The effects of assistance dogs on psychosocial health and wellbeing: A systematic literature review

Understanding the experience of assistance dog providers supporting people with disability: an exploratory study

PURPOSE

Assistance dogs can provide many health and wellbeing benefits to people with disability, however challenges remain. Assistance dog providers provide crucial support to assistance dog handlers, however limited literature exists exploring their experience working with people with disability. This study aimed to understand the experiences of assistance dog providers working in Australia.

MATERIALS AND METHODS

Twelve assistance dog providers participated in semi-structured interviews. Inductive thematic analysis was used to analyse the transcripts.

RESULTS

Five themes emerged describing the participant experience. Theme one discussed instances of discrimination experienced by assistance dog handlers, stemming from the lack of public awareness. Theme two captured the inconsistencies regarding the training of assistance dog providers with a specific focus on the gaps in the disability specific knowledge. Theme three emphasised the lack of clarity regarding legislation outlining the training requirements of assistance dog providers and the public access rights of the handlers. Theme four emphasised funding barriers, and theme five discussed barriers to interprofessional collaboration between assistance dog providers and allied health professionals.

CONCLUSION

These findings contribute to understanding the current barriers experienced by assistance dog providers and assistance dog handlers, as well as the legislative changes required to better support people with disability.

A Preliminary Analysis of Psychiatric Service Dog Placements and Sleep Patterns of Partners of Veterans With PTSD

Partners of veterans diagnosed with posttraumatic stress disorder (PTSD) are at risk of a variety of challenges, and it is unknown whether psychiatric service dogs are disruptive to their sleep or provide similar benefits that are seen in the limited literature on veterans. As part of a larger clinical trial examining the efficacy of psychiatric service dogs for veterans with PTSD and their families, this study focused on sleep patterns of veterans' partners (n = 88), incorporating both subjective (clinically validated self-report surveys) and objective sleep measures (actigraphy). Linear regression was used to analyze differences in relation to group (intervention versus control) at follow up, controlling for baseline score. Results revealed no significant differences between groups for both the subjective surveys (p = 0.15; p = 0.75) and the objective actigraphy measures (p = 0.06-0.98). This suggests that psychiatric service dogs are not disruptive, nor do they provide any benefits to partner sleep. Partners had sleep patterns on par with national norms at baseline and remained at such levels at follow up. Ultimately, using both subjective and objective measures, we found no impact of psychiatric service dogs on the sleep of veterans' partners.

Cats' and dogs' welfare: text mining and topics modeling analysis of the scientific literature

Animal welfare is a field with increasing significance and has been raising huge concerns of the public and the political stage. Cats and dogs possess an important role in human life, but their welfare is not always secured from a legal aspect. This review aimed to describe the evolution and geographical distribution of "cats and dogs" and "puppies and kittens" welfare literature over the last 40 years, distinguish the main research topics studied and highlight gaps in knowledge. A search using Scopus® was performed with different search strings and predetermined filters as time range, language, and subject area. A total of 2,725 scientific literature records were retrieved but only the ones that referred to cats and dogs' welfare aspects were retained. The final 1,775 records were processed through descriptive statistics, and text mining and topic analysis procedures were performed on their titles and abstracts. The results showed that the number of studies has been increasing, especially in Europe and North America. "Shelter" was the most frequent word, followed by "behavior," "owner" and "adopt." The nine topics that emerged from the analysis were breeding, stress and housing conditions, welfare and pain assessment, public health, shelter management and euthanasia, behavioral problems, health issues and management, human-animal interaction, and owners' and veterinarians' perceptions. While stress and housing conditions, public health, and owners' and veterinarians' perceptions were the most studied topics, human-animal interaction was the least studied. This review confirmed the increasing research and interest in cats' and dogs' welfare and showed gaps in knowledge where further studies are needed.

