The impact of family environment and decision-making satisfaction on caregiver depression: a path analytic model

OBJECTIVES. This research examines caregiver depression in the context of traditional care-related primary stressors, such as the caregiving context and care-recipient impairment, and secondary stressors, such as family environment and decision-making satisfaction. METHODS. The authors examine a causal (path) model of depression among 244 caregivers. Ordinary least squares regression results are used to determine the direct and indirect effects of stressors on caregiver depression. RESULTS. The path coefficients obtained show that adaptability and conflict have the most powerful net effects. With the caregiving context variables, they explain approximately 30% of the variance in decision-making satisfaction. Family adaptability and decision-making satisfaction also have significant paths. The caregiving context, network, family environment, and decision-making variables explain approximately 25% of the variance in caregiver depression. DISCUSSION. These findings suggest that practitioners working with caregivers to ameliorate depression need to examine the broader aspects of family environment and caregiver perceptions related to decision making.     

The importance of family relationships with nursing facility staff for family caregiver burden and depression

We explore the association between family caregiver depression and the quality of staff-family relationships, and we test burden as a mediator of this relationship. Using structural equation modeling, we used data from a representative sample of 932 family members from 20 nursing homes in Central New York to examine the association between staff-family relationship quality and family caregiver depression. We then tested family caregiver burden as a mediator of the relationship between staff-family relationship quality and family caregiver depression. Staff-family relationship quality, specifically perceived conflict with staff, is significantly associated with family caregiver depression. Further, caregiver burden mediates this relationship. Interventions to improve staff-family relationships may impact family caregiver depression by reducing the stress that family caregivers experience.     

Neuroticism and longitudinal change in caregiver depression: impact of a spouse-caregiver intervention program

PURPOSE: We examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention. DESIGN AND METHODS: We analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. We used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention. RESULTS: Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression. IMPLICATIONS: Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention like ours, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment.     

The savvy caregiver program: developing and testing a transportable dementia family caregiver training program

PURPOSE: This article reports on the development and field testing of the Savvy Caregiver Program, the transformation of a successful, academic-based caregiver psychoeducational program into a self-contained program that can be adopted in other locations. DESIGN AND METHODS: Program development began with a prototype of a 12-hr course with the aims of introducing family caregivers to the caregiving role, providing them with the knowledge, skills, and attitudes needed to carry out that role, and alerting them to self-care issues. Results from initial field trials dictated a substantial revision of the workshop materials. The next version was field tested in multiple sites in southern rural Minnesota, Colorado, and Alaska. In this expanded testing, participants evaluated the program, and cross-group comparisons were conducted by use of well-established caregiver well-being scales. RESULTS: Virtually all respondents reported increased skill, knowledge, and confidence, and all would recommend the program to others. A preintervention versus postintervention analysis indicates that caregivers' reaction to the overall behavior of the persons for whom they provide care (i.e., "total reaction"), their self-reported burden, and their beliefs about caregiving (emotional enmeshment) changed significantly in directions indicating better caregiver well-being. IMPLICATIONS:Results suggest that it is feasible to translate a research-based caregiver intervention into a packaged program that can be adopted in other settings without the direct involvement of the program initiators.     

Avatar-assisted therapy: a proof-of-concept pilot study of a novel technology-based intervention to treat substance use disorders

Background: Avatar-assisted therapy (AAT) is a novel and emerging technology that uses the Internet to enable clinicians and clients in substance abuse treatment to participate in group counseling sessions from separate and remote locations in real time through the use of avatars and virtual environments. Objectives: The current study is a pilot proof-of-concept feasibility study involving individuals in outpatient substance abuse treatment. This report addresses two questions: (1) are individuals who present for substance abuse treatment interested in receiving AAT and (2) what factors are associated with better treatment success. Methods: Individuals who presented at the treatment clinic who met study eligibility criteria, and provided their written informed consent to participate, were included in the current study (N = 59; 78% male). Results: Twenty-eight (47.5%) participants completed 16 weeks of treatment and attended more sessions compared to non-completers (M = 14.3 vs. 7.5 p < .05). Those individuals who completed treatment were less likely to have a positive urine drug screen at baseline (21.5 vs. 78.6%; p < .05). Furthermore, those individuals who successfully completed treatment were less likely to have positive urine drug screens during treatment compared to those who did not complete (29.7% vs. 70.3%, p < .05). There were no arrests during treatment for completers and non-completers. Conclusion: Poor retention in substance use disorder treatment has long been a major problem for public health. AAT is a feasible approach that has the potential to expand treatment to individuals who might have difficulty accessing treatment. Moreover, AAT may be appealing to clients who are concerned about anonymity and confidentiality.     

