Coping in Caregivers of Youth with Spinal Cord Injury

This study examined coping among caregivers of youth with spinal cord injuries (SCI). Using a cross-sectional survey study design, 164 caregivers completed a demographics questionnaire and the Brief COPE. Their children, youth with SCI ages 7–18, completed the Kidcope. T-tests were conducted to examine differences in caregiver coping by demographic and injury-related factors. Further, logistic regression models were evaluated to examine predictive relationships between caregiver coping and youth coping. Several demographic and injury-related factors were related to caregiver coping, including caregiver gender, race, and education, as well as youth gender, age at injury, and time since injury. In the logistic regressions, two caregiver coping strategies were related to youth coping: caregiver self-blame coping was related to youth self-criticism, and caregiver behavioral disengagement coping (giving up attempts to cope) was related to youth blaming others coping. The findings suggest that caregiver coping may play a role in the coping of their children, and should be considered when addressing coping among youth with SCI.     

Family Caregivers of Women with Physical Disabilities

Cross-sectional, correlational analyses of data from two separate studies were conducted to examine the correlates of adjustment among family caregivers of women with disabilities. Participants included 40 caregivers of women with spinal cord injuries in the first study and 53 caregivers of women with cerebral palsy, traumatic brain injury, and other neuromuscular disabilities in the second study. It was hypothesized that a negative problem-solving style would be associated with greater caregiver distress in both studies, and that caregiver adjustment would be associated with care recipient depression in the second study. As expected, results indicated that a higher negative orientation toward solving problems was associated with caregiver depression and lower well-being. However, in the second study, caregiver characteristics were not associated with care recipient depression. These data indicate that considerable variability exists in caregiver adjustment. Methodological limitations and the implications for research, service, and policy formation are! discussed.     

Caring for the Caregivers: An Investigation of Factors Related to Well-Being Among Parents Caring for a Child with Smith-Magenis Syndrome

Smith-Magenis syndrome (SMS) is a complex disorder characterized by numerous challenges, including intellectual disability, speech delay, decreased pain sensitivity, sleep disturbances, hyperactivity, mood instability, and self-injury. Caregivers must readily adapt to the ever-changing needs of the child. Due to these demands, caregivers may encounter difficulties maintaining their own level of well-being. Thus, a total of 112 primary caregivers (i.e., parents) of individuals diagnosed with SMS responded to online questionnaires to assess demographic and psychosocial factors, such as perceptions of child health vulnerability, benefit finding, sleep behaviors, anxiety and depression symptomatology, and caregiver satisfaction and self-efficacy, which may be related to caregiver well-being. Results show that, among mothers, caregiver well-being was directly related to perceived child health vulnerability, caregiver satisfaction, and benefit finding, and a significant moderating effect was observed for depression/anxiety counseling after beginning the caregiver role on the relationship between anxiety symptomatology and caregiver well-being. Results further suggest that maternal caregivers who report high levels of anxiety but do not seek counseling fair the worst in terms of well-being. Among fathers, lower depression symptoms and greater benefit finding were related to higher levels of caregiver well-being. These data show that many factors play roles in influencing coping and well-being among SMS caregivers. Investigating these variables and relationships may reveal additional resources and interventions to assist primary caregivers.     

Problem-Solving Appraisal and Psychological Adjustment of Persons with Chronic Low-Back Pain

To examine the role of self-appraised problem-solving ability in the prediction of psychosocial impairment, depression, hopelessness, average pain unpleasantness, and current pain ratings among persons with chronic low-back pain. A second purpose was to enhance theoretical understanding of the mechanisms by which problem-solving appraisal influences adjustment. Correlational and regression procedures were used to test the hypothesized relations procedures between elements of self-appraised problem-solving ability and each criterion variable. Seventy-eight persons enrolled in an inpatient multidisciplinary chronic pain management program. The psychosocial subscale of the Sickness Impact Profile, the Beck Depression Inventory, the Beck Hopelessness Scale, the McGill Pain Questionnaire, and Visual Analogue Scales of Pain Sensory Intensity and Affective Response were the main outcome measures. After first controlling demographic characteristics, elements of self-appraised problem-solving ability assessed by the Problem-Solving Inventory were significantly predictive of depression, hopelessness, psychosocial impairment, and average pain unpleasantness (accounting for 20, 26, 29, and 11% of the respective variance in these constructs). Results indicate complex relations among the elements of problem-solving appraisal, suggesting that the Approach–Avoidance link to psychological adjustment was mediated by Problem-Solving Confidence. Comprehensive problem-solving interventions may be beneficial to persons with chronic pain     

