Caregiver burden, attachment and cognitive emotion among the family caregivers of severe mental illness patients

BACKGROUND

Serious mental illness (SMI) is a debilitating medical condition that causes stress and challenges for the family caregivers (FCs) of affected patients, increasing their caregiver burden (CB). This situation can activate attachment styles (AS) and trigger negative emotions, further contributing to CB. Given that AS and cognitive-emotional regulation (CER) can affect the CB of FCs of patients with SMI, the aim of this study was to evaluate the relationship between CB with AS, and CER among the FCs.

METHODS

This cross-sectional descriptive-correlational study was carried out in May-November 2022. Participants were 278 FCs of patients with SMI consecutively recruited from Roozbeh leading psychiatric hospital, Tehran, Iran. Data were collected using a patients' demographic and clinical characteristics questionnaire, an FCs' demographic characteristics questionnaire, the Attachment Style Questionnaire, the Cognitive Emotion Regulation Questionnaire, and the Burden Scale for Family Caregivers, and were analyzed using the SPSS software (v. 16.0).

RESULTS

CB had significant inverse relationship with secure AS (r = - 0.262) and significant positive relationship with fearful AS (r = 0.194) and dismissive AS (r = 0.242) (P < 0.01). Moreover, CB had significant inverse relationship with adaptive CER strategies and significant positive relationship with maladaptive CER strategies (P < 0.001). Regression analysis also showed that CB had significant relationship with secure AS and catastrophizing, rumination, self-blame, and positive refocusing CER strategies (P < 0.05).

CONCLUSION

This study concludes that AS and CER can impact CB. There is a negative relationship between secure AS and CB, as well as between adaptive CER strategies and CB. Conversely, there is a positive relationship between avoidant AS and increased CB, as well as between maladaptive CER strategies and CB. It is recommended to adopt strategies that promote the use of secure AS and adaptive CER among the FCs of patients with SMI.

Emotion regulation in people living with dementia and their spouses: the role of neuropsychiatric symptoms

OBJECTIVES

People with dementia (PwD) and their care partners (CP) may have difficulties in emotion regulation, and individual differences in emotion regulation may be related to PwD's neuropsychiatric symptoms. This study explores whether there is self-awareness of PwD's difficulties in emotion regulation and whether CP's emotion regulation relates to the PwD's neuropsychiatric symptoms, potentially revealing bias or interpersonal effects.

METHOD

We used data from the Wish Outcome Obstacle Plan Study with a sample of 45 PwD and their spousal CP (n = 90 individuals). Multivariate linear regression models were used to investigate the associations between the CP-reported neuropsychiatric symptoms in PwD and self-reports of emotion regulation in both dyad members, net of sociodemographic and health factors. Separate analyses were conducted for each neuropsychiatric subsyndrome and each domain of difficulties in emotion regulation.

RESULTS

Increasing severity of neuropsychiatric symptoms was associated with higher difficulties in emotion regulation in PwD (ß = 1.23, p < 0.05), but not with CP's difficulties in emotion regulation. When CP reported more severe neuropsychiatric symptoms in PwD, PwD reported that they had difficulties in accepting emotions, controlling impulses, goal-directed behaviors, and accessing emotion regulation strategies, but not in emotion awareness and clarification. Proxy-reports of hyperactivity and psychosis subsyndromes are significantly related to PwD's self-reported difficulties in emotion regulation.

CONCLUSION

PwD reported difficulties in emotion regulation at the early stage of dementia. Proxy-reported neuropsychiatric symptoms may capture PwD's emotion regulation capability and not be biased by CP's difficulties in emotion regulation.

Emotion regulation strategies on psychological distress and psychological well-being of caregivers of mentally challenged children: moderating role of social support

This study investigates the moderating role of social support in the relationship between emotion regulation, psychological distress, and psychological well-being of caregivers of mentally challenged children. A total of 315 caregivers aged 18-62 (Mage = 36.99, SD = 9.90; 38.7% male, 61.3% female) completed the Emotion Regulation Questionnaire, Multidimensional Scale of Perceived Social Support, Depression Anxiety Stress Scale, and Psychological Well-being Scale. The results indicated that social support significantly moderated the relationship between cognitive reappraisal, expressive suppression, and psychological well-being. However, the moderating effect of social support in the relationship between cognitive reappraisal, expressive suppression, and psychological distress was insignificant. The findings suggest that caregivers of mentally challenged children with high social support will report higher psychological well-being when they adopt cognitive reappraisal and expressive suppression strategies.

Emotion regulation and mental health among professionals of long-term care institutions for older adults: the mediating role of work engagement

BACKGROUND

This study examined whether work engagement mediated the association between emotion regulation and mental health of professionals working in long-term care institutions for older adults in Brazil.

