Family Caregivers of Stroke Survivors: Characteristics of Caregivers at Risk for Depression.

Objective: To examine characteristics that best predict family caregivers of stroke survivors at risk for depression. Survivor and caregiver demographic variables and caregiver general health, problem-solving skills, social support, satisfaction with rehabilitation health care services, preparedness, and burden were examined. Design: A correlational design. Participants: Seventy-four family caregivers of individuals receiving inpatient stroke rehabilitation were interviewed 1-2 days prior to their relative's discharge. Main Outcome Measure: The Center for Epidemiologic Studies Depression Scale (L. S. Radloff. 1977). Results: Caregivers at risk for depression had a negative orientation toward solving problems, a lack of caregiver preparedness, and impaired social functioning secondary to their own health. Conclusions: Rehabilitation psychologists should be aware that these variables are important in predicting family caregivers of stroke survivors at risk for depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Family caregiver social problem-solving abilities and adjustment during the inital year of the caregiving role.

The authors examined the relation of social problem-solving abilities to trajectories of adjustment of family caregivers in the initial year of their caregiving role. Persons who recently assumed the caregiver role for a family member with a recent-onset spinal cord injury completed measures of problem solving, depression, anxiety, and health during the inpatient rehabilitation program and at 3 other times throughout the year. Hierarchical linear modeling showed that negative problem orientation explained significant variation in the rates of change in caregiver depressive behavior, anxiety, and health complaints. Caregivers with a greater negative orientation were at risk to develop psychological and health problems at a significantly higher rate over the year. Implications for psychological interventions and health policy concerning the needs of family caregivers and their care recipients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Problem-Solving Abilities and Psychological Adjustment of Persons in Low Vision Rehabilitation.

Objective: Tested the relations of social problem-solving abilities to distress, depression, and well-being and impairment reported by persons participating in a low vision rehabilitation program. Study Design: Correlational and multiple regression analyses. Setting: Outpatient low vision rehabilitation clinic. Participants: 25 men (M = 73.88 years old, SD = 11.94 years) and 29 women (M = 68.79 years old, SD = 17.25 years) participating in a comprehensive admitting examination. Main Outcome Measures: Emotional distress specific to the condition, depressive behavior, satisfaction with life, and functional ability. Results: A negative problem orientation significantly predicted depression and emotional distress; rational problem-solving skills predicted life satisfaction. Conclusions: A negative problem orientation toward problem solving predicts poor emotional adjustment reported by persons with low vision, and proactive problem-solving skills appear to promote optimal adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem-solving deficits and hopelessness, depression, and suicidal risk in college students and psychiatric inpatients

The Social Problem-Solving Inventory-Revised was used to examine the relations between problem-solving abilities and hopelessness, depression, and suicidal risk in three different samples: undergraduate college students, general psychiatric inpatients, and suicidal psychiatric inpatients. A similar pattern of results was found in both college students and psychiatric patients: a negative problem orientation was most highly correlated with all three criterion variables, followed by either a positive problem orientation or an avoidance problem-solving style. Rational problem-solving skills emerged as an important predictor variable in the suicidal psychiatric sample. Support was found for a prediction model of suicidal risk that includes problem-solving deficits and hopelessness, with partial support being found for including depression in the model as well.     

Family caregivers of persons with spinal cord injury: Predicting caregivers at risk for probable depression.

Objective: To determine the percentage of family caregivers of persons with spinal cord injury (SCI) with probable depression and to test the hypothesis that dysfunctional problem-solving abilities would be significantly predictive of risk status after taking into account important demographic characteristics and caregiver health. Design: Correlational and logistic regression analyses of data collected in a cross-sectional design. Participants: Eighteen men and 103 women caregivers (mean age of caregivers = 45.66 years, SD = 12.88) of individuals with SCI. Main Outcome Measure: The Inventory to Diagnose Depression. Results: Nineteen caregivers (15.7%) met criteria on the Inventory to Diagnose Depression for a major depressive disorder. A dysfunctional problem-solving style was significantly predictive of caregiver depression, regardless of the severity of physical impairment of the care recipient or the physical health of the caregiver and caregiver demographic variables. Conclusions: The percentage of caregivers with probable depressive disorder may parallel that observed among persons with SCI, using a more conservative self-report measure designed to assess symptoms associated with a depressive syndrome. Family caregivers with a dysfunctional problem-solving style and assisting individuals with more severe injuries may have probable depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life stress, current problems, problem solving, and depressive symptoms: An integrative model.

