The stroke caregiving trajectory in relation to caregiver depressive symptoms,burden, and intervention outcomes

Background: Caregiver depression and burden have a detrimental effect on stroke survivors’ rehabilitation and are contributors to stroke survivors’ hospital readmission and institutionalization. The stroke caregiving trajectory is unique compared to other illnesses, and the effect of length of caregiving on stroke caregiver outcomes is poorly understood. Interventions can improve caregiver outcomes, but the optimal timing of these interventions is unclear.

Objectives: We sought to determine the relationship between: (1) length of caregiving and stroke caregiver depressive symptoms and burden, and (2) length of caregiving and amount of change in depressive symptoms and burden following the Resources and Education for Stroke Caregivers’ Understanding and Empowerment (RESCUE) intervention – an online and telephone problem-solving, education, and support intervention.

Methods: We analyzed retrospective data collected from 72 stroke caregivers who participated in the RESCUE intervention. Outcomes were caregiver depressive symptoms and burden. Data were analyzed using mixed-effects regression analysis.

Results: Baseline depressive symptoms and burden were both negatively related to length of caregiving (p < 0.05). We found significant improvement in caregiver depressive symptoms and burden following an intervention. The interaction between changes in outcomes and length of caregiving was not significant for either depressive symptoms (p = 0.26) or burden (p = 0.10).

Conclusions: This study contributes to the understanding of the relationship between length of caregiving and depression, burden, and intervention outcomes. Clinicians should recognize that the stroke caregiving trajectory can be nonlinear. Routine and repeated clinical assessment of caregiver well-being is needed, along with implementation of interventions when necessary, regardless of how much time has passed since the stroke.     

Portuguese version of the Geriatric Anxiety Inventory: transcultural adaptation and psychometric validation

Objectives: The Geriatric Anxiety Inventory (GAI) is a recently developed anxiety instrument designed to assess the severity of anxiety symptoms across a range of presentations in older adults. In this study, the authors examined the validity of the Portuguese version of the GAI and assessed its psychometric properties.

Method: A cross-sectional study was designed using a sample of 152 community-dwelling older adults, and a geriatric psychiatric sample of outpatients with clinical diagnoses of depression (n?=?32), anxiety disorders (n?=?23), and early Alzheimer's disease (n?=?10).

Results: The Portuguese version of the GAI required linguistic and transcultural adaptations, particularly on the somatic expressions of anxiety. It exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberg State-Trait Anxiety Inventory, the Geriatric Depression Scale (GDS-30), and the General Health Questionnaire (GHQ-12). The optimal cut-off point to detect severe anxiety symptoms was 8/9, but no optimal cut-off point for Generalized Anxiety Disorder could be estimated.

Conclusion: These findings provide initial evidence that the Portuguese version of the GAI is a valid and reliable measure for assessing late-life anxiety and highlights the need for possible modifications of the instrument before being used in other languages and cultural groups.     

Reminiscence and adaptation to critical life events in older adults with mild to moderate depressive symptoms

Objectives: The role of reminiscence as a way of adapting to critical life events and chronic medical conditions was investigated in older adults with mild to moderate depressive symptoms. Reminiscence is the (non)volitional act or process of recollecting memories of one's self in the past.

Method: 171 Dutch older adults with a mean age of 64 years (SD?=?7.4) participated in this study. All of them had mild to moderate depressive symptoms. Participants completed measures on critical life events, chronic medical conditions, depressive symptoms, symptoms of anxiety and satisfaction with life. The reminiscence functions included were: identity, problem solving, bitterness revival and boredom reduction.

Results: Critical life events were positively correlated with identity and problem solving. Bitterness revival and boredom reduction were both positively correlated with depressive and anxiety symptoms, and negatively to satisfaction with life. Problem solving had a negative relation with anxiety symptoms. When all the reminiscence functions were included, problem solving was uniquely associated with symptoms of anxiety, and bitterness revival was uniquely associated with depressive symptoms and satisfaction with life. Interestingly, problem solving mediated the relation of critical life events with anxiety.

