Evaluation of the coping attitudes of Alzheimer patients' relatives from the perspectives of depression, anxiety and guilt

This study aims to assess coping attitudes in primary caregivers of individuals diagnosed with Alzheimer's disease residing in an institution, and to evaluate the association between coping attitudes and levels of guilt, depression, and anxiety among caregivers. The sample of this study consists of 150 individuals with relatives diagnosed with Alzheimer. The Beck Anxiety Inventory, the Coping Attitudes Scale, the Guilt Inventory, and the Beck Depression Inventory were used in the present study. It was determined that the participants' coping levels were below the average score and that they frequently used problem focus coping attitudes. A positive relationship was found between the emotion focused, nonfunctional coping levels of the participants and their continuous guilt, anxiety and depression levels. Depression and guilt has a strong effect on coping attitudes, while anxiety was determined to be a moderate predictive variable. Findings show that caregivers with depression, anxiety and continuous guilt use non-functional and emotional coping more frequently.

Coping strategies and psychological distress in family carers of frail older people: A longitudinal study

BACKGROUND

Carers of dependent older people experience high levels of psychological distress. However, little is known about the effects of coping on carer distress over time. In this one year longitudinal study we investigated the relationship between distress, and coping strategies in a representative sample of family carers living in Spain.

METHODS

Primary carers of older people were recruited (N = 200). We used probability sampling and collected data via individual interviews from 2013 to 2015. Variables investigated included psychological distress, coping, and levels of objective and subjective burden. Panel data analysis was used to test a model of association of psychological distress, and coping strategies controlling for key confounders.

RESULTS

Acceptance and emotional support were the most frequently used strategies, whereas behavioural disengagement and humour were the least used. In the panel data regressions, positive reframing (B = -0.79, p < 0.001), self-distraction (B = -0.46, p = 0.034), substance use (B = 0.57, p < 0.001) and denial (B = 0.57, p = 0,049) were significantly related to psychological distress at one year follow-up.

LIMITATIONS

Limitations include participant drop out and assessing substance use coping via a brief measure.

CONCLUSIONS

Positive reframing and self-distraction were longitudinally associated with lower levels of carer psychological distress. Using denial and substance use coping increased distress long-term. Our results suggest that interventions that focus on positive reframing and assisting carers in decreasing dysfunctional coping may be useful therapeutic targets mitigating carer psychological morbidity.

Self-Compassion, Coping Strategies, and Caregiver Burden in Caregivers of People with Dementia

OBJECTIVE

Caring for someone with dementia can have negative consequences for caregivers, a phenomenon known as caregiver burden. Coping strategies influence the impact of caregiving-related stress. Specifically, using emotion-focused strategies has been associated with lower levels of burden, whereas dysfunctional strategies have been related to increased burden. The concept of self-compassion has been linked to both positive outcomes and the coping strategies that are most advantageous to caregivers. However, as yet, no research has studied self-compassion in caregivers. Therefore, the aim of this study was to explore the relationship between self-compassion, coping strategies and caregiver burden in dementia caregivers.

METHOD

Cross-sectional survey data was collected from 73 informal caregivers of people with dementia recruited from post-diagnostic support services and caregiver support groups.

RESULTS

Self-compassion was found to be negatively related to caregiver burden and dysfunctional coping strategies and positively related to emotion-focused coping strategies. Dysfunctional strategies mediated the relationship between self-compassion and caregiver burden, whereas emotion-focused strategies did not.

CONCLUSION

Caregivers with higher levels of self-compassion report lower levels of burden and this is at least partly due to the use of less dysfunctional coping strategies.

CLINICAL IMPLICATIONS

Interventions that develop self-compassion could represent a useful intervention for struggling caregivers.