PARTICIPANTS AND PROCEDURE

A cross-sectional study with a total of 104 professionals working in 13 long-term care facilities for the elderly in Brazil was conducted. Emotion regulation (expressive suppression and cognitive reappraisal), work engagement (vigor, dedication, and absorption), and mental health (depression, anxiety, and stress) were measured using self-report scales. Multiple mediation models were used to test the mediating role of engagement.

RESULTS

Expressive suppression was associated with more vigor, which in turn was associated with less anxiety and stress; cognitive reappraisal was associated with more vigor, which in turn was associated with less anxiety and stress. No indirect effects were found for depression.

CONCLUSIONS

Expressive suppression and cognitive reappraisal strategies to regulate emotions seem to be associated with more vigor in terms of resilience and persistence to deal with work demands in these professionals. These results seem to suggest that workers who are more capable of regulating their emotions (using both expressive suppression and cognitive reappraisal in a flexible way according to work demands) are more likely to be resilient, invest in their profession, and be persistent in the face of difficulties. This, in turn, contributes to protecting them from experiencing anxiety and stress.

Positive Cognitive Reappraisal in Stress Resilience, Mental Health, and Well-Being: A Comprehensive Systematic Review

Stress-related psychopathology is on the rise, and there is a pressing need for improved prevention strategies. Positive appraisal style, the tendency to appraise potentially threatening situations in a positive way, has been proposed to act as a key resilience mechanism and therefore offers a potential target for preventive approaches. In this article, we review n  =  99 studies investigating associations of positive cognitive reappraisal, an important sub-facet of positive appraisal style, with outcome-based resilience and relevant other outcomes, which are considered resilience-related. According to the studies reviewed, positive cognitive reappraisal moderates the relation between stressors and negative outcomes and is positively related to several resilience-related outcomes. It also mediates between other resilience factors and resilience, suggesting it is a proximal resilience factor.

Fear of Incompetence in Family Caregivers and Dementia Care Transitions

Research on interpersonal interaction dynamics in relationships between persons with dementia and their family caregivers has been limited. We examine the role of these dynamics in decisions to transition a family member from home care to congregate care, with a particular focus on the role of fear of incompetence. Fear of incompetence is the fear of being unable to interact, communicate in a meaningful way, or take care of a close family member with dementia. In this study (N  =  350 family caregivers), perceived negative changes in the family member with dementia predicted increased perceived dependency, which predicted both increased caregiver burden and greater fear of incompetence in caregivers, which, in turn, predicted stronger care transition desire. Strategies should be aimed not only at reducing dependency of the care recipient but also teaching family caregivers interaction skills that decrease their fear of interactional incompetence and thus promote home care continuation.

A person-centered evaluation of subjective well-being using a latent profile analysis: Associations with negative life events, distress, and emotion regulation strategies

The present study examined the structure of subjective well-being (SWB) using a person-centered approach, and tested whether SWB profiles differed in a number of self-reported negative life events, emotional distress, and cognitive emotion regulation strategies. The sample included a total of 945 undergraduate students from Serbia (78% female, M_age  = 20.14 years). A 3-step latent profile analysis with partial conditional independence revealed four profiles, which have been tentatively labeled: low SWB (a combination of low life satisfaction, low positive affect, and high negative affect), mixed SWB (moderate to high life satisfaction, moderate to low positive affect, high negative affect), moderately low SWB (low life satisfaction, moderate to low positive affect, moderate negative affect), high SWB (high life satisfaction, high positive affect, low negative affect). A comparison of SWB profiles applied to symptoms of emotional distress, along with the number of self-reported negative life events and emotion regulation strategies, offered support to the validity of four SWB profiles. Our findings suggest that a person-centered perspective might be a valuable tool for understanding the structure of SWB.

Emotional expression in conversations about advance care planning among older adult home health patients and their caregivers

OBJECTIVES

To examine patient and caregivers' differences in emotional expression and explore topics associated with emotional expression during advance care planning (ACP) discussions.

METHODS

Older adult home health patient-caregiver dyads participated in video-recorded ACP conversations as part of a collaboration-focused intervention study. Recordings were coded in Noldus Observer XT, analyzed with descriptive statistics, Cochran-Mantel-Haenszel and Breslow-Day test, and integrated with qualitative content analysis.

RESULTS

Eighteen patient-caregiver dyads were purposively recruited. Participants were mostly female (11 patients; 13 caregivers). Mean ages were 68.22 (SD = 9.64) for patients and 61.28 (SD = 13.60) for caregivers. Emotional expression (depth of emotion, positive and negative valence) was similar across patients and caregivers. Conversations centered on positive and negative decisional, relational, and existential topics.

