Social experiences and daily routines of African American infants in different socioeconomic contexts.

Sixty-two 3- to 4-month-old African American infants from lower, middle, and upper socioeconomic status (SES) backgrounds were each observed in naturalistic contexts for 12 hr. The social experiences of infants in the 3 groups were similar in many ways: Infants from all backgrounds slept and were vocalized to for similar amounts of time. However, infants in the upper SES families engaged in more self-play, vocalized less, fussed less, had fewer but longer naps, and fewer but longer bouts of social interaction than did infants in the middle- and lower SES families. Infants in the upper SES families also received more verbal affection and soothing responses to their fussing and crying than did the other infants, whereas infants in the lower SES families interacted more with extended kin than did infants in the upper SES families. These results underscore the need to study African American families in a variety of socioeconomic contexts because families in more advantaged circumstances may greatly differ from those who are more disadvantaged, especially in terms of reliance on extended kin as caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV-related stigma in a sample of HIV-affected older female African American caregivers

Older women of color increasingly act as informal caregivers for adults and children with HIV disease. Nineteen older female (mostly African American) informal caregivers of HIV-infected individuals participated in qualitative interviews to explore their experiences with HIV-related stigma. Perceived and directly experienced stigma were examined in the context of disclosure of the presence of HIV disease. Overt HIV-related stigma was rarely experienced by these respondents, primarily because they had not widely disclosed the presence of HIV in the family and therefore had not given anyone the opportunity to ostracize or judge them. HIV-related stigma was internalized, so that disclosure decisions were based on their anticipation of censure. There also was evidence of associative stigma and of stigma management. The findings suggest the need for social work practitioners to increase awareness of the needs of stigmatized, isolated HIV-affected caregivers. Practitioners should conduct aggressive outreach and strive to provide more support to this often invisible population of caregivers to HIV-infected people.     

Respite care for families of children with disabilities

The number of children with chronic health problems and resultant disabilities is increasing. Most of the care received by these children is provided by family members, often at severe economic and psychologic cost. One service that has appeared in the past two decades to assist family caregivers is respite services. This article describes the needs for respite identified by family members, the types of respite services available, the benefits of respite care to families, and the essential roles nurses can assume in assuring this essential service is available to families.     

Family physicians' involvement with dying patients and their families. Attitudes, difficulties, and strategies

OBJECTIVE: To determine family physicians' perceptions of the difficulty in caring for dying patients and how prepared they are to provide such care relative to strategies used with difficulties encountered, personal need for support and development, and cooperation with other caregivers. DESIGN: Exploratory. SETTING: Physicians' offices. SUBJECTS: Thirty-five randomly selected family physicians (doctors of medicine and doctors of osteopathy) representative of family physicians practicing in Franklin County, Ohio. INTERVENTIONS: None. MAJOR OUTCOME MEASURES: A semistructured interview guide corresponding to a three-dimensional theoretical model developed prior to the study was used to determine family physicians' perceptions regarding care of dying patients and their families. The three dimensions include family physicians' involvement with dying patients and their families, their personal needs and development, and their cooperation with other caregivers. RESULTS: Participants agreed that the care of dying patients and their families is an important and special component of practicing family medicine. Generally seeing themselves as adequately prepared, they still found such care difficult and desired more education and training to increase comfort of their patients and of themselves. Their perceptions regarding the care of dying patients and their families could be categorized in terms of communication as part of the care process, family issues, legal and ethical issues, coordination of care, physicians' feelings, and physicians' influence and support. CONCLUSIONS: Family physicians require formal training in death issues and need to find a way to maximize learning through personal experiences. Discussion of cases in a support group may be beneficial.     

