Predictors of depression and life satisfaction among spousal caregivers in hospice: application of a stress process model

Using a stress process model, risk factors (caregiving stressors, caregiver health, and negative social interactions) and protective factors (caregiving appraisals and social resources) were examined as predictors of family caregiver well-being (depression and life satisfaction). Eighty spousal caregivers of hospice patients with dementia or lung cancer completed structured interviews and self-report measures assessing components of the stress process model. Results suggest that objective measures of patient impairment or amount of care provided are not strong predictors of caregiver depression or life satisfaction. Female gender, caregiver health problems, and negative social interactions were risk factors for poorer caregiver well-being. Caregivers who subjectively appraised caregiving tasks as less stressful, who found meaning and subjective benefits from caregiving, and with more social resources had lower depression and higher life satisfaction, even after controlling for patient impairment and caregiver appraisal variables. Regression models accounted for 42% of variance in caregiver depression and 52% of variance in caregiver life satisfaction. Counseling for hospice family caregivers could utilize the stress process framework, and pay particular attention to finding meaning or subjective benefits from caregiving, and remaining active in social roles. Further research providing evidence on caregiver risk and protective factors could improve the conceptual and empirical basis for psychosocial interventions for hospice family caregivers.     

Stress, locus of control, social support, and psychological symptoms among head nurses

This study was conducted to evaluate the relationships among work stress, nonwork stress, locus of control, social support, and head nurses' psychological symptoms. Data were collected from head nurses (N = 300) representing all Army hospitals in the United States; 21% of the volunteer sample were men. The results supported the hypotheses that perceived stress from both work and nonwork sources was positively related to psychological symptoms. Direct effects for both internal locus of control and social support, while weak, were manifest as expected; these variables demonstrated a negative relationship with psychological symptoms. None of the hypothesized buffering effects were detected. The stress model derived from this study accounted for 35.9% of the variance in psychological symptoms. Regardless of gender, the head nurses' psychological symptoms were one standard deviation higher than nonpatient norms.     

Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care

Purpose

Palliative patients and their family caregivers were interviewed at the beginning of home care in personal interviews at home in regard to their psychological distress as well as their quality of life.

Methods

Quality of life was collected with the palliative module EORTC QLQ-C15-PAL (patients) and the Short Form-8 Health Survey (caregivers). The psychological distress was assessed using the Hospital Anxiety and Depression Scale, the extent of social support with the Oslo 3-items social support scale. Two multiple regression models were employed to examine factors associated with psychological distress. Data from 106 palliative patients (39.6 % female) and their family caregivers (67.9 % female) were included in the analysis.

Results

Every fourth patient had clinically relevant anxiety levels and half of the palliative patients had clinically symptomatic depression scores. The main symptoms of the patients were: fatigue, loss of appetite, pain, and shortness of breath. Patients’ and caregivers’ anxiety and depression scores were significantly correlated (anxiety r?=?0.386, depression r?=?0.416). Thirty-three percent of caregivers suffered from high anxiety and 28 % from depression. Spousal caregivers had higher psychological distress than other caregivers. Other relevant factors for higher distress were high financial burden and low social support. There was hardly any family member receiving professional psychological support.

Conclusions

In palliative patients, depressive symptoms should not be judged as a normal attendant of the terminal illness situation. Instead, patients should be referred to appropriate support services for pharmacological or psychological treatment. Spousal caregivers and caregivers who are socially not well integrated are in particular need of support. Attention to the financial burden of family caregivers is also very important. Due to the existing correlation between the psychological situation of palliative patients and their caring relatives, couples must be considered an emotional system rather than just two individuals.     

Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer

This study aims to describe symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal tract (GIT) cancer, and to identify the extent to which demographic, physical, and psychosocial factors predict their quality of life. A convenience sample of 146 newly diagnosed GIT cancer patients recruited from 3 major hospitals in Shanghai completed a self-report questionnaire. The questionnaire was designed to obtain demographic and medical data and measures of symptoms, psychological distress, social support, health-related quality of life (HRQoL), and global quality of life (GQoL). Measures developed in English were translated into Chinese using the procedure advocated by WHO. The results showed that the most common signs and symptoms reported were fatigue, pain, and weight loss; 28% of the patients were depressed; and overall, patients had a moderate quality of life. Comparative analyses found some difference on measures for demographic and diagnostic subgroups. Depression, symptom distress, and social support accounted for 44% of the total variance for HRQoL, while perceived financial difficulty and symptom distress accounted for 20% of the total variance for GQoL. Findings from this research give insights into the importance of quality of life assessment, symptom management, and intervention to improve the quality of life of Chinese cancer patients. It also raises questions about measures of quality of life that are culturally relevant.     

Affiliate stigma,perceived social support and perceived stress in caregivers of children with autism spectrum disorder: A multiple mediation study

BackgroundAffiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored.MethodsA correlational design was used. A sample of n = 124 caregivers of children with ASD completed an online survey assessing affiliate stigma, perceived support from family, friends and significant others, and perceived stress.ResultsThe relationship between greater affiliate stigma and increased perceived stress occurred indirectly via lower perceived support from family, but not from friends or significant others.ConclusionsThese findings underscore the importance of increasing caregivers' perceived family support. Whether interventions that alleviate affiliate stigma are beneficial for reducing perceived stress, and whether this effect is mediated by increased perceived availability of support, might be the subject of future research.     

Types and sources of social support for managing job stress in critical care nursing

The theoretical model of occupational stress developed by LaRocco, House, and French, (1980) was tested in relation to job stress in critical care nursing. A sample of 164 female critical care nurses was obtained from eight hospitals. The variables of perceived social support, perceived job stress, job dissatisfaction, and psychological symptoms were measured, and specific types and sources of support were examined. Findings from the full sample supported all the main effects in the model but none of the buffering effects. For the married group, a specific type of support (work support) explained 24% of the variance of perceived job stress, nearly double that of the overall social support measure for this group. For the unmarried group, a specific source of support (from relatives) explained 10% of the variance in perceived job stress and 16% of the variance in psychological symptoms--double or triple the effect of the total network support score for the full sample.     

Predicting psychological distress of informal carers of individuals with major depression or bipolar disorder

Caring for someone with a mental illness is associated with high levels of burden and psychological distress. Understanding these factors could be important to prevent the development of physical and mental health problems in carers. The purpose of the present study was to determine the contribution of coping styles and social support in predicting the psychological distress reported by informal carers (IC) of individuals with major depression or bipolar disorder. IC (n = 72) of adults with a diagnosed depressive illness were recruited from mental health organizations within the community setting. Carers completed the General Health Questionnaire, Brief COPE, and Social Support Questionnaire. Multiple linear regression analysis revealed that 63% of the variance in psychological distress could be accounted for by adaptive and maladaptive coping styles and perceived quantity and satisfaction with social support. Satisfaction with social support (β = ?0.508, P < 0.001) and maladaptive coping (β = 0.369; P < 0.001) were significant predictors of psychological distress. These findings suggest that interventions should consider coping styles, specifically the interaction between maladaptive behaviours and enhancement of quality of support, to assist carers to manage psychological distress, especially earlier in the caring role.     

Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain

Biopsychosocial models of chronic pain that recognize psychological and environmental factors as important aspects of adjustment to pain have been proposed for understanding chronic pain and related suffering in persons with multiple sclerosis (MS), but such models have not been empirically tested. The objective of this study was to test such a model by evaluating the associations of several psychosocial variables (i.e., pain-related catastrophizing, perceived social support, pain beliefs, and pain coping) with pain intensity, pain interference with functioning, and psychological functioning in persons with chronic pain and MS, after controlling for demographic and disease-related factors. Participants were 125 community-dwelling persons with MS and pain who completed a mailed questionnaire that included measures of pain intensity and interference, psychological functioning, catastrophizing, social support, and pain beliefs and coping. The psychosocial variables accounted for an additional 25% of the variance in average pain intensity after controlling for demographic and disease-related variables (p<.001). These variables explained an additional 22% of the variance in pain-related interference (p<.001) and 43% of the variance in psychological functioning (p<.001), after adjusting for demographic and MS-related variables and average pain intensity. Catastrophizing was consistently and independently associated with all criterion measures, whereas social support, pain beliefs, and pain coping were associated with some criterion measures but not others. The results provide empirical support for a biopsychosocial understanding of chronic pain in MS and suggest that specific psychosocial factors (e.g., catastrophizing) may be important regarding adjustment to pain in persons with MS.     