Discussion: This study corroborates the theory that reminiscence plays a role in coping with critical life events, and thereby maintaining mental health. Furthermore, it is recommended that therapists focus on techniques which reduce bitterness revival in people with depressive symptoms, and focus on problem-solving reminiscences among people with anxiety symptoms.     

Medical conditions and depressive,anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder

Objective: The objective of this study was to examine medical illness and anxiety, depressive, and somatic symptoms in older medical patients with generalized anxiety disorder (GAD).

Method: A case-control study was designed and conducted in the University of California, San Diego (UCSD) Geriatrics Clinics. A total of fifty-four older medical patients with GAD and 54 matched controls participated.

Measurements: The measurements used for this study include: Brief Symptom Inventory–18, Mini International Neuropsychiatric Interview, and the Anxiety Disorders Interview Schedule.

Results: Older medical patients with GAD reported higher levels of somatic symptoms, anxiety, and depression than other older adults, as well as higher rates of diabetes and gastrointestinal conditions. In a multivariate model that included somatic symptoms, medical conditions, and depressive and anxiety symptoms, anxiety symptoms were the only significant predictors of GAD.

Conclusion: These results suggest first, that older medical patients with GAD do not primarily express distress as somatic symptoms; second, that anxiety symptoms in geriatric patients should not be discounted as a byproduct of medical illness or depression; and third, that older adults with diabetes and gastrointestinal conditions may benefit from screening for anxiety.     

Test anxiety and self-esteem in senior high school students: a cross-sectional study

Purpose: In this study, it is aimed to determine the level of test anxiety and self-esteem in the high school students preparing for the university exam in Bitlis, Turkey, and to investigate the effect of test anxiety on self-esteem.

Material and methods: Seven-hundred and twenty-four high school students who were preparing for the university entrance examination in Bitlis participated in the study. A questionnaire which includes socio-demographic data form, Rosenberg Self-Esteem Scale and Revised Test Anxiety Scale was prepared as an e-questionnaire for the students to fill easily and uploaded to the Bitlis State Hospital's website. Schools were called and informed for the students to fill out the e-questionnaire on the Internet.

Results: The most important findings from our study are that gender is influential on test anxiety and self-esteem score and test anxiety level are negatively correlated. It was observed that female students had more test anxiety than male students and those who had higher self-esteem had less test anxiety.

Conclusion: Consequently, our study shows that university entrance examination creates anxiety on students and reduces self-esteem, especially in female students.     

Does filial piety decrease depression among family caregivers?

Objectives: To examine the effects of filial piety – the practice of filial respect of and care for parents – on depressive symptoms among adult children caregivers of elderly Arab parents in Israel, and to identify factors that may mediate the association.

Method: Cross-sectional data were collected in 2006–2007 by a structured interview from 250 randomly sampled Arab–Israeli adult children caregivers (response rate, 94%). Path analysis was used to examine the study objectives.

Results: Filial piety was not directly related to depression, but rather worked indirectly through caregiving burden. Caregiver depression was predicted positively by caregiving burden, while burden was predicted negatively by filial piety. Sense of mastery emerged as a major (negative) predictor and as a mediator between caregiving burden and depressive symptoms.

Conclusion: The analysis showed that caregiving burden in this population of traditional caregivers was associated with depressive symptoms, while most other variables were mediated through caregiving burden, sense of mastery, or filial piety. Researchers and practitioners should be sensitive to issues of family care among such traditional populations in transition.     

Social support and well-being in dementia family caregivers: The mediating role of self-efficacy

Objectives: The study investigated self-efficacy as a possible mediator of the relationship between the social support and depressive symptoms of primarily informal caregivers, mainly family members, of patients with dementia in Hong Kong.

Method: One hundred and thirty-four caregivers were interviewed. Path analyses were conducted using a self-efficacy scale that consists of three subscales assessing three domains of caregiving self-efficacy. Self-efficacy for obtaining respite, responding to disruptive patient behaviours, and controlling upsetting thoughts about caregiving were measured.

Results: Results showed that self-efficacy acted as a partial mediator between social support and depressive symptoms of these caregivers.