The Circle Model--support for relatives of people with dementia

Home care for cognitively impaired elderly puts tremendous stress and burden on their families. Therefore it is important to search for effective care models in order to provide support for this group. In this study, an intervention model--the Circle Model--was developed, tested and evaluated in six places in Sweden. The model is unique in that family caregivers and volunteers were trained together in study circles. After their training, the volunteers replaced the caregivers in the homes on a regular basis, which permitted the caregivers some relief from the demands of caregiving. Interviews were conducted with the participants to gather information about their training and relief care experiences. The caregivers reported that the study circle provided opportunity to exchange experiences with other people in similar situations. They felt a spirit of community with other relatives, and were able to increase their knowledge in care providing and coping strategies. The emphasis in temporary relief care by the volunteers was placed on providing the relatives with feelings of security and relaxation. The satisfaction among the Circle Model participants was reciprocal. The volunteers also reported high satisfaction and appreciation of the knowledge which they acquired from the caregivers. The Circle Model brings new dimensions to the home care situation and should be seen as a complement to social services support.     

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.     

Differences in familism values and caregiving outcomes among Korean, Korean American, and White American dementia caregivers.

Recent theories have suggested that burden and distress among dementia caregivers may be higher in American culture, which emphasizes individualism, and lower in cultures with higher levels of familism. However, immigrants may experience higher levels of burden because of acculturation with attendant values, conflicts and stresses. Forty-four Korean caregivers and 32 Korean American caregivers were compared with 54 White American caregivers on sociodemographic variables, familism, burden, anxiety, and depression. Familism was highest in Korean caregivers and lowest in Whites, with Korean Americans in the middle. Koreans and Korean Americans reported higher levels of burden. Koreans showed higher levels of depression and of anxiety than White American caregivers, with Koreans and Korean Americans higher than Whites on anxiety. These results suggest a need for greater specificity in theories about familism values, with attention to the specific meaning of familism in different cultures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of La vie quotidienne du malade d'Alzheimer.

Reviews the book, La vie quotidienne du malade d'Alzheimer by Mitra Khosravi (2006). The objective of this book is to present the experiences of caregivers looking after patients with Alzheimer's disease. The author discusses the consequences upon daily life of the Alzheimer's diagnosis that are not usually anticipated by caregivers. Whereas the greatest part of the existing research relates to the immediate symptoms and the long-term results of Alzheimer's disease, Khosravi focuses on the caregivers. The book describes the principal difficulties involving the lack of information on the nature of the disease and the negligent psychological state of the patient. According to the author, the identification of physical and psychological limits is essential to avoiding complications and improving the quality of life Alzheimer's patients and their caregivers. This book is ideal for families and caregivers who face the long process of providing care for those afflicted with this "multiple system" disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress of parent care: Positive and negative effects of women's other roles.

The present study focused on 296 women who were primary caregivers to an ill or disabled parent or parent-in-law and who simultaneously occupied 3 other roles as mother, wife, and employee. All women lived in separate households from their impaired parent and had at least 1 child 25 years of age or younger living at home. It was predicted that stress in the roles of mother, wife, and employee would exacerbate the effects of stress in the parent care role on psychological well-being (depression and life satisfaction) and that rewards in these 3 additional roles would buffer the effects of parent care stress. For all 3 additional roles, findings supported the stress exacerbation hypothesis. In contrast, only the employee role supported the stress-buffering hypothesis. These findings underscore the complex relationships that often exist between women's multiple role experiences and their psychological well-being. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Annual review of Asian American Psychology, 2009.

The purpose of this study was to provide a systematic and critical review of research articles on Asian American psychology that were published in 2009. A search using PsycINFO led to the identification of 134 articles, and each of these articles were evaluated in terms of its topic areas, research methodology, and findings. The results showed that the articles covered a wide array of topics, including acculturation and enculturation, adoptees, career, counseling and clinical issues, educational experiences, families, health and health-related behaviors, identity, immigrants and refugees, interpersonal relationships, lesbian/gay/bisexual/transgender/intersex/questioning, masculinity, older adults, personality, politics, psychopathology, racism, spirituality, stress and coping, violence, women, and youths. A summary of articles within these topics areas are provided. In addition, various characteristics of this body of literature are presented with their implications for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compound caregiving: When lifelong caregivers undertake additional caregiving roles.

