Caregiver issues and AIDS orphans: perspectives from a social worker focus group

This study examines social workers' perceptions of the needs of families coping with acquired immunodeficiency syndrome (AIDS). This research investigates the problems of family caregivers of children orphaned by human immunodeficiency virus (HIV)-related death of their parents. A qualitative semistructured interview format was used in a focus group of 18 social workers. Four questions were designed to assess family needs and resources, as well as to evaluate the social workers' perspectives of governmental policies affecting these families. A list of four problems and two recommendations for change evolved from the focus group. Inadequate finances to house and care for the children was the primary cause for distress in these families. The major governmental policy that hindered the social workers' ability to assist families pertained to the low financial entitlement for caregivers who are related to the orphaned child. It was noted that unrelated caregivers receive substantially more money for the care of these children than family caregivers receive. Recommendations were made to change this policy and to develop guardianship laws that facilitate families' abilities to provide care to AIDS orphans. Family caregivers of AIDS orphans are bombarded with great demands and limited resources. This analysis of their situation from the social workers' perspective is a positive step toward the improvement of support services for these families. Further research should include individual qualitative interviews assessing the needs of the caregivers and AIDS orphans.     

Depression and distress predict time to cardiovascular disease in dementia caregivers.

Objective: This study assessed the impact of depressive symptoms and distress from patient problem behaviors on time to developing a diagnosis of cardiovascular disease (CVD) in a sample of 643 dementia family caregivers. Design: A longitudinal, prospective design was used. Over an 18-month period, caregivers free from a CVD diagnosis at baseline were assessed at 6, 12, and 18-month follow-ups for the onset of CVD. Main Outcome Measures: Days to the onset of CVD was the primary outcome. Results: Over the length of the study, 32 participants (5%) reported a diagnosis of CVD. After adjusting for sociodemographic and health factors (e.g., high blood pressure, age, smoking history), greater depressive symptoms (p = .040) and distress from patient problem behaviors (p = .034) were significant predictors of time to CVD diagnosis. Conclusion: This study suggests that increased depressive symptoms and reaction to patient problem behaviors (i.e., distress) may increase caregivers' risk for experiencing negative health outcomes, specifically CVD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed. (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)     

Hope in the family caregiver of terminally ill people

This longitudinal study explored the meaning of hope, the influence of specific background characteristics on hope, and identified strategies that are used to foster hope in a convenience sample of 25 family caregivers of terminally ill family members from two hospice programmes using the technique of methodological triangulation (interview, Herth Hope Index and Background Data Form). Hope was defined as a dynamic inner power that enables transcendence of the present situation and fosters a positive new awareness of being. Six hope-fostering categories and three hope-hindering categories were identified based on the interview responses. With the exception of those providing care to a family member diagnosed with AIDS and those caregivers experiencing poor personal health, a high fatigue level, severe sleep deprivation and more than two concurrent losses, overall hope levels among participants were found to remain stable across the background variables. Across time, hope levels were found to be low at interview time one, rise significantly by time two and then level off for the remainder of the time. An understanding of hope from the perspective of the family caregiver could provide a basis upon which to develop interventions that foster hope.     

The “cost of caring” in youths' friendships: Considering associations among social perspective taking, co-rumination, and empathetic distress.

The current research considered the costs of caring in youths' friendships. The development of a new construct, empathetic distress, allowed for a direct test of the commonly held belief that females suffer greater vicarious distress in response to close others' stressors and problems than do males. Empathetic distress refers to one's strongly sharing a relationship partner's distress over problems to the point of taking on the partner's distress and experiencing it as one's own. This new construct was examined in an ethnically diverse sample of early adolescents who responded to a series of questionnaires in their classrooms. Results indicated that girls did experience greater empathetic distress in friendships than did boys. In addition, the current research revealed that social perspective taking in friendships (i.e., the social–cognitive ability to infer and understand the friend's perspective) had adjustment trade-offs in that it predicted greater positive friendship quality but also greater empathetic distress in the friendship. Interestingly, the associations of social perspective taking with both positive friendship quality and empathetic distress were partially mediated by co-rumination or excessive discussion of problems. Applied implications of the findings that girls' greater social perspective taking and associated co-rumination contributed both to their greater positive friendship quality but also to greater costs of caring in the form of empathetic distress are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The distressed psychologist: Prevalence and treatment considerations.

