Development and psychometric testing of the European Heart Failure Self-Care behaviour scale caregiver version (EHFScB-C)

BackgroundThe European Heart Failure Self-Care Behaviour Scale (EHFScBS) is used worldwide to measure heart failure (HF) patient self-care, but a caregiver version does not exist.ObjectiveTo develop and test the European HF Self-Care Behaviour Scale for Caregivers (EHFScBS-C) in a population of informal caregivers of HF patients.MethodsThe EHFScBS-C was derived from the EHFScBS to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C was developed in English and then translated into Italian, Spanish and Dutch, after which it was back-translated. EHFScBS-C data were collected from 193 HF caregivers enrolled in Italy, Spain and the Netherlands.ResultsExploratory factor analysis revealed two factors with supportive fit indices (CFI = 0.990; RMSEA = 0.048): caregivers’ contributions to HF self-care related to medical issues, and caregivers’ contributions related to lifestyle. Internal consistency reliability was supported as well (Cronbach’s alpha 0.90 for the overall scale). Construct validity was demonstrated with significant correlations with the Caregiver Preparedness Scale.Conclusion and Practice ImplicationsThe EHFScBS-C has adequate validity and reliability for its use in clinical practice and research to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C can be used in combination with the EHFScBS to conduct dyadic studies.     

Understanding the impact of family caregiver cancer literacy on patient health outcomes

OBJECTIVE: Family caregivers play a significant role in the diagnosis, treatment, and recovery of individuals with cancer. This position paper reviews and links the research on family caregiving and health information with the importance of cancer literacy. METHOD: Review of literature obtained through searching in Academic Search Premier, EBSCO, Communication and Mass Media Complete, PsychArticles, PsycInfo, and Health Source: Nursing/Academic Edition library databases. RESULTS: Family members are important sources of health information, informal caregivers who learn and enact medical procedures, and influential aspects of patients' healthcare and treatment decision-making, but are not seriously considered by healthcare practitioners or researchers in terms of assessing and improving health literacy. Further, very few studies have directly examined or acknowledged the potential importance of family caregiver health literacy. CONCLUSION: The extent to which family caregivers can comprehend the health information they receive along with the patient is crucial for the patient to achieve the most successful health outcome. PRACTICE IMPLICATIONS: To acknowledge the impact that family caregiver health literacy could have on patient health outcomes, targeted practical recommendations for understanding family caregiver health literacy in the cancer context are proposed: (1) family member health literacy should be assessed; (2) close relational partners should be trained as peer health educators; (3) written cancer information should be provided directly to family caregivers; (4) health interactions between family caregivers and patients should be improved; (5) theoretical perspectives into the understanding of family caregiver health literacy should be integrated into practice; and (6) patient and family caregiver health literacy should be improved.     

Multivariate models of subjective caregiver burden in dementia: A systematic review

BackgroundBurden in dementia caregivers is a complex and multidimensional construct. Several models of burden and other representations of burden like depression or mental health are described in literature. To clarify the state of science, we systematically reviewed complex models that include both patient and caregiver determinants of caregiver burden.ObjectiveA review of determinant models of caregiver burden.DesignSystematic review.Data sourcesElectronic databases PubMed, PsycInfo and EMbase were searched in December 2013.Study selection and analysisResearch studies with quantitative outcome measures of caregiver burden or burden-related concepts, including both patient and caregiver functional characteristics as determinants. We categorized the determinant variables in the models and calculated the percentages of proven determinants within each category.ResultsWe found 32 studies with burden models and 24 depression and mental health models. Patient behavioral problems, caregiver coping and personality traits and competence are most consistent determinants of caregiver burden, depression and mental health. Behavioral problems are more significant than cognitive disorders or lack of self-care. Of all measured caregiver personality traits, neuroticism has the strongest impact on caregiver burden. Regarding caregiver competences, feeling competent or enjoying higher self-efficacy in general diminish caregiver burden and promote caregiver mental health.     

Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion,conflict and communication

ObjectivePreviously we identified three distinct cancer communication concordance groups among cancer patient-caregiver dyads. This secondary analysis examined patient and caregiver reports of family functioning (cohesion and conflict) as associated with cancer communication concordance and assessed each as independent predictors of perceived caregiver burden among hematological cancer caregivers.MethodsA case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Using the previously identified communication groups this analysis prospectively examines patient and caregiver perceptions of family cohesion and conflict and the association with burden over time.ResultsCaregiver burden decreased over time. Caregiver, but not patient perceptions of family cohesion decreased over time; decreased cohesion and increased conflict was associated with greater cancer communication discordance.ConclusionsThis work lends further support to the use of cancer communication congruence typologies for identifying potentially vulnerable dyads. Discordant cancer communication and declining caregiver perceptions of family cohesion may represent opportunities to intervene using family focused supportive services.Practice implicationsOnly caregiver perceptions of family functioning were associated with burden therefore identifying and supporting those caregivers with worsening communication and family function is important.     

A validation of the Croatian version of Zarit Burden Interview and clinical predictors of caregiver burden in informal caregivers of patients with dementia: a cross-sectional study

AimTo validate the Croatian version of the Zarit Burden Interview (ZBI) and to investigate the predictors of perceived burden.MethodsThis cross-sectional study involved 131 dyads of one informal caregiver family member and one patient with dementia visiting primary care practices (Health Care Center Zagreb-West; 10/2017-9/2018). Patient-related data were collected with the Mini-Mental-State-Examination, Barthel-index, and Neuropsychiatric-Inventory-Questionnaire (NPI-Q); caregiver-related data with the ZBI, and general information on caregivers and patients with a structured questionnaire. Principal-axis-factoring with varimax-rotation was used for factor analysis.ResultsThe caregivers'' mean age was 62.1 ± 13 years. They were mostly women (67.9%) and patients'' children (51.1%). Four dimensions of ZBI corresponding to personal strain, frustration, embarrassment, and guilt were assessed and explained 56% variance of burden. Internal consistency of ZBI (α = 0.87) and its dimensions (α₁ = 0.88, α₂ = 0.83, α₃ = 0.72, α₄ = 0.75) was good. Stronger cognitive and functional impairment of patients was associated only with personal strain, whereas more pronounced neuropsychiatric symptoms and the need for daily care were associated with more dimensions. Longer caregiver education suppressed embarrassment and promoted guilt. Guilt was higher in younger caregivers, caregivers of female patients, patients'' children, and non-retired caregivers. In multivariate analysis significant predictors of higher overall burden were male sex of the patient, higher NPI-Q, the need for daily-care services, shorter duration of caregiving, non-spouse relationship, higher number of hours caring per-week, and anxious-depressive symptoms in a caregiver.ConclusionThe Croatian version of ZBI is reliable and valid. Our data confirm that ZBI is a multidimensional construct. Caregivers may benefit from individually tailored interventions.

Dementia is an increasing health care problem associated with population aging (1-3). There are 8.9 million persons worldwide caring for patients with dementia older than 50 years (4). Caregiving for a family member with dementia substantially affects all aspects of informal caregivers'' lives and demands lifestyle reorganization and adaptation. Usually, one family member becomes a dominant caregiver, devoting three quarters of a day to caregiving tasks, an amount of time that increases with disease progression (5). Caregivers often neglect their own needs and health problems and become increasingly exposed to physical, emotional, financial, and other loads, all of which can be assembled under the term caregiver burden (6). Patients with dementia frequently experience neuropsychiatric symptoms, which become an increasingly difficult problem, often worse than cognitive deterioration itself (7-9). These symptoms can lead to an inability of the informal caregivers to care for patients within her or his own family and increase the perceived caregiving burden.The most commonly used tool for the assessment of caregiver burden is the Zarit Burden Interview (ZBI) (10). The original 29-item version was shortened to a 22-item version, which is currently the most widely used interview form. Several author groups showed that ZBI was a multidimensional construct, and that caregivers with the same total score might be differently affected by different aspects of burden (11-13). In addition, different burden dimensions might be differently affected by caregiver-related factors such as age, socio-economic factors, family relationship, availability of social support, etc (14-16). The most notable patient-related factors that affect caregiver burden are the presence of neuropsychiatric symptoms (especially irritability, agitation, sleep disorders, anxiousness, apathy, and delusions) and loss of cognitive function (17-20). These considerations have important implications for the planning of appropriate caregiver-oriented interventions.The number of patients with dementia in Croatia ranges from 67 000 (21) to 85 000 (22) (estimates from 2013 and 2010, respectively), approximately 15 000 out of whom reside in the wider Zagreb area. Due to population aging and migrations, these numbers are probably increasing. However, there is currently no official registry of patients with dementia or informal caregivers in Croatia that would provide a direct insight into the real magnitude of the problem. The population of informal caregivers of patients with dementia in Croatia has not been extensively studied so far. It was shown that a high proportion of caregivers suffer from anxious and depressive symptoms (23). In addition, in comparison with professionals, informal caregivers were more anxious and depressive, especially if they were of older age and lived in the same household with the patient (24). Caregiving burden was identified as a contributor to the satisfaction with social support (25).There is currently no version of ZBI questionnaire validated for the Croatian population. Thus, the aims of our study were to validate the Croatian version of the ZBI, to evaluate the validity and internal consistency of the questionnaire, and to assess the relationship of caregivers’ and patients’ characteristics with total and different aspects of caregiver burden.     

