A quantitative study of the emotional outcome of people caring for stroke survivors

BACKGROUND AND PURPOSE: Although the physical and, to a lesser extent, emotional outcome of stroke survivors has been well documented, there are far fewer data relating to the outcomes of those who care for them. We aimed to describe the outcome of those caring for stroke patients and to identify both patient and caregiver factors that are associated with poor caregiver outcomes. METHODS: As part of a randomized trial to evaluate a stroke family care worker, we identified 417 patients (67% of all referrals to our institution). We followed up 376 survivors of whom 246 identified a caregiver at a 6-month follow-up interview. The patients and caregivers were asked to complete 2 measures of emotional distress ( 30-item General Health Questionnaire [GHQ-30] and Hospital Anxiety and Depression [HAD] Scale). A regression analysis was used to identify factors that were independently associated with poor caregiver outcomes. RESULTS: Fifty-five percent of responding caregivers scored more than 4 on the GHQ-30, indicating that emotional distress is common in this group. Caregivers were more likely to be depressed if the patients were severely dependent (P<0.01) or emotionally distressed themselves (P<0.01). Female caregivers reported more anxiety (median HAD=8) than male caregivers (median HAD=5; P<0.01) but caregivers' levels of anxiety were not so clearly related to the patients' degree of physical disability as their levels of depression. Caregivers suffered more emotional distress if the patients had been dependent before their strokes. CONCLUSIONS: These data may help to identify those caregivers at greatest risk of poor emotional outcomes and thus help in the planning of trials and delivery of interventions aimed at preventing or treating distress among caregivers.     

Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p=.022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p=.034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the quality of life of caregivers of persons with spinal cord injury: A randomized controlled trial.

Objective: To assess the efficacy of two psychosocial interventions for caregivers of older persons with spinal cord injury (SCI). Design: A multisite, three-group, randomized controlled trial comparing two active intervention conditions with each other and to an information-only control group. One hundred seventy-three caregiver and care-recipient dyads were randomly assigned to one of three conditions: a caregiver-only treatment condition in which caregivers received a multicomponent intervention based on their risk profile; a dual-target condition in which the caregiver intervention was complemented by a treatment targeting the care recipient, designed to address both caregiver and care recipient risk factors; and an information-only control condition in which the caregiver received standard printed information about caregiving, SCI, and aging. Outcome Measures: A multivariate outcome comprised of six indicators linked to the goals of the interventions was the primary outcome of the study. The multivariate outcome included measures of depressive symptoms, burden, social support and integration, self-care problems, and physical health symptoms. Results: At 12 months, caregivers in the dual-target condition had improved quality of life as measured by our multivariate outcome when compared to the control condition. Using the dyad as the unit of analysis, the dual-target condition was superior to both the control condition and the caregiver-only condition in our multivariate outcomes analysis. Dyads enrolled in the dual-target condition had significantly fewer health symptoms than control condition and caregiver-only condition participants and were less depressed when compared to participants in the caregiver-only condition. In follow-up analyses we found that a higher proportion of caregivers in the dual-target condition had clinically significant improvements in depression, burden, and health symptoms when compared with the caregiver-only condition. Conclusion: Caregivers are in need of and can benefit from interventions that help them manage the medical and functional limitations of the care recipient. Intervention strategies that target both the caregiver and care recipient are particularly promising strategies for improving the quality of life of caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style, perceived uncertainty in illness, and distress in individuals with Parkinson's disease and their caregivers.

Examined the relationship of coping style and illness uncertainty to psychological distress in individuals with Parkinson's disease (PD) and their primary caregivers. Design: Correlational methods, within-group theory-driven hierarchical regression analyses, and transactional analyses. Ss were 44 dyads composed of individuals with PD and their caregivers. Main Outcome Measures: Hoehn and Yahr Clinical Disability Rating Scale, Instrumental Activities of Daily Living Scale, Symptom Distress Checklist-90—Revised, Mischel Uncertainty in Illness Scale-Community Form, and Revised Ways of Coping Checklist. Results: Emotion-focused coping was associated with higher levels of distress for persons with PD, whereas both emotion-focused coping and perceived uncertainty were associated with distress for the caregivers. Transactional analyses between patients and caregivers indicated that higher levels of patient problem-focused coping and perceived uncertainty in illness were associated with increased problems in caregiver distress. Adjustment to PD is influenced by several patient and caregiver variables. The results warrant consideration of a variety of clinical interventions involving patient and caregiver education about the disease and methods for managing the associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of a couple-based treatment for PTSD in returning veterans.

