社区痴呆患者的家庭照料者心理状况研究

目的：为了社区痴呆患者的家庭照料者心理状况及相关因素，方法：采用MMSE，ADL，GDS，Be-AD和GHQ对103例社区痴呆患者的家庭照料者心理状况进行调查并分析。结果：家庭照料者的焦虑失眠症状明显，主要是痴呆患者的精神／行为问题相关，与照料者本身的年龄，文化和对痴呆知识的了解程度有关。结论：对老年痴呆的照料以及照料者的心理健康状况值得重视。     

城乡Alzheimer病照料者心理状况分析

目的:了解城乡Alzheimer病家庭照料者的心理状况和应付行为及影响因素.方法:采用一般健康问卷(GHQ),家庭应付行为问卷(FCQ)对照料者(城市组103名,农村组100名)进行访谈.结 果:城市组存在的心理障碍明显高于农村组.GHQ的影响因素中,城市组偏重于患者方面的因素,农村组偏重于照料者自身的因素,两组FCQ的影响因素也不同.结论:解决痴呆照料者的心理问题和应付行为等需从多方面入手.     

老年痴呆病人照料者的心理健康状况调查

目的探讨老年痴呆病人照料者的心理健康状况及护理措施。方法使用标准化评定工具对在本院住院治疗的老年痴呆病人照料者的心理健康状况进行调查，并与老年非痴呆照料者进行对照分析。结果研究组SCL—90，HAMD，HAMA评分明显高于对照组，出现抑郁、焦虑、躯体障碍等症状的比率显著高于对照组。结论老年痴呆病人照料者存在较多的心理问题，应给予足够的关注；在关心痴呆病人的同时，帮助照料者减轻心理负担。     

老年期痴呆患者照料者负担及其相关因素调查

目的 调查老年期痴呆患者的基本情况、家庭关系、照料者的负担、躯体与心理状况. 方法采用统一自行设计的调查问卷及焦虑自评量表(SAS)、抑郁自评量表(SDS)、临床痴呆评定量表(CDR)由调查员入户调查.根据CDR评分分为轻度痴呆组(20例)、中度痴呆组(16例)、重度痴呆组(27例). 结果调查老年期痴呆患者63例.不同严重程度的老年期痴呆患者总经济损失(F=-15.40, P=0.00)、医疗护理费用(F=-14.48,P=0.00)、照料者经济损失(F=-13.57、P=0.00)、每日照料时间(F=-16.72,P=0.00)方面存在统计学差异.照料者的SAS得分平均(30.98±5.14)分,SDS得分平均为(32.27±5.39)分,不同严重程度的痴呆患者的照料者SAS(F=14.818,P=0.000)、SDS(F=5.592, P=0.040)得分有统计学差异. 结论不同严重程度的老年期痴呆患者的照料者的负担不同.痴呆的严重程度影响照料者的心理状况.     

阿尔茨海默病行为和精神症状对于照料者心理健康的影响

目的探讨阿尔茨海默病(AD)行为和精神症状(BPSD)对照料者心理健康状况的影响。方法46例AD患者均作AD病理行为评分表(BEHAVE-AD),日常生活能力量表,简易智力状态检查,临床痴呆评定表评定,并作头颅CT,脑电图检查。患者之照料者均作一般调查问卷及90项症状清单(SCL-90)测定。对相关数据作统计分析。结果SCL-90总分除与BEHAVE-AD的幻觉分量表分无统计学显著性相关外,与其他分量表分及总分均呈正相关(P＜0．05)；SCL-90除强迫、精神病性两因子分与常模的差异无统计学显著性外,其他因子分和总分均较常模高(P＜0．01)；高BEHAVE-AD总分组照料者的SCL一90总分、因子分中的躯体化、抑郁、焦虑、恐怖及其他均较低BEHAVE—AD总分组照料者高(P＜0．05)。逐步回归分析发现影响照料者心理健康状况的因素主要是BEHAVE-AD总分和攻击行为分量表分。结论影响AD照料者心理健康状况的因素主要是患者的BPSD。     

