Relationship quality and potentially harmful behaviors by spousal caregivers: How we were then, how we are now.

Structured interview data from 142 caregivers (98 wives, 44 husbands) indicate that more depressed caregivers are more likely to treat their spouses in potentially harmful ways. However, consistent with hypotheses derived from communal relationships theory, when the preillness relationship between caregiver and care recipient was characterized by mutual responsiveness to each other's needs (i.e., was more communal), caregivers were less depressed and less frequently engaged in potentially harmful behaviors. These effects were not attributable to demographic factors, amount of care provided, care recipient dementia status, or length of time in the caregiving role. Rather, multivariate analyses suggest that the extent to which premorbid relationships were communal in nature determines whether caregivers perceive their current relationships as rewarding, which, in turn, predicts caregiver depression and potentially harmful behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family burden following traumatic brain injury.

Investigated burden experienced by 60 spouses and 71 parents who served as primary caregivers to individuals with traumatic brain injury (BI). Burden levels, as assessed by the Questionnaire on Resources and Stress (QRS-SF), were compared for spouses and parents. Both parents and spouses exhibited high levels of burden. Relative to spouses, parents reported significantly greater burden related to lifespan care. Spouses reported significantly less personal reward than did parents. The presence of social aggression and cognitive disability in the individual with BI was found to have a greater association with subjective burden of caregivers than was the presence of physical disability or injury severity. Results of previous studies with QRS-SF scores show that the responsibility assumed by spouses and parents of persons with BI was as great as that experienced by families of people with severe chronic physical disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alzheimer's disease afflicted spouses who remain at home: can human dialectics explain the findings?

When one spouse has Alzheimer's disease (AD), marital interactions tend to decline. Findings from this study suggest that level of spousal interactions influence longitudinal outcomes for afflicted spouses. Thirty AD spouses and their spouse caregivers were assessed at baseline (time 1) and two years later (time 2). Continued in-home care at time 2 is predicted by high levels of positive spousal interactions, high caregiver commitment, good caregiver health, and shorter time as caregiver (all assessed at time 1). The same variables but in an inverse relationship predict which AD spouses are deceased at time 2. Nursing home placement is predicted by AD spouses' higher educational level, unhappy marital relationships, and low caregiver commitment. Afflicted spouses' cognitive and functional impairment levels, their physical health and depression do not predict outcomes. A theoretical explanation is developed drawing on Riegel's dialectical theory of human development and Bowlby's attachment theory. It is suggested that interactions between spouses are crucial for afflicted spouses' survival.     

Effects of a videotape information intervention for spouses on spouse distress and patient recovery from surgery.

Shortly before hospital release, the spouses of 226 male and 70 female coronary artery bypass graft patients were randomly assigned to view an optimistically slanted information tape, a tape that featured coping with more ups and downs, or no tape at all. Results indicated that women, whether as patients or as caregivers, were at elevated risk for a variety of negative outcomes during the subsequent 6 months. However, female patients who had spouses in the optimistic, mastery-tape condition were protected from the elevated levels of problems that characterized women whose spouses received only standard discharge preparation. Results are discussed in relation to research on optimism effects and work that suggests men may generally be less effective caregivers than women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why do adults with mucoviscidosis refuse a medically recommended course of intravenous antibiotic therapy?

OBJECTIVE: To better understand the needs of spouses who provide care to spinal cord injury (SCI) survivors, by comparing their self-perceptions and complaints with those of their partners with disabilities and with those of spouses who do not provide care. DESIGN: Survey, including demographics, health concerns questionnaire, and administration of the Center for Epidemiologic Studies Depression Scale (CES-D), the Perceived Stress Scale (PSS), the Life Satisfaction Index (LSI-Z), and the Quality of Life and Individual Needs Questionnaire. SETTING: Two British SCI treatment centers, serving a defined population-based catchment area. PARTICIPANTS: One hundred twenty-four spouses of a longitudinally followed sample of SCI survivors, all of whom had been injured 23 or more years when the study was conducted in 1993. OUTCOME MEASURES: Scores on the above standardized tests, and responses to survey questions. RESULTS: Spouses had more depressive affect (p < .001) than their partners with disabilities, as measured by the CES-D. On the PSS, they exhibited no significant differences. Compared with spouses who were not caregivers, the caregiving spouses reported more physical stress (p = .005), emotional stress (p = .011), burnout (p = .007), fatigue (p = .002), and anger and resentment (p = .029). On the CES-D, they had more symptoms of depressive affect (p = .004) and somatic depression (p = .005). CONCLUSIONS: Spouses of long-term SCI survivors who fulfill a caregiving role report more symptoms of stress and depression than their partners with disabilities and other spouses who are not caregivers.     

Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups

The purpose of this study were to examine the influence of personality on mental and physical health of spouse caregivers and to determine whether there were differences in such influences depending on disease context. The disease contexts compared were Alzheimer's disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both chronic, degenerative diseases of later life. It was predicted that personality would be related to mental and physical health, directly and indirectly, and that AD caregivers would have higher levels of perceived stress and worse mental and physical health outcomes. Participants in the study were 175 caregivers (88 AD; 87 PD) living at home with their ill spouses. The data provided an excellent fit to the hypothesized model of the relationships between personality, disease group, social support, perceived stress, and mental and physical health. Seventy-eight percent of the variance in mental health was accounted for and 35% of the variance in physical health was explained. Personality had significant direct and indirect effects on mental health and significant indirect effects on physical health. As predicted, AD caregivers had significantly worse mental health than PD caregivers; however, AD caregivers had better physical health than PD caregivers, controlling for other variables in the model. These results are discussed in relation to the existing caregiving and behavioral medicine literature. Future research should include different domains of personality--states and longer term self-regulatory processes in addition to traits--to advance models of caregiving processes further.     

Distress, depressive symptoms, and depressive disorder among caregivers of patients with brain injury

OBJECTIVE: To examine the prevalence and correlates of major depression in caregivers of individuals with moderate to severe traumatic brain injuries. DESIGN: Repeated-measures design involving structured diagnostic interview and self-report of psychological distress administered on two occasions separated by 6 months. SETTING: Three acute care rehabilitation hospitals. SUBJECTS: Fifty-nine caregivers (39 mothers and 20 spouses) of individuals with moderate to severe brain injuries recruited from previous inpatient rosters. All caregivers were currently residing with the person with traumatic brain injury. MAIN OUTCOME MEASURE: The Diagnostic Interview Schedule-Revised [DIS-R] was utilized to assess depression. The Symptom Checklist 90-Revised (SCL 90-R) measured general psychological distress. RESULTS: Forty-seven percent of caregivers initially met diagnostic criteria for depression, and 43% met criteria 6 months later. Nearly two thirds of those who were initially depressed continued to be depressed 6 months later, and 17% of those who were not depressed initially subsequently met criteria for depression. The best predictor of depression was a previous (pre-brain injury) depressive episode. Neither time since injury nor injury severity predicted diagnostic status, and spouses were no more likely to be depressed than were mothers. The SCL 90-R, including its depression scale, showed high specificity but low sensitivity in predicting diagnostic status. CONCLUSIONS: The prevalence of major depression is high in caregivers of individuals with brain injuries. Because depression may interfere with the capacity to provide care and contribute to the rehabilitation process, it is important for clinicians to carefully assess both the current and preaccident affective status of primary caregivers.     

Weight changes in caregivers of Alzheimer's care recipients: Psychobehavioral predictors.

Relationships of changes in body mass index (BMI) were examined with changes in psychobehavioral variables in spouse caregivers of individuals with Alzheimer's disease (n?=?81) and matched spouses of controls (n?=?86). Men caregivers had significantly greater BMI and obesity than men controls at both times. Over 15–18 months, women caregivers gained significantly more weight than did women controls. A trend for greater obesity occurred in women caregivers than in women controls at follow-up. Although weight gain was not related to psychobehavioral variables in controls, in men caregivers decreased perceived control and increased fat intake explained significant variance in weight gain. In women caregivers, increased anger control and increased calories explained weight gain. Such caregivers may be at risk for health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitively impaired spouses as primary caregivers for demented elderly people