Military personnel deployed in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high levels of emotional distress and posttraumatic stress disorder (PTSD), and these deployment-related problems may be expected to have a devastating impact on their relationships. It is urgent that researchers develop couple-based treatments to reduce PTSD in OEF/OIF veterans and to reduce PTSD-related relationship problems. This article describes the development of a novel couple-based treatment for PTSD, called Structured Approach Therapy (SAT), that uses empathic communication training and stress inoculation procedures to help couples improve their ability to cope with trauma-related anxiety and a multicomponent emotion activation program to help couples reduce emotional numbing. The theoretical basis of the SAT Treatment Model is described, and the various treatment components are presented. The authors recommend that couple-based interventions be used to provide OEF/OIF veterans and their partners with empathic communication skills to discuss their thoughts and feelings about deployment and with dyadic coping skills to confront trauma-related aversive emotions and emotional numbing and return intimacy to their lives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of neuroticism and mastery in spouse caregivers' assessment of and response to a contextual stressor

Data from more than 300 spousal caregivers and their care recipients were analyzed to demonstrate the effects of caregivers' personality attributes--neuroticism and mastery--on their assessment of a contextual stressor (the care recipient's behavioral and functional impairment) and on their experience of distress associated with that stressor. Caregivers who were high in neuroticism and/or low in mastery reported higher levels of behavioral and functional impairment in their disabled spouse and experienced more strain and depressive symptoms associated with caregiving relative to caregivers with lower neuroticism or higher mastery scores. We further showed that the widely reported association between caregiver-assessed impairment of the care recipient and caregiver outcomes can in part be explained by caregivers' personality attributes, such as neuroticism and mastery. Our findings that caregivers' personality variables are related to their assessment of a given objective stressor and their response to a given level of stress have implications for interventions targeting caregivers and for the use of caregivers as proxy informants.     

A new framework for urinary continence outcomes in long-term care

Careful assessment and individual care planning are especially important when approaching the problems of incontinence in long-term care patients. Identification of appropriate interventions and desired outcomes is assuming greater prominence. This article provides an overview of some of the issues that affect incontinence with long-term patients and presents a refined concept of several classifications of incontinence that direct approaches to care. The classifications are based on whether a patient is dependent or independent on a caregiver to achieve continence. Assumptions, goals, and evidence for effectiveness of these interventions are discussed for the four classifications. Further implications for nursing are also addressed.     

Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder.

Caregiver burden in 58 partners of Vietnam War veterans with posttraumatic stress disorder (PTSD) was examined. The relationship between patient PTSD severity and caregiver burden, as well as the effect of several caregiver and patient variables on caregiver psychological status, was evaluated twice, an average of 8 months apart. Patient symptom severity was positively correlated with caregiver burden. Time 1 cross-sectional analysis indicated that greater caregiver burden was associated with greater caregiver psychological distress, dysphoria, and anxiety. Patient symptom severity also contributed to caregiver psychological distress; financial stress contributed to caregiver dysphoria and trait anxiety. Time 2 cross-sectional analyses essentially replicated the Time 1 findings. A third set of analyses examining change scores indicated that changes in caregiver burden for individuals in the sample positively predicted individual changes in caregiver psychological distress, dysphoria, and state anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Theory of Unpleasant Symptoms and Alzheimer's disease

This article evaluates the emergent fit of the Theory of Unpleasant Symptoms for Alzheimer's Disease (AD) clients in an effort to evaluate the usefulness of the theory in thinking about AD and planning nursing interventions. Qualitative data from a 3-year study on the range and diversity of behavioral symptoms in AD and published research, treated as textual data, illustrate the theory. Although the components of the theory appear blurred when used with AD client behavior, the theory is useful because it emphasizes the complexity and interaction of symptoms and the interrelationships among symptoms, influencing factors, and symptom consequences/performance outcomes. These interrelationships make assessment more challenging than when symptoms are considered individually. The importance of the caregiver and the social and environmental context, called situational factors in the theory, emerge as especially relevant in AD. When symptoms are examined in their entirety, and nursing interventions take the interactive nature of symptoms, influencing factors and symptom consequences/performance outcomes into consideration, interventions should be client specific and, therefore, more effective.     

Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006.