Predictors of psychological distress in low‐income mothers over the first postpartum year

Up to 25% of postpartum women experience psychological distress including stress, depressive, or anxiety symptoms during the postpartum period. The purpose of this study was to explore the extent to which social determinants of health and allostatic load score, a 10‐item index of biologic measures of chronic stress, predict psychological distress in low‐income pregnant women over the first postpartum year. We conducted a secondary data analysis of the Child Community Health Research Network data set. The psychological distress outcome variables were perceived stress (n = 842), depression ( n = 845), and anxiety ( n = 846) symptoms, all measured categorically over the first year postpartum (T1:1 month, T2: 24–29 weeks, and T3: 50–65 weeks). Our predictors were social determinants of health (e.g., demographics, maternal hardship, percent poverty level, interpersonal violence, and food security) and allostatic load score. Generalized linear mixed models were used to determine which predictors were significantly associated with psychological distress symptoms across the first postpartum year. Interpersonal violence was a statistically significant risk factor for stress, depression, and anxiety symptoms over the first year postpartum. Other significant risk factors included low‐income level, nativity, and perceived food security. Receiving food stamps was a significant protective factor for stress symptoms. The significance of risk factors for psychological distress, both modifiable and nonmodifiable, can be used as potential targets for further research, screening, and intervention. Future work should explore why and in what conditions these risk factors vary over time.     

The stress process in family caregivers of persons receiving chemotherapy

The purpose of this analysis was to explore strain and depression among family caregivers of persons receiving chemotherapy for cancer using the Pearlin Stress Process Model. Seventy-five family caregivers of persons receiving chemotherapy participated, completing the Caregiver Strain Index and the Depression Subscale of the Profile of Mood States within 3 weeks of the initiation of chemotherapy. Hierarchical regression analyses indicated that 44% of the variance in strain and 40% of the variance in depression were explained by the antecedent variables of caregiver age and gender, patient age and gender, patient functional status, the presence of recurrent disease, perceived efficacy of coping strategies, and perceived adequacy of social support. Further analysis aimed at delineating the mechanisms through which coping and social support operate in the model found no evidence for a moderating or stress-buffering effect. However, coping mediated the relationship between strain and depression and social support mediated the relationship between functional status and depression.     

Problem-solving counseling for caregivers of the cognitively impaired: effective for whom?

BACKGROUND: Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving. Few studies have shown the effectiveness of counseling for these caregivers. OBJECTIVES: To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization. METHOD: Caregivers (n = 77) of the cognitively impaired living at home were randomized to receive nurse counseling or not. Psychosocial adjustment to their relative's illness, psychological distress, burden, coping skills, and expenditures were measured after 6 months and 1 year. RESULTS: Although on average, all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative's illness, psychological distress, or caregiver burden, they found counseling very helpful and it was effective for a subgroup of caregivers. Those with poor logical analysis coping skills at baseline had decreased psychological distress (F(1,53) = 9.7, p = .003) and improved psychosocial adjustment (F(1,53) = 4.7, p = .035) after 1 year. Caregivers in control and counseling groups whose relatives entered a nursing home improved their psychosocial adjustment 23% on average whereas those continuing to live in the community decreased by 8%. Almost half as many relatives entered nursing homes in the counseling group (n = 9 vs. n = 5) but these compared to control group relatives had greater annualized per person expenditures for health and social services (Cdn$23,437 vs. Cdn$15,151). CONCLUSIONS: Caregivers found nurse counseling most helpful. Those indicating infrequent use of logical analysis coping skills showed benefits.     