Predictors of burden and infectious illness in schizophrenia caregivers.

OBJECTIVE: The objective of the study was to test predictive models of schizophrenia caregiver burden and infectious illness episodes for caregivers who had regular contact with their mentally ill family members. METHODS: A nurse interviewer, blind to the patient's symptoms, caregiver burden, and psychosocial status, administered the Health Review to 70 caregivers. A second family interviewer, blind to caregiver health status and patient symptoms, assessed caregiver resources (eg, active coping and social support), vulnerabilities (eg, anger expression and passive coping) and burden. Concurrently, independent patient raters, blind to caregiver health and psychosocial status, assessed caregiver stressors. The Brief Psychiatric Rating Scale and the Modified Scale for the Assessment of Negative Symptoms were used to assess the severity of positive (eg, hallucinations and delusions) and negative (eg, anhedonia and asociality) symptoms, respectively. RESULTS: Predictive models, including measures of stressors, resources, and vulnerability factors for caregiver burden and for presence of infectious illness, were each highly significant, accounting for 40% and 29% of the variance, respectively. However, the specific measures that predicted burden and infectious illness differed. Greater burden was predicted by more severe patient negative symptoms (stressor), greater anger control and blame self-coping (vulnerability), and decreased tangible social support (resource). Presence of infectious illness episodes was predicted by more severe patient positive symptoms (stressor) and less satisfaction with social support while controlling for the frequency of reporting on the Health Review. When scores from the Brief Psychiatric Rating Scale (stressors) were categorized into quartiles, it was found that the frequency of infectious illness in the highest quartile was four times that in the lowest quartile. Other results indicated that even though burden was not associated with infectious illness, it was associated with "continuing health problems," perceived stress, and depression. CONCLUSIONS: These data indicate that although schizophrenia caregiver burden and infectious illness are predicted by measures of patient stressors, vulnerabilities, and resources, the specific measures predicting these outcomes differ. The results also call attention to the powerful influence of patient symptoms as a predictor of burden and the presence of infectious illness among caregivers.     

Family caregivers’ attributions about care‐recipient behaviour: Does caregiver relationship satisfaction mediate the attribution‐distress relationship?

Objectives. The relations of caregiver attributions about care‐recipient's problem behaviour to caregiving relationship satisfaction and caregiver distress were examined. Design. This is a cross sectional study. Seventy‐five family caregivers of individuals diagnosed with various disabling health conditions were recruited and interviewed. Caregiver attributions (internality, intentionality, responsibility, and controllability), caregiving relationship satisfaction, and caregiver distress variables were measured. Results. Structural equation techniques tested an a priori model of the latent constructs of caregiver attributions and caregiver relationship satisfaction to caregiver distress. Maladaptive caregiver attributions (i.e., more trait, higher intentionality, higher responsibility, and higher controllability) about care‐recipients’ problem behaviours predicted lower caregiving relationship satisfaction, which in turn was predictive of higher caregiver distress. Unexpectedly, caregiver attributions were not directly related to caregiver distress. However, attributions had an indirect effect on distress through relationship satisfaction. Younger caregivers experienced higher caregiver distress. Conclusions. Caregivers’ explanations about care‐recipient's problem behaviour are indicative of their satisfaction in the relationship with the care recipient, and poor caregiving relationship satisfaction is predictive of caregiver distress. Caregiver attributions and relationship quality may be considered in interventions with family caregivers.     

