Religious coping among caregivers of terminally ill cancer patients: main effects and psychosocial mediators

Care burden and the predictive role of spiritual well-being and religious coping: A cross sectional study among Iranian family caregivers of patients with stroke

Background and Aims

The burden of care after a stroke is gaining recognition as a significant healthcare issue. Factors like religion and spirituality, encompassing religious coping and spiritual health, prove to be influential in anticipating the challenges faced by caregivers. The present study aimed to determine the relationship between care burden, spiritual health, and religious coping among caregivers of stroke patients.

Methods

This cross-sectional research was conducted with the participation of 129 caregivers of stroke patients. The data was collected using the Ellison and Paloutzian spiritual well-being instruments, Pargament Religious Coping (RCOPE) brief version, and the Zarit burden interview (ZBI). Through a census, participants were recruited for the investigation. Data were analyzed using descriptive and inferential statistics (multivariate linear regression analysis).

Results

The study results indicate a strong and statistically significant relationship between the burden of caring and spiritual health (p < 0.001, β = 0.33). Furthermore, specific variables were identified as indicators of an increased burden of care, including positive religious coping (p = 0.04, β = 0.63), the familial relationship between the caregiver and patient, specifically as a child (p = 0.001, β = 29.26), and a sister (p < 0.001, β = 35.93).

Conclusion

It is advisable to consider adopting and implementing appropriate support measures for coping strategies rooted in religion and spirituality. So, it is recommended to enhance the provision of comprehensive support, including psychological and religious interventions. This can be achieved through the collaborative efforts of support groups comprising psychiatric nurses, psychiatrists, psychologists, and religious experts.

Cross-Cultural Validation and the Psychometric Properties of the Korean Version of the Brief Religious Coping Scale

This study examined the psychometric properties of the Korean version of the Brief Religious Coping Scale (RCOPE) among Korean Protestant Christians to determine its reliability and validity in South Korea considering the unique characteristics of Korean Protestant Christianity. Exploratory Factor Analysis (n = 251) and confirmatory factor analysis (n = 268) identified the original two-factor structure of the positive and negative religious coping subscales. Also, the scale exhibited robust reliability and construct validity. This study affirmed the scale is a valid and reliable instrument for measuring religious coping in Korean Christian adults.

Association between Social Support and Depressive Symptoms in Informal Caregivers of Adult and Older Dependents: A Systematic Review and Meta-Analysis

Social support is an important determinant of a carer's mental health. In recent decades, despite many studies reporting on the relationship between social support and depressive symptoms in informal caregivers of adult and older dependents, there are no systematic reviews synthesizing the available evidence. The purpose of the present study was to perform a systematic review and meta-analysis on the relationship between social support and depressive symptoms in informal caregivers of adults and older dependent people. We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), and Scopus, up to 15 January 2023 for studies. We applied no date or language limits to our search. A random-effects model was used to pool effect estimates. The included studies were also independently assessed for quality. Publication bias was evaluated by funnel plots, Egger's regression test, and the Trim and Fill method. Ninety-three studies were included in the review, reporting on a total of 15,431 informal caregivers. We found a moderate negative association between perceived social support and caregiver depressive symptoms (78 studies; r = -0.35, 95% CI = -0.39, -0.31; low heterogeneity and low risk of publications bias) and a small negative association between received social support and caregiver self-reported depressive symptoms (12 studies; r = -0.14, 95% CI = -0.20, -0.07; low heterogeneity and low risk of publications bias). Our results indicate that social support is a clinically relevant construct for carer well-being and an important protective factor for depressive symptoms in informal caregivers of adult and older dependents.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Closeness to God, Spiritual Struggles, and Wellbeing in the First Year of College

Spirituality is an important, but oft-overlooked, aspect of the self that may affect college students’ wellbeing and belonging. Few studies have systematically examined closeness to God and spiritual struggles as predictors of college student wellbeing during early college, which is a critical window for identity development. Moreover, research exploring interactions between spiritual struggles and closeness to God in predicting wellbeing outcomes is scarce. We address these gaps in the literature with an analytic sample comprised of 839 first-year college participants who identify as religious. The results of correlational analyses and linear mixed effect models are presented. Closeness to God was associated with greater wellbeing and belonging, and spiritual struggles were associated with lower wellbeing and belonging. In exploratory analyses, a moderating effect of closeness to God on the relation between spiritual struggles and negative outcomes was observed. Implications for higher education and college student development are discussed.

Religious Coping Styles and Depressive Symptoms in Geriatric Patients: Understanding the Relationship through Experiences of Integrity and Despair

Older persons are often confronted with challenging events in their lives. Religion can offer them a way to deal with these challenges. The study of religious coping styles helps us to understand how people find support in their religion or wrestle with aspects of their religion when they are confronted with difficulties. Especially when older adults face illness and hospitalization, religious coping styles might be triggered. Despite the fact that the public role of religion, especially Christianity, is diminishing in West European societies, a large group of Belgian geriatric patients call themselves religious. Previous studies have shown that there is a link between positive/negative religious coping styles and the depressive symptoms that often occur in older adults. More recently, some scholars have emphasized that this relationship is more complex. Therefore, this paper investigates the role of one possible underlying mechanism between positive/negative religious coping styles and depressive symptoms in geriatric patients, namely the developmental process of integrity and despair as two factors within this mechanism. One hundred thirty-nine geriatric inpatients from three hospitals in Belgium who reported to feel religiously affiliated were involved in this study. Our results indicate that experiences of integrity and despair function as an explanatory pathway in the relationship between negative religious coping styles and depressive symptoms. Further, a direct link was found between both when accounting for experiences of integrity and despair. For positive religious coping styles, no direct or indirect relationship with depressive symptoms was found. In healthcare, geriatric caregivers need to be aware of the interaction between positive and negative religious coping styles, the developmental process of integrity and despair, and depressive symptoms.

