We-Care-Well: exploring the personal recovery of mental health caregivers through Participatory Action Research

Family caregivers play a critical role in supporting the recovery journeys of their loved ones, yet the recovery journeys of family caregivers have not been well-explored. Using a Participatory Action Research approach, we explore the personal recovery journeys of family caregivers for individuals with mental illness. This case study involved piloting and exploring the impact of a novel online workshop series offered to mental health caregivers at Ontario Shores Center for Mental Health Sciences. Recovery courses and workshops conventionally engage patients living with mental health conditions. In the current case, the recovery model is adapted to the needs and experiences of their family caregivers, resulting in a pilot workshop series called "We Care Well". Through participant-led discussions, interactive and take-home activities, and experiential learning, caregivers co-created workshop content and engaged in peer-learning on seven personal recovery-oriented topics. This included: self-care, resilience-building, non-violent communication, storytelling, and mental health advocacy. Throughout the sessions, participants implemented their learnings into their caregiving roles, and shared their experiences with the group to progress through their own recovery journeys. The We Care Well series was found to be an effective intervention to adapt and apply the personal recovery framework to mental health caregivers. PAR, and co-design are viable approaches to engage caregivers in mental health research, and can facilitate knowledge exchange, as well as relationship building with peers and program facilitators.

Self-rated mental health in the transition to adulthood predicts depressive symptoms in midlife

Self-rated mental health (SRMH), a single item asking individuals to evaluate their mental or emotional health, is included in some surveys as an indicator of risk for mental disorders and to monitor population health, yet little longitudinal research examines how well it predicts future outcomes. Following a life course perspective, the current longitudinal study of 502 Canadian high school seniors tracked into midlife examined to what extent SRMH at ages 20, 25, and 32 years predicted depressive symptoms at ages 43 and 50. Hierarchical linear regressions showed that lower SRMH at age 25 and at 32 years was a significant predictor of higher levels of depressive symptoms at ages 43 and 50, even when controlling for sex, participant education, marital/cohabitation status, self-rated physical health, and baseline depressive symptoms. The results provide evidence that SRMH assessed during the transition to adulthood may be useful as a broad and powerful measure of risk for mental health problems decades into the future.

Issues in Caregivers' Stress and Providers' Support

This study examined whether support from care recipients' primary care providers affects the stress and health of caregivers. This two-year longitudinal study addressed changes in caregivers' mental and physical health, both self-assessed and evaluated by professional nurse practitioners in physical examinations, and the effects of provider support on caregivers' health. Randomly selected participants from three previous studies plus a group of volunteer Alzheimer's caregivers constituted the sample. Of 254 eligible individuals, 150 agreed to participate, but by time 2, care recipient deaths and other reasons had reduced the number of caregivers to 99. Participants showed significant increases in stress and service use but declines in all areas of health and in provider support. Provider support did not materially affect caregivers' health but had an indirect effect on caregivers' self-assessed health through rewards. Despite the need for bolstering caregivers' health, perceived support from care recipients' providers is limited.

Health-promoting practices and the factors associated with self-reported poor health in caregivers of children orphaned by AIDS in southwest Uganda

Informal caregivers worldwide are faced with the dilemma of maintaining their health and meeting the caregiving demands of their loved ones. This study explores the health outcomes of caregiving, caregivers' health-promoting practices and the challenges to providing care among caregivers to children orphaned by AIDS in southwest Uganda. A descriptive design and interview questionnaires were used to collect data from 204 caregivers. The average age of the caregivers was 41.36 (±10.9) years and most of them (53%) were grandmothers to the orphans. The majority (65%) of the caregivers were caring for at least three orphans, had been in the caregiver role for more than five years (61%), and stated that their health had been negatively impacted by caregiving (61%). According to self-reports, the most common new health problems since taking up the caregiving role were chronic ill health (97%), social isolation (95%) and mental stress (92%). The health-promoting practices most often engaged in were eating a balanced diet (67%), seeking spiritual support (58%), and performing self-care activities (44%). The challenges to caregiving most often reported were poverty (88%) and a lack of time to seek personal medical care (59%). The predictors of self-reported poor health among the caregivers were stress (odds ratio [OR] = 3.43; p ≤ 0.01), caring for three or more orphans (OR = 2.19; p ≤ 0.01), female gender (OR = 1.77; p ≤ 0.01), and having spent more than five years as a caregiver to an orphan (OR = 1.35; p ≤ 0.01). The findings suggest that caregivers commonly experience poor health and their health-promoting practices are inadequate. There is a need for organised and formal health-promotion programmes for caregivers of children orphaned by AIDS, especially in rural areas of developing countries. Interventions for health promotion can be achieved through integrated programmes that provide health education, social services, respite from caregiving and counselling.