Hypothesized that a strong association would exist between level of current problems and depressive symptoms in a direct fashion (i.e., the more problems an S had, the higher the likelihood that he/she would experience depressive symptomatology). The model was tested by administering the Beck Depression Inventory, the Life Experiences Survey, and measures of problem-solving behavior and attitudes and current problems to 205 undergraduates. Results from a path analysis generally support the model. Negative life stress was associated with depressive symptoms in both a direct and an indirect manner via level of current problems. Current problems had a significant direct impact on depressive symptoms and an indirect influence via problem solving. The model accounted for 42% of the variance associated with the prediction of depressive symptoms. It is suggested, however, that because the measures were self-report, social desirability factors cannot be ruled out. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

World understanding and well-being in a Hong Kong Chinese marital context

According to social constructionist theory, an individual's understanding of the world serves to maintain social order and well-being. In this study, this assertion was tested by investigating a mediating process through the contribution of world understanding to problem-solving confidence. Causal modeling with data from 138 married couples in Hong Kong supported this mediating process: World understanding was positively related to problem-solving confidence, which in turn was positively related to well-being, defined by life satisfaction and depression. In addition, social support and exposure to information were possible determinants of one's world understanding. Social support also contributed to problem-solving confidence and well-being. The causal model was applicable to both husbands and wives.     

Social support, problem solving, and the longitudinal course of newlywed marriage.

Married couples (N = 172) were observed as newlyweds and observed again 1 year later while engaging in 2 problem-solving and 2 personal support discussions. Microanalytic coding of these conversations was used to examine associations between problem-solving and social support behaviors for 1 year and their relative contributions to 10-year trajectories of self-reported relationship satisfaction and dissolution. Results demonstrated that initially lower levels of positive support behaviors and higher levels of negative support behaviors predicted 1-year increases in negative emotion displayed during problem-solving conversations. Emotions coded from the initial problem-solving conversations did not predict 1-year changes in social support behaviors. Controlling for emotions displayed during problem-solving interactions eliminated or reduced associations between initial social support behaviors and (a) later levels of satisfaction and (b) relationship dissolution. These findings corroborate models that prioritize empathy, validation, and caring as key elements in the development of intimacy (e.g., Reis & Shaver, 1988) and suggest that deficits in these domains foreshadow deterioration in problem solving and conflict management. Implications for integrating support and problem solving in models of relationship change are outlined, as are implications for incorporating social support in education programs for developing relationships. (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)     

Family cohesion, family adaptability, social support, and adolescent depressive symptoms in outpatient clinic families.

The relationships among adolescent depressive symptoms and self-reported family cohesion, adaptability, satisfaction with family functioning, family structure, and social support received from family and friends were investigated in a sample of 93 families attending family therapy at an outpatient clinic. Results were in keeping with previous studies of nonclinical samples, in that family cohesion and family social support were inversely related to depression. In contrast to nonclinical samples, family characteristics were more strongly associated with depression among boys than among girls, and social support from friends did not act as a buffer against depression. The strongest predictor of depressive symptoms was adolescents' levels of satisfaction with the cohesiveness and adaptability in their families, suggesting the importance of subjective cognitive appraisal in the link between family functioning and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, coping, and perceptions of child behavior in parents of preschoolers with cerebral palsy.

This study explored the relationships among stress, coping, and perceptions of child behavior in parents of preschoolers with cerebral palsy. Parents (62 mothers and 22 fathers) completed measures of parenting stress, depression, parenting satisfaction, social support, and child behavior problems. For mothers, only parenting self-efficacy was a significant predictor of maternal perceptions of child adjustment. High levels of maternal social support satisfaction were related to low levels of depression and parenting stress and to high levels of parenting satisfaction. High levels of depression were related to high levels of parenting stress and low levels of parenting satisfaction. For fathers, high levels of distress were related to low levels of parenting satisfaction and high levels of child maladjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problem-solving appraisal and the effects of social support among college students and persons with physical disabilities.

Tested the hypothesis that the appraisal of one's own ability to solve problems would moderate the effects of social support among 2 distinct samples. In the 1st study, college students completed measures of depression, problem-solving appraisal, and social support. Although both predictor variables were significantly associated with depression, the 2 did not significantly interact in the prediction of depression. In the 2nd study, persons who had sustained severe physical disabilities completed the same independent measures and questionnaires of depression and psychosocial impairment. Problem-solving appraisal and social support were predictive of both criterion variables. The 2 independent variables significantly interacted in the prediction of psychosocial functioning. Results are discussed as they pertain to the effects of social support, with particular focus on persons who may have a higher frequency of contact with institutionalized and formal sources of support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study

OBJECTIVE: Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients. METHOD: A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age. RESULTS: Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age. CONCLUSIONS: Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.     