Objective: Lifetime parental caregivers of adults with intellectual disabilities (ID) may also become caregivers to other family members. This study investigated caregiver experiences of compound caregiving (i.e. additional caregiving roles) and its association with caregiver quality of life. Participants: Ninety-one older caregivers living with their adult son/daughter with ID were interviewed. Mean age of the caregivers was 60 years and their sons'/daughters' mean age was 29 years. Main Outcome Measures: Compound caregiving status, physical and mental health, life satisfaction, depressive symptomatology, and desire for alternative residential placement for their co-residing son/daughter. Results: Thirty-four (37%) reported being current compound caregivers to an additional care recipient, predominantly a mother, father, or spouse. Caregivers averaged 39 hours per week fulfilling their primary caregiving tasks, an additional 12 hours per week on the compound caregiving role, and the median duration of compound caregiving was 3 years. Compared with the non-compound caregivers, the compound caregivers had increased desire to place their son/daughter into residential care, though no group differences were apparent in life satisfaction, depressive symptomatology, physical health, or mental health. The most problematic issues reported by compound caregivers were having little personal time and a lack of adequate help from others. Conclusion: Compound caregiving was often experienced, and may galvanize these lifetime caregivers to start making future plans for their sons/daughters. Future research is warranted to refine more homogeneous groupings of compound caregivers, who may be at greater risk for adverse outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lessons learned in creating a safe and therapeutic milieu for children, adolescents, and families: developmental considerations

TOPIC: Converging developmental characteristics, responses to stress, and underlying psychopathological processes of this population present unique challenges in assessment, treatment planning, and approaches to patient care. PURPOSE: To share lessons learned in designing and implementing a developmentally sensitive and safe psychiatric milieu for children, adolescents, and families. SOURCES: Personal observations and experiences, and information derived from literature in the field. CONCLUSIONS: Psychiatric nurses contribute essential roles in designing and implementing a developmentally sensitive and safe psychiatric milieu for children, adolescents, and families.     

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.     

Child's play with adults, toys, and peers: An examination of family and child-care influences.

Toddler-age children's (11 to 30 months old) play with care-giving adults and with toys and peers was observed and rated in family day-care homes. Fifty-five children, their mothers, and family day-care home providers participated in this study. The quality of the family day-care homes was assessed with the Harms and Clifford Family Day Care Rating Scale (FDCRS) and by measures of ratio and group size. Information on family stress, social support, child-rearing attitudes, and maternal role satisfaction was reported by mothers. More nurturing and supported families were associated with higher quality child care, whereas more restrictive and stressed families were associated with lower quality child care. More restrictive and stressed families were associated with more changes in child-care arrangements. Greater numbers of child-care changes also were associated with lower levels of competent play with objects and peers. When quality of care was controlled, both more nurturing and supported families and less restrictive and stressed families were associated with higher levels of competent play with adult caregivers, peers, and objects. When family characteristics were controlled, higher quality child care was associated with more competent play with adult caregivers and with peers and objects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological, social, and health impact of caregiving: A comparison of Black and White dementia family caregivers and noncaregivers.

Psychological, social, and health variables were compared in 175 Black and White family caregivers of patients with dementia and 175 Black and White noncaregivers. Caregivers and noncaregivers did not differ within race on demographic variables. Caregiving was associated with increased depression and decreased life satisfaction only in White families. However, caregiving appears to have similar social consequences for Black and White families, including restriction of social activity and increased visits and support by family from outside of the home. Race, but not caregiving, was associated with physical health variables. Methodological issues in comparing well-being in Black and White caregivers, in particular the importance of including noncaregiving comparison subjects, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregivers of Turkish schizophrenic patients: causal attributions, burdens and attitudes to help from the health professionals

The purpose of this study was to examine the causal attributions, difficulties, perceived and expected help behaviour of health care professionals, and hope for the future well-being of the caregivers of Turkish schizophrenic patients in order to form guidelines for forming a collaboration with the families of schizophrenic patients. Sixty caregivers were interviewed by using a semi-structured interview schedule. The responses of the caregivers were categorized within the guidelines of the literature in this area. The caregivers attributed schizophrenia mainly to psychosocial causes, namely stressful events (50%), family conflicts (40%) and patients' characteristics (28%). The most frequently reported difficulties were family conflicts and disruptions of family life, subjective burden (48%), and financial costs due to the patient (27%). The number of difficulties reported by caregivers was related to the duration of the patient's illness. Caregivers perceived pharmacological treatment (42%), interest and support given to the caregiver (28%), and the hospitalization of the patient (20%) as helpful. THeir expectations of help were in similar areas. About half of the caregivers were optimistic about the future well-being of their relatives. Optimistic and pessimistic caregivers differed in the educational level of the caregiver and the duration of the patient's illness. The results suggested that the families of schizophrenics need support of professionals and the establishment of networks focusing on the caregivers and their relationships with their ill relatives and with health care institutions.     