Conclusion: Findings suggest that self-efficacy may function as a mechanism through which social support influences depressive symptoms, and the importance of this self-efficacy mechanism can be domain-specific.     

Patient and proxy measurement of quality of life among general hospital in-patients with dementia

Background: We aimed to investigate quality of life ratings among people with varying severity of dementia and their carers, recruited in general hospital.

Method: We recruited 109 people with dementia, and their proxies (carers), from psychiatric referrals of inpatients in two general hospitals in England. From patients, we gathered data on quality of life (QoL-AD and EQ5-D) and depressive symptoms, and from proxies we gathered data on patient quality of life (Proxy QoL-AD and EQ5-D), severity of dementia, activities of daily living, physical illness and depressive symptoms, and on carer stress.

Results: Completion rates for both measures were progressively lower with increasing dementia severity. Patients rated their quality of life more highly than proxies on Qol-AD (patients?=?32.2, CI?=?30.7–33.7, proxies?=?24.7, CI?=?23.8–26.0, p?p?p?=?0.003) and more severe dementia (p?=?0.019) were associated with ratings, while for proxy QoL-AD, only more severe dementia (p?=?0.039) was associated with ratings. Lower patient EQ-5D scores were independently associated only with carer stress (p?=?0.01). Lower patient QoL-AD scores were associated with patient depression (p?=?0.001), impaired activities of daily living (p?=?0.02) and proxy psychiatric symptoms (p?=?0.002).

Conclusions: Among patients with moderate to severe dementia in general hospital, proxy measures of quality of life are the only practical option. Patients and proxies appear to have very different concepts of quality of life in dementia.     

Self-rated health as a moderator of the relation between functional impairment and depressive symptoms in older adults

Objectives: The purpose of this study was to examine the relation between functional impairment, self-rated health, and depressive symptoms. Independently, self-rated health and functional impairment each contribute to depressive symptoms; however, it remains unknown how these variables are related to depression in combination. It was hypothesized that self-rated health would moderate the relation between functional impairment and depressive symptoms in a sample of older adults.

Method: A community sample of adults aged 60 and above was recruited from primary care clinics (n?=?106); 98 of these participants had usable data. Participants completed self-report questionnaires that assessed depressive symptoms, functional impairment, and self-rated physical health.

Results: Self-rated health moderated the relation between functional impairment and depressive symptoms. For participants with poor self-rated health, greater functional impairment was associated with greater depressive symptoms.

Conclusion: It appears that patient perceptions of health may be protective against depressive symptoms for those with functional impairment.     

The interactive role of chronic medical conditions and sleep disturbance in predicting depressive symptoms among Korean American older adults

Objectives: This study examined the independent and interactive effects of chronic medical conditions and sleep disturbance on depressive symptomatology. The sample (N?=?675) consisted of community-dwelling Korean American older adults, a group that has been found to be particularly high in depressive symptomatology.

Methods: A hierarchical regression model of depressive symptoms was estimated with an array of predictors: (a) demographic variables, including immigration history, (b) chronic medical conditions, (c) sleep disturbance, and (d) an interaction between chronic medical conditions and sleep disturbance.

Results: After controlling for the effects of demographic variables, both chronic medical conditions and sleep disturbance were identified as independent risk factors for depressive symptoms. Moreover, their interaction was significant, indicating that the coexistence of chronic medical conditions and sleep disturbance was significantly associated with higher levels of depressive symptoms (β?=?0.15, p?

Conclusion: Our findings call attention to sleep hygiene among older individuals with chronic medical conditions and recommend that sleep quality should be closely monitored and assessed by healthcare professionals.     

Global and caregiving mastery as moderators in the caregiving stress process

Objectives: The study tests the circumstances under which global mastery and caregiving mastery moderate the impact of objective and subjective stressors on depressive and anxious symptoms among Alzheimer's caregivers.

Methods: Data from a sample of 200 spousal caregivers to people with Alzheimer's disease were examined. Sixteen separate models were tested with depression and anxiety regressed on two measures of objective demand (activities of daily living and problem behaviors) and two measures of subjective demand (role overload and role captivity) matched with each of the two mastery measures and their relevant interaction terms.