影响痴呆患者照料者健康的因素分析

目的探讨影响痴呆患者照料者健康的因素。方法采用横断面调查研究设计及电子调查问卷的方式,结合ordered pro-bit回归模型分析痴呆患者照料者年龄、性别、婚姻状况、学历、收入及痴呆患者病情严重程度等对照料者自评价健康的影响。结果有61.6%的照料者感觉自己的健康受损。ordered probit回归分析结果显示,在控制性别、年龄、学历、婚姻、家庭收入等照料者的一般人口学特点时,痴呆患者日常生活能力[系数:0.148(0.136)]、认知情况[系数:0.133(0.019)]、精神行为状态[系数:0.361(0.169)]对照料者的自评价健康影响显著。结论痴呆患者的病情越严重、日常生活能力及认知情况越差、精神行为异常越显著,照料者更容易感到自身健康受到了损害。我们在关注痴呆患者的同时,应积极关注照料者的健康。     

影响精神分裂症预后的多因素分析

对102例住院的精神分裂症病人进行与预后有关的多因素分析,结果显示:第一胎和独生子女,住院总时间长,病前个性内向,家庭和社会照料不当,病后的生活事件较多较重者均与病人不良的预后有关,文化程度较高者其病后的适应能力和个人生活料理能力较好,经济状况较差者其病后的适应能力恢复差,住院次数较多者其主动性恢复较差,首次住院前病程较长者其自知能力恢复差,较早医疗干预者自知力恢复较好。     

影响癫患者智力状况的多因素分析

目的:探讨影响癫(疒间)患者智力状况的主要因素。方法:用韦氏儿童智力量表(WISC-CR)和韦氏成人智力量表(WAIS-RC)对205名5~60岁的癫(疒间)患者进行智力测试并对结果与影响智力的因素进行分析。结果:癫(疒间)患者FIQ均分为87.74±23.67,智力低下者为20%。逐步回归分析提示影响患者语言智商(VIQ)的主要因素依次为文化程度低、低年龄、无职业、有脑病史及药物治疗效果差;影响患者操作智商(PIQ)依次为文化程度低、无职业者、低年龄、有脑病史及治疗效果差;影响患者总智商(IQ)依次为文化程度低、有脑病史、低年龄、病程久、治疗效果差及无职业者。从回归分析可以看出,文化程度对言语智商和总智商影响最大。而有无脑病史对操作智商受影响最大。结论:癫(疒间)患者易发生智力减退,且智力减退受多种因素的影响。     

痴呆照料者的心理健康和应付行为

本文主要对痴呆照料者的心理健康状况和应付方式加以综述     

痴呆照料者的心理健康和应付行为

本文主要对痴呆照料者的心理健康状况和应付方式加以综述。     

Primary stressors and depressive symptoms in caregivers of dementia patients

Pearlin et al . (1990) propose a model for examining the wellbeing of caregivers of dementia patients. The present paper focuses on one part of this model, examining the relationship between primary stressors and mental health, particularly depression, in a cross-sectional sample of 91 caregivers of dementia patients. The primary stressors examined are: patient cognitive status, objective burden, subjective burden and generalized perceived stress. Linear and non-linear relationships between patient cognitive status and caregiver depression were considered. Some evidence was found for a non-linear relationship between patient cognitive status and caregiver depression, but only the interaction between subjective caregiving burden and generalized perceived stress was found to significantly predict caregiver depression when all variables were considered. Implications for including global as well as caregiver-specific measures of subjective burden in models of caregiver wellbeing are discussed.     

住院老年痴呆患者监护人的心理状态及其影响因素

目的探讨住院老年痴呆患者监护人的心理状态及其影响因素。方法采用一般情况调查表、症状自评量表（SCL-90）、社会支持评定量表（SSRS）、简易智力状态检查（MMSE）及AD病理行为评分表（BEHAVE-AD）对住院老年痴呆患者及门诊老年痴呆（AD和VD）患者和其监护人进行评定，并与正常老人的监护人和老年非痴呆患者的护理人员进行比较。结果住院痴呆患者监护人SCL-90总分及因子分比正常对照组和老年非痴呆患者护理组评分高，但较门诊痴呆组评分低，均有显著差异（P〈0．01-0．05）。单因素分析发现不同性别、年龄、文化程度、婚姻状况、工作情况、性格、病程、与患者的关系及有无躯体疾病之间SCL-90总评分均具有非常显著差异（P〈0．01）：逐步回归分析显示影响监护人心理状态的因素依次为患者痴呆的严重程度、精神行为症状、与患者关系、性别及社会支持。结论住院老年痴呆患者监护人的心理状态较差，影响因素是多方面的，应引起社会高度重视。     