Coping strategies among caregivers of people with Alzheimer disease: a systematic review

Abstract Introduction Caregivers of people with Alzheimer disease (PwAD) report significant stress, burden and depression compared to caregivers of people with other dementias, especially when neuropsychiatric symptoms are prominent. Adequate coping strategies can modify the impact of stressful situations and increase the caregivers’ quality of life. Objective To systematically review the different coping strategies used by caregivers of PwAD to manage neuropsychiatric symptoms. Method We carried out electronic searches using MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) and PsycINFO databases to select studies on coping in PwAD caregivers published from January 2005 to July 2017. The search terms were coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. The studies were organized in three categories: problem-focused, emotion-focused and dysfunctional coping strategies. Results We found 2,277 articles. After application of exclusion criteria and exclusion of redundant references, 24 articles were analyzed. Emotion-focused coping was the most commonly used strategy among PwAD caregivers. The use of this strategy associated with religion and spirituality may help reduce symptoms of depression and anxiety. Problem-focused coping strategies were mostly used with active coping interventions. Problem-solving coping may have buffered the impact of acute psychological stressors on procoagulant activity. Dysfunctional coping strategies were associated with increase of caregiver burden. Conclusion The evaluated studies showed that the use and development of coping strategies may have ameliorated the depressive symptoms, anxiety and burden of caregivers. However, longitudinal studies are still needed that clearly describe the type of coping strategy used in relation to the presented results.

Cardiovascular Risk Factors in Parents of Food-Allergic Children

Previous studies suggest that chronic stress may induce immune system malfunction and a broad range of adverse health outcomes; however, the underlying pathways for this relationship are unclear. Our study aimed to elucidate this question by examining the relationship between parental cardiovascular risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and waist-to-hip ratio (WHR) and maternal psychological stress score (MPSS) relative to the severity of the child's food allergy (FA) and number of affected children. SBP, DBP, BMI, and WHR were measured and calculated at the time of recruitment by trained nurses. MPSS was obtained based on self-report questionnaires covering lifestyle adjustments, perceived chronic stress, and quality of life. General linear models examined whether caregiver chronic stress was associated with FA. For mothers with children under age 5 years, SBP, DBP and number of affected children had strong and graded relationships with severity of the child's FA. MPSS was also significantly and positively associated with child FA severity (P < 0.001). However, no relationships were found between FA severity, BMI, or WHR for either parent. This was also the case for paternal SBP, DBP, and number of affected children of any age. There is a strong and graded link between cardiovascular risk and perceived stress in mothers of food-allergic children under age 5. Findings may have important implications for family-centered care of FA, may generalize to caregivers of children with chronic conditions, and extend the literature on allostatic load.

Coping, subjective burden and anxiety among family caregivers of older dependents

AIMS AND OBJECTIVES

To investigate relationships between anxiety and stressors,coping and subjective burden and to contribute to defining factors related to anxiety among family caregivers of older dependents.

BACKGROUND

Despite the studies analysing factors related to anxiety in caregivers, there is not enough evidence about this issue.

DESIGN

Cross-sectional design.

METHODS

Data from 140 family caregivers (convenience sample) were analysed using descriptive statistics, correlation coefficients and path analysis. Socio-demographic data and several scales (Barthel Index, Short Portable Mental Status Questionnaire, Cummings Neuropsychiatric Inventory, Brief COPE, Caregiver Strain Index and Hamilton Anxiety Rating Scale) were used to collect data.

RESULTS

Stressors (psychiatric and psychological symptoms and number of assisted activities of daily living), emotion-focused coping, dysfunctional coping and subjective burden were related to greater anxiety. Subjective burden mediated the effects of psychiatric and psychological symptoms on anxiety and partially mediated the effects of dysfunctional coping on anxiety.

CONCLUSIONS

Stressors, dysfunctional coping and subjective burden were identified as factors related to anxiety. The mediating role of subjective burden in the relationship between dysfunctional coping and anxiety was supported. The effect of dysfunctional coping on anxiety was independent of the stressors.

RELEVANCE TO CLINICAL PRACTICE

These conclusions justify several recommendations regarding nursing interventions for family caregivers of older dependents: (1) stressors,dysfunctional coping and subjective burden can be used in clinical practice for early detection of and early intervention for anxiety; (2) to prevent subjective burden and anxiety,approach-coping skills should be promoted through interventions such as problem-solving,positive reappraisal, assertiveness and control of negative thoughts; (3) these interventions for dysfunctional coping should be systematically developed for individuals with dysfunctional coping regardless of the level of stressors and/or the possibility of respite.