Religious coping and psychological well-being in Latino Alzheimer's caregivers

OBJECTIVES

Prior research has demonstrated the benefits of religion on caregiver well-being; however, less research exists on the processes underlying this relationship, particularly in Latino Alzheimer's disease (AD) families. This study's aim was therefore to explore the direct and indirect influences of positive religious coping (RC-P) and negative religious coping (RC-N) on caregivers' experiences of depression and anxiety.

METHODS

The data are from the Circulo de Cuidado Study baseline interviews; participant eligibility criteria were that the person identifies as being Latino, providing at least 5 h of care weekly, and their relative has an AD diagnosis and neuropsychiatric symptoms. In person at-home interviews were conducted in Spanish with 67 caregivers. Religious coping was assessed with the Brief RCOPE; depression and anxiety were measured with the Center for Epidemiological Studies Depression Scale-Spanish version and State Anxiety Inventory. Multivariate regression analyses, controlling for caregiving stressors, were used to test our core hypotheses.

RESULTS

As hypothesized, RC-N had significant direct effect on depression (p < 0.001) and anxiety (p < 0.001) as well as partially mediated the relationship between caregiver subjective stressor and depression (p < 0.01) and anxiety (p < 0.01). However, contrary to our hypothesis, RC-P did not have a direct or indirect effects on psychological well-being.

CONCLUSIONS

Our findings are consistent with other studies linking RC-N to poorer caregiver outcomes. Caregivers who questioned God's power, perceived God punishing them, or felt abandoned by God reported greater levels of depression and anxiety. The results suggest that caregivers experiencing religious distress may feel overwhelmed and view a more hopeless future.

Spirituality-Integrated Interventions for Caregivers of Patients with Terminal Illness: A Systematic Review of Quantitative Outcomes

This systematic review of published quantitative research was conducted to explore the effects of spirituality-integrated interventions for informal caregivers of terminally ill patients. Multiple databases were searched for articles published between January 2004 and November 2019. Twelve randomized controlled trials were identified. Methodological quality was assessed using the revised Cochrane Collaboration's tool for assessing risk of bias. Studies were notably diverse in terms of spiritual background, intervention design, technology used, and outcomes measures. Spirituality-integrated interventions were found to show positive outcomes for caregivers. However, methodological flaws negatively affected the quality of most studies, warranting further and rigorous research into the topic.

Sad Eyes, Crooked Crosses: Religious Struggles, Psychological Distress and the Mediating Role of Psychosocial Resources

In this paper, we employed data from the 2011 Miami-Dade Health Survey (n = 444) to formally test whether the association between religious struggles and psychological distress is mediated by psychosocial resources. We found that religious struggles were associated with lower levels of social support, self-esteem, the sense of control, and self-control. We also observed that religious struggles were associated with higher levels of non-specific emotional distress, depression, and anxiety, but not somatization. Our mediation analyses revealed significant indirect effects of religious struggles on emotional distress (not somatization) through social support, self-esteem, and the sense of control, but not self-control.

Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review

PURPOSE

Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors.

METHOD

A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review.

RESULTS

Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45-60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes.

CONCLUSIONS

Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains.

Psychometric evaluation of the brief RCOPE and relationships with psychological functioning among caregivers of children undergoing hematopoietic stem cell transplant

OBJECTIVE

Spiritual and religious (S/R) coping is a relevant yet understudied domain of coping among caregivers of children undergoing hematopoietic stem cell transplantation (HCT). The aims of this manuscript are to: (1) conduct the first psychometric evaluation of the Brief RCOPE in this population; (2) examine levels of and changes in S/R coping over time; and (3) explore the relationship between S/R coping trajectories and psychological functioning post-HCT.

METHODS

Caregivers (n = 170) of children (ages ≤12 years, n = 170) undergoing HCT completed the Brief RCOPE and the Brief Symptom Inventory (BSI) pre- and at multiple time points post-HCT discharge. Factor structure, internal consistency, and validity were examined. Growth mixture models were used to identify subgroups with similar S/R coping trajectories, with group memberships added to mixture models to explore relationships between group membership and caregiver psychological functioning trajectories.

RESULTS

The Brief RCOPE exhibited the previously-supported two factor structure and each subscale demonstrated strong internal consistency (α = 0.85 and 0.92). Validity was supported by significant correlations with BSI scores. There were distinct subgroups of caregivers with different patterns of positive (n = 4 subgroups) and negative (n = 3 subgroups) S/R coping, with negative coping subgroup membership predicting changes in psychological functioning.

CONCLUSIONS

The Brief RCOPE is a promising measure for assessing S/R coping among caregivers of children undergoing HCT and has the potential to identify caregivers at risk for poorer long-term psychological functioning.