The role of sense of belonging and social support on stress and depression in individuals with depression

This longitudinal study examined the role of sense of belonging, social support, and spousal support on the relationship between perceived stress and symptoms of depression in 90 men and women who had a history of depression (n = 51) and who did not have (n = 39) a history of depression. Data were obtained at 3, 6, and 9 months after initial entry into the study. A series of regression analysis procedures revealed a mediation effect, but not a moderation effect, of sense of belonging and perceived social support on the relationship between perceived stress and depression in only the depressed group. Spousal support had neither a direct effect nor an interaction effect on the perceived stress-depression relationship in the depressed group. For the comparison group, perceived stress did not correlate significantly with the symptoms of depression. Repeated measures analysis of variance showed that increased perceived stress and lower sense of belonging had significant direct effects on the severity of depression and the effects were consistent over the period of 9 months. Social support and spousal support had only indirect effects that fluctuated over time. The results emphasize that interventions geared toward stress reappraisal and promotion of sense of belonging should yield direct and stable effects of decreasing depression.     

The desire for hastened death in patients with metastatic cancer

A substantial minority of patients in palliative care settings report a high desire for hastened death (DHD), in association with physical and emotional distress, low social support, and impaired spiritual well being. To clarify to what extent DHD emerges in association with suffering prior to the end of life, we determined its prevalence and correlates in ambulatory patients with metastatic cancer, the majority of whom had an expected survival of >6 months. We hypothesized that DHD in this sample would be directly linked to physical and psychological distress, and inversely related to perceived social support, self-esteem, and spiritual well being. Three hundred twenty-six outpatients completed the Schedule of Attitudes Toward Hastened Death (SAHD), Brief Pain Inventory, Memorial Symptom Assessment Scale, Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Medical Outcomes Study Social Support Survey, FACIT-Spiritual Well-Being Scale, Rosenberg Self-Esteem Scale, and Karnofsky Performance Status. Over 50% of participants reported pain, >20% reported elevated levels of depression (BDI-II ≥ 15) and hopelessness (BHS ≥ 8), but <2% had a high DHD (SAHD ≥ 10). DHD was correlated positively with hopelessness, depression, and physical distress, and negatively with physical functioning, spiritual well being, social support, and self-esteem; it was not associated with treatment status or proximity to death. Over 34% of the variance in predicting SAHD scores was accounted for by hopelessness, depression, and functional status. The relative absence of a strong DHD in this sample suggests that the will to live tends to be preserved in cancer patients prior to the end of life, in spite of significant emotional and physical suffering.     

Stress and depression in family carers following traumatic brain injury: the influence of beliefs about difficult behaviours

OBJECTIVE: Difficult behaviours are significant contributors to the distress experienced by carers of people with a traumatic brain injury. This study investigated whether the beliefs carers hold about such behaviours also contribute to the distress. DESIGN: Questionnaire survey. PARTICIPANTS: Forty family carers recruited from Headway, a traumatic brain injury support organization. MAIN MEASURES: Zung's Self-Rating Depression Scale, Perceived Stress Scale, Social Support Questionnaire, a measure of the severity of difficult behaviours shown by the person cared for and two measures of carer beliefs about the behaviour (including the Controlling Beliefs Scale). RESULTS: Higher depression and stress scores were associated with more severe behaviours and less social support. Carer belief in their own ability to control the behaviours was associated with less stress. Belief that the behaviour was under the control of the person with traumatic brain injury and/or was motivated by hostile intentions was associated with more depression but less stress. Taken together, severity of behaviour and social support accounted for about 19% of the variance in both depression and stress scores. Carer beliefs accounted for another 5% of the depression scores, and another 11% of the stress scores. CONCLUSIONS: The results were consistent with the idea that carer beliefs about difficult behaviour contribute to carer distress, but longitudinal and treatment studies are needed to establish causality.     

Psychological and social profile of family caregivers on commencement of palliative care

ContextPalliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized.ObjectivesWe sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services.MethodsA self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire.ResultsThree hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief.ConclusionThis study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers.     

Predictors of burden for caregivers of patients with Parkinson's disease.