Relationship of coping style to mood and anxiety disorders in dementia carers

PURPOSE OF REVIEW

Mood and anxiety disorders are common in family carers of people with dementia, and are associated with poor carer and care recipient outcomes. Caring for someone with dementia is stressful, but how carers cope may be an important determinant of carer psychological morbidity. This review summarizes and integrates the literature on the effect of coping style and its role in effective carer interventions.

RECENT FINDINGS

Two systematic reviews evaluated relationships between coping style and mood/anxiety disorders in observational studies and randomized controlled trials (RCTs), respectively. Several subsequent cross-sectional studies have also investigated these relationships, including in the context of coping as a mediator or moderator. Studies also investigated suicidality and cultural factors underlying coping.

SUMMARY

More dysfunctional, and less emotional support and acceptance-based coping styles are robustly associated with carer depression and anxiety symptoms and caseness in cross-sectional studies. There is also preliminary evidence from longitudinal studies that these coping styles may predict subsequent carer psychological morbidity. Psychological interventions successful in reducing depression counterintuitively increased dysfunctional coping in RCTs, but no RCTs have directly tested whether emotional support and acceptance-based coping mediates the effects of psychological intervention.

Anxiety and depression are associated with coping strategies in caregivers of Alzheimer's disease patients: results from the MÁLAGA-AD study

BACKGROUND

Caregiving for people with Alzheimer's disease (AD) is highly stressful and has significant negative consequences, such as anxiety and depression. Previous research offers conflicting findings as to whether coping strategies are associated with greater psychological distress or not. We conducted this study with a view to obtaining new data regarding the association of coping strategies and psychological distress in AD caregivers.

METHODS

Eighty people with AD and their primary caregivers living in the community were recruited from local health services. Purposive recruitment was carried out to ensure that the sample was representative of people living with dementia in terms of dementia severity, gender, and care setting. We used the State-Trait Anxiety Inventory to measure anxiety, the Beck Depression Inventory to measure depression, and the Coping Strategies Inventory to measure coping strategies.

RESULTS

Most caregivers reported higher anxiety and depression levels. Use of disengagement coping strategies (Wald = 3.35, p = 0.01) and higher caregiver burden (Wald = 4.83, p = 0.02) predicted anxiety on logistic regression. In turn, use of disengagement coping strategies (Wald = 12.48, p = 0.001) and higher caregiver burden (Wald = 6.91, p = 0.009) predicted depression on logistic regression.

CONCLUSION

These results may be useful for designing treatment interventions that aim to modify the use of coping strategies and thus reduces caregiver anxiety and depression.

Coping strategies and psychological morbidity in family carers of people with dementia: a systematic review and meta-analysis

BACKGROUND

Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression.

METHOD

We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses.

RESULTS

We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC=0.39, 95% CI 0.28-0.50; N=688) and depression (0.46, 0.36-0.56; N=1428) cross-sectionally, and with depression 6 and 12months later (0.32, 0.10-0.54; N=143). Emotional support and acceptance-based coping correlated with less anxiety (-0.22, 95% CI -0.26 to -0.18; N=628) and depression (-0.20, -0.28 to -0.11; N=848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity.

LIMITATIONS

Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies.

CONCLUSIONS

There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style.

Disengagement coping partially mediates the relationship between caregiver burden and anxiety and depression in caregivers of people with Alzheimer's disease. Results from the MÁLAGA-AD study

BACKGROUND

Caring for people with Alzheimer's disease can be considered stressful and demand adjustment strategies. While various variables have been associated with caregiver anxiety and depression, a possible mediator role of coping strategies adopted by caregivers between caregiver burden and anxiety and depression is still unclear. We hypothesized that caregivers with clinically significant anxiety and depression were more likely to use disengagement coping strategies that non-anxious and non-depressed caregivers.