Communal Behaviors and Psychological Adjustment of Family Caregivers and Persons With Spinal Cord Injury

OBJECTIVE: Examined the influence of mutual communal behaviors on the adjustment reported by persons with spinal cord injury (SCI) and their family caregivers. Previous research has found that persons who have a history of mutually communal behaviors in relationships may react differently to relationship changes after an acquired physical disability than dyads with few communal behaviors. METHOD: Family caregivers and persons with SCI were administered measures of mutual communal behaviors, depression, and life satisfaction. Structural equation modeling was used to test the relations among caregivers' communal behaviors and care recipients' communal behaviors, depression, and life satisfaction. RESULTS: Caregiver and care recipient reports of communal behaviors were not significantly correlated. Significant paths indicated that care recipients' communal behavior scores were positively associated with their life satisfaction, and care recipients' depression was inversely associated with their life satisfaction. Caregivers' communal behavior scores were unrelated to their self-reported adjustment. CONCLUSIONS: Caregiver-care recipient dyads may differ in their perceptions of communal behaviors in their relationships. Although care recipient reports of communal behavior may be related to their life satisfaction, communal behaviors may not serve a similar function among caregivers of persons with SCI.     

Problem-solving training via videoconferencing for family caregivers of persons with spinal cord injuries: a randomized controlled trial

Objective

To examine the effectiveness of an individualized problem-solving intervention delivered in videoconferencing sessions with family caregivers of persons living with a spinal cord injury (SCI) and possible contagion effects on care recipients.

Design

Family caregivers were randomly assigned to an education-only control group or an intervention group in which participants received problem-solving training (PST) in monthly videoconference session for a year.

Participants

Sixty-one caregivers (54 women, 7 men) and their care recipients (40 men, 21 women) consented to participate.

Main outcome measures

The Social Problem-Solving Inventory-Revised was administered to caregivers. Caregivers and care recipients completed the Inventory to Diagnose Depression, the SF-36 and the Satisfaction with Life scale at pre-treatment, 6 months and 12 months.

Results

Twenty-eight caregivers discontinued the study and their follow-up data were unavailable at the final assessment. Older caregivers were more likely than younger caregivers to remain in the study. Intent-to-treat analyses projected a significant decrease in depression among caregivers receiving PST; efficacy analyses indicated this effect was pronounced at the 6th month assessment. ITT analyses and efficacy analyses revealed that care recipients of caregivers receiving PST reported gains in social functioning over time.

Conclusions

Community-based, telehealth interventions may benefit family caregivers and their care recipients, but the mechanisms of these effects are unclear. Attrition and sample issues should be considered in future studies with these populations.     

Family interaction and caregivers of Alzheimer's disease patients: correlates of depression.

Depression is ubiquitous in primary family caregivers of Alzheimer's Disease (AD) patients, but its relationship to the overall behavior patterns of these families has received little attention thus far. The focus of the exploratory study reported here was on one aspect of this issue — affective responses between caregiver and other family members as they relate to level of depressive symptoms in the primary caregivers. Family affective responses, especially negative responses, have proven of particular salience in studies of major psychiatric disorders. Would they be equally salient in a study of depressive symptoms in primary caregivers of Alzheimer's patients? Apparently so. Thirty caregivers and extended family members participated in problem-solving family interaction tasks that were videotaped, transcribed, and coded on affect. Two variables representing angry and sad responses of extended family members to the caregiver accounted for over 44% of the variance in caregiver depressive symptoms. The relevance of these findings for treatment approaches and future research efforts are discussed.     

Cognitive vulnerability to depression in never depressed subjects

The purpose of this study was to investigate whether dysfunctional cognitions could be measured in never-depressed individuals after a sad mood prime, and if these dysfunctional cognitions would predict future depression. Subjects were first screened for current or past depression. Never-depressed subjects were randomly assigned to a prime or no-prime condition and completed the Dysfunctional Attitudes Scale. After one month, subjects completed the Beck Depression Inventory. The mood induction was successful in producing a sad mood, but had no effect on accessibility of dysfunctional cognition. Dysfunctional cognitions did predict depressive symptoms one month later, for the women in the sample, but not the men. These results were actually stronger for the unprimed subjects. The results provide some support for the cognitive diathesis-stress model, and suggest that cognitive vulnerability to depression may exist prior to a clinically significant depressive episode. However, mood priming does not appear to be a useful strategy with never-depressed subjects.     