Benefits and challenges of mobility and medical alert service dogs for caregivers of service dog recipients

PURPOSE

Mobility and medical alert service dogs are an assistive technology for individuals with disabilities or chronic conditions. Informal caregivers of individuals with disabilities are subject to physical and emotional stress due to their responsibilities. Understanding how service dogs, an increasingly common assistive technology, may add to or subtract from caregiver stress is crucial for promoting caregiver well-being. The purpose of this study was to analyze caregiver accounts to understand their perspective on benefits and challenges they face with mobility and medical alert service dogs.

MATERIALS AND METHODS

Open ended survey responses from 117 caregivers of service dog recipients (N = 72 with a service dog, N = 45 on the waitlist) were analysed through a conventional content analysis.

RESULTS

Four major themes were found regarding caregiver and service dog: Family Benefits, Caregiver Benefits, Assistance Through Service Dog's Training, and Drawbacks.

CONCLUSIONS

Findings suggest that benefits and challenges of mobility and medical service dogs extend beyond the service dog recipient, affecting the caregiver and other family members as well. Future studies should further explore this interaction to determine the best way to support caregivers of individuals with disabilities.IMPLICATIONS FOR REHABILITATIONMobility and medical alert service dogs are increasingly partnered with individuals with disabilities or chronic diseases as an assistive technology but few studies have focussed on the experience of the caregivers of service dog recipients. Caregivers of individuals with disabilities or chronic diseases may be subject to both psychological and physiological stressors as a result of their caregiver duties.Results found that caregivers perceive both benefits to themselves and to their families in terms building a bond with the animal that helps to reduce worry and offers emotional support. The most commonly mentioned drawbacks include general maintenance of the service dog, grooming needs and travel restrictions.This research is important in order to offer appropriate support to caregivers of individuals with disabilities.

Animal-Assisted Interventions for Autism Spectrum Disorder: A Systematic Review of the Literature from 2016 to 2020

In the last five years, the literature on animal-assisted intervention (AAI) for Autism Spectrum Disorder (ASD) has doubled in size from 42 studies prior to 2015 to 85 studies (cumulative total assessed in 2020). Horses remain the most commonly researched animal for AAI, followed by dogs. The most commonly researched outcome was social interaction, across 21 studies. Though the quantity of studies has increased, issues with methodological rigor remain. Results highlight the need for a continued focus on methodological rigor as well as refining the structure of animal-assisted interventions, addressing the welfare needs of the animals involved, and continuing to establish an evidence base of both significant and nonsignificant findings for AAI for individuals with ASD.

Paws on the Street: Neighborhood-Level Concentration of Households with Dogs and Urban Crime

The formative work of Jane Jacobs underscores the combination of "eyes on the street" and trust between residents in deterring crime. Nevertheless, little research has assessed the effects of residential street monitoring on crime due partly to a lack of data measuring this process. We argue that neighborhood-level rates of households with dogs captures part of the residential street monitoring process core to Jacobs' hypotheses and test whether this measure is inversely associated with property and violent crime rates. Data from a large-scale marketing survey of Columbus, OH, USA residents (2013; n = 43,078) are used to measure census block group-level (n = 595) rates of households with dogs. Data from the Adolescent Health and Development in Context study are used to measure neighborhood-level rates of trust. Consistent with Jacobs' hypotheses, results indicate that neighborhood concentration of households with dogs is inversely associated with robbery, homicide, and, to a less consistent degree, aggravated assault rates within neighborhoods high in trust. In contrast, results for property crime suggest that the inverse association of dog concentration is independent of levels of neighborhood trust. These associations are observed net of controls for neighborhood sociodemographic characteristics, temporally lagged crime, and spatial lags of trust and dog concentration. This study offers suggestive evidence of crime deterrent benefits of local street monitoring and dog presence and calls attention to the contribution of pets to other facets of neighborhood social organization.