CONCLUSIONS

This study explored emotional expression and identified topics associated with emotion for patients and caregivers during collaborative ACP. Findings suggest that collaboration in ACP can have positive relational aspects for patient-caregiver dyads, while negative emotions can also be distressing.

PRACTICE IMPLICATIONS

This study describes the range of emotions that are common during patient and caregiver ACP discussions. Clinical implications for the assessment of caregiver support and awareness of the interdependent nature of decision making is discussed.

A systematic review and meta-analysis of the association between expressive suppression and positive affect

People differ in their self-reported propensities to experience positive affect (PA). Even those prone to internalizing symptoms show varied proclivities to PA; social anxiety (SA), for instance, unlike other types of anxiety, shows a strong negative association with PA that cannot be explained by diminished reward sensitivity. Heightened reliance on suppression of emotional displays (expressive suppression; ES) may be an alternate contributor to attenuated PA among people with elevated SA, relative to people with other types of anxiety. A first step toward testing this hypothesis is clarifying the ES-PA association and examining whether it varies as a function of anxiety type (social anxiety vs. other types of anxiety). This meta-analysis (k = 41; n = 11,010) revealed a significant, negative association between ES and PA (r = -0.158); however, this relationship was not significant for individuals with social or other anxiety disorders. Moreover, two moderators (sample culture-Western: r = -0.16; Eastern: r = 0.003; type of emotion suppressed-Negative: r = 0.18; Positive: r = -0.12) accounted for significant heterogeneity in effect sizes. This review synthesizes the literature on ES and PA in healthy and anxious samples; findings suggest moderating variables merit closer attention in future studies.

Relationships between frustration intolerance beliefs, cognitive emotion regulation strategies and burnout among geriatric nurses and care assistants

The purpose of this study was to address cognitive emotional factors (frustration intolerance beliefs, cognitive emotion regulation strategies) related to burnout among professionals caring for older persons. A sample of 202 nurses and care assistants for older people completed online questionnaires about their cognitive emotion regulation strategies, frustration intolerance beliefs, and burnout. Use of maladaptive strategies, especially self-blame and catastrophizing, predicted greater emotional exhaustion and depersonalization. Adaptive strategy use, such as refocusing on planning and positive reappraisal, was found to be linked to both lower emotional exhaustion and higher personal accomplishment. Frustration intolerance beliefs appeared to be closely associated with the emotional exhaustion and depersonalization dimensions of burnout, with higher frustration intolerance beliefs indicating a high risk of depersonalization. The present findings have several practical implications for reducing nurses' burnout based on cognitive behavioral therapy approaches, such as rational emotive behavior or mindfulness therapies.

Poor Disgust Suppression Is Associated with Increased Anxiety in Caregivers of People with Neurodegenerative Disease

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.

DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers (DETERMIND): A protocol paper

OBJECTIVES

DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.

METHOD

DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings.

OUTCOMES

During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia.

Psychosocial Job Stressors and Mental Health: The Potential Moderating Role of Emotion Regulation

OBJECTIVE

This study examines whether emotion regulation moderates the association between psychosocial job stressors and psychological distress.

METHODS

We used data from the Work and Wellbeing Survey of 1044 Australian working adults. An adjusted linear regression model was used to estimate the moderating effect of emotion regulation.

RESULTS

The impact of low fairness and low control at work on distress was stronger in individuals with low (rather than high) cognitive reappraisal [β = 2.42, 95% confidence interval (95% CI) = 0.07 to 4.76; β = 2.58, 95% CI = 0.04 to 5.12, respectively], whereas the impact of high demands on distress was stronger in those with high (rather than low) expressive suppression (β = 2.94, 95% CI = 0.78 to 5.10).

CONCLUSION

Individual differences in emotion regulation in response to adverse job conditions should be considered in the management of workplace mental health.

Sobrecarga, rede de apoio social e estresse emocional do cuidador do idoso

Objetivo: determinar a sobrecarga do cuidado e sua associação com a rede de apoio social e estresse emocional do cuidador principal do idoso atendido no serviço de atenção domiciliar.Metodologia: estudo quantitativo e analítico realizado com 94 idosos e seus respectivos cuidadores. Quanto à coleta de dados, para o idoso foram utilizados os instrumentos deperfil sociodemográfico e morbidades, Mini Exame do Estado Mental, índice de Katz, escala de Lawton e Brody; e para o cuidador, o instrumento de perfil sociodemográfico, escala de sobrecarga de Zarit, Self-Reporting Questionnaire e instrumento de medida da rede e apoio social.Resultados: verificou-se predomínio de idosos do sexo feminino, idade superior a 80 anos, casados e com escolaridade de 1 a 4 anos. Os cuidadores principais são do sexo feminino,menores de 60 anos, casados, escolaridade de 9 a 12 anos; a maioria era filha do idoso e viviam com ele. Observouse uma associação entre a sobrecarga do cuidador e a dependência do idoso para as atividades instrumentais da vida diária, o estresse emocional e o domínio “interação social”.Conclusão: cuidar de idosos pode gerar sobrecarga quando o cuidador principal está sob estresse, não possui uma rede social de apoio e o idoso é dependente, portanto, o profissionalprecisa traçar um plano de cuidados para o binômio idoso-família.

