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.     

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.     

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.     

Impact of bipolar affective disorder on family and partners

BACKGROUND: Successful management of major mental illness in the community relies significantly on an informal or non-professional network of caregivers. The needs and experiences of such caregivers have been little studied with respect to major chronic mood disorders. METHOD: A sample of caregivers (n=41) of RDC bipolar disorder was systematically interviewed to determine how this role affected them. RESULTS: Caregivers reported significant difficulties in their relationships with the patient when s/he was unwell, with considerable impact on their own employment, finances, legal matters, co-parenting and other social relationships. Violence was a particular worry for partner/parent caregivers of both male and female patients when the patient was manic. The caregiver's own mental health appeared unaffected. Despite this, the caregivers appeared emotionally committed to the patients and showed considerable tolerance of problem behaviours, which they rank-ordered for difficulty. Among nonfamily partners, knowledge of the illness before cohabitation was poor. LIMITATION: The sampling does not capture caregivers who have abandoned their role, such as spouses who have divorced the bipolar sufferer. CONCLUSIONS: Management of this illness requires a partnership between mental health professionals and the informal caregivers and the authors suggest that each group needs to understand the difficulties encountered by the other. Although erosion of relationships is a well-known complication of bipolar disorder, findings indicate that treating clinicians can rely on caregivers committed to the welfare of the patient.     

Information seeking behavior and perceived health literacy of family caregivers of persons living with a chronic condition. The case of spinal cord injury in Switzerland

ObjectiveTo examine the information seeking behavior and health literacy of caregivers of individuals living with spinal cord injury in Switzerland and their impact on the caregiving experience.MethodsNationwide survey of family caregivers of people with spinal cord injury (N = 717). Caregivers aged 18+ who assisted with activities of daily living were included. Self-reported information seeking behavior, including topics, preferred sources, and health literacy were assessed and analyzed.ResultsHealth professionals were the most trusted source of information. Among information-seekers, higher health literacy levels were shown to be associated with lower subjective caregiver burden and, in turn, with higher caregivers’ satisfaction with own health.ConclusionCaregivers use information on different topics and coming from different sources. In order for information to improve the caregiving experience, however, caregivers need health literacy skills to make sense of it.Practice implicationsBuilding health literacy is a promising approach to support caregivers in their activities, reduce their subjective burden, and even to improve their health. Interventions should consider involving health professionals, as the most trusted source of information, and address both health-related and more practical issues.     

Diabetes mellitus patients' family caregivers' subjective quality of life

OBJECTIVES: To assess the subjective quality of life (QOL) of family caregivers of Sudanese type-1 and type-2 diabetic outpatients, using the WHO 26-item QOL instrument, compared with a general population sample; and to examine the factors associated with caregiver QOL. METHOD: Responses of caregivers of 105 outpatients with type-1 diabetes and 135 with type-2 diabetes were compared with 139 general population subjects. RESULTS: Caregivers were satisfied with the content of items related to general social supports. Type-1 caregivers had significantly lower QOL scores than type-2 caregivers and the general population. Parents and siblings had lowest scores compared with other family groups. Caregivers scored higher than patients. Patients' age and duration of illness, and caregivers' education, marital status and state of health were positively associated with caregiver QOL. Caregivers' QOL was predicted by their appraisal of patients' QOL. CONCLUSIONS: Caregivers who were sick, younger, single, less educated and caring for patients with more recent illness appeared relatively vulnerable. Clinicians should be interested in the dynamics of the family caregiving situation--as it impacts QOL--and in promoting caregiver awareness of diabetes in order to enhance the caregiving role, quality of care and QOL.     

Stress among Care Givers: The Impact of Nursing a Relative with Cancer

Aims:

The aim of the present study is to assess the level and areas of stress among care givers nursing their loved ones suffering from cancer.

Setting and Design:

An assessment of care givers’ stress providing care to cancer patients at Cipla Palliative Care Center was conducted. The study involves data collection using a questionnaire and subsequent analysis.

Materials and Methods:

A close-ended questionnaire that had seven sections on different aspects of caregivers’ stress was developed and administered to 137 participants and purpose of conducting the survey was explained to their understanding. Caregivers who were willing to participate were asked to read and/or explained the questions and requested to reply as per the scales given. Data was collected in the questionnaires and was quantitatively analyzed.