Predicting caregiver gains: A longitudinal study

Objectives. The aim of this study was to examine if changes in motivations to care, familism, illness perceptions, caregiver tasks, coping, and social support were related to caregiver reported gains (subjective feelings of satisfaction and rewards as a result of the care role). Design. A longitudinal design was employed whereby 123 caregivers completed a questionnaire at three time points: baseline, 3 months, and 9 months from baseline. Method. Independent variables were converted into residual change scores (between time 1 and time 2) and their influence on caregiver gains at time 2 and time 3 was examined. Results. Caregiver reported gains remained stable over time. Hierarchical regression analysis found that an increase in illness coherence was a strong predictor of caregiver gains at time 2, whereas predictors of time 3 gains included ethnicity, number of hours caregiving, and an increase in self‐distraction and denial as coping methods. Conclusion. The study has implications for the development of time‐specific interventions to increase caregiver gains and also for service development.     

Factors associated with caregiver burden in mental illness: a critical review of the research literature.

This article reviews caregiver burden studies that evaluated burden of care for a mentally ill relative using measurement instruments with established validity and reliability. The review identifies aspects of caregiving that are most burdensome to caregivers. It describes the nature of the relationships between variables and different dimensions of caregiver burden, and identifies mixed findings that are theoretically relevant to caregiver burden. The review discusses research findings in light of the methodological issues and research designs characterizing the literature, and briefly summarizes the effects of burden on the caregiver's life. Finally, it identifies advances made in this line of research in recent years and highlights areas that need further attention in future research work. Summary tables are included.     

Ethnic variations in the caregiver role: a qualitative study

The present study aimed to establish an in-depth qualitative analysis of the convergence and divergence of the experiences of caregivers from four ethnic groups. Eight Bangladeshi, nine Indian, four Pakistani and nine White-British caregivers participated in five focus groups. Differences and similarities between motivations for role adoption, willingness to care, experience of role, adaptation to role, coping, use of and satisfaction with support were discussed. Key differences were found in adaptation to care role and use of social support. The article highlights the need for further study of the ethnic minority caregiver experience and has implications for service development.     

Burden, reward and family functioning of caregivers for relatives with mood disorders: 1-year follow-up

BACKGROUND: Longitudinal caregiver studies of patients with mood disorders report no consistent pattern in burden over time. This naturalistic study of caregivers of patients with mood disorders assesses caregiver perceptions of burden, reward and family functioning at hospitalization and at 1 year follow-up. METHODS: Thirty-nine caregivers of patients with mood disorders were recruited during their relative's in-patient psychiatric hospitalization. Caregivers were given an assessment packet to complete at the time of enrollment and identical assessment packets were mailed to the caregivers at 1 year. RESULTS: Caregivers of bipolar disorder relatives reported less reward, more subjective burden and worse family functioning than depression caregivers, at recruitment. Bipolar caregivers showed a significant reduction in burden 1 year after their relative was discharged from the hospital, whereas depression caregivers showed no change at 1 year. At 1 year, overall family functioning was unchanged and was in the unhealthy range in all dimensions except for behavior control. Limitations of the study include the small sample size, the selective recruitment from a hospital setting where family members did not actively seek out help and the high drop-out rate. CONCLUSIONS: Caregivers of relatives with mood disorders show a different pattern of burden and reward, over time, depending on the patient diagnosis. In all cases, however, family functioning was significantly impaired. CLINICAL RELEVANCE: Short-term family interventions can be offered at the time of hospitalization to try to reduce caregiver burden and increase caregiver reward.     

Perceived social support as a moderator of the relationship between caregiver well-being indicators and psychological symptoms

The present study examined the moderating role of perceived social support in caregiver well-being indicators-psychological symptoms relationship. The data obtained from 100 caregivers of children with leukaemia revealed that the caregivers who were more able to satisfy their basic needs, and perform their daily activities, reported lower levels of psychological symptoms if they perceived higher levels of social support. However, perceived social support did not alleviate the level of psychological symptoms of the caregivers who reported lower levels of satisfaction of basic needs and performance on daily activities. The findings were discussed in the light of the literature.     

Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study

ObjectivesWe sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children.MethodsThirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified.ResultsThere was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change.ConclusionsThe study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children.Practice implicationsRemote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.     

Impact of a psychoeducational family intervention on caregivers of stabilized bipolar patients

BACKGROUND: Environmental stress has an important role in the course of bipolar disorder. Some findings have shown that family beliefs about the illness could predict family burden, and this burden could influence the outcome of bipolar disorder. To the best of our knowledge, there is scant information about the effects of family intervention on the caregiver's burden in bipolar disorder. The aim of this study was to assess the effects of psychoeducational family intervention on bipolar patients' caregivers, including the assessment of the caregiver's burden. METHODS: 45 medicated euthymic bipolar outpatients were randomized into an experimental and a control group. Relatives of patients from the experimental group received 12 psychoeducational, 90-min sessions about bipolar disorder and coping skills. The caregivers' knowledge of bipolar disorder, the relationship subscales of the Family Environment Scale, and the family burden subscales from an adapted version of the Social Behavior Assessment Schedule were assessed for both caregiver groups before and after the intervention. RESULTS: Psycho-educated caregivers significantly improved their knowledge of bipolar disorder and reduced both the subjective burden and the caregiver's belief about the link between the objective burden and the patient. No significant differences were found in the objective burden nor in the family relationship subscales. CONCLUSIONS: These preliminary results suggest that psychoeducational intervention on caregivers of bipolar patients may improve the caregiver's knowledge of the illness, reduce their distress or subjective burden and alter their beliefs about the link between the disruptions in their life and the patient's illness.     

Patient depression and caregiver attitudes: results from The AgeD in HOme Care study

BACKGROUND: The present cross-sectional study was aimed to evaluate the association between care recipient depression and caregiver attitudes. METHODS: Data were from The AgeD in HOme Care project, a study enrolling subjects aged >or=65 years receiving home care in Europe. Depression was diagnosed as a score >or=3 on the MDS Depression Rating Scale. Caregiver attitudes were assessed using two measures: 1) caregiver dissatisfaction (the caregiver was dissatisfied with the support received from family and friends); and 2) caregiver distress (the caregiver expressed feelings of distress, anger, or depression). RESULTS: Mean age of 3415 participants was 82.4 years, 2503 (73.3%) were women and 430 (12.6%) were depressed. Dissatisfaction was significantly more common among caregivers of depressed, compared with those of non depressed patients (32/430, 7.4% vs. 78/2985, 2.6%; p=<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver dissatisfaction (OR: 1.84; 95% CI: 1.12-3.03). Similarly, distress was significantly more common among caregivers of depressed patients, compared with those of non depressed patients (81/430, 18.8% vs. 175/2985, 5.9%; p<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver distress (OR: 2.41; 95% CI: 1.72-3.39). LIMITATIONS: The cross-sectional design of the study cannot provide the cause-effect relationship between depression and caregiver attitude; no data were collected on caregiver characteristics. CONCLUSIONS: Among older adults depression is associated with increased caregiver dissatisfaction and distress. Knowledge of factors influencing caregiver attitudes may be valuable to study interventions aimed to promote patient and caregiver well being.     

Perceived needs of African-American caregivers of elders with dementia

To assess the perceived needs of African-American caregivers and their expectations of the health care system, perceived level of success and satisfaction in meeting their needs, and their level of distress, we convened two focus groups at a local church in Oklahoma City, OK to discuss three questions. Responses were qualitatively analyzed for common themes. The groups comprised 13 African-American caregivers of demented elders. All participants completed a demographic form, the Zarit Burden Interview, and the Depression Scale. We found that African-American caregivers are frustrated with health care and service providers. The main differences of this group compared with other caregivers were their perceptions of racism and the absence of an available local support group. This information can serve to guide future studies in developing ways to increase caregiver satisfaction, decrease caregiver stress, and increase patient quality of life for this subgroup of caregivers.     

Academic achievement among adolescents in Cambodia: does caregiver trauma matter?

How will hostilities occurring around today's world influence future generations in affected areas? Cambodia may be one place where this question can be answered, and academic achievement is one way to measure these effects. Cambodian adolescent/caregiver dyads (n=288) were examined for links between caregiver trauma history and adolescent academic achievement, using self reports of adolescents' relationships with caregivers, caregivers' reports of trauma history and symptoms (Harvard Trauma Questionnaire), and school records of adolescents' academic achievement. Fourteen percent of caregivers met criteria for posttraumatic stress disorder (PTSD). Overall, caregiver trauma predicted caregiver education, which then predicted caregiver warmth, but not adolescents' academic achievement. Adolescents' academic achievement was predicted by caregivers' brain‐related trauma, child gender, hours taking extra classes, and father's education. Implications for community health professionals are offered. © 2009 Wiley Periodicals, Inc.     

The relationship between job strain and coronary heart disease: evidence from an english sample of the working male population

BACKGROUND: Many, but not all, studies have reported that job strain is related to cardiovascular morbidity and mortality. To date, this relationship has not been tested on an English full population sample. This study examines whether the demand-control model of job strain contributes to our understanding of the determinants of coronary heart disease. METHODS: The analysis uses data from 4350 working men aged 20-64 in the 1993 Health Survey for England. Job demand and control characteristics were determined by questionnaire. Several health outcomes were examined: self-rated health; psychiatric health; angina and possible myocardial infarction, measured by the Rose questionnaire; doctor-diagnosed heart disease; any heart disease. The relationship between job strain and the health outcomes was determined by logistic regression analyses after controlling for known confounders. RESULTS: Those in high strain jobs consistently reported poorer health on all measures than men with lower strain. Similarly, men reporting low job strain were least likely to report poor health in 5/6 health outcomes. Those with intermediate levels of strain tended to have intermediate prevalence rates for poor health. The pattern of association between job strain and the CHD was independent of coronary risk factors. CONCLUSIONS: The analyses broadly support Karasek's demand-control model of job strain. Health selection into low strain jobs may account for the lack of an association between job strain and doctor diagnosed heart disease while independent associations between job strain and all CHD measures considered together indicate that job strain may have aetiological significance for heart disease.     

What are we doing to support informal caregivers? A scoping review of caregiver education programs in cancer care

ObjectivesThe cancer system is experiencing a rise in cancer prevalence, a workforce shortage, and is resource-stretched. In this environment, informal caregivers (unpaid family caregivers of cancer patients) are required to take on expanded care roles and experience the debilitating effects of caregiver burden. Education programs are increasingly being developed to support caregivers. The aim of this review is to summarize what is known about these programs.MethodsA scoping review was conducted from May 2019 to January 2020. The literature search yielded 34,906 articles.Results119 articles were included, and ninety-two (77%) were focused on in-person psychoeducational programs.ConclusionMost caregiver programs have a unidimensional focus on psychoeducational training, demonstrating a need for more comprehensive programming to address the full spectrum of caregiver needs.Practice implicationsClinicians and educators must collaborate to create accessible, equitable education programs that comprehensibly address the needs of unpaid family caregivers beyond addressing psychological aspects of cancer care. This will ensure that a broader range of patients and caregivers are equipped with the knowledge and skills needed to cope with a cancer diagnosis, navigate the health system and to maintain their quality of life.     

Brief problem‐solving training for family caregivers of persons with recent‐onset spinal cord injuries: a randomized controlled trial

Our objective was to examine the effectiveness of a brief individualized problem‐solving intervention for family with caregivers of persons with recent‐onset spinal cord injury (SCI). Family caregivers were randomly assigned to a usual care control group (N=30) or an intervention group (N=30) in which participants were to receive three face‐to‐face problem‐solving training sessions (PST), educational materials, and telephone contacts as requested over the first year of caregiving. The participants included 60 caregivers (49 women, 11 men). The Social Problem‐Solving Inventory‐Revised, the Inventory to Diagnose Depression, and the SF‐36 were administered at baseline, 6 months and 12 months. Caregivers in the intervention group reported a significant decrease in dysfunctional problem‐solving styles scores over time; there were no observable effects for PST on caregiver depression. There was also some indication that the intervention had beneficial effects on caregiver social and physical functioning. An intervention for new caregivers featuring brief PST, education, and contact may be associated with lower dysfunctional problem‐solving styles over time and may promote certain aspects of caregiver quality of life. We also discuss limitations and implications of the present study. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–17, 2009.