Brief Report: Above and Beyond Safety: Psychosocial and Biobehavioral Impact of Autism-Assistance Dogs on Autistic Children and their Families

Autism-Assistance Dogs (AADs) are highly-skilled service animals trained primarily to ensure the safety of an autistic child by preventing elopement and mitigating 'meltdowns'. Although anecdotal accounts and case-studies have indicated that AADs confer benefits above and beyond safety, empirical support anchored in validated clinical, behavioral, and physiological measures is lacking. To address this gap, we studied children and their families before and after receiving a well-trained AAD using a within-subject, repeated-measures design. Notably, this study is the first to assess change in a biomarker for chronic stress in both autistic children and their parents. Final analyses included pre-/post-AAD data from 11 triads (parent/handler-dog-child) demonstrating significantly positive psychosocial and biobehavioral effects of AADs.

A Systematic Review of the Effect of Assistance Dog Ownership on Practical Support, Health, and Wellbeing: Implications for Older Adults

OBJECTIVES

While assistance dog use has received considerable recent attention, few studies have focused on benefits for older adults. The current review examined effects of assistance dog acquisition across practical, mental, physical, and social wellbeing domains for older adults. Further, it compared assistance dog types and identified potential barriers to acquisition.

METHODS

A systematic review was completed. Criteria focused on older adults with relevant disabilities (visual/hearing impairments, and PTSD), who received support from an assistance dog (guide, hearing or other assistance dog). Identified studies (n = 2,951) were screened, 256 assessed for eligibility, and 28 included, with key information extracted and summarized.

RESULTS

All dog types demonstrated benefits across all assessed domains. Disadvantages and acquisition barriers were identified. However, limited empirical evidence was available, and no studies focused exclusively on older adults, revealing the need for studies including this age-group.

CONCLUSIONS

While results indicated support for assistance dog acquisition, disadvantages and barriers require further attention. Methodologically improved research should focus on assistance dog acquisition for older persons.

CLINICAL IMPLICATIONS

The study indicated assistance dog acquisition could produce positive clinical impacts, including on mental health and everyday functioning. Thus, acquisition could be considered as part a multi-faceted treatment or recommended to appropriate older adults.

Assistance dogs for military veterans with PTSD: A systematic review, meta-analysis, and meta-synthesis

Psychiatric assistance dogs for military veterans with posttraumatic stress disorder (PTSD) currently make up over 19% of assistance dog partnerships globally. We conducted a systematic review of the literature relating to these partnerships, with specific aims to (1) summarize their characteristics, (2) evaluate the quality of existing evidence, and (3) summarize outcomes. A total of 432 records were independently screened (Cohen’s kappa = 0.90). Of these, 41 articles (29 peer-reviewed publications and 12 unpublished dissertations) met inclusion criteria. Data extraction was conducted to address the research aims, including a meta-analysis (quantitative outcomes) and meta-synthesis (qualitative outcomes). All peer-reviewed publications on the topic of psychiatric assistance dogs for veterans with PTSD were published within the last five years. The majority of included articles were quantitative (53%), 41% were qualitative, and 6% employed mixed methods. Mean methodological rigor scores were 80% for peer reviewed articles and 71% for dissertations, where higher scores represent more rigorous methodology. Quantitative articles reported significant improvements in the domains of PTSD severity, mental health, and social health. Impacts on physical health and global quality of life appear inconclusive. Meta-analysis (9 articles) revealed that partnership with an assistance dog had a clinically meaningful, significant, and large effect on PTSD severity scores (g = −1.129; p<0.0001). Qualitative meta-synthesis identified two third order constructs: (1) Impact on the individual: mental & physical health and (2) Impact beyond the individual: building relationships & connection. This synthesis of increasingly prevalent research on assistance dogs for veterans with PTSD provides support for the impact of this complementary and integrative health intervention on PTSD symptom severity, and signs of meaningful improvements in adjacent domains including mental and social health. Gaps between quantitative and qualitative findings, along with the need to report greater demographic detail, highlight key opportunities for future research.