Results: Caregiving mastery functions as a moderator in the relationship between subjective demands and depression and anxiety, that is, at higher levels of caregiving mastery, the positive association between role overload and role captivity on depression and anxiety was weaker. Although there is a strong main effect of global mastery on mental health, it was not found to act as a moderator in this study.

Conclusion: The findings demonstrate the importance of evaluating role-specific measures, such as caregiving mastery, as well as assessing a variety of stressful demands, in order to explicate the pathways through which psychosocial resources exert their protective effects.     

The effects of caregiver emotional stress on the depressive symptomatology of the care recipient

Objectives: Depression is a leading mental health issue affecting elderly individuals worldwide. Previous research widely neglects caregiver emotional stress as a probable contributing factor of depression in the elderly. This study investigated caregiver emotional stress as a chronic life stressor of an elderly care recipient using the life stress paradigm as the theoretical foundation.

Methods: The relationships between caregiver emotional stress and care receiver depressive symptoms, as well as other social and psychological mediation factors, were investigated using the 2004 wave of the National Long-Term Care Study (NLTCS). The NLTCS is a nationally representative longitudinal study used to identify frail and disabled elderly Medicare recipients living in the United States. The analytic sample of this study included 1340 caregiver–care receiver dyads who were asked a series of questions concerning their mental health (i.e. emotional stress and depressive symptoms), as well as the availability of social and psychological resources.

Results: Overall, the results showed that high levels of emotional stress reported by the caregiver were associated with a higher likelihood of the disabled care receiver reporting depressive symptoms.

Conclusion: The findings of this investigation point to the importance of studying caregivers and care receivers as dyads as the stress associated with the caregiving role affects each member.     

Components of the difficulties,satisfactions and management strategies of carers of older people: A principal component analysis of CADI-CASI-CAMI

Objectives: To perform a psychometric evaluation of the Carers Assessment of Difficulties Index, Carers Assessment of Satisfactions Index and the Carers Assessment of Managing Index (CADI-CASI-CAMI).

Method: Data was collected in three European countries from informal carers of older people (n = 295) via a common protocol. Carers completed: (a) a questionnaire containing items on demographics and caregiving characteristics and (b) the CADI-CASI-CAMI indices. Principal component analysis of the CADI-CASI-CAMI indices was followed by internal consistency analysis of emergent components. Scales derived by summing items loading on the components were analysed for their association with the demographic and caregiving characteristic variables.

Results: CADI produced six internally consistent and interpretable components, CASI five and CAMI seven. Subscales derived from the components were significantly associated with the demographic and caregiving characteristic variables, providing initial support for construct validity.

Conclusion: The CADI-CASI-CAMI indices are recommended as an assessment tool for in-depth work with family carers of older people and as a research tool for large-scale studies of family care.     

Quality of life and depression in carers of patients with early onset dementia

Objective: To investigate the quality of life (QoL) and depression and its correlates in carers living with early onset dementia (EOD) patients.

Method: The subjects were 49 carers, either married to or cohabiting with EOD patients, 38 with Alzheimer's disease and 11 with other types of dementia. The Quality of Life – Alzheimer Disease scale (QoL-AD) and Geriatric Depression Scale – 15 items (GDS-15) were used.

Results: The mean QoL score for the carers was 37.9 (SD 5.5) and the mean GDS-15 score 5.1 (SD 2.9). Linear regression analyses with QoL and GDS-15 score as dependent variables were performed. Increased age of the carer (B?=?0.32) and greater insight of the patients (B?=??0.186) were significantly associated with a better QoL for the carer. Being married (B?=?2.10), having children together with the patient (B?=?1.61) and being the carer of a patient with cardiovascular disease (B?=?2.28) were associated significantly with a higher GDS-15 score, whereas being the carer of a patient who received domiciliary nursing care (B?=??2.29) was significantly associated with a lower GDS-15 score.

