Chronic stress and depressive disorders in older adults

Current and lifetime rates of Diagnostic and Statistical Manual (rev. 3rd ed.) disorders were compared in 86 older adults caring for a spouse with a progressive dementia and 86 sociodemographically matched control subjects. Dementia caregivers were significantly more dysphoric than non-care givers. The frequencies of depressive disorders did not differ between groups in the years before care giving, and there were no group differences in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 30% of care givers experienced a depressive disorder (major depression, dysthymia, or depression not otherwise specified) versus 1% of their matched controls in the same time period. Only two care givers who met criteria during care giving had met criteria for a depressive disorder before care giving, and family history was not even weakly related to the identification of at-risk care givers. In contrast to these group differences in depressive disorders, there were no significant differences in other Axis I disorders either before or during care giving. Thus, the chronic strains of care giving appear to be linked to the onset of depressive disorders in older adults with no prior evidence of vulnerability.     

Toward a social ecology of the home-care household

I examined the relation between household parameters of size, composition, and temporal variability and indicators of care-giver and elder well-being. Two discrete groups of 20 care-giver-elder pairs were included in the study: (a) a group in which elders were moderately to severely cognitively impaired, but physically well, and (b) a group in which elders were moderately to severely physically disabled, but cognitively unimpaired. Care givers and elders were interviewed and assessed in their homes, and the care giver completed a 3-day log of home-care activities. Results indicated that care-giver and elder well-being are related to opposite values of the same household parameters in the two groups. The study demonstrates the utility of a social-ecological framework for research on home care, and suggests that the degree of fit of any particular household arrangement is relative to the competence-disability profile of the elder in care.     

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.     

Interventions with care givers of dementia patients: comparison of two approaches

We compared the effect of two approaches, family counseling and support groups, for relieving the stress and burden experienced by care givers of dementia patients. Both treatments are designed to implement features of a stress-management model that have been identified in prior research with this population: providing information about the patient's disease and its effects on behavior, teaching behavioral problem solving for managing difficult behavior, and identifying potential support for care givers. Subjects were primary care givers of dementia patients living in the community; they included husbands, wives, daughters, and other relatives. Although subjects in the treatment groups made significant gains over time, they did not differ from wait-list subjects who showed similar improvements. One-year follow-up interviews indicated that gains made during the treatment period were maintained.     

The influence of emotional awareness and expressiveness on care-giving burden and health complaints in women and men

This study was designed to investigate the role of emotional awareness and expressiveness as influences on the experience of burden and impaired health for women and men maintaining a spouse or relative at home who had been diagnosed as having dementia. One hundred and thirty-one Caucasian care givers, 41 males and 90 females, participated in the study. Multivariate analysis of variance indicated that women scored higher than men on measures of burden, health complaints, and awareness of others' emotions. Regression analysis indicated that self-awareness of emotions interacted with care-giver gender to decrease health complaints for female care givers but increased health complaints for male care givers. Self-awareness of emotions also increased feelings of burden for male care givers in general and for female care givers experiencing low levels of burden. Awareness of others' emotions tended to reduce feelings of burden. Emotional expressiveness did not influence burden or health complaint scores.This research was funded by grants from the Health Research Funds of Quebec, the Quebec Council for Social Research, and the Montreal Alzheimer Society. The authors would like to express their gratitude to Valerie Takeda, Charlene Stamegna, and Helene Fyfe for their work on the project, and to the families, patients, and staff of the various referral agencies for their cooperation with the study.To whom reprint requests should be addressed at Centre for Research in Human Development, Concordia University, 1455 de Maisonneuve Boulevard West, Montreal, Quebec, Canada, H3G 1M8.     

Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.     

Children's Sensitivity to Ulterior Motives When Evaluating Prosocial Behavior

Reasoning about ulterior motives was investigated among children ages 6–10 years (total N = 119). In each of two studies, participants were told about children who offered gifts to peers who needed help. Each giver chose to present a gift in either a public setting, which is consistent with having an ulterior motive to enhance one's reputation, or in a private setting, which is not consistent with having an ulterior motive. In each study, the 6‐ to 7‐year olds showed no evidence of understanding that the public givers might have ulterior motives, but the 8‐ to 10‐year olds rated the private givers more favorably. In 3. , the older children were more likely than the younger children to refer to impression management when explaining their judgments of the givers. The younger children who mentioned impression management did so to justify a preference for public givers (e.g., by explaining that public givers are nicer because more of their peers will know that they are nice). Results from 4. suggest that developmental change in children's reasoning about intentions and social outcomes contributes to their understanding of ulterior motives.     

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

OBJECTIVE: To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. DESIGN: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. MAIN OUTCOME MEASURES: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. RESULTS: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). CONCLUSION: The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population.     