Parkinson's disease (PD) is a chronic, progressive neurological disease that affects an estimated 1 million Americans each year. Its progressive nature leads to increased burden for the caregiver. This study explored factors that contribute to the perception of burden in caregivers of individuals with PD using a cross-sectional design. The sample consisted of 41 caregivers who were married to or cohabitating with individuals with PD. Questionnaires were mailed to spousal caregivers and returned via mail. Burden was determined by utilizing the Zarit Burden Inventory. The independent variables that were measured were activities of daily living (ADLs), perceived social support, psychological well-being, and marital satisfaction. All four factors were found to significantly predict perceived burden. Multiple regression analysis showed that ADLs and perceived social support were significant predictors of caregiver burden, accounting for 44.3% of the variance. The implication for healthcare professionals is that they should provide information on PD symptom management, thus promoting independence in performing ADLs, identifying appropriate resources to reduce caregiver burden, and using support groups.     

Antecedents of perceived support: Is perceived family environment generalized to new social relationships?

Cognitive models of social support hypothesize that relatively enduring expectancies about social support influence ongoing social information processing. Drawing from research that suggests that perceived support cognitions are generalized to novel social stimuli, we hypothesized that negative perceptions of the family environment would be generalized to perceptions of new social relations. Incoming freshmen who had moved away to college were assessed in the first week of their first semester on perceived family environment, psychological distress, and a variety of interpersonal person variables (i.e., social skills, agreeableness, and extraversion). Followup measures of perceived support at college were obtained at the end of their first semester. Controlling for social desirability, persons with negative perceptions of their family environments, higher distress, and lower levels of social competence, agreeableness, and extraversion developed lower levels of perceived support than their more fortunate counterparts. In addition, the relation between perceived family environment and developed perceived support did not appear to be mediated by psychological distress or the interpersonal person variables. Implications for understanding the processes by which perceived support is developed in new social settings were discussed.     

Community Nurse Executives''Psychologic Weil-Being: Relationships Among Stressors, Social Support, Coping, and Optimism

The purposes of this study were to (1) determine the occupational stressors, coping strategies, and sources and types of social support of nurse executives; (2) compare the sample's level of psychologic symptomatology with norms; and (3) examine the effects of stress, social support, and optimism in predicting psychologic well-being. Public health nursing directors located throughout California participated in the study. Mailed questionnaire booklets were used to collect data from the target population. A subset of the sample participated in face-to-face, taped, structured interviews that elicited additional data on nurse executives' work stress, coping strategies, and social support dimensions. Several significant findings emerged. The mean psychologic symptom score for the subjects was greater than the published norm, suggesting psychologic distress. In regression analysis, total number of years in nursing accounted for 14.8% of the variance in psychologic symptoms, the dependent variable. Level of optimism accounted for an additional 29.8% of the variance. Total hassles and co-worker social support together accounted for 6.57% of the variance in the last step, but were not statistically significant. Interview data identified the major occupational stressors, coping strategies, and sources and types of social support for this group of nursing directors.     

Social support, threat, and coping responses and effectiveness in the functionally disabled

A causal model based on Lazarus' (1966) cognitively oriented theory of psychological stress and coping was tested in a functionally disabled population to determine the effects of social support variables, threat appraisal, and coping responses on coping effectiveness. Social support variables (perceived availability of social support, perceived effectiveness of social support, and personal constraints to the use of social support) were hypothesized to effect coping responses both directly and through the variable of threat appraisal. Coping responses (use of social support, cognitive reappraisal, emotion-focused coping, and problem-focused coping) were hypothesized to directly effect coping effectiveness and to mediate the effect of all other variables. Data from 50 functionally disabled, wheel-chair-bound individuals discharged within 3 years from two rehabilitation facilities were analyzed using path analysis. The model fit the data and accounted for 61% of the variance in coping effectiveness. Findings indicated that perceived availability of social support, but not the use of social support, was significantly and positively related to coping effectiveness through the mediating variables of problem- and emotion-focused coping. In contrast to the relationship of marital status to coping effectiveness usually found in the literature, nonmarried subjects coped more effectively and perceived less threat.