METHODS

This study involved 80 Alzheimer disease patients and their primary caregivers. Patients were evaluated using the Mini Mental State Examination, the Bayer Activities of Daily Living Scale, the Global Deterioration Scale and the Neuropsychiatric Inventory. Caregivers were evaluated with the Caregiver Burden Interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Coping Strategies Inventory. We conducted a series of multiple linear regressions to determine the relationship between caregiver burden and caregiver anxiety and depression, and if the coping strategies mediated this relationship.

RESULTS

Using more disengagement (β=0.270, p<0.001) and less engagement coping (β=-0.310, p<0.001) were predictors for anxiety scores. Using more disengagement (β=0.250, p<0.001) and less engagement coping (β=-0.261, p<0.001) were predictors for depression scores.

LIMITATIONS

This study was a cross-sectional design, so the direction of causality should be strengthened by a longitudinal study.

CONCLUSIONS

Most caregivers reported higher anxiety and depression levels and this was partially mediated by their dysfunctional coping strategies.

Relationships between quality of life and family function in caregiver

BACKGROUND

There are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregiver's situation has not been the subject of much evaluation. The aim of this study is to analyse the relationship between the functionality of the family and the QoL of caregivers of dependent relatives.

METHODS

We conducted a cross-sectional study including 153 caregivers.

SETTING

Two health centers in the city of Salamanca(Spain). Caregiver variables analysed: demographic characteristics, care recipient features; family functionality (Family APGAR-Q) and QoL (Ruiz-Baca-Q) perceived by the caregiver. Five multiple regressions are performed considering global QoL and each of the four QoL dimensions as dependent variables. The Canonical Correspondence Analysis (CCA) was used to study the influence of the family function questionnaire on QoL.

RESULTS

Family function is the only one of the variables evaluated that presented an association both with global QoL and with each of the four individual dimensions (p<0.05). Using the CCA, we found that the physical and mental well-being dimensions are the ones which present a closer relationship with family functionality, while social support is the quality dimension that is least influenced by the Family APGAR-Q.

CONCLUSION

We find an association between family functionality and the caregiver's QoL. This relation holds for both the global measure of QoL and each of its four individual dimensions.

Personality features, caring burden and mental health of cohabitants of partners with chronic obstructive pulmonary disease or dementia

OBJECTIVES

The interplay between personality, mental health and type of disease in explaining caring burden was studied in home-dwelling cohabitants of partners with chronic obstructive pulmonary disease (COPD) or dementia.

METHODS

A cross-sectional study including 206 participants with 80% response rate. Neuroticism was assessed by Eysenck Personality Questionnaire (EPQ) and externality by Locus of Control of Behaviour. The Relative Stress Scale evaluated caring burden. Mental health was determined by the General Health Quality (GHQ-28) questionnaire.

RESULTS

Neuroticism and type of illness played a major role in explaining caring burden and mental health. In the COPD and dementia groups, 30.5% and 58.4%, respectively, were above the cut-off point for psychiatric caseness on the GHQ. Both groups had low scores for depression and high scores for social dysfunction, anxiety, insomnia and somatisation. Compared to the dementia group, the COPD group had lower scores and fairly stable levels on all subscales of the GHQ. Females had higher scores on somatic symptoms, anxiety and insomnia; they also reported higher scores on neuroticism and externality.

CONCLUSION

Differences in personality and illness explained both caring burden and mental health among caregivers. To mitigate the caring burden and mental health problems among home-dwelling caregivers, public health services need to take into account the personality and gender of the caregiver, and also the disease of the ill partner.

The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review

Food allergy affects 6% of children but there is no cure, and strict avoidance of index allergens along with immediate access to rescue medication is the current best management. With specialist care, morbidity from food allergy in children is generally low, and mortality is very rare. However, there is strong evidence that food allergy and food hypersensitivity has an impact on psychological distress and on the quality of life (QoL) of children and adolescents, as well as their families. Until recently, the measurement of QoL in allergic children has proved difficult because of the lack of investigative tools available. New instruments for assessing QoL in food allergic children have recently been developed and validated, which should provide further insights into the problems these children encounter and will enable us to measure the effects of interventions in patients. This review examines the published impact of food allergy on affected children, adolescents and their families. It considers influences such as gender, age, disease severity, co-existing allergies and external influences, and examines how these may impact on allergy-related QoL and psychological distress including anxiety and depression. Implications of the impact are considered alongside avenues for future research.

