Stressors, burnout and social support: nurses in acute mental health settings

AIMS: This paper reports a study which aims (1) to investigate and compare levels of stressors and burnout of qualified and unqualified nursing staff in acute mental health settings; (2) to examine the relationships between stressors and burnout and (3) to assess the impact of social support on burnout and stressor-burnout relationships. BACKGROUND: Several studies have noted that the work of mental health nurses can be highly stressful, but relatively few have focused specifically on staff working in acute inpatient settings. Although many of the pressures faced by this group are similar to those in other nursing specialties, a number of demands relate specifically to mental health settings, including the often intense nature of nurse-patient interaction and dealing with difficult and challenging patient behaviours on a regular basis. METHODS: A convenience sample of 93 nursing staff from 11 acute adult mental health wards completed the Mental Health Professionals Stress Scale, Maslach Burnout Inventory and House and Wells Social Support Scale. RESULTS: Lack of adequate staffing was the main stressor reported by qualified staff, while dealing with physically threatening, difficult or demanding patients was the most stressful aspect for unqualified staff. Qualified nurses reported significantly higher workload stress than unqualified staff. Approximately half of all nursing staff showed signs of high burnout in terms of emotional exhaustion. A variety of stressors were positively correlated with emotional exhaustion and depersonalization. Higher levels of support from co-workers were related to lower levels of emotional exhaustion. Higher stressor scores were associated with higher levels of depersonalization for staff reporting high levels of social support, but not for those reporting low levels of support (a reverse buffering effect). CONCLUSIONS: Qualified and unqualified nursing staff differed in terms of the prominence given to individual stressors in their work environment. The findings were consistent with the notion of burnout developing in response to job-related stressors. While staff support groups may be useful in alleviating feelings of burnout, the reverse buffering effect suggests that they should be structured in a way that minimizes negative communication and encourages staff to discuss their concerns in a constructive way.     

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles

Background. To reach the Millennium Development Goals, maternal health‐promoting behaviours need to be encouraged after childbirth; little is known about the health‐promoting behaviour among first‐time mothers during their postpartum period. Aim. To examine levels of engagement in health‐promoting behaviours and related factors among postpartum women in Taiwan. Methods. This cross‐sectional study was conducted through a convenience sample of 122 qualified women. Participants self‐completed a questionnaire and mailed it back using a stamped, self‐addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert‐type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self‐developed social support scale. Results. The average overall Health Promotion Lifestyle Profile score was low (mean, 2·83 SD 1·35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers‐in‐law, mothers and husbands. An astonishing 42·6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health‐promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self‐actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model. Conclusions. This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles. Relevance to clinical practice. This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.     

Relation between post-stroke satisfaction with time use,perceived social support and depressive symptoms

Purpose. To determine if perceived level of social support and number of depressive symptoms differentiates those who are satisfied with their time use post-stroke from those who are dissatisfied.

Method. Secondary analysis of data of 54 subjects grouped by yes/no responses to ‘Are you satisfied with how you spend your time?’ Perceived social support and number of depressive symptoms were evaluated using the MOS Social Support Scale and Geriatric Depression Scale respectively.

Results. Time use satisfaction was high (64.8%). Dissatisfied subjects reported lower affectionate support and fewer positive social interactions (t < ?2.70, p < 0.009) as well as higher levels of depression (t = 2.06, p = 0.05). Dissatisfied subjects were more likely to endorse only three Geriatric Depression Scale items (i.e., ‘dropped activities’, ‘often bored’, and ‘often felt helpless’) (χ²(1) > 7.27, p < 0.007).

Conclusions. Persons post-stroke who are dissatisfied with their time use may not be depressed but may benefit from participation in meaningful social occupations.     

The association between depressive symptoms and social support in Taiwanese women during the month

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.     

脑卒中失能老人照顾者健康促进与社会支持的相关性研究

[目的]分析脑卒中失能老人家庭照顾者的健康促进生活方式及失能老人社会支持现状,并探讨二者的相关性。[方法]采用健康促进生活方式评定量表Ⅱ、社会支持量表及微型营养评定精法等,对天津市207例脑卒中失能老人及其家庭照顾者进行调查研究。[结果]家庭照顾者健康促进生活方式总分(118.84±30.87)分,低于城市一般人群(P0.01);常模各维度得分由高到低依次为营养、人际关系、自我实现、压力应对、健康责任、运动锻炼;病人社会支持得分(34.26±5.13)分,低于常模(P0.01);照顾者健康促进生活方式与病人社会支持得分呈正相关(r=0.357,P0.01)。[结论]加强对脑卒中失能老人照护单元的社会支持,不仅有助于减轻照护负荷,改善家庭照顾者健康行为及生活质量,同时促进长期照护水平的提高及脑卒中病人的康复。     

