Social factors and depression in carers of people with dementia

BACKGROUND: Research has highlighted the influence of psychosocial factors on the wellbeing of carers of people with dementia. This study aimed to investigate the interrelationships between life events, depression and social support in carers of people with dementia. METHOD: Participants were 72 carers of people with dementia. They were interviewed using the Bedford College Life Events and Difficulties Schedule and the Geriatric Depression Scale. RESULTS: The results showed that 31 (43%) of carers were depressed. Factors associated with depression in carers were a lack of confiding relationship, depression in the person with dementia, and living with the person with dementia. CONCLUSIONS: Carers of people with dementia appear more vulnerable to depression in the context of the caring experience rather than threatening life events.     

The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator

Objectives: The aim of this study was to explore caregiving self-efficacy as a mediator for the association between family functioning and caregiving appraisal of dementia family caregivers in Taiwan.

Method: This study adopted a cross-sectional correlational design. Purposive sampling was used to recruit 115 dyads of dementia patients and family caregivers from the outpatient neurological clinics of two hospitals in northern Taiwan. Data were gathered through interviews with a structured questionnaire, which included demographic characteristics for caregivers and patients, family functioning, caregiving self-efficacy, as well as positive and negative aspects of caregiving appraisal.

Results: Family functioning, patients' activities of daily living score, Neuropsychiatric Inventory caregiver distress, and three domains of self-efficacy were significantly associated with caregiver burden. Hierarchical multiple regression analyses indicated that self-efficacy for obtaining respite (SE-OR) significantly explained 20.5% of the variance in caregiver esteem. Caregiver perceived worsened health status, family functioning, and SE-OR significantly explained 59% of the variance in caregiver burden. The mediation test only supported the partially mediating role of SE-OR on the relationship between family functioning and caregiver burden, while the mediating effect of self-efficacy for responding to disruptive behaviours and controlling upsetting thoughts were insignificant.

Conclusion: Our findings provided preliminary evidence for health professionals recommending that future studies should assess the family dynamic and health problems of caregivers, and develop appropriate family-centred interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden.     

Meditation-based interventions for family caregivers of people with dementia: a review of the empirical literature

Objectives: Providing care for a family member with dementia is associated with increased risk of adverse mental health sequelae. Recently, interventions utilising meditation-based techniques have been developed with the aim of reducing psychological distress among dementia caregivers. The present review aimed to critically evaluate the extant empirical literature in order to determine: (1) whether meditation-based interventions can reduce depression among dementia caregivers and (2) whether meditation-based interventions can reduce subjective burden among dementia caregivers.

Method: After adhering to inclusion and exclusion criteria, a total of eight studies were included in the present review. Methodological quality was assessed using one of two scales dependent on study design.

Results: The results provide tentative evidence that meditation-based interventions do indeed improve levels of depression and burden in family dementia caregivers.

Conclusions: The review highlighted the strengths and weakness of the studies’ methodological designs. Whilst this novel review offers evidence in support of meditation-based interventions to improve the psychological distress of family dementia caregivers, future research should direct efforts to conduct larger scale, more rigorous studies. Clinical implications of the findings are also discussed.     

The Circle Model—support for relatives of people with dementia

Home care for cognitively impaired elderly puts tremendous stress and burden on their families. Therefore it is important to search for effective care models in order to provide support for this group. In this study, an intervention model—the Circle Model—was developed, tested and evaluated in six places in Sweden. The model is unique in that family caregivers and volunteers were trained together in study circles. After their training, the volunteers replaced the caregivers in the homes on a regular basis, which permitted the caregivers some relief from the demands of caregiving. Interviews were conducted with the participants to gather information about their training and relief care experiences. The caregivers reported that the study circle provided opportunity to exchange experiences with other people in similar situations. They felt a spirit of community with other relatives, and were able to increase their knowledge in care providing and coping strategies. The emphasis in temporary relief care by the volunteers was placed on providing the relatives with feelings of security and relaxation. The satisfaction among the Circle Model participants was reciprocal. The volunteers also reported high satisfaction and appreciation of the knowledge which they acquired from the caregivers. The Circle Model brings new dimensions to the home care situation and should be seen as a complement to social services support.Copyright © 1998 John Wiley & Sons, Ltd.     

The psychological well-being and associated factors of caregivers of outpatients with schizophrenia in Taiwan

The purpose of this study attempted to understand the psychological well-being of caregivers of individuals with schizophrenia and factors affecting the caregivers' psychological well-being. More specifically, quality of life and psychiatric morbidity were used to represent the psychological well-being. Personal interviews using questionnaires were administrated to 57 caregivers. Data regarding knowledge of schizophrenia, perceived causes of schizophrenia, quality of life and psychiatric morbidity was collected. Psychiatrists assessed the symptoms severity of the schizophrenic patients. Compared with the controls, the psychological well-being of caregivers of patients with schizophrenia was poorer. There was a significant association between the positive symptoms score and the psychological well-being of caregivers. Life quality and psychiatric morbidity were affected by caregivers' knowledge of schizophrenia and beliefs about the cause of schizophrenia. Health care providers should consider the patients and their caregivers as a whole and provide psychoeducaiton to reduce the negative psychological impact of caregivers.     

Social support networks and formal support as factors influencing the psychological adjustment of spouse caregivers of dementia sufferers

The study investigated the relationship between social and formal support in promoting the psychological adjustment of spouse caregivers of dementia sufferers. It was found that the quality of social support was negatively correlated with the degree of perceived strain and the level of depression. This result suggests that social support reduces the caregiver's strain or depression. In contrast, formal support was positively correlated with strain, but not with depression, indicating that in the present sample, increased formal support may be reactive to strain in the caregiver. The implications of the findings for the community care of dementia sufferers are discussed.     