Religious Struggle and Life Satisfaction Among Adult Christians: Self-esteem as a Mediator

The religious dimension of life represents an important source of human strength, meaning, and coping for many people. However, the religious life is not always "smooth and easy" and can be associated with weak personal adjustment, poorer psychological well-being, and lower satisfaction. Yet, besides the direct relationship between these variables, some researchers postulate the existence of an indirect association that has not been fully explained by various psychosocial mediators. The aim of the present study was to verify whether self-esteem could be a potential mediator between religious strain and life satisfaction. The sample consisted of 607 adult Christians (49.6% women) aged between 18 and 79. We used the Religious Comfort and Strain Scale, the Satisfaction with Life Scale, and the Rosenberg Self-Esteem Scale. Consistent with our hypotheses, life satisfaction positively correlated with religious comfort and was negatively associated with fear/guilt, negative emotions toward God, and negative social interactions surrounding religion. The same pattern of results was shown in the case of self-esteem. Moreover, the outcomes obtained from bootstrap sampling (5000) with a 95% confidence interval indicated a significant role of self-esteem as a mediator in all of the relationships between: (1) religious comfort and life satisfaction; (2) fear/guilt and life satisfaction; (3) negative emotions toward God and life satisfaction; and (4) negative social interactions surrounding religion and life satisfaction.

Coping with caregiving stress among caregivers of patients with schizophrenia

This study aimed to evaluate the coping strategies, including religious coping, used by the caregivers of patients with schizophrenia to deal with caregiving stress. Caregivers of 100 patients with schizophrenia, currently in clinical remission, were evaluated on Ways of the coping questionnaire, Brief religious coping scale, and General Health Questionnaire (GHQ-12). More often use of adaptive coping mechanisms (such as seeking social support, accepting responsibility, planful problem solving, and positive reappraisa) was associated with a lower level of residual symptoms and better functioning of the patient, and lower level of psychological morbidity as per the GHQ-12 among the caregivers. A higher grade of negative symptoms, general psychopathology, and PANSS total score was associated with lower use of positive religious coping and higher use of negative religious coping in the caregivers. More severe psychological morbidity among the caregivers was associated with lower use of positive religious coping and higher use of negative religious coping. To conclude, this study depicts that caregivers of patients with schizophrenia use a mixture of adaptive and maladaptive coping strategies, including religious coping. The use of adaptive coping is associated with better patient-related outcomes and lower levels of psychological morbidity/distress among caregivers. Whereas, more frequent use of maladaptive coping is associated with both patients' and caregivers' outcomes.

Understanding and Addressing the Role of Coping in Palliative Care for Patients With Advanced Cancer

Advanced cancer, with its considerable physical symptoms and psychosocial burdens, represents an existential threat and major stressor to patients and their caregivers. In response to such stress, patients and their caregivers use a variety of strategies to manage the disease and related symptoms, such as problem-focused, emotion-focused, meaning-focused, and spiritual/religious coping. The use of such coping strategies is associated with multiple outcomes, including quality of life, symptoms of depression and anxiety, illness understanding, and end-of-life care. Accumulating data demonstrate that early palliative care, integrated with oncology care, not only improves these key outcomes but also enhances coping in patients with advanced cancer. In addition, trials of home-based palliative care interventions have shown promise for improving the ways that patients and family caregivers cope together and manage problems as a dyad. In this article, we describe the nature and correlates of coping in this population, highlight the role of palliative care to promote effective coping strategies in patients and caregivers, and review evidence supporting the beneficial effects of palliative care on patient coping as well as the mechanisms by which improved coping is associated with better outcomes. We conclude with a discussion of the limitations of the state of science, future directions, and best practices on the basis of available evidence.

The Relationship Between Psychological Distress and Religious Practices and Coping in Malaysian Parents of Children with Thalassemia

STUDY PURPOSE

This study was conducted to examine the relationship between religious practice, religious coping methods and psychological distress among parents caring for children with transfusion-dependent thalassemia.

DESIGN AND METHODS

This is a cross-sectional survey. Data were collected on 162 parents of children diagnosed with thalassemia aged 12 years and younger in thalassemia day care centers of three public hospitals in Sabah, Malaysia. Data were collected using questionnaires, including General Health Questionaire-12 (GHQ-12), Duke University Religion Index (DUREL) and Brief RCOPE.

RESULTS

Forty-two percent of parents had psychological distress with GHQ score ≥ 3 (mean score of 2.85 ± 3.17). Ninety-five percent of parents used positive religious coping methods (mean P-COPE score 22.35 ± 2.33) more than negative religious coping methods (mean N-COPE score was 12.19 ± 5.23). They used Organized Religious Activities (mean ORA score of 4.20 ± 1.27), and Non-Organized Religious Activities (NORA, the mean was 4.17 ± 1.37). Positive and negative religious coping methods were significantly related to parents' psychological distress (P-COPE and GHQ-12 scores (r_s (df) = 0.19, p < .05; N-COPE and GHQ-12 scores r_s (df) = 0.38, p < .001)).

CONCLUSION

The study findings showed the parents experienced psychological distress. They used positive religious coping methods more than negative religious coping methods. Psychological distress was significantly related to organized religious activities, non-organized religious activities and positive and negative religious coping methods.

PRACTICE IMPLICATION

The study findings facilitate understanding of psychological distress and how parents use religious coping strategies to deal with the stress caring for their child.

The experience of family caregivers of patients with cancer in an Asian country: A grounded theory approach

BACKGROUND

Strong family bonds are part of the Indonesian culture. Family members of patients with cancer are intensively involved in caring, also in hospitals. This is considered "normal": a societal and religious obligation. The values underpinning this might influence families' perception of it.

AIM

To explore and model experiences of family caregivers of patients with cancer in Indonesia in performing caregiving tasks.

DESIGN

A grounded theory approach was applied. The constant comparative method was used for data analysis and a paradigm scheme was employed for developing a theoretical model.