Investigated the level and types of distress in a sample of 379 psychologists, using survey methodology. Overall, Ss were healthy and satisfied with work and interpersonal relationships. 10% of Ss experienced distress in the areas of depression, marital/relationship, physical illness, alcohol use, and loneliness. A distress band was calculated and ranged from 9% for multiple categories to 19% for single categories of distress. A subsample of Ss in distress from alcohol use was characterized by use of controlled drinking strategies with notable failure of these options to reduce distress levels. The authors conclude that (a) distress is a multifaceted phenomenon requiring careful examination on several levels; (b) controlled drinking strategies do not function to reduce distress among problem-drinking psychologists; and (c) verification of the distress band prevalence is needed to guide planning of intervention efforts on a state and national basis. (PsycINFO Database Record (c) 2010 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.     

Smoking, nicotine dependence, and depressive symptoms in the CARDIA Study. Effects of educational status

We propose that two related sources of variability in studies of caregiving health effects contribute to an inconsistent pattern of findings: the sampling strategy used and the definition of what constitutes caregiving. Samples are often recruited through self-referral and are typically comprised of caregivers experiencing considerable distress. In this study, we examine the health effects of caregiving in large population-based samples of spousal caregivers and controls using a wide array of objective and self-report physical and mental health outcome measures. By applying different definitions of caregiving, we show that the magnitude of health effects attributable to caregiving can vary substantially, with the largest negative health effects observed among caregivers who characterize themselves as being strained. From an epidemiological perspective, our data show that approximately 80% of persons living with a spouse with a disability provide care to their spouse, but only half of care providers report mental or physical strain associated with caregiving.     

Explaining gender differences in caregiver distress: The roles of emotional attentiveness and coping styles.

In previous studies, female caregivers generally reported more distress than did male caregivers. This study assesses the validity of 2 explanations of this gender difference. The 1st model hypothesizes that male caregivers are less likely to be attentive to their emotions and, therefore, fail to recognize and report distress. The 2nd model hypothesizes that women are socialized to use coping styles that are less effective for alleviating distress. The data partially supported both explanations. These results support the importance of seeking explanations for observed gender differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal effects of suffering in older adult caregiving relationships.

Examining the interpersonal effects of suffering in the context of family caregiving is an important step to a broader understanding of how exposure to suffering affects humans. In this review article, the authors first describe existing evidence that being exposed to the suffering of a care recipient (conceptualized as psychological distress, physical symptoms, and existential/spiritual distress) directly influences caregivers’ emotional experiences. Drawing from past theory and research, the authors propose that caregivers experience similar, complementary, and/or defensive emotions in response to care recipient suffering through mechanisms such as cognitive empathy, mimicry, and conditioned learning, placing caregivers at risk for psychological and physical morbidity. The authors then describe how gender, relationship closeness, caregiving efficacy, and individual differences in emotion regulation moderate these processes. Finally, the authors provide directions for future research to deepen understanding of interpersonal phenomena among older adults, and they discuss implications for clinical interventions to alleviate the suffering of both caregivers and care recipients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Dispositional pessimism predicts illness-related disruption of social and recreational activities among breast cancer patients.

The authors tested whether dispositional pessimism would predict withdrawal from social activities among women treated for breast cancer. In a cross-sectional sample 3-12 months postsurgery, disruption of social and recreational activities (measured by the Sickness Impact Profile) correlated with concurrently assessed pessimism. This association appeared mediated by emotional distress and fatigue. A longitudinal sample was studied shortly postsurgery and over the next year. Initial pessimism predicted disruption of social activities concurrently and prospectively (3, 6, and 12 months later) but predicted change in disruption from one time to the next only at final follow-up. These associations appeared partially mediated by distress. The authors conclude that pessimism places patients at risk for adverse outcomes in several respects rather than solely with regard to emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competition in the NHS internal market: an overview of its effects on hospital prices and costs

Two-year stability coefficients were computed for several measures of borderline personality disorder within a nonclinical sample (n = 65) that included individuals with significant borderline features. Overall, the stability coefficients were modest (r ranging from .28 to .62; intraclass correlations ranging from .26 to .62). Stability values for each of the self-report measures under study were higher than those for the interview-based measure of BPD features, and, in some cases, these values varied as a function of the prototypicality of the subsamples examined. Analyses conducted to identify moderator effects provided no evidence that the stability of BPD scores was moderated by change in personal distress level; however, changes in BPD self-report scores were related to changes in level of negative affectivity.     