Social skill deficit interventions for substance abusers.

Because substance abusers demonstrate significant cognitive and behavioral skill deficits, 2 social competency models of habilitation are proposed to increase abusers' life management skills and coping abilities. Social problem-solving training programs focus on generic cognitive problem-solving deficits, while social skills training programs address specific behavioral deficiencies. Social problem solving is a cognitive-behavioral approach that teaches people how to think, emphasizing thinking that is alternative, consequential, means-end, perspective taking, and social-causal. Social skills training may be taught using modeling, role playing, rehearsal, coaching, and feedback. Both approaches have been successful for increasing social adjustment and diminishing psychopathology among high-risk substance abusers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and social problem solving.

20 depressed patients with major depressive disorder, 20 nondepressed matched control Ss, and 17 patients with anxiety disorders were compared in different measures of social problem solving. Problem solving was assessed with the Means-Ends Problem-Solving Test (Study 1), the solution of personal problems, and a problem-solving questionnaire (Study 2). Results showed that, as predicted, depressed Ss suffered from a deficit in problem solving in all 3 measures. The majority of these deficits were also displayed by the clinical control group rather than being specific to a diagnosis of depression. However, depressed Ss produced less effective solutions than did normal and clinical control Ss. The results suggest that depressed and anxious patients may have difficulties at different stages of the problem-solving process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy.

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Method: Participants with chronic depression (n = 491) received cognitive-behavioral analysis system of psychotherapy (CBASP; McCullough, 2000), which emphasizes interpersonal problem solving, plus medication; brief supportive psychotherapy (BSP) plus medication; or medication alone for 12 weeks. Results: CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Conclusions: It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social control, health risk taking, and psychological distress among the elderly.

Most research on older adults' social networks has focused on the support-providing function of social relationships. Little gerontological research has addressed social control, or the role of social bonds in regulating deviant or risky behavior. Drawing on sociological theory, this study examined the hypothesis that social control discourages risky health practices while provoking psychological distress. Structured interviews conducted with 162 community-residing older adults assessed social control (direct attempts by others to influence participants' health practices and the existence of significant role obligations to others), health risk taking (medication misuse, alcohol consumption, cigarette smoking, and the overall level of unsound health practices), psychological functioning (depression, loneliness, and self-esteem), and interpersonal satisfaction (satisfaction with friends and family members). Analyses revealed little support for the hypothesis. Social control was only weakly related to participants' health practices and, contrary to expectation, was generally related to less psychological distress and to greater interpersonal satisfaction. Implications for social control theory and for further research are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social context, coping strategies, and depressive symptoms: an expanded model with cardiac patients

This research broadened and refined a resources model of coping to encompass negative as well as positive aspects of social relationships and examined this expanded conceptualization in a 4-year prospective model with 183 cardiac patients (140 men and 43 women). Social support and social stressors in the family and extrafamily domains contributed significantly to a common social context latent construct. In addition, this conceptualization of social context was significantly related to depressive symptoms 4 years later. Especially important conceptually, coping strategies functioned as a mechanism through which both social support and social stressors related to subsequent depressive symptoms. Moreover, positive and negative aspects of social relationships made essentially unique contributions in predicting subsequent coping efforts.     

Recurrent syndromal depression in caregivers

The authors investigated recurrent syndromal depression in 103 caregivers using a structured clinical interview. Participants who cared for a family member with a progressive dementia were assessed annually for 3 years and divided into 3 groups: never depressed (47%), episodically depressed (33%), and chronically depressed (20%). Compared with the other 2 groups, the chronically depressed caregivers reported greater levels of stress, upsetting social support, depressive symptomatology, along with higher frequencies of negative life events and more negative reactions to disruptive patient behavior. Precaregiving depression predicted depression during caregiving but did not sufficiently explain recurrent depression in caregivers. Lower levels of positive social support and higher number of life events were related to chronically elevated depressive symptoms and stress.     

Negative life events, marital interaction, and the longitudinal course of newlywed marriage

Life events and problem-solving behavior were examined relative to longitudinal change in depressive symptoms and marital adjustment over 18 months in 60 newlywed couples. Spouses' problem-solving behavior moderated, but did not mediate, the relationship between life events and adjustment. Some behaviors contributed to spouses being more resilient to life events, and some behaviors made spouses more vulnerable. In particular, wives' anger facilitated their adjustment to major and interpersonal events such that their depressive symptoms declined and their marital satisfaction increased. Husbands' humor contributed to marital instability when spouses reported more major events. The results further specify the vulnerability-stress-adaptation model of marriage and expand on the role of behavior in marriage.