SETTING/PARTICIPANTS

The study was conducted in three hospitals in Indonesia. The participants were family caregivers of patients with cancer.

RESULTS

A total of 24 family caregivers participated. "Belief in caregiving" appeared to be the core phenomenon. This reflects the caregivers' conviction that providing care is an important value, which becomes the will power and source of their strength. It is a combination of spiritual and religious, value and motivation to care, and is influenced by contextual factors. It influences actions: coping mechanisms, sharing tasks, and making sacrifices. Social support influences the process of the core phenomenon and the actions of the caregivers. Both positive and negative experiences were identified.

CONCLUSION

We developed a model of family caregivers' experiences from a country where caregiving is deeply rooted in religion and culture. The model might also be useful in other cultural contexts. Our model shows that the spiritual domain, not only for the patient but also for the family caregivers, should be structurally addressed by professional caregivers.

Community-Based Mental Health Care: Stigma and Coping Strategies Among Professionals and Family Caregivers in the Eastern Region of Ghana

To a large extent caregivers perceive stigma through their social and community interactions by virtue of their association with persons with mental health problems. Meanwhile, evidence on their strategies for coping with potentially undesirable experiences linked with stigma is limited. Using a descriptive qualitative approach, the present study explored affiliate stigma among mental health professionals and family caregivers of persons with mental illness. Data, collected through one-on-one interviews with 10 mental health professionals and 10 family caregivers, were examined with content analysis. Findings revealed that, although stigma attached to mental illness was largely directed at sufferers and family caregivers, professionals sometimes had their fair share. To manage the negative impact of stigma, caregivers adopted various strategies including the use of realisation, tactical or planned ignoring, self-motivation, acceptance and religion. Implications of the findings necessitate the intensification of mental health education among the general populace, which must be targeted at demystifying mental illness.

Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults

BACKGROUND

Satisfaction with life is recognized to be a factor in alleviating burden in stressful caregiving duties. However, the mechanism underlying this relationship is indistinct. Positive aspects of caregiving (PAC) may help to regulate caregiving burden among caregivers of older adults. The study aims to examine whether positive caregiving characteristics mediate the effect between satisfaction with life and burden of care.

METHODS

Participants were 285 caregivers of older adults (aged 60 and above) in Singapore and were recruited in a cross-sectional, self-report study (mean [M] = 47.0 years; 64.6% females). Measures included in the study were the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and the Satisfaction with Life Scale (SWLS). Mediation analyses were used to study the indirect effects of life satisfaction on caregiver burden through features of PAC.

RESULTS

Mean scores for the ZBI, PAC, and SWLS scales were M = 23.15 (standard deviation [SD] = 15.98), M = 34.55 (SD = 8.19), and M = 23.56 (SD = 6.62) respectively. Results from the mediation analysis revealed that the association between life satisfaction and caregiving burden was significantly mediated by the PAC ( P < .001).

DISCUSSION

Positive aspects of caregiving may be a mechanism that links satisfaction with life and caregiver burden. Findings may represent attempts to manage caregiving duties as well as maintaining a positive attitude toward their responsibilities.

The Burden of Care: Psychosocial Experiences and Coping Strategies among Caregivers of Persons with Mental Illness in Ghana

This study investigated psychosocial experiences and coping strategies of caregivers of persons with mental illness in a psychiatric hospital in Ghana. The study adopted a qualitative design in which 20 participants (10 psychiatric nurses and 10 family caregivers) were sampled from the hospital and interviewed. Using thematic analysis, the results showed that stress was common with both psychiatric nurses and family caregivers, which impact on their physical health. Both groups of caregivers reported experiences of stigma, with psychiatric nurses being stigmatized mainly by other health workers whereas family caregivers reported stigma from the public, particularly neighbors. Coping strategies differed between family caregivers and psychiatric nurses, in that nurses mostly used avoidance strategies and humor in dealing with stress and stigma associated with their work whereas family caregivers used emotion-focused coping. The implications of these findings include the need for counseling services to help caregivers manage negative experiences and psychoeducation of caregivers on adaptive coping strategies as well as training strategies targeting the public and healthcare workers on measures to reduce the stigma associated with caring for persons with mental illnesses.

Providing Social Support to Female Olympic Athletes

Support providers may experience positive and negative outcomes associated with supporting others. However, there is a lack of research on support provision to elite athletes and the views of athletes' support providers. This study addressed this gap by exploring the experiences of providing and receiving support between female Olympians and their main support providers. Five female Olympians and their main support providers participated in separate semistructured interviews. It appeared that support provision was personally and professionally rewarding, as well as challenging, for support providers, and athletes were generally satisfied with the support they received. Athletes appeared highly dependent on their support providers, but both athletes and support providers felt that high levels of support were necessary for athletic success. Further research is needed to understand how support providers are able to foster their own personally supportive relationships and whether high levels of interpersonal dependence are required to achieve athletic success.

The Sense of Quality of Life and Religious Strategies of Coping with Stress in Prison Inmates

The aim of the presented research was to analyze differences in religious strategies of coping with stress in a group of prison inmates characterized by different levels of the sense of quality of life-general, psychophysical, psychosocial, personal, and metaphysical. The participants were 390 males, aged 19-68 years, serving sentences in prisons in Poland. The measures used were the Sense of Quality of Life Questionnaire by M. Straś-Romanowska and K. I. Pargament's RCOPE Questionnaire. As expected, individuals with a high sense of quality of life-both general and pertaining to specific dimensions-more often chose positive religious strategies, whereas participants with a low sense of quality of life more often chose negative strategies. The exception was the metaphysical aspect of the quality of life: individuals with a high intensity of this dimension more often chose some of the positive as well as negative religious strategies.