School-related social support and subjective well-being in school among adolescents: The role of self-system factors

This 6-week longitudinal study aimed to examine a moderated mediation model that may explain the link between school-related social support (i.e., teacher support and classmate support) and optimal subjective well-being in school among adolescents (n = 1316). Analyses confirmed the hypothesized model that scholastic competence partially mediated the relations between school-related social support and subjective well-being in school, and social acceptance moderated the mediation process in the school-related social support--> subjective well-being in school path and in the scholastic competence--> subjective well-being in school path. The findings suggested that both social contextual factors (e.g., school-related social support) and self-system factors (e.g., scholastic competence and social acceptance) are crucial for adolescents' optimal subjective well-being in school. Limitations and practical applications of the study were discussed.     

The relationship between self-efficacy and positive aspects of caregiving in Alzheimer's disease caregivers

Objectives: Positive aspects of the caregiving experience may buffer caregivers from the many negative psychological and physical consequences of caregiving. Understanding what factors relate to the recognition of positive aspects of caregiving is important for the enhancement of caregiver well-being. Self-efficacy is a potentially modifiable psychological construct that has been associated with positive thinking, improved control of negative affect, and enhanced motivation.

Methods: This study examined the relationship between positive aspects of caregiving and self-efficacy among 57 family members caring for a loved one with Alzheimer's disease. Participant data was gathered through individual interviews conducted as a part of a larger randomized controlled trial of a caregiver intervention.

Results: We found that self-efficacy accounted for a significant percentage of the variance in positive aspects of caregiving after controlling for other factors commonly associated with positive aspects of caregiving including caregiver demographics, care recipient neuropsychiatric symptoms, and caregiver depression.

Conclusions: Our results suggest that high self-efficacy relates to caregivers’ perception of positive aspects of the caregiving experience.     

Quasi-experimental evaluation of an educational model for dementia caregivers

Dementia caregivers are known to be distressed and may be helped by psychoeducational interventions. We investigated the effectiveness of one model of intervention comprising a structured package of six sessions of training, focusing on education, stress management and problem behaviour management in a group setting. Three groups of caregivers were compared-those who had completed (N= 33) or partially completed (N= 22) training and a control group (N= 26)-on measures of psychological stress, burden, satisfaction with life, well-being and knowledge. There were no significant differences in outcome between the three groups. We conclude that, with methodological qualifications, this quasi-experimental study of one model of training was not empirically effective. Interventions for caregivers should be tailored to individual needs from a range of techniques encompassing psychological and practical strategies.     

Changes in social support and their impact on psychosocial outcome over a 5-year period for African American and White dementia caregivers

BACKGROUND: African Americans have been found to be more resilient to the caregiving role than Whites. Amount of social support and satisfaction with social support were studied as possible explanations for these racial differences. METHODS: Family caregivers of patients diagnosed as having dementia participated in a longitudinal study. There were 166 caregiver-patient dyads enrolled and annual follow-up assessments were completed. Linear random effects regression models examined the longitudinal trajectories of social support, depressive symptoms, and life satisfaction over 5 years of community follow-up. Social support was also included as a time-dependent predictor of depressive symptoms and life satisfaction. RESULTS: The number of helpful support persons available decreased significantly for both racial groups. African American caregivers reported more satisfaction with their social support networks than Whites. They also reported fewer depressive symptoms and higher levels of life satisfaction when compared to their White counterparts. Higher levels of satisfaction with social support were associated with fewer depressive symptoms and increased levels of life satisfaction and explained a portion of the racial differences on these measures of psychosocial outcome. CONCLUSIONS: The resilience of African American caregivers, as displayed by their fewer depressive symptoms and higher levels of life satisfaction, was partially explained by their higher levels of satisfaction with social support. Results suggest that health care providers should view low levels of social support as a possible precursor to poor psychological outcomes in caregivers. Future research should focus on social support and cultural variables that might explain racial differences in caregiver outcomes.     

Subjective experiences of family caregivers of patients with dementia as predictive factors of quality of life

Background: The aim of the present study was to investigate predictive factors of quality of life (QOL) in home caregivers of patients with dementia. Methods: A total of 118 home caregivers (48 male, 70 female) were asked to complete the World Health Organization (WHO) Quality of Life 26 (WHO/QOL‐26) questionnaire, the Pines Burnout Measure (BM), and the Beck Depression Inventory, second edition (BDI‐II). Patient demographics and clinical data regarding cognitive impairment, neuropsychiatric symptoms, and dementia severity were obtained from medical records. Results: Spearman rank correlation coefficients revealed that caregiver QOL was significantly correlated with patients' neuropsychiatric symptoms (r=−0.19; P < 0.05), as well as depressive symptoms (r=−0.59, P < 0.01) and burnout (r=−0.59, P < 0.01) in caregivers. Stepwise multiple regression analysis revealed that depressive symptoms in caregivers was the strongest predictor for caregiver QOL (R²= 0.37, P < 0.001) and that caregiver QOL was best predicted by the combination of depressive symptoms, burnout, and the cognitive impairment of patients (R²= 0.46, P < 0.05). Conclusion: The results of the present study demonstrate that subjective experiences of caregivers are more strongly correlated with caregiver QOL than patient‐related variables and are thus powerful determinants of caregiver QOL. These findings suggest that caregiver intervention, which aims to increase QOL, may benefit from the incorporation of strategies to reduce depressive symptoms and burnout.