乙型肝炎患者及其配偶心理健康状况与社会支持相关研究

目的 探讨慢性乙肝患者和配偶的心理健康状况及其社会支持相关性.方法 采用Beck抑郁自评量表、社会支持量表对126例住院慢性乙肝患者及其126例配偶进行问卷调查.结果 Beck抑郁自评量表测评,乙肝患者及其配偶抑郁情绪总发生率分别为80.95%、60.32%;乙肝患者轻度抑郁情绪及抑郁情绪总发生率均显著高于配偶组(P＜0.05或0.01).患者及其配偶客观支持因子分均显著低于主观支持因子分(P＜0.05).相关分析发现.乙肝患者Beck抑郁自评量表总分与社会支持量表总社会支持、主观支持、支持利用度因子分及职业均呈显著负相关(P＜0.01～0.05),与年龄呈显著正相关(P＜0.05);患者配偶Beck抑郁自评量表总分与社会支持量表主观支持、支持利用度因子分以及年龄均呈显著负相关(P＜0.05).结论 乙肝患者及其配偶抑郁情绪发生率较高,乙肝患者的社会总支持越低及从事职业条件越差其抑郁情绪越高.且年龄越大.抑郁情绪越重.二者的客观支持低于主观支持;乙肝患者的配偶主观支持越低,年龄越小,抑郁情绪越重.     

Stress and coping in older people with Alzheimer’s disease

Aim. To investigate stress intensity and coping style in older people with mild Alzheimer’s disease. Background. The potential risk assessment of a stress event and the devising of coping strategies are dependent on cognitive function. Although older individuals with Alzheimer’s disease present significant cognitive impairment, little is known about how these individuals experience stress events and select coping strategies in stress situations. Design. Survey. Method. A convenient sample of 30 cognitively healthy older people and 30 individuals with mild Alzheimer’s disease were given an assessment battery of stress indicators (Symptom Stress List, Cornell Scale for Depression in Dementia, State‐Trait Anxiety Inventory), coping style (Jalowiec Coping Scale) and cognitive performance (mini‐mental state exam) were applied in both groups. Statistical analysis of the data employed the Mann–Whitney test to compare medians of stress indicators and coping style, Fischer’s exact test to compare proportions when expected frequencies were lower than five, and Spearman’s correlation coefficient to verify correlation between coping style and cognitive performance. Results. Both groups suffered from the same stress intensity (p = 0·254). Regarding coping styles, although differences were not statistically significant (p = 0·124), emotion‐oriented coping was predominant in the patients with Alzheimer’s disease. However, those individuals displaying better cognitive performance in the Alzheimer’s disease group had selected coping strategies focused on problem solving (p = 0·0074). Conclusions. Despite a tendency for older people with Alzheimer’s disease to select escape strategies and emotional control, rather than attempting to resolve or lesser the consequences arising from a problem, coping ultimately depends on cognitive performance of the individual. Relevance to clinical practice. The findings of this study provide information and data to assist planning of appropriate support care for individuals with Alzheimer’s disease who experience stress situations, based on their cognitive performance.     

Predictors of depressive symptoms and physical health in caregivers of individuals with schizophrenia

This cross‐sectional study examined relationships among factors influencing caregiver burden, depressive symptoms, and physical health in family caregivers of individuals with schizophrenia. Two hundred family caregivers of individuals with schizophrenia completed standardized questionnaires related to depressive symptoms, physical health, perceptions of burden, coping, and social support. The results revealed that 19.5% of family caregivers of individuals with schizophrenia experienced significant depressive symptoms and 65.5% perceived themselves in poor physical health. Burden, self‐controlling coping strategies, and physical health status were all independently predictive of depressive symptoms. Two emotion‐focused coping strategies (self‐controlling and escape‐avoidance) were independently predictive of caregiver burden. Only burden predicted physical health status. The findings suggest that health professionals who provide community care for those with schizophrenia need to consider the “unit of care” as the family rather than the individual. The health status of family caregivers should be routinely assessed. Individualized interventions to reduce family burden could include community‐based health professionals as well as trained community volunteers, opportunities for social interaction, and improving self‐care for all family members.     