Assessment of Perceived Attractiveness, Usability, and Societal Impact of a Multimodal Robotic Assistant for Aging Patients With Memory Impairments

The aim of the present study is to present the results of the assessment of clinical application of the robotic assistant for patients suffering from mild cognitive impairments (MCI) and Alzheimer Disease (AD). The human-robot interaction (HRI) evaluation approach taken within the study is a novelty in the field of social robotics. The proposed assessment of the robotic functionalities are based on end-user perception of attractiveness, usability and potential societal impact of the device. The methods of evaluation applied consist of User Experience Questionnaire (UEQ), AttrakDiff and the societal impact inventory tailored for the project purposes. The prototype version of the Robotic Assistant for MCI patients at Home (RAMCIP) was tested in a semi-controlled environment at the Department of Neurology (Lublin, Poland). Eighteen elderly participants, 10 healthy and 8 MCI, performed everyday tasks and functions facilitated by RAMCIP. The tasks consisted of semi-structuralized scenarios like: medication intake, hazardous events prevention, and social interaction. No differences between the groups of subjects were observed in terms of perceived attractiveness, usability nor-societal impact of the device. The robotic assistant societal impact and attractiveness were highly assessed. The usability of the device was reported as neutral due to the short time of interaction.

Work Stress and Depressive Symptoms in Fishermen With a Smoking Habit: A Mediator Role of Nicotine Dependence and Possible Moderator Role of Expressive Suppression and Cognitive Reappraisal

This study examined pathways of influence between work stress, depressive symptoms, nicotine dependence, expressive suppression, and cognitive reappraisal in fishermen with smoking habits in Qionghai, Hainan province, China (N = 1068). These fishermen responded to multiple assessments a week before leaving on a deep-sea fishing trip, including a Mental Stressor Investigation Questionnaire (MSIQ), the Center for Epidemiological Studies Depression Scale (CES-D), the Russell Reason for Smoking Questionnaire (RRSQ), and an Emotion Regulation Questionnaire (ERQ). Structural equation modeling (SEM) analyses of the collected data in Mplus 7 showed that work stress and nicotine dependence were independent predictors of depressive symptoms. The relationship between work stress and depressive symptoms was found to be partially mediated by nicotine dependence and be moderated by cognitive reappraisal. The evidence suggests it advantageous to examine the need of work stress, nicotine dependence, and cognitive reappraisal when attempting to understand depressive symptoms in fishermen with a smoking habit. These findings suggest that improving nicotine dependence through work stress management and training in cognitive reappraisal could be utilized as effective modalities for improving depressive symptoms.

A non-linear relationship between the cumulative exposure to occupational stressors and nurses' burnout and the potentially emotion regulation factors

BACKGROUND

Stressful situations can increase the likelihood of nurses experiencing negative emotions, especially burnout.

AIMS

To explore the association of cumulative exposure to occupational stressors and emotion regulation strategies with nurses' burnout.

METHODS

Participants were 602 nurses from three general hospitals in Jinan, China. Social demographic characteristics, occupational stress, burnout, and emotion regulation strategies (cognitive reappraisal, expressive suppression, and rumination), were assessed.

RESULTS

Nearly 70% of nurses reported that they were burnt out. Those with a moderate level and high level of stressors were 3.203 times and 26.444 times more likely to have burnout, respectively (x²_trend = 62.732). Logistic regression revealed that nurses had higher cognitive reappraisal score (odds ratios (OR) = 0.941), scored lower for burnout. Those who had higher expressive suppression score (OR = 1.054), higher rumination score (OR = 1.037), and a higher level of stressors (OR = 2.779-18.259) scored higher for burnout. The results of sensitivity analysis were similar.

CONCLUSIONS

A non-linear relationship exists between the cumulative exposure to occupational stressors and nurses' burnout. Those who less frequently use cognitive reappraisal, more frequently use rumination and expressive suppression, and have a high level of stressors may be more likely to experience burnout.

End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice

Background

Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia.

Methods and findings

Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia.

Conclusions

The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.