OBJECTIVE: To describe problems of dementia patients whose spousal caregivers are also cognitively impaired. DESIGN: Retrospective chart review. SETTING: The geriatric assessment clinic at University of California, San Diego, which is one center for the California State sponsored Alzheimer's Disease Diagnosis and Treatment Center Program. PATIENTS: During the period from January 1992 through May 1994, 65 patients completed the assessment and met the entry criteria of being demented and having a spousal caregiver. Twelve of the spouses scored six or more error points on the Katzman Short Orientation-Memory-Concentration Test. MEASUREMENTS: Patient data included age, living situation, other caregivers, use of formal and informal support systems, profiles of medical, cognitive, and functional ability, caregivers interactions, and recommendations from the evaluation. MAIN RESULTS: Dementia patients with cognitively impaired spouses utilized fewer community resources (P = .021) and experienced difficulty with medication compliance (P = .041) more often than those with cognitively normal spousal caregivers. CONCLUSIONS: Older caregivers of patients suffering from dementia should be screened for cognitive problems.     

Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms.

Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of caregiver burden and satisfaction on affect of older end-stage renal disease patients and their spouses.

We examined the extent to which a 2-factor model of affect explains how the burdens and satisfactions experienced by caregivers influence their own well-being and that of the spouses for whom they provide care. Using data from 315 older patients with end-stage renal disease and their spouses, we extended tests of Lawton et al.’s (1991) 2-factor model both longitudinally and dyadically. Multilevel modeling analyses partially support the 2-factor model. Consistent with the model, mean caregiver burden has a stronger effect on both caregiver and patient negative affect than does mean caregiver satisfaction. Contrary to the model, mean caregiver satisfaction has an effect on caregiver positive affect that is similar to that of mean caregiver burden, and it has no effect on patient positive affect. Time-varying effects of caregiver burden are consistent with the 2-factor model for caregiver but not patient negative affect. Time-varying effects of caregiver satisfaction are not consistent with the 2-factor model for either patients or caregivers. Results highlight the powerful role of caregiver burden for both caregivers and patients and suggest important new directions for conducting health-related research with late-life marital dyads. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spouses, adult children, and children-in-law as caregivers of older adults: A meta-analytic comparison.

The present meta-analysis integrates the results from 168 empirical studies on differences between caregiving spouses, adult children, and children-in-law. Spouses differ from children and children-in-law significantly with regard to sociodemographic variables; also, they provide more support but report fewer care recipient behavior problems. Spouse caregivers report more depression symptoms, greater financial and physical burden, and lower levels of psychological well-being. Higher levels of psychological distress among spouses are explained mostly—but not completely—by higher levels of care provision. Few differences emerge between children and children-in-law, but children-in-law perceive the relationship with the care recipient as less positive and they report fewer uplifts of caregiving. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

IL-12 promotes the accessory cell function of epidermal Langerhans cells

With the rapid aging of end-stage renal disease patients have come increasing burdens on families to provide care and support. This article focuses on the role changes, strains, and burdens for family caregivers, particularly spouses. Analysis is on the process of dramatic role changes and losses that occur within families and the resulting risks to dialysis patients and caregivers. Importance of constant assessment of caregivers by renal professionals is emphasized. Suggestions for families and professionals coping with role change and care burdens are offered. Concern is raised about American society shifting more care burdens onto families at a time of cultural change and stress on families, without enough societal support and programs to assist families adequately with care burdens of aging members.     

Depressive symptoms and marital satisfaction in the context of chronic disease: A longitudinal dyadic analysis.

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and marital functioning: An examination of specificity and gender differences.

Recent work has emphasized the importance of assessing the marital relationships of depressed persons. The present study was designed to examine the specificity to clinical depression of problematic marital functioning and to assess potential gender differences in the marital relationships and spousal interactions of depressed persons. Depressed psychiatric patients, nondepressed medical patients, and nondepressed community control subjects and their spouses completed measures of marital satisfaction and then participated in a 20-min marital interaction task. Subjects then completed measures assessing their postinteraction mood and perceptions of their spouses, and the interactions were scored with respect to the frequency of occurrence of a number of behaviors. The depressed couples differed from the community controls on virtually every measure of marital functioning. Furthermore, although the medical patients and their spouses also reported marital dissatisfaction and exhibited dysfunctional interactional behavior, only the depressed couples were characterized by negative affect following the interactions and by negative appraisals of their spouses' behaviors. This negative affect was particularly pronounced for the depressed women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Irrational beliefs and perceptions of marital conflict.