Emotional and physical health of spouse caregivers of persons with Alzheimer's disease and stroke

Providing care for a cognitively impaired spouse can adversely affect caregivers' health. It is not known how early in the caregiver's 'career' emotional and physical health deteriorates. The progressive deterioration associated with Alzheimer's disease (AD) may have different effects on caregivers' health when compared with the potential recovery following a stroke. An exploratory study was conducted with 42 couples, equally divided among early phase AD, ischaemic stroke after hospital discharge, and well controls. Couples were evaluated at baseline (time 1), 6 months (time 2) and 1 year (time 3). At time 1, depression was significantly higher in AD and stroke caregivers when compared to controls. Over time, depression increased significantly for AD caregivers with 21% evidencing moderate to severe depression at time 1 and 50% at time 3. For stroke caregivers there was a significant interaction effect with race: white stroke caregivers' depression increased over time while African American stroke caregivers' depression decreased. Physical health was not significantly different for the three groups and remained stable over time. Cognitive and functional impairment levels of care recipients were significantly related to stroke caregivers' but not AD caregivers' depression. Long-term counselling and support to family caregivers is advocated.     

老年COPD病人抑郁状况与社会支持相关性调查

[目的 ]探讨老年慢性阻塞性肺疾病 (COPD)病人抑郁情绪和社会支持之间的关系 ,为老年COPD病人提供合理、有效的社会支持提供依据。 [方法 ]采用抑郁量表和社会支持评定量表对年龄≥65岁 60例门诊COPD病人进行调查。[结果 ]无抑郁者 2 9例 ,可能抑郁者 16例 ,抑郁者 15例。其中 5 3例病人社会支持处于中等水平 ,7例病人处于高水平。病人抑郁得分与社会支持总分、主观支持总分、社会支持利用度得分存在负相关。 [结论 ]社会支持可能对减少抑郁发生率有积极作用。     

Lean on me: Effects of social support on low socioeconomic‐status pregnant women

This study identified how close relationships are related to low‐income pregnant women's ability to cope and overall health. Previous research has shown that stress during pregnancy is related to long‐term negative physical and psychological health outcomes for both the mother and the infant. Lower socioeconomic status has been related to higher morbidity and mortality across the lifespan. Women typically rely on close relationships for social support to help reduce stress. However, stress levels can be elevated when women engage in co‐rumination. Co‐rumination is defined as excessive problem discussion with negative‐affect focus. Thirty‐one low‐income pregnant women from central Oklahoma, USA, reported their daily stressors, social support, communication habits with friends and family, and general health in a series of questionnaires at a prenatal visit. The results revealed that daily stressors, co‐rumination with friends, and the relationship with the baby's father were related to physical pain and depressive symptoms. The results suggested that specific social support dynamics, such as co‐rumination, during pregnancy have implications for the health of low‐income mothers and their infants.     

社会支持对肠造口患者抑郁状况的影响

目的探讨社会支持对直肠癌结肠造口患者抑郁状况的影响。方法采用抑郁自评量表(SDS)和领悟社会支持量表(PSSS),对1999年7月～2003年6月入住广东医学院附属医院普外科65例需行经腹会阴联合直肠癌根治术的患者进行了调查分析。结果直肠癌术后抑郁发生率为33.8%,抑郁的发生情况因个体社会支持各维度得分的不同而不同(P<0.05),其中家庭内支持、朋友支持及其他支持各维度的得分越高,抑郁的发生率越低。结论良好的社会支持可消除或降低直肠癌结肠造口术后患者的抑郁程度,有利于患者保持良好的心理素质,使其勇敢地与疾病做斗争,从而健康地工作和生活。     

The relationship between caregiver’s strain and social support among mothers with intellectually disabled children

Aims and objectives. To explore caregiver’s strain, the relationship between social support and caregiver’s strain and the predictors of caregiver’s strain among mothers with school‐aged intellectually disabled children in Taiwan. Background. Strain is a common condition among mothers who take care of intellectually disabled children; this correspondingly reduces their ability to care for children, thereby affecting the functioning of the entire family. Yet, there have been very few studies on caregivers of intellectually disabled children of school age. Design. Cross‐section correlational design. Methods. Data collection consisted of face‐to‐face interviews combined with a structured questionnaire. Instruments employed were the Caregiver Strain Index, Social Support Scale and three open‐ended questions. In total, 127 mothers completed the questionnaire. Results. Results showed that mothers with intellectually disabled children had a rather high level of strain and received inadequate social support. Social support and strain had a significant and negative correlation. Stepwise regression analysis revealed that mothers’ health status, social support and amount of time spent as a caregiver, as well as the intellectually disabled children’s dependent degree of daily living activity, were major predictors of caregiver’s strain, which accounted for 38·4% of the total variance. Conclusions. The results provide a guide for healthcare professionals in designing effective interventions and preventive care to reduce the level of strain in mothers with intellectually disabled children. This, in turn, could improve the quality of life of the mother and her family. Relevance to clinical practice. In Taiwan, care of intellectually disabled children is primarily provided by family members. Therefore, we should emphasise family‐centred care to enable healthcare professionals to become more effective as case managers in local clinics, schools and communities.