Biomarkers of Resilience in Stress Reduction for Caregivers of Alzheimer’s Patients

Caregiving for a dementia patient is associated with increased risk of psychological and physical health problems. We investigated whether a mindfulness-based stress reduction (MBSR) training course for caregivers that closely models the MBSR curriculum originally established by the Center of Mindfulness at the University of Massachusetts may improve the psychological resilience of non-professional caregivers of Alzheimer’s disease patients. Twenty adult non-professional caregivers of dementia patients participated in an 8-week MBSR training course. Caregiver stress, depression, burden, grief, and gene expression profiles of blood mononuclear cells were assessed at baseline and following MBSR. MBSR training significantly improved the psychological resilience of some of the caregivers. We identified predictive biomarkers whose expression is associated with the likelihood of caregivers to benefit from MBSR, and biomarkers whose expression is associated with MBSR psychological benefits. Our biomarker studies provide insight into the mechanisms of health benefits of MBSR and a basis for developing a personalized medicine approach for applying MBSR for promoting psychological and cognitive resilience in caregivers of dementia patients.     

Caregivers' relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers' physical health and psychological well-being

Closer relationships between caregivers and care recipients with dementia are associated with positive outcomes for care recipients, but it is unclear if closeness is a risk or protective factor for the health and psychological wellbeing of caregivers. We examined 234 care dyads from the population-based Cache County Dementia Progression Study. Caregivers included spouses (49%) and adult offspring (51%). Care recipients mostly had dementia of the Alzheimer’s type (62%). Linear mixed models tested associations between relationship closeness at baseline or changes in closeness prior to versus after dementia onset, with baseline levels and changes over time in caregiver affect (Affect Balance Scale, ABS), depression (Beck Depression Inventory, BDI), and mental and physical health (components of the Short-Form Health Survey, SF-12). After controlling for demographic characteristics of the caregiver, number of caregiver health conditions, and characteristics of the care recipient (type of dementia, functional ability, and behavioral disturbances), we found that higher baseline closeness predicted higher baseline SF-12 mental health scores (better mental health) and lower depression. Higher baseline closeness also predicted greater worsening over time in ABS and SF-12 mental health. In addition, caregivers who reported a loss of closeness in their relationship with the care recipient from pre- to post-dementia displayed improved scores on ABS and SF-12 mental health, but worse SF-12 physical health over the course of the study. These results suggest that closeness and loss of closeness in the care dyad may be associated with both positive and adverse outcomes for caregivers, both cross-sectionally and over time.     

Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder

OBJECTIVES: Caring for a relative with schizophrenia or dementia is associated with reports of high caregiver burden, symptoms of depression, poor physical health, negligence of the caregiver's own health needs, elevated health service use, low use of social supports, and financial strain. This study presents the design and preliminary data on the costs and consequences of caring for a relative or friend with bipolar disorder from the Family Experience Study, a longitudinal study of the primary caregivers to 500 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. METHODS: Subjects were primary caregivers of 500 patients with bipolar disorder diagnosed by the Mini International Neuropsychiatric Interview and the Affective Disorder Evaluation. Caregivers were evaluated within 1 month after patients entered Systematic Treatment Enhancement Program using measures of burden, coping, health/mental health, and use of resources and costs. RESULTS: Eighty-nine percent, 52%, and 61% of caregivers, respectively, experienced moderate or higher burden in relation to patient problem behaviors, role dysfunction, or disruption of household routine. High burden caregivers reported more physical health problems, depressive symptoms, health risk behavior and health service use, and less social support than less burden caregivers. They also provided more financial support to their bipolar relative. CONCLUSIONS: Burdens experienced by family caregivers of people with bipolar disorder are associated with problems in health, mental health, and cost. Psychosocial interventions targeting the strains of caregiving for a patient with bipolar disorder are needed.     