Longitudinal analysis of midlife generativity, intergenerational roles, and caregiving

Items from the California Adult Q-Sort (CAQ) were used to assess psychosocial generativity (E. H. Erikson, 1950) in a sample of educated women at midlife. CAQ scores measured at age 43 demonstrated convergent validity with an inventory measure of generativity assessed at age 53. According to other longitudinal analyses, women who attained a generative stance at age 43 reported greater investment 10 years later in intergenerational roles (e.g., daughter, mother) but not nonintergenerational ones (e.g., friend, sister). Generative women also reported less subjective burden in caring for aging parents and more knowledge about community elder care programs. Further evidence suggests that participants felt embedded in a reciprocal caregiving network in which they themselves were the recipients of care.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

Gender roles and care giving to the elderly: An empirical study

The purpose of this research was to examine care giving to the elderly from a gender role perspective. Data were collected from a randomized sample of Québec care givers (n=294) who provide various levels of care giving to people with different kinds of impairments. The results indicate that although women provide more care than men, both experience an equivalent burden. Familial obligations (Presence of a Spouse × Presence of Children) affect men and women care givers differently. An intersex generation effect is evident with regard to professional burden: husband care givers report a greater burden than wives, whereas daughters and sons report the same level. The findings suggest that men have more difficulty assuming responsibilities associated with multiple roles, whereas women have adopted new roles in addition to the traditionally ascribed care-giving role.The research reported in this paper is part of a study funded by the Conseil québécois de la recherche sociale, the Social Sciences and Humanities Research Council of Canada, and the Ministère de la Santé et des Services sociaux. The authors wish to thank Jocelyne Boivin for her helpful work with the documentation and Lottie White for her help with the English version of this paper, as well as the anonymous reviewers of whose judicious comments were greatly appreciated.     

Evaluation of a cognitive behavioral group intervention program for spouses of stroke patients

This study investigated the effectiveness of a cognitive behavioral group program for spouses of stroke patients. The program consists of 15 bi-monthly 112h sessions. The goal of the intervention is to reduce the prevalence of mental disorders and burnout among care-giving spouses of stroke patients. The sample (stroke patients and their spouses) consisted of one intervention group (n=38 couples) and two different control conditions, those receiving informational support (n=35 couples) and those receiving standard care (n=51 couples). We used the following instruments to measure spouses' mental health and quality of life: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), WHO Quality of Life Questionnaire. Measurements were taken before the intervention (Time 1), directly following the intervention (Time 2) and 6 months after Time 2 (Time 3). Several regression analyses allowed for examination of the short-term and long-term effects of the intervention. The spouses' participation in the intervention program was associated with significant short-term changes in care-giving spouses' quality of life and with long-term changes in their quality of life and depression. The presented multi-component intervention appears to have an immediate effect on care-giving spouses' quality of life. In contrast, the intervention-related changes in more resistant mental-health-related variables did not appear until after a latent stage in the later post-intervention phase.     

Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age

BackgroundTo determine the effect of developmental care on neurodevelopmental outcome in formerly preterm infants at a corrected age of 2 years.MethodsA prospective phase-lag study was performed at an Austrian neonatal intensive care unit (NICU). From January 2003 to December 2005 (study period of conventional care) and January 2007 to December 2009 (study period of developmental care), we enrolled all infants born in Tyrol at less than 32 weeks of gestation. During this period a total of 261 of 359 preterm infants (participation rate 72.7%) completed the follow-up visit at 2 years of age; there were 124 children in the conventional and 137 in the developmental care group. The association between developmental care and delayed motor or mental development (Bayley Scales of Infant Development II; psychomotor or mental developmental index <85) was analyzed by means of logistic regression analysis at a corrected age of 24 months.ResultsChildren in the developmental care group showed less psychomotor delay than did those in the control group (developmental care group: 16.1%, conventional care group 27.4%; adjusted odds ratio 0.37 [95% confidence interval: 0.19–0.74], P = 0.005). Not smoking in pregnancy and higher gestational age were also significant predictors for a better psychomotor outcome at 2 years of age. Regarding cognitive outcome, no significant difference was observed between these two groups.ConclusionOur data implicate that developmental care may result in an improved 2-year psychomotor outcome in formerly preterm infants.     

Prevalence and predictors of expulsion in home-based child care settings

This study explored the prevalence of expulsion in home-based child care (HBCC) settings using a nationally representative sample of HBCC providers from the National Survey of Early Care and Education. In addition to prevalence, enrollment and provider characteristics that predicted expulsion were examined. Although there is increasing awareness of the prevalence of early childhood suspension and expulsion in early care and education settings and the negative effects it has on children's development, few studies have included or focused on HBCC, where many children receive care. This study highlights that many home-based providers, especially listed providers, report that they expelled at least one child within the last year. Significant predictors of expulsion emerged, including enrollment characteristics such as caring for children with disabilities, enrolling more children, and caring for children unrelated to the provider. Provider characteristics, including years of experience, provider education, and provider age, also predicted provider report of expulsion. These results provide insight as to possible strategies that may be effective in reducing expulsion rates in this caregiving context.     