Self-disgust mediates the relationship between dysfunctional cognitions and depressive symptomatology

Disgust has been linked to several psychopathologies, although a role in depression has been questioned. However, it has recently been proposed that rather than general disgust sensitivity, disgust directed toward the self (self-disgust) may influence the development of depression, providing a causal link between dysfunctional cognitions and depressive symptomatology. This possibility was examined by developing a scale to measure self-disgust (the Self-Disgust Scale; SDS) and then using mediator analysis to determine if self-disgust was able to explain the relationship between dysfunctional cognitions (measured with the use of the Dysfunctional Attitudes Scale) and depressive symptomatology (measured with the use of the Beck Depression Inventory and the Depression, Anxiety and Stress Scale). The developed SDS was found to exhibit a high level of internal consistency, test-retest reliability, and concurrent validity. Principal-components analysis revealed two factors to underlie responses to SDS items: the 'Disgusting self,' concerned with enduring, context independent aspects of the self, and 'Disgusting ways,' concerned with behavior. Self-disgust was found to mediate the relationship between dysfunctional cognitions and depressive symptomatology, demonstrating for the first time that self-disgust plays a role in depression.     

Problem-solving training for family caregivers of women with disabilities: A randomized clinical trial

ObjectiveTo examine the effectiveness of an individualized problem-solving intervention provided to family caregivers of women living with severe disabilities.DesignFamily caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.ParticipantsFamily caregivers (64 women, 17 men) and their care recipients (81 women with various disabilities) consented to participate.Main outcome measuresCaregivers completed the Social Problem-Solving Inventory – Revised, the Center for Epidemiological Studies Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in three additional assessments throughout the year.ResultsMultilevel modeling was used to conduct intent-to-treat analyses of change trajectories for each outcome variable. Caregivers who received PST reported a significant linear decrease in depression over time; no effects were observed for caregiver health or life satisfaction. Caregivers who received PST also displayed an increase in constructive problem-solving styles over the year.ConclusionsPST may benefit community-residing family caregivers of women with disabilities, and it may be effectively provided in home-based sessions that include face-to-face visits and telephone sessions.     

Assessment of depression in patients with Alzheimer's disease: concordance among informants.

This study is an investigation of the concordance among different sources of information on ratings of depression in patients with Alzheimer's disease (AD). Informants were 75 outpatients with diagnosed AD (22 with major depressive disorder), their caregivers, and geriatric clinicians. Clinicians rated each patient on the Hamilton Rating Scale for Depression on the basis of (a) the patient's report, (b) the caregiver's report, and (c) the clinician's evaluation. Overall, patients perceived themselves as less depressed than did caregivers or clinicians; for nondepressed patients, caregivers reported patients less depressed than clinicians reported; for depressed patients, no significant differences were obtained between caregiver or clinician. Certain items were more discrepant among informants and significantly differentiated depressed from nondepressed AD patients. Level of patient dementia did not affect ratings. These findings support the need for comprehensive, accurate assessment of depression in AD patients.     

Anxiety and Depression in Patients with Amyotrophic Lateral Sclerosis and Their Caregivers

A large number of studies have investigated a variety of psychological aspects in people with Amyotrophic Lateral Sclerosis, but there is still considerable uncertainty concerning the actual morbidity, in particular for anxiety. We aim to evaluate depression levels and anxiety disposition in ALS patients and their caregivers, in comparison to healthy controls. We conducted a cross-sectional comparison between people with ALS, their caregivers and a non-clinical control group in order to evaluate anxiety and depression levels. 40 ALS patients, their caregivers and 40 healthy adult subjects completed the Beck Depression Inventory II (BDI-II) and the State-Trait Anxiety Inventory—Y2 scale (STAI). We compared overall and single item scores in order to find differences between the three groups. BDI-II scores were significantly different between groups. Depression scores were higher for patients than for healthy controls, in both somatic and psychological sub-scales. Caregivers presented higher levels of psychological depression in comparison with healthy controls, and lower scores of somatic depression in comparison to patients. No differences were found in trait anxiety levels comparing the three groups. ALS patients and their caregivers developed more depression related symptomatology than the non-clinical sample. However, susceptibility to anxiety for both patients and caregivers seemed to be at a normal level.     

Cognitive aspects of chronic depression

Previous research on chronic depression has focused on its link with other mood disorders and Axis II personality disorders. However, there are few data examining whether the cognitive perspective applies to this condition. In this cross-sectional study, 42 outpatients with chronic depression were compared with 27 outpatients with nonchronic major depressive disorder and 24 never psychiatrically ill controls on cognitive variables thought to be related to vulnerability to depression (e.g., dysfunctional attitudes, attributional style, a ruminative response style, and maladaptive core beliefs). Both depressed groups were more elevated than a never-ill comparison group. However, chronically depressed individuals were generally more elevated on measures of cognitive variables than those with major depressive disorders even after controlling for mood state and personality disorder symptoms.     

