothesis that a functional polymorphism of the serotonin transporter gene (serotonin-transporter-linked polymorphic region [5-HTTLPR]), which is thought to be associated with differential environmental sensitivity, moderates the association between low levels of empathic accuracy (i.e., ability to recognize emotions in others) in patients with neurodegenerative disease and caregivers' well-being. METHODS Participants were 54 patients with neurodegenerative disease and their caregivers. Patients' empathic accuracy was measured using a dynamic tracking task in which they continuously rated the emotions of a character in a film; accuracy was determined by comparing patient ratings with those made by an expert panel. Caregivers provided a saliva sample for genotyping. Caregivers' well-being was measured as a latent construct indicated by validated measures of depression, anxiety, and negative affect. RESULTS Lower levels of patients' empathic accuracy were associated with lower levels of caregivers' well-being. Importantly, caregivers' 5-HTTLPR genotype moderated this association such that lower empathic accuracy in patients predicted lower well-being for caregivers with the short/short genotype (standardized β = 0.66), but not for caregivers with the short/long (standardized β = 0.05) or long/long genotypes (standardized β = -0.21). CONCLUSION Consistent with previous findings that the short/short variant of 5-HTTLPR is associated with greater sensitivity to environmental influences, caregivers with the short/short variant manifest lower well-being when caring for a patient with low levels of empathic accuracy than caregivers with the other variants. This finding contributes to the authors' understanding of biological factors associated with individual differences in caregiver vulnerability and resilience.
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Affiliation(s)
- Jenna L. Wells
- Department of Psychology, University of California, Berkeley, CA
| | - Casey L. Brown
- Department of Psychology, University of California, Berkeley, CA
| | - Alice Y. Hua
- Department of Psychology, University of California, Berkeley, CA
| | - Peter D. Soyster
- Department of Psychology, University of California, Berkeley, CA
| | - Kuan-Hua Chen
- Department of Psychology, University of California, Berkeley, CA
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15
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Abstract
Research on stress and disease has often afforded an important role to emotion, typically conceptualized in broad categories (e.g., negative emotions), viewed as playing a causal role (e.g., anger contributing to pathophysiology of cardiovascular disease), and measured using self-report inventories. In this article, I argue for the value of evaluating specific emotions, considering bidirectional causal influences, and assessing actual emotional responding when considering the role that emotions play in the stress-disease relationship. In terms of specificity, specific emotions (e.g., anger, sadness, and embarrassment) can be linked with particular health outcomes (e.g., cardiovascular disease and musculoskeletal disease). In terms of bidirectionality, the influences of emotions on disease as well as the influences of disease on emotional functioning can be considered. In terms of assessing actual emotional responding, emotions can be studied in vivo under controlled conditions that allow behavioral, physiological, and subjective responses to be measured during different kinds of emotional functioning (e.g., responding to emotional stimuli, interacting with relationship partners, and downregulating emotional responses). With these considerations in mind, I review early theories and empirical studies in psychosomatic medicine that considered the role of specific emotions and emotion-related behaviors. Studies from our laboratory are presented that illustrate a) differences in patterns of autonomic nervous system responding associated with specific emotions, b) relationships between specific emotions and particular health outcomes in the context of social relationships, c) age as a moderator of the relationship between specific emotions and well-being, d) bidirectional influences (emotions influencing disease and disease influencing emotional functioning), and e) impact of changes in emotional functioning in individuals with neurodegenerative diseases on the health of familial caregivers.
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Affiliation(s)
- Robert W Levenson
- From the Department of Psychology, University of California, Berkeley, Berkeley, California
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16
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Hua AY, Wells JL, Haase CM, Chen KH, Rosen HJ, Miller BL, Levenson RW. Evaluating Patient Brain and Behavior Pathways to Caregiver Health in Neurodegenerative Diseases. Dement Geriatr Cogn Disord 2019; 47:42-54. [PMID: 30630168 PMCID: PMC6568322 DOI: 10.1159/000495345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/12/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Caregivers of patients with neurodegenerative diseases are at heightened risk for serious health problems, but health differences between individual caregivers abound. AIMS To determine whether atrophy in patient brains could be used to identify caregivers at heightened risk for health problems and which patient variables mediate this relationship. METHODS In 162 patient-caregiver dyads, we assessed patient atrophy using structural MRI, caregiver health, and patient behavior and cognitive symptoms. RESULTS Patient atrophy in the right insula and medial frontal gyrus was associated with worse caregiver health; this relationship was partially mediated by patient neuropsychiatric symptoms, and assessing atrophy in these regions improved predictions of poor caregiver health above and beyond patient behavioral symptoms. CONCLUSIONS This study shows the value of patients' brain data in identifying caregivers at risk for becoming sick themselves.
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Affiliation(s)
- Alice Y. Hua
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Jenna L. Wells
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Claudia M. Haase
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Kuan-Hua Chen
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Robert W. Levenson
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
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