Use of mental health and primary care services by caregivers of patients with bipolar disorder: a preliminary study

OBJECTIVES: Caring for a relative with schizophrenia or dementia has been associated with reports of caregiver burden, symptoms of anxiety, depression, poor self-rated health, and elevated health service use; however, comparable data for caregivers of relatives with bipolar disorder are lacking. This study reports preliminary data on the health, psychological distress and health service use of caregivers of patients with bipolar disorder. It additionally evaluates the relationship of the level of burden caregivers report experiencing to their use of health services, controlling for level of psychological distress and health status. METHODS: Subjects were primary caregivers of 264 patients with Research Diagnostic Criteria-diagnosed bipolar disorder and their bipolar relatives. Caregiver mental health and primary care service use were assessed retrospectively for the 7-month period prior to inpatient or outpatient admission of the bipolar patient. Caregiver depression, anxiety, medical conditions and patient symptomatology were assessed as well. RESULTS: Hierarchical logistic regression analysis demonstrated that caregiver burden significantly increased the likelihood of mental health service use (OR = 13.53, p < 0.001) even after controlling for caregiver psychological distress and medical conditions, while anxiety and depression level, but not burden, significantly increased the likelihood of primary care service use, controlling for other variables (OR = 1.72, p = 0.02). CONCLUSIONS: Burdens experienced by family caregivers appear to increase use of health services, and presumably cost, and may be reduced by psychosocial intervention.     

Financial Difficulty Effects on Depressive Symptoms Among Dementia Patient Caregivers

The financial difficulty of dementia caregivers and its effects on mental health has gained increasing attention from researchers. The present study examines the longitudinal relationship between financial difficulty and the depressive symptoms of dementia caregivers using matching methods to account for potential selection bias. Propensity score matching methods and mixed-effects models were used to determine the effects of financial difficulty on depressive symptoms among caregivers participating in the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) intervention program. Propensity score matching confirmed that caregivers experiencing financial difficulty were more likely to have depressive symptoms. The results suggest that dementia caregivers require support for their financial difficulty. Future research should fully examine the complex relationship between financial difficulty and the mental health of caregivers and how this issue can be addressed through assessment and intervention methods.     

Mental health and physical health of family caregivers for persons with dementia: a comparison of African American and white caregivers

This investigation analyzed the differences between African American and white caregivers in the effects of family caregiving for a person with dementia on mental health and physical health variables (including subjective health, reported diseases and cardiovascular measures). A population-based sample of 102 caregivers is compared with 102 non-caregivers matched on ethnicity, gender and age. There were no significant group differences for mental health effects. Most significant physical health effects were attributable to main effects of ethnicity rather than caregiving status. However, African American caregivers had higher diastolic blood pressure than all other groups, a finding consistent with group-specific risk for circulatory system disorders.     

Behavioral problems in dementia patients and salivary cortisol patterns in caregivers

This study examines cortisol profiles in caregivers of dementia patients and their relationship to patients' behavioral problems. Salivary cortisol profiles and cortisol response to awakening were measured in 57 caregivers and 55 noncaregiver comparison subjects. Caregivers showed significantly higher levels of cortisol at the time of morning awakening than did comparison subjects, with a smaller increase after awakening. A higher cortisol awakening response was found in caregivers of patients with high versus low levels of behavioral and psychological symptoms of dementia (BPSD). Elevated morning cortisol levels could predispose caregivers to negative health consequences, with caregivers of patients with BPSD at greater risk.     

Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study.

OBJECTIVE: Providing care to a loved one with dementia and the death of that loved one are generally considered two of the most stressful human experiences. Each puts family caregivers at risk of psychologic morbidity. Although research has suggested that religious beliefs and practices are associated with better mental health, little is known about whether religion is associated with better mental health in family caregivers. Our objective, then, is to explore the relationship between religion and mental health in active and bereaved dementia caregivers. METHODS: A total of 1,229 caregivers of persons with moderate to severe dementia were recruited from six geographically diverse sites in the United States and followed prospectively for up to 18 months. Three measures of religion: 1) the frequency of attendance at religious services, meetings, and/or activities; 2) the frequency of prayer or meditation; and 3) the importance of religious faith/spirituality were collected. Mental health outcomes were caregiver depression (Center for Epidemiological Studies-Depression [CES-D] scale) and complicated grief (Inventory of Complicated Grief [ICG]). RESULTS: Religious beliefs and practices were important to the majority of caregivers. After controlling for significant covariates, the three measures of religion were associated with less depressive symptoms in current caregivers. Frequent attendance was also associated with less depression and complicated grief in the bereaved. CONCLUSIONS: Religious beliefs and practices, and religious attendance in particular, are associated with better mental health in family caregivers of persons with dementia.