The Benefits and Limitations of a Behavioral Intervention for Caregivers of Dementia Patients: A Qualitative Study

This study used qualitative methods to understand dementia caregivers’ experience of personal and therapeutic factors contributing to outcome following REACH VA, a behavioral intervention designed to alleviate caregiver burden and depressive symptoms. Caregivers and their interventionists were queried about their experiences of the treatment in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. The following themes emerged reflecting aspects of the intervention caregivers and interventionists found helpful: self-care, shared goals, psychoeducation, and stress-management skills. Some caregivers and interventionists found the provision of problem-solving skills to be helpful and others did not. Finally, some caregivers and interventionists reported that interpersonal support/bearing witness, insight, emotional transformation, and the discussion of interpersonal process were useful when part of the intervention or, when not included, would have been helpful. While behavioral interventions tend to be highly structured, interventionists’ ability to work flexibly within the protocol and tailor it to the caregiver’s needs was related to positive treatment response. The beneficial aspects of this treatment represent multiple theoretical orientations highlighting the importance of transtheoretical models of therapeutic action.     

The Caregivers of Stroke Patients: An Investigation of Factors Associated with Depression

Caregivers of the elderly and infirm are often under more stress and report lower life satisfaction than matched groups of noncaregivers. Forty caregivers of stroke patients (usually a spouse) were interviewed an average of 9 months poststroke to determine the factors associated with poorer caregiver adjustment. Four classes of variables were expected to be related to depression in caregivers: level of functioning of the patient, caregiver perceptions of increased work and burden due to the stroke, the quality of the patient-caregiver relationship, and caregivers' interpretations of their situation. Background characteristics were also measured. As predicted, variables in each class were significantly related to depression. Multiple regression analysis showed three significant independent predictors of caregiver depression. Caregivers are more depressed if the patient is more physically impaired, if caregivers report disharmony in the family, and if they have lesser perceptions of hope Ways to apply these findings to the development of interventions to ameliorate caregiver depression are discussed.     

Self appraisal and behavioural activation in the prediction of hypomanic personality and depressive symptoms

Hypomanic personality is characterised by increased positive mood and energy but also more depression and greater risk of bipolar disorder. It is linked with positive self-appraisals for hypomania-relevant events and Behavioural Activation System (BAS) sensitivity such that hypomanic individuals tend preferentially towards goal-related activities. This study investigated relationships between positive and negative self-appraisal and BAS functioning and hypomanic personality and depressive symptoms. Participants (N = 231) completed measures of hypomanic personality, mood symptoms, dysfunctional attitudes, self-appraisal and behavioural activation/inhibition.Positive but not negative self-appraisal contributed to prediction of hypomanic personality as did higher BAS fun seeking and lower Behavioural Inhibition System (BIS) scores. Conversely, negative self-appraisal was positively predictive of current depressive mood, whilst BAS reward responsiveness was negatively predictive. There are specific relationships between positive and negative appraisal styles and hypomanic personality and depressive mood, respectively. The findings of complimentary contributions from appraisal style, BAS and BIS to prediction of hypomanic personality are relevant to developing a better understanding of risk factors for bipolar disorder.     

青少年孤独感与抑郁症状:反应风格的中介作用以及性别的调节作用

基于反应风格理论,本研究探索反应风格在青少年孤独感与抑郁症状之间的中介效应。使用孤独感量表、儿童反应风格量表以及儿童抑郁量表对 795 名 青少年进行调查。结果发现：（1）青少年孤独感能显著预测抑郁症状。（2）青少年孤独感能通过反刍、问题解决间接预测抑郁症状。（3）反应风格整体（比率分数）中介青少年孤独感与抑郁症状之间的关系。本研究结果显示,反应风格能够解释青少年孤独感与抑郁症状之间的内在机制。     

Managing antidepressants in primary care: physicians' treatment modifications

To examine antidepressant management practices in primary care, patients (N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI-II), the Patient Health Questionnaire-9 (PHQ-9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.     

青少年孤独感与抑郁症状:反应风格的中介作用以及性别的调节作用

基于反应风格理论,本研究探索反应风格在青少年孤独感与抑郁症状之间的中介效应。使用孤独感量表、儿童反应风格量表以及儿童抑郁量表对 795 名 青少年进行调查。结果发现：（1）青少年孤独感能显著预测抑郁症状。（2）青少年孤独感能通过反刍、问题解决间接预测抑郁症状。（3）反应风格整体（比率分数）中介青少年孤独感与抑郁症状之间的关系。本研究结果显示,反应风格能够解释青少年孤独感与抑郁症状之间的内在机制。