Results:

The study results showed that overall stress level among caregivers is 5.18 ± 0.26 (on a scale of 0-10); of the total, nearly 62% of caregivers were ready to ask for professional help from nurses, medical social workers and counselors to cope up with their stress.

Conclusion:

Stress among caregivers ultimately affects quality of care that is being provided to the patient. This is also because they are unprepared to provide care, have inadequate knowledge about care giving along with financial burden, physical and emotional stress. Thus interventions are needed to help caregivers to strengthen their confidence in giving care and come out with better quality of care.     

Sleep in spousal caregivers of people with Alzheimer's disease

STUDY OBJECTIVE: This study examined differences in objective and subjective measures of sleep between caregivers and noncaregivers. DESIGN: Cross-sectional design. SETTING: All assessments were conducted within the home. PARTICIPANTS: Seventy-three community-dwelling spousal caregivers of patients with Alzheimer's disease and 40 noncaregiving controls. MEASUREMENTS AND RESULTS: Subjects completed a semistructured interview on sociodemographics, cognitive status of the care recipient, self-reported sleep quality, and functional outcome. A polysomnogram was conducted. Caregivers of patients with moderate to severe Alzheimer's disease reported significantly more sleep problems (P<.05) and more functional impairment as a result of sleepiness than noncaregivers (P<.01). Objectively, older caregivers of those with moderate to severe Alzheimer's disease slept less than older noncaregivers (P<.05); there were no other significant differences in objective sleep measures. There was a main effect for age, with older caregivers and older noncaregivers having lower sleep efficiency, less slow-wave sleep, and more stage 1 sleep than younger caregivers and noncaregivers (P<.05). CONCLUSIONS: This study suggests that nighttime sleep is shorter but not otherwise disrupted in caregivers of patients with moderate to severe Alzheimer's disease compared with noncaregivers, and the impact of caregiving on sleep disturbance may be most salient for older caregivers. It is possible that these older caregivers are more vulnerable to the effects of sleep disruption and thus have trouble falling back to sleep when the time is afforded them. Future work is needed to examine the differences in care practices in caregivers by age and dementia severity. Perhaps more importantly, studies examining the health consequences of shortened sleep in this group are needed.     

Subjective life satisfaction and objective functional outcome in bipolar and unipolar mood disorders: a longitudinal analysis

BACKGROUND: Quality of life (QOL) has gained increasing attention as an important yet underappreciated component of functional outcome in mood disorders. In particular, the relationship between subjective life satisfaction and objective measures of psychosocial adjustment has not been well-studied. The goal of the present study was to examine the longitudinal associations between subjective life satisfaction and objective functional outcome among individuals with bipolar and unipolar mood disorders. METHOD: One hundred fifty-seven mood disordered subjects were assessed at index hospitalization for bipolar mania (n=35), unipolar psychotic depression (n=27), or unipolar nonpsychotic depression (n=95). All were prospectively followed up three times, at approximately 2, 4.5 and 7-8 years. Global outcome, work performance, social adjustment, recurrent depressive episodes, and dimensions of life satisfaction were assessed by semi-structured interviews using standardized ratings. RESULTS: Subjective life satisfaction strongly paralleled global functioning, work performance and social adjustment at each follow-up for patients with unipolar nonpsychotic depression, but not bipolar disorder or unipolar psychotic depression. Depressive symptoms and objective functional impairment contributed to poor QOL in most domains, independent of illness chronicity, medication use, or affective disorder subtype. LIMITATIONS: Findings might have differed had a different QOL measure been used, although the present measure showed concurrent validity with a previously used instrument. Sample sizes for the bipolar and psychotic depression groups were sufficient to detect moderate, but not small, correlations between objective functioning and subjective QOL. CONCLUSIONS: Recurrent depression remains a substantial contributor to poor life satisfaction across affective disorder subtypes. Subjective QOL in bipolar and unipolar psychotic depression patients may not accurately reflect objective functional outcome status, potentially due to diminished insight, demoralization, or altered life expectations over time.     

The moderating effects of positive appraisal on the burden of family caregivers of older people

This study focused on the moderating effects of positive appraisal of family caregivers of older people on caregiving burden. In Study 1, 16 original items of the Caregiving Burden Scale and 14 original items of the Positive Appraisal Scale were administered 140 caregivers. By factor analysis, the Caregiving Burden Scale was divided into four subscales named: "Restriction of freedom (Kosoku-kan)"; "Wish to give up caregiving (Genkai-kan)"; "Family trouble (Taijin-katto)"; and "Economic restraint (Keizaiteki-futan)". The positive appraisal scale was also divided into three subscales named "Caregiving satisfaction (Manzoku-kan)", "Caregiver's self-growth (Jiko-seicho-kan)", and "Will to continue care-giving (Kaigo-keizoku-ishi)". In Study 2, 306 caregivers completed the Caregiving Burden Scale and Positive Appraisal Scale. The results indicated that; (a) positive appraisal moderated caregiver's wish to give up caregiving ("Genkai-kan"); (b) Caregiving satisfaction ("Manzoku-kan") was more effective than caregiver's self-growth ("Jiko-seicho-kan"); (c) moderating patterns varied by the combination of stressor, burden and positive appraisal.     

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.     

Caregiving burden and its determinants in Polish caregivers of stroke survivors

Introduction

Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization.

Material and methods

Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver''s sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden.

Results

Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients’ functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patient''s gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden.

Conclusions

Clinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients’ dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.     

消化道肿瘤手术患者照顾者照护知识需求调查及影响因素分析

目的 了解消化道肿瘤手术患者照顾者照护知识需求情况,分析影响照顾者照护知识需求的相关因素。方法 方便抽样选取上海市某三甲医院2018年10月1日~2019年4月30日普通外科病房收治的消化道肿瘤手术患者照顾者作为研究对象,通过自设问卷,收集患者及照顾者基本信息,使用《外科手术患者主要照顾者照护需求问卷》调查出院后照顾者的照护知识需求水平和特征。通过单因素和多因素分析影响照顾者照护知识需求水平的相关因素。结果 ①共发放问卷198份,回收有效问卷198份。②消化道肿瘤患者年龄（63.60±9.70）岁,平均住院时间（15.15±4.67）d。照顾者年龄（48.45±12.37）岁,既往有照护经历者122人（61.62%）,照顾者平均每日间接经济损失（411.66±625.87）元。③消化道肿瘤手术患者照顾者照护知识需求排名前三的条目分别为“需要了解患者可能出现的不适及应对方法”“需要了解出现异常情况的一些迹象”及“需要了解患者饮食调理的相关知识”。多因素分析显示,照顾者年龄、是否有照护经历、照顾者身体状况、患者术前是否需要长期照护、照顾者人数及住院期间是否聘请护工为照顾者照护知识需求水平的主要影响因素。结论 临床护士在工作中应重视消化道肿瘤照顾者的照护知识需求,针对不同患者和照顾者,制定更加合理的宣教方案和出院计划,落实延续护理,促进患者康复。     

Caregiver's distress is associated with delusions in Alzheimer's patients

Behavioral disturbances in Alzheimer's (AD) patients might be caused by environmental factors. The authors tested the hypothesis that delusions in AD might be a result of caregiver's distress. Participants were 22 delusional and 21 nondelusional mild AD patients and their caregivers. Those who cared for nondelusional patients, compared with the delusional patients' caregivers, reported higher levels of distress because of behavioral disturbances other than delusions. When patients were stratified into 2 groups according to median distress value, 64% of the delusional patients and 33% of the nondelusional patients showed a high level of caregiver's distress, chi2(1, N = 43) = 3.94, p = .047. Although final conclusions about the causal direction of the association cannot be drawn, these findings are consistent with the hypothesis that distressed caregivers might use inappropriate coping strategies that, in turn, might favor the development of delusions.     

Older adults with chronic illness – Caregiver burden in the Asian context: A systematic review

IntroductionUpsurge in life expectancy, filial responsibility of caring, and healthcare advances have increased the older adult population in Asia. The last decade has witnessed nuclear families' proliferation in Asia, leaving family caregivers with more accountability and responsibility. This review explores the pattern of caregiver burden among caregivers of older adults with chronic illness in Asia.MethodsPRISMA guidelines serves as the framework for this systematic review. Studies from selected databases assessed caregivers' physical state, psychological dysfunction, and or burden as an outcome measure. The Newcastle - Ottawa Quality Assessment Scale appraised the quality of the selected studies.ResultsThe review included 12 research articles. Caregivers consistently report mild to a moderate burden. Care recipient with functional dependency, comorbidities, memory, and sleep impairments, escalate caregiver burden. Caregiver variables intensifying burden were advancing age, male gender, spouse as a care recipient, longer care provision duration, and no assistance.ConclusionOptimal levels of emotional well-being, significant family/social support, and self-preparedness among caregivers are grounds for their empowerment.Practical ImplicationsA paradigm shift from 'caregiver burden' to 'caregiver resilience' is advocated. Routine screening, preventive measures (skill-building and psychosocial empowerment), and restorative services (respite care and problem-based home visiting) for caregivers are forecasted.     

Association between asthma control in children and loss of workdays by caregivers.

BACKGROUND: Although the economic burden of pediatric asthma is a significant public health issue, the loss of workdays by caregivers because of their children's asthma remains scarcely investigated. OBJECTIVES: To evaluate asthma-related loss of workdays incurred by caregivers of asthmatic children and its association with the level of asthma control. METHODS: A retrospective observational study was conducted based on a French computerized general practitioners' database and a survey questionnaire. Children aged 6 to 16 years with persistent asthma (Global Initiative for Asthma grade > or = 2) were included in the study. Level of children's asthma control was evaluated from recent asthma symptoms. Caregivers reported the number of workdays lost because of their child's asthma during the 12-month study. RESULTS: Nearly 30% of caregivers lost workdays during the study because of their children's asthma. More than 13% of caregivers lost more than 5 days. Caregiver absenteeism significantly correlated with all components of asthma control (use of relievers, nocturnal symptoms, impairment of activities, and asthma crises). A significant 8-fold risk of losing more than 5 workdays by caregivers was observed when the child's asthma was poorly controlled (odds ratio, 8.6; 95% confidence interval, 2.4-30.5); caregivers' absenteeism also increased significantly with the number of episodes of oral corticosteroid use during the study. CONCLUSIONS: Caregivers' loss of workdays owing to their children's asthma is substantial and is highly correlated with the level of asthma control. These findings highlight the necessity of educational programs for children with poor asthma control and their caregivers to prevent severe asthma attacks that lead to caregiver absenteeism.     

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms study. Participants included 640 children and their caregivers in the Longitudinal Assessment of Manic Symptoms cohort. Children had a mean age of 9.4 ± 1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5 ± 8.3 years (84% mothers). Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen’s d = .49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Although parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.     

全髋关节置换术后患者主要照顾者的负担及其影响因素

目的:调查了解全髋关节置换术(total hip replacement,THR)后患者主要照顾者的负担情况并探讨其相关影响因素.方法:采用自行设计的患者及照顾者一般情况调查表、患者自我护理评估表(ADL)、心理资本量表、社会支持评定量表(social support rating scale,SSRS)和照顾者负担问卷(caregiver burden inventory,CBI)对南方医科大学珠江医院的120名THR患者及其照顾者进行问卷调查.结果:THR患者主要照顾者的CBI得分为45.82±12.77,属于健康危险性负担;患者的CBI得分与社会支持总分及客观支持、对支持利用度的得分,以及心理资本总分及感恩奉献维度的得分呈负相关(P＜0.05);多元回归分析结果显示,患者自理能力、照顾者年龄、家庭人均月收入、照顾时间、感恩奉献、客观支持和对支持的利用度是照顾者负担的影响因素(P＜0.001),共可解释方差变异量的61.8％.结论:THR患者照顾者存在明显的照顾负担,提示临床医护人员应结合患者及其照顾者的个性特征制定有针对性的干预方案,调动社会支持力量,以减轻其照顾负担.     

长沙市唐氏综合征患者经济负担及女性照护者心理与社会歧视评估

目的:对长沙市的唐氏综合征(Down syndrome,DS)疾病负担进行估算,从女性角度对DS患者主要照护者的心理负担及受社会歧视程度进行评估。方法:2020年3月,对居住在长沙地区且志愿参与的DS患者家庭进行深度访谈及问卷调查。DS的经济负担测算包括直接成本、间接成本和福利保障性收入。使用斯坦福心理幸福感(Psyc...     

Smart Choices (Book)

Extended the study of interpersonal processes in depression to a naturally occurring relationship and situation. Sixty-one pregnant adolescents and their primary caregivers participated. As predicted, adolescent depression was significantly related to a mixed pattern of caregiver reactions. Caregivers of relatively depressed adolescents reported: (a) a pattern of affective reactions that reflected both more anger and more concern, (b) a more negative attitude about the pregnancy, and (c) a level of support equal to that reported by the caregivers of relatively nondepressed adolescents. Adolescent depression was unrelated to the degree of social support the adolescents reported receiving and the amount of support the caregivers reported providing.