Spiritual and religious coping and depression among family caregivers of pediatric cancer patients in Latin America

OBJECTIVE

Several studies have shown that spiritual/religious beliefs are associated with mental health and quality of life. However, so far, no study assessed the relationship between spiritual/religious coping (SRC) and depressive symptoms in family caregivers (FCs) of pediatric cancer patients, particularly in Latin America. This study aimed to investigate whether Positive and Negative SRC strategies are associated with depressive symptoms in FCs of pediatric cancer patients in Brazil.

METHODS

We conducted a cross-sectional study comprising 77 FCs of pediatric cancer patients from one Brazilian Pediatric Oncology Institute. Spiritual/religious coping was assessed using the Brief SRC scale, and depressive symptoms were evaluated by the Beck Depression Inventory. Multiple regression models were performed to identify factors associated with SRC of FCs and their depressive symptoms.

RESULTS

In the unadjusted linear regression models, depressive symptoms were positively associated with Negative SRC (B = 0.401; P < .001; Adjusted R²  = 16.1%) but not with Positive SRC (B = 0.111; P = .334). After adjusting for socio-demographics, religious practice/faith, and health, Negative SRC remained associated with depressive symptoms (B = 3.56; P = .01; Adjusted R²  = 37.8%). In the logistic regression models, depressive symptoms were positively associated with Negative SRC (OR = 3.68; 95% CI, 1.46-9.25; P = .006), but not with Positive SRC (OR = 1.49; 95% CI, .69-3.22; P = .309). After adjustments, Negative SRC remained significant (OR = 4.01; 95% CI, 1.21-13.33; P = .023).

CONCLUSIONS

Negative SRC was associated with depressive symptoms in FCs of pediatric cancer patients. Health professionals must be aware of the use of Negative SRC strategies in oncology care.

Psychological health and religious coping of Ghanaian women with infertility

Background

Infertility has been shown to have considerable psychological effects on the well-being of couples, especially women. Religion has been found as a resource used by infertile women to cope with their distress. Little research has examined the influence of religious coping on psychological distress among infertile women in Ghana. This study examines the relationship between positive and negative religious coping and psychological health for women with infertility problems in Ghana.

Methods

One hundred and fifty married women who were receiving assisted reproduction care in two specialized clinics were recruited for this study. Participants were administered with the Brief Symptom Inventory and Brief Religious Coping Scale to assess psychological health associated with infertility and religious coping respectively. A hierarchical regression was performed to examine the relative contribution of the domains of psychological health (i.e. somatization, anxiety and depression) in predicting negative religious coping and positive religious.

Results

The results showed that negative religious coping was significant and positively correlated with somatization, depression and anxiety. Furthermore, a positive relationship also existed between positive religious coping and somatization and anxiety but not depression. After controlling for age and duration of infertility, somatization and anxiety predicted positive religious coping whilst all the domains of psychological health (somatization, anxiety and depression) precited negative religious coping.

Conclusions

This study expanded on the existing literature by examining positive and negative religious coping with psychological distress associated with infertility for women. These results underscore the need for health professionals providing therapies for women with infertility to acknowledge and consider their religious beliefs as this influences their mental health.

Influence of Religion on Later Burden and Health of New Black and White Caregivers

Objective: We assessed the relationship between positive aspects of religiosity and reduced stress in caregivers, and negative aspects of religiosity and increased caregiver burden. Method: Using data from the Biopsychosocial Religion and Health Study, we performed multiple linear regression analysis on 584 caregivers. Results: Mental health, but not physical health, was predicted by caregiver burden. Caregivers who viewed God as loving and not controlling and felt a sense of community with their church family had less burden. Caregivers who engaged in negative religious coping had a greater decline in mental health than those who saw God as loving and not controlling and who gave emotional support to others. Discussion: Some aspects of religion appear to play an important role in alleviating the mental stresses of being a caregiver.

The Greek-Orthodox version of the Brief Religious Coping (B-RCOPE) instrument: psychometric properties in three samples and associations with mental disorders, suicidality, illness perceptions, and quality of life

BACKGROUND

The B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated.

METHODS

The B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated.

RESULTS

The Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach's alphas were 0.91-0.96 and 0.77-0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility.

CONCLUSIONS

These findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies.

Suppressor Effects of Positive and Negative Religious Coping on Academic Burnout Among Korean Middle School Students

Statistical suppressor effects in prediction models can provide evidence of the interdependent relationship of independent variables. In this study, the suppressor effects of positive and negative religious coping on academic burnout were examined using longitudinal data. First, 388 middle school students reported their type of religion and use of positive and negative religious coping strategies. Four months later, they also reported their level of academic burnout. From structural equation modeling, significant suppressor effects were found among religious students. That is, the coefficients became larger when both positive and negative religious coping predicted academic burnout simultaneously, compared to when each religious coping predicted academic burnout alone. However, suppressor effects were not found among non-religious students.

Religious Coping Among Adults Caring for Family Members with Serious Mental Illness

This cross-sectional study investigated the use of religious coping strategies among family members of adults with serious mental illness. A sample of 436 individuals caring for a family member with serious mental illness were recruited into a randomized clinical trial for the National Alliance on Mental Illness Family to Family Education Program. Relationships are reported between religious coping and caregiving, care recipient, and mental health services outcomes. Religious coping was associated with more objective caregiving burden, greater care recipient need, less mental health knowledge, and less receipt of mental health services after adjusting for non-religious types of coping. At the same time, religious coping was associated with a positive caregiving experience and greater religious support. Religious coping plays an important role for many caregivers of persons with serious mental illness. Caregivers who use more religious coping may have an especially high need for mental health education and mental health services.