Maternal adaptation to pediatric neurosurgical diagnosis: a growth curve analysis

OBJECTIVE

To describe trajectories of change in maternal adaptation to chronic pediatric neurosurgical diagnosis and to identify variables predicting the level and rate of adaptation.

METHODS

One hundred and thirty seven mothers of children diagnosed with neurosurgical illness participated. Mothers reported socio-demographic variables, neuroticism, optimism, spouse support, mental health, and personal growth. The coordinating nurse assessed illness variables. Data were collected from diagnosis to 32+months post-diagnosis.

RESULTS

Results showed poor maternal mental health at diagnosis, followed by a gradual improvement over the next 18 months, and then a slight regression. Optimism, spouse support and religiosity were identified as resistance factors, while neuroticism, treatment needs, maternal age, and maternal education were identified as risk factors. The rate of change in mental health was moderated by neuroticism.

CONCLUSIONS

Maternal adaptation to pediatric illness changes over time. The trajectories of adaptation vary in relation to personal, social and medical variables.

Coping strategies, anxiety and depression in caregivers of people with Alzheimer's disease

OBJECTIVES

There have been few longitudinal studies investigating the impact of coping on psychological morbidity in caregivers of people with dementia. Findings have been inconsistent and little attention has been paid to anxiety in caregivers. We explored the hypothesis that the relationship between caregiver burden and anxiety and depression is mediated by coping style.

METHODS

As part of the LASER-AD study, 93 (73.8%) people with Alzheimer's disease and their family caregivers recruited at baseline were re-interviewed 1 year later. Sampling aimed to ensure that the participants were representative of people living in the UK with Alzheimer's disease in terms of dementia severity, gender and care setting. We used the Hospital Anxiety and Depression Scale, the Zarit Burden scale and the Brief COPE to measure coping strategies.

RESULTS

Using fewer emotion-focused strategies and more problem-focused strategies (but not dysfunctional strategies) mediated the relationship between caregiver burden and anxiety a year later, after controlling for potential confounders, in a well-fitting structural equation model (chi(2)=0.93, df=3, p=0.82; NFI=1.0, RFI=0.97, IFI=1.0, TLI=1.1, RMSEA=0.0). Using fewer emotion focused strategies also predicted higher psychological morbidity in general. The hypothesised relationship was not proved for depression.

CONCLUSIONS

Using emotion-focussed coping strategies in response to caregiver burden seemed to protect caregivers from developing higher anxiety levels a year later; however using problem-focussed strategies did not. Our results suggest that a psychological intervention package to emphasise emotion-focused coping may be a rational approach to reduce anxiety in dementia caregivers. Studies are needed to test such interventions.

Coping strategies and anxiety in caregivers of people with Alzheimer's disease: the LASER-AD study

BACKGROUND

Caregivers of people with dementia (CGPD) frequently have anxiety symptoms but little is known about the relationship of anxiety with coping strategies.

METHOD

126 people with Alzheimer's disease (AD) and their family caregivers living in the community were recruited from local psychiatric services, the voluntary sector and care homes. Sampling was designed to ensure that the sample was epidemiologically representative in terms of dementia severity, gender and care setting. We used the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and the Brief COPE to measure coping strategies.

RESULTS

Use of dysfunctional coping strategies (Wald = 7.3, p = 0.007) and HADS depression caseness (Wald = 14.0, p < 0.001) were the only factors that predicted HADS anxiety caseness on logistic regression.

LIMITATIONS

Anxious caregivers may be more likely to report their coping strategies negatively; these results do not clarify direction of causality.

CONCLUSIONS

Dysfunctional coping strategies and depression appear to be the most important factors predicting caregiver anxiety. Addressing coping strategies may be a helpful intervention for managing caregiver anxiety.