Conclusion: The QoL for carers of EOD patients corresponds positively with the increased age of carers and with patients’ insight into their condition. Increased depressive symptomatology in carers was associated with being married, having offspring and caring for a patient with dementia and a co-morbid cardiovascular disease. A reduction in depression was seen in carers when the patients received domiciliary nursing care.     

Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam

Objectives: This study investigates whether, and if so how, anxiety symptoms are related to cognitive decline in elderly persons and whether anxiety symptoms precede cognitive decline.

Method: Data were obtained from the Longitudinal Aging Study Amsterdam. Anxiety symptoms were measured with the Hospital Anxiety and Depression Scale. General cognitive functioning was measured with the Mini-Mental State Examination, episodic memory with the Auditory Verbal Learning Test, fluid intelligence with the Raven's Coloured Progressive Matrices and information processing speed with the coding task. Multilevel analyses were performed to investigate the relationship between anxiety symptoms and cognitive decline over 9 years, taking into account confounding variables.

Results: Although not consistent across all dimensions of cognitive functioning, a curvilinear effect of anxiety on cognitive performance was found. Furthermore, we found that previous measurement of anxiety symptoms were not predictive of cognitive decline at a later time-point.

Conclusion: This study suggests that the effect of anxiety on cognition depends on the severity of the present anxiety symptoms with mild anxiety associated with better cognition, whereas more severe anxiety is associated with worse cognition. The effect of anxiety symptoms on cognitive functioning seems to be a temporary effect, anxiety is not predictive of cognitive decline.     

Caregiving burden and psychological distress in Chinese spousal caregivers: gender difference in the moderating role of positive aspects of caregiving

Objectives: This study endeavors to advance the current literature by examining the gender differences in the caregiving experiences and the stress-buffering role of positive aspects of caregiving (PAC) among Chinese spousal caregivers of frail elders in Hong Kong.

Method: Forty-nine husband caregivers and 121 wife caregivers of frail elders in Hong Kong (N = 170) responded to the Positive Aspects of Caregiving (PAC) scale, the Zarit Burden Interview (ZBI), the 21-item Depression, Anxiety, and Stress Scales (DASS-21), and demographic questions. These spousal caregivers were diverse in age, and their care receivers were diverse in terms of age and health condition.

Results: As predicted, there were significant gender differences in the moderating effects of PAC on the relationships of caregiving burden to depression, anxiety, and overall psychological distress. While PAC significantly buffered the effects of caregiving burden on depression, anxiety, and overall psychological distress for wife caregivers, the moderating effects of PAC were not significant for husband caregivers. Unexpectedly, wife caregivers reported lower PAC, higher caregiving burden, and higher psychological distress.

Conclusion: As these findings suggest that PAC is lower but more beneficial for Chinese wife caregivers than Chinese husband caregivers, helping professionals are recommended to use strengths-based interventions that target PAC when working with Chinese wife caregivers.     

Body dysmorphic disorder and its associated psychological and psychopathological features in an Italian community sample

Objective: Body Dysmorphic Disorder (BDD) is a psychiatric condition characterized by preoccupation with perceived defects in physical appearance that are not observable or appear slight to others, along with low self-esteem, high perfectionism, and high comorbidity. Little is known about BDD prevalence and phenomenology in the Italian context, and no data are currently available on BDD prevalence using DSM-5 criteria in the Italian context. The aims of the current study were to explore the prevalence and the phenomenology of BDD and its associated psychological and psychopathological features such as self-esteem, perfectionistic traits, social anxiety, depressive, and obsessive–compulsive symptoms in a community sample.

Methods: Six hundred and fifteen community individuals completed a battery of self-report questionnaires.

Results: 10 (1.63%) individuals met DSM-5 diagnostic criteria for BDD; hair, nose and teeth were the most common areas of concern. Individuals with BDD reported also lower levels of self-esteem, more severe social anxiety symptomatology, general distress, depression and obsessive–compulsive features than people without BDD.

Conclusions: BDD is not a rare condition in the Italian context and it emerged to be associated with significant morbidity.     

Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean Blacks

Objective: The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks.

Method: This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis.

Results: Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms.

Conclusion: This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.