Objective: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV= adults. Design: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N = 3,077). Main Outcome Measures: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). Results: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s + 0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. Conclusion: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bone marrow changes in HIV-positive patients (clinical, cytological, histological, and ultrastructural study of 57 cases)

Individuals with systemic autoimmune diseases develop autoantibodies to nucleosome antigens. For many years, investigators have devoted much effort to precisely mapping epitopes on individual chromatin components. This approach, however, overlooks the existence of determinants that result from multimolecular interactions among nucleosome elements, such as DNA and histones. Anti-nucleosome antibodies can recognize a variety of complex epitopes and are especially prevalent in spontaneous and drug-induced lupus. Using numerous monoclonal anti-nucleosome antibodies obtained from autoimmune mice, we have further characterized these determinants and sequenced the variable region genes of these autoantibodies. I herein review these studies and their implications for the origin of antinuclear autoantibodies.     

Simulation of paraequilibrium growth in multicomponent systems

A methodology to simulate paraequilibrium (PE) growth in multicomponent systems using the DIC-TRA (Diffusion-Controlled Transformation) software is presented. For any given multicomponent system containing substitutional and interstitial elements, the basic approach is to define a hypothetical element Z, whose thermodynamic and mobility parameters are expressed in terms of the weighted average (with respect to site fraction) of the thermodynamic parameters and mobilities of the substitutional alloying elements. This procedure facilitates the calculation of PE phase diagrams and the PE growth simulations directly in the Thermo-Calc and DICTRA software, respectively. The results of two distinct case studies in multicomponent alloys are presented. In the first example, we simulate the isothermal growth of PE cementite in an Fe-C-Co-Cr-Mo-Ni secondary hardening steel during tempering. This is of practical importance in modeling the carbide precipitation kinetics during secondary hardening. In the second example, we have presented the results of PE ferrite growth during continuous cooling from an intercritical temperature in an Fe-Al-C-Mn-Si low-alloy steel. This is of importance to the design of triple-phase steels containing an austenite that has optimum stability, to facilitate stress-induced transformation under dynamic loading. The results of both simulations are in good accord with experimental results. The model calculations do not consider any resistive or dissipative forces, such as the interfacial energy, strain energy, or solute drag, and, as a result, the interface velocities represent an upper limit under the available chemical driving force.     

The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review.

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissecting daily distress in mothers of children with ADHD: An electronic diary study.

It is well known that parents of children with attention-deficit/hyperactivity disorder (ADHD) experience elevated levels of caregiver stress, but little is known about the ebb and flow of parental distress as it happens, or the degree of synchrony between short-term oscillations in child behaviors and maternal distress. Electronic diaries (eDiaries) were used to dissect daily distress in natural settings. Across 7 days during nonschool hours, half-hourly eDiaries were completed independently by mothers and their 8- to 12-year-old children (51 receiving medication for ADHD and 58 comparison peers). Diary items tapped behaviors, moods, and contexts, with children reporting their own behaviors and mothers reporting on themselves and their children. Maternal distress and child ADHD-type behaviors exhibited moderate to strong associations “in the moment,” whether child behaviors were reported by mothers or children. This mother-child synchrony emerged for the comparison as well as the ADHD group, although the associations were stronger when the dyad included a child with ADHD. Because fixed-effects analyses were conducted, these patterns are not attributable to levels of psychopathology or other stable individual differences in mothers or children. Further moderation analyses revealed that the links between child behaviors and maternal distress were strengthened by maternal risk and attenuated by child behavioral self-esteem; these effects were modest but detectable. These findings can help guide not only interventions targeted on improving quality of life in families of children with ADHD, but also programs designed to help all parents identify and manage their own parenting stressors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers.

A stress and coping model was used to study predictors of individual differences in caregiver adaptation. A total of 54 family caregivers of elderly dementia patients completed interviews and questionnaires assessing the severity of patient impairment and caregiving stressors; caregiver appraisals, coping responses, and social support and activity; and caregiver outcomes, including depression, life satisfaction, and self-rated health. Correlational and regression analyses supported the utility of the stress and coping model. Appraisal, coping responses, and social support and activity were significant predictors of caregiver outcome, even when severity of caregiving stressors was statistically controlled. The importance of a multidimensional approach to assessing caregiver outcomes was supported by regression analyses indicating that each caregiver outcome was predicted by different patterns of stressors, appraisal, coping, and social support and activity. Results are discussed in terms of a stress and coping model of caregiving, and clinical implications for work with caregiving families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

多元体系铂饰品校正样品的研制及在X射线荧光无损检测中应用

研制了成分为Pt,Pd,Au,Ag,Cu,Zn,Ni,Co的多元体系的铂饰校正样品,并用于多元体系铂饰品的X射线荧光光谱无损检测,结果令人满意。测量结果误差<1.0%,符合GB/T18043-2000国家标准规定的允许差,方法RSD小于3.0%。