Women's responses to young infants' cries.

Women's caregiving and perceptual responses to young infants' cries were assessed as a function of parity and cry cause. Ss cared for a crying infant manikin in a simulated baby-sitting situation. Mothers and nonmothers were quite similar in basic features of their caregiving behaviors, suggesting that the effects of parity may be to fine-tune skills that many women bring to the task of caring for young infants. The specific cause of the cry (hunger or pain) was associated with few differences in caregiving behavior, even though a subsequent perceptual task showed that Ss reliably discriminated the two cries. Further analyses of the perceptual data indicated that cry sounds communicate information about the general distress level of the infant better than information about specific causes. Thus, although the sound of the cry may inform caregivers about overall distress level, caregiving behaviors appear to be determined by additional factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To grandmother's house we go ... and stay. Children raised in intergenerational families

An increased incidence in child abuse and neglect has resulted in a dramatic rise in the number of grandparents raising grandchildren and great-grandchildren. Grandchildren raised by grandparents often suffer from emotional and behavioral problems due to prior abuse, neglect, and abandonment. Grandparent caregivers experience increased health problems, psychological distress, and social isolation related to their roles as primary caregivers of children. Grandparents who become caregivers of grandchildren face increased financial responsibilities at a time in their lives, close to or at retirement, when income is dramatically decreased.     

Voltage gating of Shaker K+ channels. The effect of temperature on ionic and gating currents

This study investigated the distress levels of 150 family members of homicide victims, as well as how pre-event, peri-event, and postevent variables were related to distress. Distress levels were very high, with 26% of the sample reporting clinical distress. Because it was not possible to say if this distress resulted from the homicide itself or from the fact that people who lose family members to homicide generally have lives rooted in stressful contexts, we compared the homicide sample to two sociodemographically comparable groups of 108 other trauma victims and 119 nonvictims selected from a larger epidemiological dataset. Homicide survivors were significantly more distressed than either group, suggesting that loss of a family member to homicide has definite clinical implications. Although event-related variables were somewhat predictive of distress, pre-event and postevent variables selected for this study had greater predictive utility.     

Appraisal, coping, and social support as mediators of well-being in Black and White family caregivers of patients with Alzheimer's disease.

Family caregivers of patients with Alzheimer's disease (AD) commonly have high levels of psychological distress. Black caregivers often report less depression than White caregivers, but the process underlying this difference is poorly understood. With the use of a stress process model, 123 White and 74 Black family caregivers of patients with AD and other progressive dementias were studied. Black caregivers appraised patient problems as less stressful and reported higher self-efficacy in managing caregiving problems and less depression than did White caregivers. White and Black caregivers also differed significantly in coping responses but not in social supports. Structural equation analyses indicated that the correlational structure of the stress process was similar in White and Black caregivers. Caregiving stressors and race did not affect well-being through direct paths, but they were mediated by effects for appraisal, social support and activity, and coping. Possible cultural mechanisms explaining the better adjustment among Black caregivers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in job strain, social support at work, and psychological distress.

Using the demand-control-support model of job strain, the authors examined gender differences in the relationship between psychosocial work exposures and psychological distress in a cross-sectional sample of 7,484 employed Canadians. Compared with low-strain work, high-strain and active work were associated with a significantly higher level of distress in both men and women. Differences in psychological distress in relation to psychosocial work exposures were greater for men than for women. Low social support was associated with higher distress across all categories of job strain, and the combined effect of low social support and high job strain was associated with the greatest increase in distress. This pattern was similar in men and women. This study suggests that psychosocial work exposures may be a more significant determinant of psychological well-being in male workers compared with female workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)