The buffering effect of a computer support network on caregiver strain

ComputerLink was a computer support network for family caregivers of people with Alzheimer's disease. In a 12-month experiment, 102 caregivers were randomly assigned to an experimental group that had access to ComputerLink or to a control group that did not. This investigation examined whether caregivers in the experimental group had greater reductions in four types of care-related strain by the end of the 1-year study. ComputerLink reduced certain types of strain if caregivers also had larger informal support networks, were spouses, or did not live alone with their care receivers. More frequent use of the communication function was related to significantly reduced strain for caregivers who were initially more stressed and for non-spouse caregivers. Greater use of the information function was related to significantly lower strain among caregivers who lived alone with care receivers. Overall, ComputerLink appeared to be an effective tool for reducing strain for some caregivers.     

化瘀开窍解郁颗粒对脑卒中后抑郁大鼠的保护作用

目的探讨化瘀开窍解郁颗粒(HY颗粒)对脑卒中后抑郁(PSD)大鼠的改善作用及机制。方法首先对大鼠MCAO处理,再进行慢性应激刺激两步完成PSD模型的复制,给药后观察HY颗粒对大鼠糖水消耗、开场活动情况的影响,以及对水迷宫实验中游泳时间、游泳距离、游泳速度、近站台区游泳距离、远站台区游泳距离、近/远站台区距离比、近站台区时间、远站台区时间、近/远站台区时间比的影响。通过免疫组织化学法观察HY颗粒对海马和皮层(额叶)中脑源性神经营养因子(BDNF)和神经生长因子(NGF)表达的影响。结果 HY颗粒治疗后可显著增加PSD大鼠体重、糖水消耗体积、水平活动次数、垂直活动次数,缩短总游泳距离、近站台区的游泳距离、远站台区的游泳距离、游泳时间、近站台区游泳时间、远站台区游泳时间,增加近/远站台区游泳距离比和时间比。HY颗粒还可剂量依赖性增加海马和皮层脑区中BDNF和NGF蛋白的表达。结论HY颗粒能促进PSD大鼠行为学改善,其机制涉及BDNF和NGF表达量的增加。     

ADOPT干预对居家不出老年人自我感知老化和抑郁的影响

目的探讨基于ADOPT干预对居家不出(housebound)老年人自我感知老化和抑郁的影响。方法采用分层整群随机抽样方法,抽取河北省邯郸市复兴区所辖之建安社区,采用随机数字表法将社区中211例housebound老年人分为干预组105例和对照组106例,干预期间对照组失访1例。根据ADOPT模式制定干预方案对干预组进行为期6个月的干预,对照组为空白对照。分别在干预前、干预3个月和6个月对两组housebound老年人自我感知老化和抑郁进行效果评价。结果在干预3个月、6个月后,干预组老年人自我感知老化的积极维度得分均高于对照组,消极维度得分均低于对照组(P<0.05);干预组老年人抑郁比例降低,与对照组比较有显著性差异(P<0.05)。结论 ADOPT干预模式可有效强化积极的自我感知老化,减弱消极的自我感知老化,改善housebound老年人抑郁状况。     

Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes

OBJECTIVES: Family caregiving is an integral part of the care system for persons with dementing disorders, such as Alzheimer's disease. This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving. DESIGN: Training effectiveness was tested in a trial in which family care receiver dyads were randomly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months, following completion of data collection. SETTING: A community-based 14-hour training program provided in seven weekly 2-hour sessions. The training program curriculum was built on a stress and coping theory base. Recruitment and randomization were ongoing. Programs were begun every 2 months over a two and one half-year period for a total of 16 programs. PARTICIPANTS: Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate. MEASUREMENTS: Data reported in this paper were gathered from each participating family at entry to the study and 5 months later. Standard measures of beliefs about caregiving, burden, depression, and reaction to care receiver behavior were administered to caregivers. A standard measure of mental status was administered to the person with dementia and standardized instruments were used to gather information from caregivers concerning care receivers' behavior and abilities to perform activities of daily living (ADLs). RESULTS: Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data. Treatment and control caregivers and care receivers were similar at baseline, and care receivers in both groups declined similarly over the 5-month period. Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving (P = .044) and reaction to behavior (P = .001). When outcomes were compared, treatment group caregivers were significantly different (in the expected direction) from those in the control group on measures of the stress mediator, beliefs (P = .025), and key outcomes, response to behavior (P = .019), depression (P = .040), and burden (P = .051). There was a significant positive association between the strengthened mediator, the caregivers' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities, and the outcome, namely improvements in burden (P = .019) and depression (P = .007). CONCLUSION: A caregiver training intervention focused on the work of caregiving and targeted at knowledge, skills, and beliefs benefits caregivers in important outcome dimensions. The results suggest the benefits of providing information, linkage, and role coaching to dementia family caregivers.     