To test the hypothesis that observers would attribute more negative qualities to relationships of disagreeing spouses than to relationships of agreeing spouses, particularly when the observers held irrational beliefs, 54 undergraduates completed the Irrational Beliefs Test and reported their impressions of actors portraying couples on videotape. Disagreeing couples were rated as experiencing more negative feelings, sharing less affection, having less intact relationships, and being less compatible than agreeing couples. Observers high in irrational beliefs reported more negative impressions of disagreeing couples than those low in irrational beliefs, when rating feelings and affection. Females were more likely to perceive compatibility than males. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construals of preillness relationship quality predict cardiovascular response in family caregivers of Alzheimer's disease victims.

Examined the relationships between family caregivers' construal of their pre-illness affection for and cohesiveness with an Alzheimer's disease (AD) patient and subsequent cardiovascular functioning. Scale validation demonstrated the psychometric properties. In a study conducted 2 yrs later, 31 family caregivers of AD victims performed stress-inducing tasks while cardiovascular activity was monitored. Path analyses revealed that caregivers relatively high in pre-illness affection for the AD patient were characterized by lower heart rate reactivity and resting diastolic blood pressure. In contrast, caregivers relatively high in pre-illness cohesion were characterized by higher resting systolic and diastolic blood pressure. These results suggest that caregivers' social relationships may play an important, although not always beneficial, role in cardiovascular regulation and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spouses of late-life problem drinkers: Functioning, coping responses, and family contexts.

This prospective study focused on spouses of late-life problem drinkers. At initial assessment, 87 spouses of late-life problem drinkers reported poorer health-related and social functioning, more reliance on cognitive coping strategies, and more shared, cognitive avoidance coping than did 87 spouses of nonproblem drinkers; they also reported more stressful, less supportive family contexts. 22 spouses of individuals who would remit over a 1-yr interval did not appear to provide their partners with an impetus for recovery. However, spouses of remitted problem drinkers improved in several areas over the 1-yr follow-up. By contrast, 65 spouses of nonremitted partners continued to function more poorly and reported less supportive relationships with partners and escalating conflicts with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive components of deficit awareness in Alzheimer's disease.

Awareness of deficit was examined in 24 patients with Alzheimer's disease (AD) and their spouses (for a total of 48 participants) using performance prediction-postdiction and questionnaire discrepancy (QD) paradigms. Participants estimated their own memory performances as well the performances of spouses and of a fictional, memory-disordered patient observed on videotape. Patients overpredicted self-performances, but the extent of overestimation decreased for postdictions. Patients and caregivers accurately estimated caregiver performances but overestimated performances of the fictional patient. QD data revealed that patients underestimated their difficulties performing daily functioning tasks as compared with caregiver reports. Awareness of deficit is a complex ability, involving dissociable cognitive processes. AD patients may display intact immediate awareness of memory dysfunction but fail to incorporate incidents of memory failure into generalized self-belief systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of the caregiver–care recipient relationship: Does it offset negative consequences of caregiving for family caregivers?

This study examined whether relationship quality mediates, moderates, or both mediates and moderates the associations between caregiving stressors (e.g., disability and behavioral problems) and negative consequences associated with caregiver well-being (overload, role captivity, and depression). Data on family (spouses and children) caregivers (n?=?118) came from a longitudinal study of a representative sample of disabled older people and their primary caregivers. Relationship quality mediated the linkages between the presence of problem behaviors and the outcomes of role captivity and depression. That is, when problem behaviors were present, they related to higher levels of captivity and depression because quality of the relationship suffered. Relationship quality moderated the linkage between disability and overload. Specifically, for those with a higher quality of relationship, increased disability was related to higher levels of perceived overload. (PsycINFO Database Record (c) 2010 APA, all rights reserved)