Mothers' and Fathers' Behaviors Toward Their 3- to 4-Month-Old Infants in Lower, Middle, and Upper Socioeconomic African American Families.

African American mothers' and fathers' availability, caregiving, and social behaviors toward their infants in and around their homes were examined. Twenty lower, 21 middle, and 21 upper socioeconomic families and their 3- to 4-month-old infants were observed for 4 3-hr blocks between 8:00 a.m. and 8:00 p.m. on 4 different weekdays. With increasing economic resources, children's exposure to multiple caregivers and nonresident fathers declined. Mothers were more available to infants than fathers were, regardless of socioeconomic status. Mothers fed infants more than fathers did, whereas fathers vocalized more and displayed more affection to infants than mothers did when they were examined in proportion to caregiver presence. Mothers and fathers interacted with male and female infants quite similarly, although, in the upper socioeconomic families, fathers of daughters were more available than fathers of sons. Fathers and mothers in the different socioeconomic groups held, displayed affection to, and soothed their infants differently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change in caregiver depression as a function of the Strong African American Families Program.

A randomized prevention trial contrasted families who participated in the Strong African American Families Program (SAAF), a preventive intervention for rural African American parents and their 11-year-olds, with control families. This article focuses on the program's effect on primary caregivers' depressive symptoms. Among the 167 caregivers with elevated scores on the Center for Epidemiologic Studies-Depression Scale, SAAF participation was associated with reduced depressive symptoms, enhanced parenting, and perceived improvements in youth behavior. Change in parenting (consistent discipline, youth monitoring, and open communication) but not change in youth intrapersonal competencies significantly mediated intervention effects on caregivers' depression. Results support the link between reduced depressive symptoms and stronger family relationships, particularly the importance of enhanced parenting efficacy in alleviating depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Environmental context of caregiving for severely mentally ill adults: an African American experience

Most people with severe mental illness depend on family to provide care. Although an increasing amount of research has examined caregiving, there is much to be discovered about the caregiving experience of African American families. This ethnographic study reports findings from 16 African American caregivers, presenting a picture of how they navigate through their environment to meet the needs of caregiving. Formal resource selection and use, and perceived barriers to and facilitators of care within an urban environment, are discussed. The impact of the African American community's perception of mental illness on caregiving and involvement in policy change also is discussed.     

Trauma, mental representation, and the organization of memory for mother-referent material

Research on the effects of child maltreatment and exposure to community violence suggests that children who experience these types of traumatic events may be at risk for alterations and biases in attention and memory similar to those that have been observed in adults suffering from traumatic stress reactions. Along these lines, attachment theory posits that representational models of relationships also may act as moderators of similar cognitive biases by selectively guiding children's attention to and processing of interpersonal stimuli. Building upon the trauma and attachment literatures, the present investigation examined the links among trauma, representational models of caregivers, and children's memory for mother-relevant information using an incidental recall task in a sample of maltreated (n = 71) and nonmaltreated (n = 102) children between the ages of 8 and 13 years. Results were consistent with the hypothesis that experiences of trauma and representational models of caregivers are associated with differences in the way children process and retrieve information about positive and negative mother attribute words. In particular, experiences of trauma initially were associated with increased insecurity in children's representational models. Moreover, the interaction of traumatic experience and security of mental representation predicted children's recall for mother attribute words: victimized children with insecure models recalled the highest proportion of negative mother stimuli. Trauma and mental representation did not have a consistent effect on structurally encoded aspects of recall. Results were discussed in terms of the ways in which children who have experienced trauma process information about their worlds. The importance of assessing functioning in multiple developmental domains when studying memory also was discussed.