Predicting caregiver burden and depression in Alzheimer's disease

OBJECTIVES: The purpose of this study was to investigate the predictors of caregiver burden and depression, including objective stressors and mediation forces influencing caregiving outcomes. METHODS: This investigation is based on the 1994 Canadian Study of Health and Aging (CSHA) database. Participants were 613 individuals with dementia, living in either the community or an institution, and their informal caregivers. Participants for the CSHA were identified by screening a large random sample of elderly persons across Canada. Structural equation models representing four alternative pathways from caregiving stressors (e.g., functional limitations, disturbing behaviors, patient residence, assistance given to caregiver) to caregiver burden and depression were compared. RESULTS: The data provided the best fit to a model whereby the effects on the caregiver's well-being are mediated by appraisals of burden. A higher frequency of disturbing behavior, caring for a community-dwelling patient, and low informal support were related to higher burden, which in turn led to more depressive symptomatology. Caregivers of patients exhibiting more disturbing behaviors and functional limitations received less help from family and friends, whereas those whose care recipients resided in an institution received more informal support. DISCUSSION: Our findings add to the preexisting literature because we tested alternative models of caregiver burden using an unusually large sample size of participants and after overcoming methodological limitations of past research. Results highlight the importance of the effective management of disturbing behaviors, the provision of formal services for caregivers with highly impaired patients and no informal support, and the improvement of coping skills in burdened caregivers.     

心理干预对抑郁症患者康复效果的影响

目的探讨心理干预对抑郁症患者康复效果的影响。方法将60例抑郁症患者随机分为干预组和对照组,每组30例,对照组进行常规治疗与护理,干预组在此基础上进行心理干预治疗。6周后应用汉密顿抑郁量表(HAMD)及护士观察量表(NOSIE)进行评定。结果治疗6周后,干预组中社会能力、社会兴趣、个人清洁度等分值明显高于对照组(P0.05),差异有统计学意义。结论心理干预可以促进抑郁症患者的治愈及社会功能的恢复,对抑郁症患者的治愈有积极的临床意义。     

Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: results of a randomized trial

Behavioral problems are among the most challenging aspects of caring for a person with Alzheimer's disease. A sample of 406 spouses-caregivers of patients with Alzheimer's disease was randomized to an active multicomponent counseling and support intervention condition or to a usual care condition. Caregivers reported on the frequency of troublesome patient behaviors and their reactions to them at baseline and at regular follow-up interviews. Random-effects regression models over the first 4 years after randomization revealed that, although the intervention did not affect the frequency of patient behavioral problems, it did significantly reduce caregivers' reaction ratings. Because caregiver appraisals have been found to mediate the impact of caregiving stress on depression and to predict nursing home placement rates, they deserve greater attention as an important target of intervention services.     

Preliminary reliability and validity of a family caregiver conflict scale for stroke

Recovery from stroke is a challenging process for stroke survivors and their families. Assessing family conflict may be useful in guiding interventions to reduce caregiver distress. The purpose of this study was to assess preliminary reliability and validity data for a 15-item family caregiver conflict scale [FCCS] for stroke. Construct validity was assessed using subscales from the family assessment device: communication, problem solving, general family functioning, and a perceived criticism scale. Data were pooled from three studies of caregivers of stroke survivors (total N=93). Internal consistency for the FCCS was adequate (>0.70). Higher family conflict was related to more ineffective family communication, general family functioning, and higher perceived criticism (p > or =0.05). Nonspouse caregivers reported more family conflict than spouse caregivers. The FCCS appears to have adequate internal consistency and construct validity and may provide information about family conflicts around stroke recovery and direction for family-focused interventions.     

单纯抗抑郁治疗对抑郁伴轻度高血压影响的临床研究

目的探讨单纯抗抑郁治疗对合并抑郁的轻度高血压患者血压的影响。方法300例合并抑郁的轻度高血压患者被随机分为舍曲林组和氨氯地平组。舍曲林组患者单纯给予盐酸舍曲林抗抑郁治疗而不予降压治疗;氨氯地平组患者给予氨氯地平每日5mg,4周后观察患者血压变化及用药的不良反应。结果舍曲林组患者69例（46．O％）血压达标,氨氯地平组血压达标87例（58．0％）,两组间差异无统计学意义（P〉0．05）。舍曲林组有51例（34．0％）血压水平下降但未达标,28例（18．6％）血压无明显改善,而氨氯地平组患者中46例（30．7％）血压下降但未达标,17例（11．3％）血压无明显改善,两组相比差异均无统计学意义。结论对于伴有抑郁的轻度高血压患者,积极的抗抑郁治疗可以起到与氨氯地平相近的良好降压效果,且具有良好的药物安全性。