What Patients Prioritize for Research to Improve Their Lives and How Their Priorities Get Dismissed again

Health researchers increasingly work with patients in a participatory fashion. Active patient involvement throughout the research process can provide epistemic justice to patients who have often only had an informant role in traditional health research. This study aims to conduct participatory research on patient experiences to create a solid research agenda with patients and discuss it with relevant stakeholders. We followed a participatory research design in 18 sub-studies, including interviews and group sessions (n = 404 patients), and dialogue sessions (n = 367 professionals and directors in healthcare and social work, municipality civil servants, and funding agencies) on patient experiences with psychiatric care, community care, daycare, public health, and social work. Findings from the eight-year study show that four priorities stood out: attention for misuse of power and abuse; meaningful participation; non-human assistance, and peer support. Moreover, that: (1) patients, based on their experiences, prioritize different topics than experts; (2) most topics are trans-diagnostic and point to the value of a cross-disability approach; and (3) the priorities of patients are all too easily dismissed and require ethics work to prevent epistemic injustice. Long-term investment in a transdisciplinary community of practice offers a solid basis for addressing patient-centered topics and may impact the quality of life of people living with chronic illness, disability, or vulnerability.

Depression, anxiety, and happiness in dog owners and potential dog owners during the COVID-19 pandemic in the United States

Major life events, such as the COVID-19 pandemic, affect psychological and physiological health. Social support, or the lack thereof, can modulate these effects. The context of the COVID-19 pandemic offered a unique opportunity to better understand how dogs may provide social support for their owners and buffer heightened symptoms of stress, anxiety and depression and contribute to happiness during a major global crisis. Participants (768 pet dog owners and 767 potential pet dog owners) answered an online survey, including validated depression, anxiety, happiness psychometric scales, attitude to and commitment towards pet, and perceived social support. Potential pet dog owners were defined as individuals who did not own a dog at the time of the survey but would be very or extremely interested in owning one in the future. Dog owners reported having significantly more social support available to them compared to potential dog owners, and their depression scores were also lower, compared to potential dog owners. There were no differences in anxiety and happiness scores between the two groups. Dog owners had a significantly more positive attitude towards and commitment to pets. Taken together, our results suggest that dog ownership may have provided people with a stronger sense of social support, which in turn may have helped buffer some of the negative psychological impacts caused by the COVID-19 pandemic.

Interactions between the Public and Assistance Dog Handlers and Trainers

This research aimed to explore the experiences of handlers and trainers of disability assistance dogs in terms of the types of interactions they had with members of the Aotearoa NZ (NZ) public and how these interactions were perceived, interpreted, and managed. A qualitative method, guided by an interpretive approach and social constructionism, was utilised to collect data via semi-structured interviews with six handlers and six trainers of assistance dogs. Data were analysed using thematic analysis with the social model of disability as the theoretical base. Findings indicated that participants regularly faced a complex range of unique interactions due to various factors such as the public's lack of knowledge and understanding of the dog's role and right of access to public places. While participants encountered brief friendly comments about the dog and its role, other encounters involved long conversations, invasive personal questions, interference with their dogs, and denied access to businesses, cafés, restaurants, and public transport. These findings underpin the need to provide more education to the public on the etiquette of engaging with handlers and their assistance dogs and more support for businesses to understand the legal rights of handlers. Through education and support to change societal attitudes and remove structural barriers, disabled people using assistance dogs may be able to independently participate in community life and be fully included without hindrance.

Hearing dogs for people with severe and profound hearing loss: a wait-list design randomised controlled trial investigating their effectiveness and cost-effectiveness

Background

Hearing loss increases the risk of poor outcomes across a range of life domains. Where hearing loss is severe or profound, audiological interventions and rehabilitation have limited impact. Hearing dogs offer an alternative, or additional, intervention. They live permanently with recipients, providing sound support and companionship.