Estructura factorial de la escala de soporte social subjetivo : validación en una muestra de estudiantes universitarios Chilenos

El objetivo de este artículo es adaptar y validar la Escala de Apoyo Social Subjetivo (EASS, de Vaux et al., 1986), a la vez que describir su estructura factorial. Esta escala está compuesta por 10 ítems distribuidos en dos dimensiones: apoyo familiar y apoyo de los amigos. Se examinan las propiedades psicométricas de la escala y la dimensionalidad de la misma en una muestra de estudiantes universitarios chilenos (N = 681). Los resultados indican que el EASS constituye un instrumento fiable (α = .86) y válido para la medición del apoyo social subjetivo. Las dimensiones de la EASS obtienen entre sí una correlación significativa y moderada (r = .41; p < .001). Las cargas factoriales para los ítems en el análisis factorial confirmatorio fluctuaron entre .40 y .93, mostrando buenos índices de ajuste para el modelo de dos factores de primer orden correlacionados (CFI = .97, TLI = .93, RFI = .97, IFI = .97, NFI = .96 y RSMEA = .08).

A Critical Comprehensive Review of Religiosity and Anxiety Disorders in Adults

Over the past three decades, there has been increasing research with respect to the relation of religion and mental health disorders. Consequently, the current article aims to first provide a comprehensive literature review of the interplay between different domains of religiosity and a wide variety of categorical anxiety disorders in adults, and secondly, to uncover the major methodological flaws often yielding mixed, contradictory and unreliable results. The search was conducted using the PubMed/Medline database and included papers published between 1970 and 2012, under a rigorous set of inclusion/exclusion criteria. A total of ten publications were retained as part of the current study, and three main outcomes were identified: (1) certain aspects of religiosity and specific religious interventions have mostly had a protective impact on generalized anxiety disorder (40% of the studies); (2) other domains of religiosity demonstrated no association with post-traumatic stress disorder (30% of the studies); and (3) mixed results were seen for panic and phobic disorders.

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

BACKGROUND

Cancer caregivers are key stakeholders in the final weeks of life and in bereavement. Research has highlighted end-of-life (EOL) factors important to caregivers, as well as factors contributing to caregiver mental health and bereavement outcomes. There has been limited data on factors predicting caregiver perceptions of quality of EOL care.

OBJECTIVE

This study's purpose was to identify modifiable predictors of caregivers' Caregiver Evaluation of Quality of End of Life Care (CEQUEL) scores, with the broader aim of informing clinical interventions to improve caregiver impressions of care and subsequent bereavement adjustment.

METHODS

Study data came from Coping with Cancer I (CwC1). CwC1 investigators interviewed advanced cancer patients and caregivers prior to the patient's death (Wave 1) and reinterviewed caregivers following the death (Wave 2) (N=275 dyads). The authors identified potential Wave 1 predictors of CEQUEL scores and performed a series of linear regression analyses to identify a parsimonious predictive model using corrected Akaike's Information Criterion (AICc) values.

RESULTS

In adjusted analyses, caregivers rated quality of care as poorer when patients died in a hospital (B=-1.40, SE=0.40, p=0.001) (B, unstandardized regression coefficient; SE, standard error) or had less than one week of inpatient hospice care (B=-1.98, SE=-0.70, p=0.006). Whole-person physician care and caregiver religiosity were associated with perceived higher quality of care in unadjusted, but not adjusted, analyses.

CONCLUSIONS

Findings suggest that place of death and hospice length of stay best predict bereaved caregiver evaluations of quality of EOL care. These findings equip health care providers with modifiable targets to improve caregivers' experience of EOL care and subsequent bereavement.

Spirituality and Spiritual Care of Adolescents and Young Adults with Cancer

OBJECTIVES

To review research on spiritual perspectives and spiritual care of adolescents and young adults (AYA) living with cancer.

DATA SOURCES

Peer-reviewed publications, book chapters, and websites of professional organizations.

CONCLUSION

There is a paucity of research specifically investigating AYA spirituality and lack of AYA-sensitive instruments to measure spirituality. Research that applies robust scientific methods to the study of AYA spirituality is needed. Research that provides evidence on which to base best practices for spiritual care that supports AYA spiritual well-being is likewise necessary.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can influence AYA health-related outcomes and experiences by providing ethical and evidence-based spiritual nurture.

Caregiver evaluation of the quality of end-of-life care (CEQUEL) scale: the caregiver's perception of patient care near death

Purpose

End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. Because none include caregiver perception of patient suffering or prolongation of death, we sought to develop and validate the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale to include these dimensions of caregiver-perceived quality of EOL care.

Patients and Methods

Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N = 275 dyads). Caregivers were assessed before and after patient deaths. CEQUEL's factor structure was examined; reliability was evaluated using Cronbach's α, and convergent validity by the strength of associations between CEQUEL scores and key EOL outcomes.

Results

Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The 13-item CEQUEL and its subscales showed moderate to acceptable Cronbach's α (range: 0.52–0.78). 53% of caregivers reported patients suffering more than expected. Higher CEQUEL scores were positively associated with therapeutic alliance (ρ = .13; p≤.05) and hospice enrollment (z = −2.09; p≤.05), and negatively associated with bereaved caregiver regret (ρ = −.36, p≤.001) and a diagnosis of Posttraumatic Stress Disorder (z = −2.06; p≤.05).

Conclusion

CEQUEL is a brief, valid measure of quality of EOL care from the caregiver's perspective. It is the first scale to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment.

The spiritual struggle of anger toward God: a study with family members of hospice patients

INTRODUCTION

Anger toward God is a common form of spiritual struggle, one that people often experience when they see God as responsible for severe harm or suffering. The aim of this study was to assess the prevalence, correlates, and preferred coping strategies associated with anger toward God among family members of hospice patients.

METHODS

Teams from a large hospice in the midwestern United States distributed surveys, one per household, to family members of home-care patients. The survey assessed feelings toward God (anger/disappointment and positive feelings), depressive symptoms, religiosity, and perceived meaning. Participants also rated their interest in various strategies for coping with conflicts with God.

RESULTS

Surveys (n=134) indicated that 43% of participants reported anger/disappointment toward God, albeit usually at low levels of intensity. Anger toward God was associated with more depressive symptoms, lower religiosity, more difficulty finding meaning, and belief that the patient was experiencing greater pain. Prayer was the most highly endorsed strategy for managing conflicts with God. Other commonly endorsed strategies included reading sacred texts; handling the feelings on one's own; and conversations with friends, family, clergy, or hospice staff. Self-help resources and therapy were less popular options.

CONCLUSION

Anger toward God is an important spiritual issue among family members of hospice patients, one that is commonly experienced and linked with depressive symptoms. It is valuable for hospice staff to be informed about the issue of anger toward God, especially because many family members reported interest in talking with hospice team members about such conflicts.

Testing the Validity of a Protocol to Screen for Spiritual Struggle among Parents of Children with Cystic Fibrosis

Spirituality is important to many Americans and is used to cope with adverse events. Some forms of spiritual coping are maladaptive or troubling, and are known as negative spiritual coping or spiritual struggle. These forms of spirituality are often associated with poorer physical and mental health outcomes. Thus, in clinical contexts there is a need to identify persons who may be experiencing spiritual struggle and, if indicated, offer spiritual care that may address that struggle. Twenty-two parents of children with cystic fibrosis (CF) completed semi-structured interviews and questionnaires exploring spirituality's role in their child's illness. Interviews included oral administration of a protocol to screen for spiritual struggle. The parents also completed the negative religious coping subscale of the Brief RCOPE, a commonly used measure of spiritual struggle. Descriptive statistics were obtained. The screening protocol identified 18% of the parents as potentially having spiritual struggle. Thirty-two percent had negative religious coping scores suggestive of spiritual struggle. Comparison of results with both measures found the screening protocol had good specificity (87%) but relatively low sensitivity (29%). Using either measure, indications of spiritual struggle were associated with higher levels of depressive symptoms. The screener's administration was acceptable and feasible. The low sensitivity may be due in part to differences between the focus of the screener and that of the negative religious coping subscale, which focuses on struggle with the Divine. Further work is needed to establish the best approach to screening for spiritual struggle.

An examination of advanced cancer caregivers' support provided by staff interventions at hospices in Argentina

The aim of the study was to describe the type of intervention provided by hospice staff in order to address the pragmatic, psycho-social, and spiritual needs of home-caregivers for patients in the last stage of cancer. The qualitative inquiry was carried out in real life contexts. The explicit demands that caregivers (n = 40) identified in the first interviews were: (1) helping to organize the care of the patient at home; (2) unspecific demands, with unclear or unrealistic purposes (e.g., curative treatment or a miracle expected to occur); (3) specific resources (such as formal caregivers to replace them), and (4) a place to leave the patient either for a temporary period (a respite for the family) or in a permanent way. The main issues discussed were the delays in the patients' referral to the hospice and the lack of time for long-term interventions; explicit focus is placed on the care by addressing the spiritual and emotional needs of caregivers, unlike in hospital settings where professionals avoid discussions of spiritual needs due to a lack of time, inadequate training and poor understanding of spirituality; hospices' interventions are based upon an ethos similar to the movement's original Christian spirit with emphasis placed on qualities of care such as love, charity, and compassion besides expertise and end-of-life competence, all while tolerating a sense of abandonment by health and social security systems following the patient's referral.

Screening for religious/spiritual struggle in blood and marrow transplant patients

PURPOSE

A growing body of research documents the harmful effects of religious/spiritual (R/S) struggle (e.g., feeling abandoned or punished by God) among patients with a wide variety of diagnoses. Documented effects include poorer quality of life, greater emotional distress, poorer recovery, and increased disability. This study reports the use of a screening protocol that identified patients who may have been experiencing R/S struggle. We also examined the prevalence and correlates of possible R/S struggle, its association with quality of life, pain, and depressive symptoms and compared the results from the screening protocol with social workers' assessments.

METHODS

One hundred seventy-eight blood and marrow transplant patients completed the Electronic Self-Report Assessment--Cancer (ESRA-C) which included the Rush Religious Struggle Screening Protocol and other measures of quality of life, pain, and depressive symptoms prior to transplant therapy. All participants were assessed by a social worker, 90 % within 2 weeks of the ESRA-C assessment.

RESULTS

Using the Rush Protocol, 18 % of the patients were identified as potentially experiencing R/S struggle. R/S struggle was not reported in any social work assessments. In a multivariable model, potential R/S struggle was more likely in patients who were more recently diagnosed, male, and Asian/Pacific Islanders. There were no significant associations between potential R/S struggle and quality of life, pain, or depressive symptoms.

CONCLUSIONS

Early identification of patients with R/S struggle will facilitate their referral for further assessment and appropriate intervention. Further research is needed to identify the best methods of screening patients for R/S struggle.

The moderating role of ethnicity in the relation between religiousness and mental health among ethnically diverse college students

Many studies have documented the links between dimensions of religiousness with mental health (e.g., Hackney and Sanders 2003; Mofidi et al. 2006). However, very little is known about whether these links differ across ethnic groups. This study examined the contribution of dimensions of religiousness to the prediction of mental health in an ethnically diverse sample of 413 college students (167 European Americans, 83 African Americans, 81 Asian Americans, and 82 Latino Americans). Results indicated significant ethnic differences across dimensions of religiousness. African Americans were significantly higher on religious engagement and religious conservatism than the other ethnic groups and significantly lower on religious struggle than European Americans. Moderated multiple regressions revealed that increases in religious struggle was associated with poorer mental health for African Americans and Latino Americans, while increases in religious engagement and ecumenical worldview were associated with better mental health for African Americans. The findings indicate that ethnicity is an important factor to consider when examining the link between religiousness and mental health.

Alcohol use, daily hassles, and religious coping among students at a religiously affiliated college

OBJECTIVE

This article presents empirical findings which suggest that religious coping moderates the relationship between daily hassles stress and alcohol use among female college students.

METHOD

This study utilized a cross-sectional data collection strategy and convenience sampling to examine the relationship between alcohol use, daily hassles stress, and religious coping among 423 undergraduate students (269 females and 154 males) at a religiously affiliated college in the Midwestern USA. Data were collected in 2008. Instruments utilized for data collection included the Inventory of College Student Recent Life Experiences, the Brief RCOPE, and quantity/frequency measures of alcohol use.

RESULTS

Involvement in positive religious coping was significantly related to lower rates of alcohol use. Hierarchical multiple regression analysis revealed that among women, positive religious coping moderated the relationship between two types of daily hassles stress (academic alienation and romantic problems) and alcohol use.

CONCLUSIONS

This study found that among female college students, the relationship between daily hassles stress and alcohol use weakened with increased participation in religious coping. This finding suggests that religious coping may protect against alcohol use among female college students. The results of this study also suggest that it may be important for university-based treatment and prevention practitioners to assess involvement in religious coping practices and to include such practices in the treatment planning process, when culturally appropriate and desired by consumers. Study limitations and areas for further research are also discussed.

Cancer family caregivers during the palliative, hospice, and bereavement phases: A review of the descriptive psychosocial literature

Objective:

Because caregiving to an adult with cancer is a dynamic process, a caregiver's perceived burden and psychosocial concerns may be different at different phases of the patient's disease. There is evidence of escalation in caregiver anxiety, depression, and psychological distress as the patient's functional status declines and as the patient nears death. The purpose of this review was to organize the literature in a meaningful way that can potentially capture the unique needs of caregivers to patients receiving palliative and/or hospice care, and caregivers who are in the post-death bereavement phase.

Method:

A systematic review was conducted. Major databases were searched for non-intervention descriptive studies that included psychosocial variables of family caregivers to adults with cancer during the palliative, hospice, or bereavement phases.

Results:

The 19 studies reviewed were conducted in six countries and varied considerably by samples, outcome measures, methodologies, and analytic approaches. Despite limiting to the palliative, hospice, and bereavement phases, inconsistent results were found for key variables, such as age, gender, and relationship to the patient. When patient–caregiver dyad analysis was conducted, with rare exception, there was mutuality between the patient's condition and the caregiver's response. Across the 19 studies, 89 unique instruments were used, almost half of which were study specific with no psychometric testing reported.

Conclusions/significance of research:

As a direct consequence of assuming the caregiver role, cancer family caregivers in the palliative, hospice, and bereavement phases are at increased risk for physical and mental morbidity. Often, the psychological burden of the caregiver exceeds that of the critically ill patient. It is possible that distressed caregivers have a deleterious influence on patient well-being. This review demonstrates the need to develop research standards, especially regarding measurement instruments, so that caregiver research can mature and interventions can be developed to support family caregivers.

How do informal caregivers of patients with cancer cope: A descriptive study of the coping strategies employed

PURPOSE

A trend exists towards moving from the hospital and caring for the patients with cancer at home, which has directed the burden of caring to the family. As a result the numbers of informal caregivers, who assumed the care of their loved ones, has increased rapidly. The aim of the study is to explore the ways that families use to cope with the stressors and hardships of caregiving and expand the knowledge about coping.

METHODS

This is a descriptive research design, with the use of a convenience sample of 130 dyads. Consenting patients identified their primary family caregiver who was asked to participate in the study.

KEY RESULTS

The majority of the caregivers employed emotionally focused ways of coping with the caregiving burden such as: "I was hoping for a miracle" (mean 2.19), "I was hoping that time would change things and simply waited" (mean 2.14) and "I found consolidation in my faith to God" (mean 2.05). Assertive ways of coping such as "I expressed my anger to the patient" (mean 0.78) and "I dared to do something risky" (mean 0.98) were less likely to be used by the caregivers.

CONCLUSIONS

Findings are consistent with those of previous research that informal caregivers experience substantial psychological morbidity in the form of depression in addition to caregiver burden when they assume the role of the informal caregiver. Caregivers employ various strategies in order to cope with the strains associated with the complex physical and emotional demands involved in caring.