Single item measures of self-rated mental health: a scoping review

BACKGROUND

A single-item measure of self-rated mental health (SRMH) is being used increasingly in health research and population health surveys. The item asks respondents to rate their mental health on a five-point scale from excellent to poor. This scoping study presents the first known review of the SRMH literature.

METHODS

Electronic databases of Medline, CINAHL, PsycINFO, EMBASE and Cochrane Reviews were searched using keywords. The databases were also searched using the titles of surveys known to include the SRMH single item. The search was supplemented by manually searching the bibliographic sections of the included studies. Two independent reviewers coded articles for inclusion or exclusion based on whether articles included SRMH. Each study was coded by theme and data were extracted about study design, sample, variables, and results.

RESULTS

Fifty-seven studies included SRMH. SRMH correlated moderately with the following mental health scales: Kessler Psychological Distress Scale, Patient Health Questionnaire, mental health subscales of the Short-Form Health Status Survey, Behaviour and Symptom Identification Scale, and World Mental Health Clinical Diagnostic Interview Schedule. However, responses to this item may differ across racial and ethnic groups. Poor SRMH was associated with poor self-rated health, physical health problems, increased health service utilization and less likelihood of being satisfied with mental health services. Poor or fair SRMH was also associated with social determinants of health, such as low socioeconomic position, weak social connections and neighbourhood stressors. Synthesis of this literature provides important information about the relationships SRMH has with other variables.

CONCLUSIONS

SRMH is associated with multi-item measures of mental health, self-rated health, health problems, service utilization, and service satisfaction. Given these relationships and its use in epidemiologic surveys, SRMH should continue to be assessed as a population health measure. More studies need to examine relationships between SRMH and clinical mental illnesses. Longitudinal analyses should look at whether SRMH is predictive of future mental health problems.

Effort, workload, and depressive symptoms in family caregivers of older adults: conceptualizing and testing a work-health relationship

Increasing effort in response to a complex workload is detrimental to workers' health and may explain the negative health consequences experienced by millions of family caregivers who are the primary workforce for older adult care in the United States. This cross-sectional, descriptive correlational study used survey data from 110 family caregivers of community-dwelling older adults to theoretically explain caregiving effort (as perceived exertion) and to examine the relationship between effort and depressive symptoms, a particularly persistent adverse caregiver health outcome. Visual analog scales and exemplar quotes explicated physical, mental, emotional, and time-related effort. Notably, effort was considered too multidimensional by several caregivers to discretely categorize. Among the relationships tested, effort was statistically significantly correlated with workload proxies (time, difficulty, overload), caregiver health and depressive symptoms, and care receiver function. Using regression analysis, effort and workload did not have direct effects on depressive symptoms. Surprisingly, effort was not decreased for caregivers who had formal or informal caregiving help. These findings support an energetical conceptualization in caregiving and highlight the complexity of a caregiving workload assessment. Practice suggestions are offered toward tailored health promotion strategies to benefit the families who constitute this essential, global caregiving workforce.

An Uneven Burden

Using data from a large, nationally representative U.S. survey, the authors examine differences in adult caregiving responsibilities, working conditions, and caregiver outcomes by gender, ethnicity, immigration status, and educational attainment. Women, Hispanics, and first-generation immigrant caregivers are more likely to have worse working conditions including an unsupportive culture at work, less schedule flexibility, and less access to paid vacation leave. Women and first-generation immigrant caregivers are more likely to report caregiving contributing to poor job outcomes including quitting work, retiring early, or reducing hours involuntarily. Caregivers with less than a college degree experience both worse working conditions including lack of access to paid sick days and worse job outcomes including having lost wages or a job. Women, second-generation immigrants, and those with a high school diploma or less are more likely to report that their caregiving responsibilities interfere with their quality of life including negative impacts on their ability to spend time with friends. Research and policy implications are discussed.