The Early Risers Preventive Intervention: Testing for Six-year Outcomes and Mediational Processes

We examined effects of the Early Risers “Skills for Success” early-age-targeted prevention program on serious conduct problems following 5 years of continuous intervention and one year of follow-up. We also examined if intervention effects on proximally-targeted variables found after 3 years mediated intervention effects on conduct problems found after 6 years. Participants included 151 at-risk children (106 males and 45 females) followed from first through sixth-grade, from 23 semi-rural schools in Minnesota. After 6 years, program children showed fewer oppositional defiant disorder (ODD) symptoms than control children. Program children did not significantly differ from controls on number of conduct disorder (CD) symptoms, DSM-IV diagnoses of ODD and CD, or drug use involvement. Results of the mediation analysis indicated that fewer ODD symptoms among program youth after 6 years were partially mediated by social skills and effective discipline. The study provides support for the early-starter model of conduct problems development that provides the framework for the Early Risers intervention. The study’s implications for prevention and limitations are discussed.     

Occult participation: its impact on adolescent development

This study investigated the relationship between occult participation, substance abuse, and level of self-esteem in adolescents. Data were collected from 50 adolescents who ranged in age from 12 to 19 years and who spoke English as their primary language. The combined group of adolescents consisted of 25 clinical and 25 nonclinical youth. Participants completed a three-part questionnaire package which included Rosenberg's Self-Esteem Scale, the Adolescent Magic Questionnaire, and the Drug and Alcohol Assessment Scale. Results indicated that adolescent substance abuse and occult participation were significantly related. High and low occult participation groups were determined, and significant differences were found between the high versus low occult groups when compared on the primary variables of self-esteem and substance abuse. Significant differences were also noted when comparing the high versus low occult groups with various psychosocial developmental variables. Included is a discussion of the impact of occult participation on the psychosocial elements of adolescent self-esteem, self-concept, tolerance for deviance, and religious involvement.     

Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial

This study was a randomised control trial with a waiting control group. It was designed to evaluate the effectiveness of a 6-month, group-based diabetes prevention programme, The Healthy Living Course and assess whether participation in the programme led to changes in modifiable risk factors for type 2 diabetes among an already at-risk pre-diabetic population. Individuals designated at risk for diabetes by their general practitioners (GPs) were screened using an Oral Glucose Tolerance Test. Volunteers (N = 307) with pre-diabetes were assigned to an intervention or wait-control group in the ratio of approximately 2 : 1. The sample was pre-tested on biochemical, anthropometric and self-report behavioural, cognitive and mood variables and post-tested either at the end of the educational/support-based lifestyle programme or the end of the wait period. The intervention group significantly improved their diabetes knowledge, motivation to change, positive affect, healthy eating and activity levels and showed significantly greater reductions in weight, body mass index, waist circumference, diastolic blood pressure and fasting plasma glucose in comparison with controls. The intervention group also changed their diagnostic status from pre-diabetes to non-diabetes at a greater rate than the wait group (43% vs. 26%) who received standard care from their GPs.     

Happy Being Me in the UK: A controlled evaluation of a school-based body image intervention with pre-adolescent children

This study evaluated an adapted version of ‘Happy Being Me’, a school-based body image intervention, with girls and boys aged 10–11 years. Forty-three children participated in a three-week intervention, and 45 children formed a control group. Both groups completed measures of body satisfaction, risk factors for negative body image, eating behaviors, self-esteem, and intervention topic knowledge, at baseline, post-intervention, and 3-month follow-up. For girls, participation in the intervention resulted in significant improvements in body satisfaction, appearance-related conversations, appearance comparisons, eating behaviors and intervention topic knowledge at post-intervention, although only the change in body satisfaction was maintained. There was also a significant decrease in internalization of cultural appearance ideals from baseline to follow-up. For boys, participation in the intervention resulted in significant improvements in internalization and appearance comparisons at post-intervention; however, neither of these changes were sustained at follow-up. There were no improvements in the control group over time.     

Parent education home visitation program: adolescent and nonadolescent mother comparison after six months of intervention

This study examined the effect of an intervention over a 6-month period to improve first time mothers knowledge about parenting and safety in the home. The sample included 61 mothers who completed a baseline and follow-up survey. Mothers were first time adolescent (38) and nonadolescent (22) mothers recruited from rural county health departments for participation in a voluntary home visitation intervention program. Four hypotheses were tested that associated home visitation with greater parenting skill and child development knowledge and safety. Adolescent mothers were expected to make greater gains but to lag behind nonadolescent mothers in child development knowledge, parenting skills knowledge, household safety, and use of community resources. The sample included 32% with a high school degree and 12% African American. 83% were in school. 85% lived at or below the US federal poverty level. Parent Educators provided weekly in-home education based on a manual and individualized curriculum. Parenting skills knowledge was measured by the Adolescent-Adult Parenting Inventory (Bavolek, 1984). Home safety was measured by Culp's Home Safety Checklist. Educators recorded use of 13 community services. Analysis of variance revealed that infant knowledge increased to the same level among all mothers regardless of adolescents' lesser knowledge at baseline. Parenting skill knowledge of child roles increased for both ages, but older mothers scored higher. