Predictors of postbereavement depressive symptomatology among family caregivers of cancer patients

The present study investigated two aspects of the sequelae of recent bereavement among family caregivers following the death of their cancer patient: (1) the extent to which depressive symptomatology among family caregivers measured following the death of their patient could be predicted by their levels of depressive symptomatology in the months prior to death, their physical health, the setting in which the patient's death occurred, patient age, gender of the caregiver, consanguinity, financial stress, social support from family and friends during the terminal stage, impact of caregiving activities on caregiver's daily schedule, caregiver optimism, perceived esteem attributed to caregiving, the time between the prebereavement assessment and death, and the time between death and the postbereavement assessment; and (2) whether these same explanatory variables could successfully differentiate those bereaved caregivers whose psychological health improved during the first 3 months following bereavement from those who did not improve. A sample of 114 family caregivers of cancer patients were surveyed for approximately 3 months before and 3 months after the death of their patient. A multivariate analysis of variance using the regression approach was undertaken to determine the primary predictors of postbereavement depressive symptomatology. In addition, a logistic regression analysis was used to attempt to predict those caregivers whose depressive symptomatology would improve during the postbereavement period. Critical factors in determining levels of postbereavement depressive symptomatology were caregiver optimism, prebereavement depressive symptomatology, and levels of social support from friends. Caregiver optimism and prebereavement depressive symptomatology were important in predicting whether caregivers' depressive symptomatology would improve or not. Physicians must be aware that if the social history of a patient reveals that he/she is anticipating or has recently experienced the loss of a family member for whom they were the primary caregiver, this information may be critical in determining whether the illness behavior exhibited by the patient has medical or psychosocial origins.     

The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial

A 12-week randomized controlled trial was conducted (n = 20) investigating the effects of a multi-intervention programme of exercise and social support compared to a control group. Both groups had given birth in the past 12 months and were experiencing depressive symptomatology. Pretest data of physical fitness and structured questionnaires were compared to post-test data. The results from the study showed that mothers who were in the multi-intervention group improved their fitness levels and depressive symptomatology significantly more than the control group. However, there were no significant changes to either group's social support levels. These results are encouraging and suggest that a pram push walking intervention might be an effective treatment for mothers suffering postnatal distress.     

Effects of Chinese square dancing on older adults with mild cognitive impairment

The present study aimed to explore the effects of square dancing on global cognition, depressive symptoms, balance, and quality of life of older adults with mild cognitive impairment. We studied 66 older adults with mild cognitive impairment in a large nursing home. Participants were assigned to the intervention group (n = 33) or the control group (n = 33), according to their residential floor, which was determined by coin tossing. The intervention group underwent a 12-week Chinese square dancing routine, while the control group maintained usual lifestyle (without square dancing). Outcomes were assessed at baseline and at weeks 6 and 12. The results showed positive effects of square dancing on all outcomes assessed, especially on depressive symptoms and quality of life-related mental well-being of the participants. This study showed that square dancing is a promising strategy for older adults with mild cognitive impairment and that long-term adherence can be beneficial.     

Caregiver characteristics predict stroke survivor quality of life at 4 months and 1 year

Evaluating factors that reduce stroke survivors' (SS) health‐related quality of life (HRQOL) is important for developing interventions to improve HRQOL after stroke. The influence of baseline caregiver and family characteristics (physical health, depressive symptoms, family communication) on five domains of SS HRQOL (physical function, memory/thinking, social activities, communication, and mood) was examined. Data were collected on 132 SS‐caregiver dyads at baseline, 4 months, and 12 months. Baseline caregiver depressive symptoms predicted lower scores for SS physical function and communication at 4 months and social participation and mood at 12 months. Male caregiver gender was negatively associated with SS HRQOL (communication and mood) at 12 months. Early intervention targeting these family characteristics, especially caregiver depressive symptoms, may improve survivors' HRQOL. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:592–605, 2009     

Clinical trial of exercise for shoulder pain in chronic spinal injury

BACKGROUND AND PURPOSE: The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. SUBJECTS: Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. METHODS: The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. RESULTS: Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. DISCUSSION AND CONCLUSION: A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.     

The influence of end-of-life cancer care on caregivers

The purpose of this secondary analysis was to glean from prospective data whether those caring for elderly family members recently diagnosed with cancer who ultimately died reported different caregiver depressive symptomatology and burden than caregivers of those who survived. Findings from interviews with 618 caregivers revealed that caregiver depressive symptomatology differed based on family members' survival status, and spousal caregivers experienced greater burden when a family member was near death than did non-spousal caregivers. Family member symptoms and limitations in daily living, as well as caregiver health status, age, and employment, were associated with caregiver depressive symptomatology and burden; however, these associations had no interaction with family member survival status.     

The impact of a problem-solving intervention on increasing caregiver assistance and improving caregiver health

Purpose

There is a paucity of research evaluating the impact of symptom management interventions on increasing family caregiver involvement in symptom management and on caregivers' emotional health. In addition, most caregiver interventions are delivered by a health care professional, which can be costly to implement in clinical practice. The purpose of this study was to determine whether, in patients with solid tumors, a nurse-delivered symptom management intervention was more effective than a coach-led intervention in increasing caregiver involvement in symptom management and improving caregivers' emotional health.

Methods

Both caregivers and care recipients were recruited for the study. Inclusion criteria for patients were ≥40?years of age, English speaking, cognitively intact, and having a diagnosis of stage III or IV tumor. Dyads were randomized to a nurse-delivered symptom management intervention (N?=?88) versus the coach-led group (N?=?81). Data were collected via telephone interviews at baseline, 10, and 16?weeks.

Results

There was no significant main effect of the problem-solving intervention on symptom assistance at 10?weeks, but there were two significant interactions, between trial arm and depressive symptoms and between baseline assistance with symptoms and relationship to the patient. Caregivers with lower depressive symptoms were more likely (OR?=?1.99, 95% CI?=?1.45–2.76) to provide assistance at 10?weeks if they received the nurse-delivered intervention. Spousal (versus non-spouses) caregivers who provided assistance at baseline were less likely to provide assistance at 10?weeks (OR?=?0.58, 95% CI 0.36–0.94). No significant trial arm effects were found on caregiver emotional health, but assistance with greater number of symptoms was associated with worse caregiver depressive symptoms (p?p?Conclusions Findings suggest that a nurse-delivered problem-solving intervention increases family caregivers' level of assistance in symptom management for caregivers with lower levels of depressive symptoms. Data also suggest interventions focused solely on care recipient symptom management may not be effective in improving caregivers' emotional health.     

Caregivers of frail rural older adults. Effects of an advanced practice nursing intervention

Informal caregivers are responsible for providing the majority of post-discharge care for many frail older adults in rural settings. The purpose of this study was to investigate whether an advanced practice nurse (APN) intervention would promote more positive physical and emotional outcomes in caregivers of rural older adults who are frail and were recently discharged from urban-based hospitals. Thirty-two caregivers of frail rural elderly individuals were randomly assigned to treatment (APN intervention) and control groups (no APN intervention). Assessments of caregiver outcomes were collected via telephone interviews at 48-hour, 2-week, and 4-week intervals after hospital discharge of the frail rural older adults. Outcomes were operationalized as caregiver physical health and well being, and stress and burden. The former was measured using the Health and Daily Living form (HDL) and the latter by the Thoughts and Feeling and Time and Energy subscales of the Caregiver Burden Inventory (CBI). Additional information on caregiver problems and APN visit time was collected by the APN using the Omaha Classification System. Caregivers in the treatment group experienced significantly more positive physical and emotional health outcomes. The caregivers who received the APN intervention had higher self-rated emotional health scores, fewer emotional symptoms at Week 4, fewer depressive symptoms at Week 2 and 4, and lower Thoughts and Feelings stress scores at 48 hours than the control group. Findings support the importance of addressing the needs of caregivers post-discharge and the ability of APNs to improve post-discharge outcomes for home health care recipients and their caregivers.     

Depression among nursing home elders: Testing an intervention strategy

This study focused on the assessment of depression among nursing home elders, and on determining the efficacy of an intervention strategy for depression using a geropsychiatric nurse in conjunction with trained older adult volunteers in the role of mental health paraprofessionals. Nursing home residents (n = 139) were assessed for depression using the Geriatric Depression Scale (GDS); 94 (68%) were found to have depressive symptomatology. Among those receiving the intervention, depressive symptomatology was significantly reduced, but no significant decline was evident in the control group. The ability of the minimum data set (MDS) to detect depression as compared to the GDS was evaluated. Relationships between depression and health status, life satisfaction, and social support were also examined.     

Effect of a Psychoeducational Intervention on Depression, Anxiety, and Health Resource Use in Implantable Cardioverter Defibrillator Patients

Background: Psychological responses have been reported for some patients after the insertion of an implantable cardioverter defibrillator (ICD). This study tested the effects of a psychoeducational intervention on anxiety, depressive symptoms, functional status, and health resource use during the first year after ICD implantation.
Methods: ICD patients (n = 246) were randomized to usual care (UC), group (GRP), or telephone counseling (TC) intervention that included education, symptom management, and coping skill training. Participants were 58 ± 11 years, 73% men, and 23% minorities. Anxiety (State-Trait Anxiety Inventory [STAI]), depressive symptoms (Beck Depression Inventory II [BDI-II]), and functional status (Duke Activity Status Inventory [DASI]) were measured at baseline and after 1, 3, 6, and 12 months. Health resource use and disability days were tracked. Analyses were repeated-measures analysis of covariance to assess Group × Time effects, χ² for percentage with clinically significant anxiety and depression at each time point, and logistic regression.
Results: All groups experienced decreased anxiety and depressive symptoms over the 12 months; GRP intervention had lower STAI (P = 0.03) than UC at 3 months. Logistic regression revealed group differences for predicted probability of having depressive symptoms at 12 months (UC = 0.31, GRP = 0.17, TC = 0.13, P = 0.03). UC had greater calls to providers at 1 and 6 months (P < 0.05) and more sick/disability days at 12 months (P = 0.01) than intervention groups.
Conclusions: A psychoeducational intervention reduced anxiety and depressive symptoms early after ICD implant, lowered probability of depressive symptoms at 1 year, and decreased disability days/calls to providers. These findings support further study and clinical use of both group and telephone interventions to yield better psychological outcomes after ICD implant.     

Moderators of Treatment Outcomes After Telehealth Self-Management and Education in Adults With Multiple Sclerosis: A Secondary Analysis of a Randomized Controlled Trial

Objective

To examine moderators of treatment effects in a randomized controlled trial comparing a telehealth self-management intervention with a telehealth multiple sclerosis (MS) education intervention for fatigue, pain, and mood in adults with MS.

护理干预对妊娠剧吐患者心理和临床症状的影响

目的探讨护理干预对妊娠剧吐患者心理和临床症状的影响,寻求提高妊娠剧吐患者生活质量的方法。方法将62例妊娠剧吐患者随机分为两组,对照组（n=30）给予常规治疗护理,试验组（n=32）在常规治疗护理的基础上给予护理干预。于护理干预前和4周末采用焦虑自评量表（SAS）分析对两组患者评定,比较两组的治疗效果。结果护理干预前两组患者SAS评分差异无统计学意义（P〉0．05）;4周末试验组SAS评分（30．12±5．68）分,对照组为（35．28±6．57）分;临床症状改善情况比较,试验组有效率为96．88％,对照组有效率为80．00％;两组比较,差异均有统计学意义（P〈0．05）。结论护理干预有助于改善妊娠剧吐患者负性情绪,减轻妊娠剧吐症状,提高患者的生活质量,有临床应用价值。     

Stress management for African American women with elevated blood pressure: a pilot study

This article reports the results of a pilot study testing the effects of two stress management interventions on blood pressure (BP) and stress-related variables in employed African American women. Thirty-three women with mean age 44.8 +/- 7.6 years were randomly assigned to a cognitive mediation group (n=10), a relaxation group (n=12), or a delayed treatment control group (n=11). The participants in the two stress management groups participated in a 10-week intervention; the delayed treatment control group received BP monitoring during the 10-week period. Measures included BP, the State-Trait Anger Expression Inventory, Personal Strain, and Coping Resources. Although no significant Group x Time effects were found in BP, anger, or personal strain, several of the outcome measures appear to be sensitive and showed cell means in the hypothesized direction. Further study of the effects of stress management interventions on BP and stress, with a larger sample, is warranted.     

Exploring the Mechanism of the Clinical Encounter on Depressive Symptoms in Young Adults: A Path Analysis

Elucidating mechanisms of how high quality clinical encounters with providers may alleviate depressive symptoms in young adults are critical to reduce psychological morbidity and disability. Guided by Street's Model of Health Communication (SMHC), this study explores the predictive relationships of the clinical encounter, which includes communication functions (patient-provider communication and patient self-appraisal of communication skills with provider) and proximal outcomes (patient activation; PA) to improve health outcomes (depressive symptoms) in young adults. This study of young adults (n = 60) employed path analysis to examine the overall model fit and direct and indirect effects of each variable on depressive symptoms. The final SMHC had excellent model fit (X² = 2.26, p =.32, TLI =.99, CFI = 1.00, RMSEA =.05). Patient-provider communication and self-appraised communication skills with providers had indirect effects on depressive symptoms and a direct effect on PA; PA had a direct effect on depressive symptoms (R² =.30, p <.01). Findings elucidate potential novel targets, amenable to behavioral intervention, to improve depressive symptoms within the clinical encounter, and provide a foundation for hypothesis-driven model testing among young adults with depressive symptoms.     

Physical functioning: effect of behavioral intervention for symptoms among individuals with cancer

BACKGROUND: Individuals with cancer receiving chemotherapy suffer deterioration in physical functioning due to symptoms arising from the cancer disease process and its treatment. OBJECTIVES: To determine if age, chronic health conditions (comorbidity), stage of cancer, depressive symptomatology, symptom limitations, sex, and site of cancer moderate the effects of cognitive behavioral intervention on physical function and to determine if symptom limitations mediate the effect of the intervention on physical functioning. METHODS: Two hundred thirty-seven individuals with solid tumor cancer (118 experimental and 119 control group) participated in this 10-contact, 18-week randomized control trial. Cognitive behavioral theory guided the nurse-delivered problem-solving experimental intervention. The control group received conventional care. Interviews occurred at baseline and 10, 20, and 32 weeks. RESULTS: Women with breast cancer had significantly better physical functioning than women with lung cancer. Chronic health conditions, symptom limitation, and depressive symptomatology at baseline were found to moderate the effect of intervention on physical function. Symptom limitation, however, was not found to mediate the effect of intervention on physical functioning. DISCUSSION: The intervention was shown to affect physical function trajectories differently for individuals with different personal and health characteristics. Because poor physical functioning is strongly associated with mortality and poor quality of life, this information may be used by health professionals to target interventions to those who might be most responsive.     

食管癌放疗后局部复发再放疗的护理干预分析

目的对食管癌患者在接受放疗后其局部出现复发再放疗的患者行护理干预后的临床分析。方法对自愿参加本研究并能合作完成交谈的,在本院就诊的食管癌放疗后局部复发再放疗的患者,采用交谈法收集资料,32例为观察组,从心理护理、皮肤护理、生活护理、饮食护理以及健康指导方面进行综合性护理干预,并与同期未行护理干预的对照组32例患者进行比较。结果经过护理干预6周后,对32例患者的病历进行分析发现,进行细致周到且有针对性的护理干预使该病的治疗效果增大,出现再复发和并发症的概率大大降低。结论对食管癌放疗后局部出现复发进行再放疗的患者,采用有效的护理干预,对保证临床治疗效果有着积极意义,对降低其再复发率和并发症有促进作用,值得临床使用和推广。     

Coronary artery bypass graft surgery patients and their family member caregivers: outcomes of a family-focused staged psychoeducational intervention.

This experimental study examined the effectiveness of a psychoeducational intervention delivered over 12 weeks. The sample was comprised of 38 coronary artery bypass graft (CABG) surgery patient-family member caregiver dyads who completed all six data collection points. Experimental and control groups did not differ in emotional health, functional health status, or satisfaction. Differences in the number of self-reported complications/symptoms were not in the predicted direction. Improvement occurred in clinical, functional, and emotional outcomes; however, several symptoms, such as fatigue and pain, persisted. Family caregivers reported more depressive symptoms than patients preoperatively and at later stages of recovery. Implications include the need for instruction about the recovery trajectory and adequate preparation and support of home health nurses and family caregivers.     

Effects of a multicomponent physical exercise programme on perceived health-related quality of life and on depressive symptoms in older adults living in long-term nursing homes

ObjectivesThis study aimed to investigate the impact of a multicomponent exercise programme on perceived health-related quality of life (HRQoL) and depressive symptomatology in older people living in a long-term nursing home (LTNH).MethodsA quasi-experimental study was conducted. Forty-one older people were conveniently selected from the largest LTNH in the Basque Country. The participants were assigned to either an intervention group (n = 21) or a control group (n = 20). The intervention group participated in 50-min moderate intensity multicomponent physical exercise sessions (strength and balance, three sessions a week for 3 months). The control group participants continued their usual activities in the LTNH. Assessments were completed at baseline and reassessed after the 12-week intervention by the same nurse researchers who filled out the questionnaires: the 36-item Short Form Survey (SF-36) and the Geriatric Depression Scale (GDS).ResultsThirty-eight participants completed the study (19 participants in each group). In the SF-36 parameters, physical functioning increase in the intervention group tends with a mean increase of 11.06 units (a 17.2% increase over the pre). In the role-emotional, the increase in the intervention group is with a mean increase of 5.27 units (a 29.1% increase over the pre) (P < 0.05). In social functioning, the increase in the control group is significant with a mean increase of 13.16 units (a 15.4% increase over the pre) (P < 0.05). There are no significant changes in the rest of the parameters, there are no differences between groups in the evolutionary pattern either.ConclusionsAs for the effects of the multicomponent exercise programme on HRQoL and depressive symptomatology, no statistically significant effects were obtained in the outcome data among older adults living in LTNHs. An increase in the sample size could confirm the trends obtained. The results may help inform the design of future studies.     

Disease severity and symptoms of depression in Black Americans infected with HIV.

The purpose of this study was to examine depressive symptomatology in a sample of human immunodeficiency virus (HIV) infected Black Americans and to determine the extent to which measures of HIV disease severity were associated with depressive symptoms. Seventy-nine HIV-infected Black men and women (ages 25 to 68 years) participated. Measures included the Center for Epidemiologic Studies Depression Scale (CES-D) and multiple HIV disease severity variables including CD4+ lymphocyte count, CDC HIV stage, and HIV RNA viral load. Levels of self-reported depressive symptoms were high, with 58% (n = 48/79) of study participants exhibiting elevated depressive symptoms (CES-D score of > or =16). No relationship was found between CD4+ count, CDC HIV stage, sociodemographic variables, and depressive symptoms. Viral load, however, was positively correlated with elevated depressive symptoms. Although the level of depressive symptomatology was high, only two participants were receiving antidepressant medication. This study suggests that there is a significant unmet need for identification and treatment of depressive symptoms among Blacks receiving routine care for HIV disease.