Methods

A single-centre, randomised controlled trial (RCT) evaluated the impacts of a hearing dog on mental well-being, anxiety, depression, problems associated with hearing loss (responding to sounds, fearfulness/social isolation), and perceived dependency on others. Participants were applicants to the UK charity ‘Hearing Dogs for Deaf People’. Eligibility criteria were as follows: first-time applicant; applying for a hearing dog (as opposed to other support provided by the charity). Participants were randomised 1:1 to the following: receive a hearing dog sooner than usual [HD], or within the usual application timeframe (wait-list [WL] comparator). The primary outcome was mental well-being (Short Warwick-Edinburgh Mental Well-Being Scale) 6 months (T1) after HD received a hearing dog. The cost-effectiveness analysis took a health and social care perspective.

Results

In total, 165 participants were randomised (HD n = 83, WL n = 82). A total of 112 (67.9%) were included in the primary analysis (HD n = 55, WL n = 57). At T1, mental well-being was significantly higher in the HD arm (adjusted mean difference 2.53, 95% CI 1.27 to 3.79, p < 0.001). Significant improvements in anxiety, depression, functioning, fearfulness/social isolation, and perceived dependency, favouring the HD arm, were also observed. On average, HD participants had used fewer statutory health and social care resources. In a scenario whereby costs of provision were borne by the public sector, hearing dogs do not appear to be value for money. If the public sector made a partial contribution, it is possible that hearing dogs would be cost-effective from a public sector perspective.

Conclusions

Hearing dogs appear to benefit recipients across a number of life domains, at least in the short term. Within the current funding model (costs entirely borne by the charity), hearing dogs are cost-effective from the public sector perspective. Whilst it would not be cost-effective to fully fund the provision of hearing dogs by the public sector, a partial contribution could be explored.

Trial registration

The trial was retrospectively registered with the International Standard Randomised Controlled Trial Number (ISRCTN) registry on 28.1.2019: ISRCTN36452009.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05607-9.

Love, fear, and the human-animal bond: On adversity and multispecies relationships

Love and strong social bonds are known buffers in the experience of adversity. Humans often form strong bonds with non-human animals. The human-animal bond refers to a mutually beneficial and dynamic relationship between humans and non-human animals. Previous research suggests that strong bonds with pets may promote resilience in the experience of adversity, but a strong bond with a pet can also complicate this very experience of adversity, particularly among low-resourced and disadvantaged populations. What is the role of the human-animal bond in adversity, and what is the role of adversity in the bond between a human and a non-human animal? In this article we outline the state of research on the role of various types and sources of adversities in multispecies households (i.e., families, relationships) to consider this overarching question. We focus specifically on intimate partner violence, housing discrimination, LGBTQ+ identity-based discrimination, racism, neighborhood disadvantage, and economic inequality. We then outline an agenda for future research about love, adversity, and multispecies relationships, and discuss implications for public policy and community-based interventions.

Assistance, Service, Emotional Support, and Therapy Dogs

This article focuses on the areas where harnessing the canine's trainability, mobility, and sociability enables their use for aiding and augmenting humans. This area, which is rapidly expanding, has provided life-changing solutions for persons affected by various impairments and disabilities (eg, visual, hearing, physical, mental).

Dogs Supporting Human Health and Well-Being: A Biopsychosocial Approach

Humans have long realized that dogs can be helpful, in a number of ways, to achieving important goals. This is evident from our earliest interactions involving the shared goal of avoiding predators and acquiring food, to our more recent inclusion of dogs in a variety of contexts including therapeutic and educational settings. This paper utilizes a longstanding theoretical framework- the biopsychosocial model- to contextualize the existing research on a broad spectrum of settings and populations in which dogs have been included as an adjunct or complementary therapy to improve some aspect of human health and well-being. A wide variety of evidence is considered within key topical areas including cognition, learning disorders, neurotypical and neurodiverse populations, mental and physical health, and disabilities. A dynamic version of the biopsychosocial model is used to organize and discuss the findings, to consider how possible mechanisms of action may impact overall human health and well-being, and to frame and guide future research questions and investigations.