Predictors of the depressive symptomatology of the family caregivers of Chinese stroke patients in Hong Kong

The aim of this cross-sectional study was to determine the socio-demographic and clinical factors associated with depressive symptoms in the family caregivers of Hong Kong Chinese stroke patients. One hundred and twenty-three patients at a stroke clinic and their family caregivers formed the study sample. The depressive symptoms of both the patients and their family caregivers were rated with the Chinese version of the 15-item Geriatric Depression Scale (GDS). Participants' socio-demographic data and clinical characteristics served as the independent variables in relation to the caregivers' GDS scores. Patients' and caregivers' somatic and psychological conditions were measured with 10 scales. In univariate analysis, caregivers' GDS scores were significantly correlated with certain of their characteristics [Modified Life Event Scale (MLES), Cumulative Illness Rating Scale (CIRS) and Lubben Social Network Scale (LSNS) scores, sex and being a housewife] and those of the patients (GDS score and being a housewife). Multiple regression analysis showed caregivers' MLES and CIRS scores and patients' GDS scores to be independent correlates of caregivers' GDS scores. Adverse events encountered by caregivers in the past 6 months, their current health problems and patients' depressive symptoms were found to be the principal factors associated with caregivers' depressive symptoms.

The Effectiveness of a Telephone Support Program for Caregivers of Frail Older Adults

PURPOSE

The purpose of this study was to evaluate the effectiveness of a telephone support group program on spouses and adult child caregivers of frail older adults.

DESIGN AND METHODS

The Telephone Support Group (TSG) model is a multicomponent group program offered in 12 weekly, 90-minute group sessions. It includes emotion-focused and problem-focused coping strategies, education, and support. We recruited for this study 36 spouses and 61 adult children and randomly assigned them to TSG or to usual services. We assessed the participants before and after the completion of TSG or usual services.

RESULTS

The results indicated that, for adult child caregivers, TSG was more effective than usual services in reducing burden, depression, social support, and pressing problems, and increasing knowledge and use of community services. We found no significant differences for spouse caregivers.

IMPLICATIONS

This is the first study to compare the effectiveness of TSG for adult child and spouse caregivers of frail older adults. TSG showed itself to be an effective means of delivering support to adult child caregivers of frail older adults but not to spouses. More research is needed about how to make TSG effective for spouse caregivers.

Longitudinal changes in the well-being of Japanese caregivers: variations across kin relationships

This study examined how the psychological well-being of Japanese caregivers changed over time; it also examined the variation across kin relationships with care recipients. Three interviews over the course of 30 months were conducted with a representative sample of community-dwelling caregivers of frail elderly persons living in a Tokyo suburb. Latent growth modeling demonstrated that mean levels of both depression and emotional exhaustion worsened over time. Change in emotional exhaustion over time showed significant individual variability, whereas change in depression showed little individual variability. Although wife caregivers tended to experience the worst trajectory of emotional exhaustion, daughters-in-law also showed a similar negative trend. The difference in individuals' well-being trajectories by kinship may be explained partly by differences in care recipients' disabilities.

Assessing the health of adult daughter former caregivers for elders with Alzheimer's disease

Past research is varied in assessing the effect of caregiving on health, particularly caregivers in the postcaregiving phase. The variation may be due, in part, to methodological issues, including the use of health measures not psychometrically tested. The study examines the Medical Outcomes Study Short Form 36 (SF-36) health survey with 102 former caregivers whose family member was deceased for at least one year at the time of the study and had been identified as having Alzheimer's disease or a related disorder. The SF-36 measures eight dimensions of physical and mental health and has been tested on a variety of populations, though not with former daughter caregivers. Confirmatory Factor Analysis supported the factorial validity of the SF-36 for this population, indicating it is a promising tool for understanding postcaregiver health.

Profiles of respite use

Profiles of long-term respite use are reported for a diverse sample of 4,369 families from seven states who participated in the Alzheimer's Disease Demonstration Grant to States program. Data from service records spanning a period of seven years were analyzed using hierarchical linear modeling techniques. Respite use was examined in both day care and in-home settings using three different measures of use. Client characteristics related to use include the caregiver's gender and relationship to the elder, and the ethnicity, income, functional level, and problem behaviors of the elder. Provider characteristics linked with different patterns of use include level of service, fee structure, and level of capitation. Implications for service delivery are discussed.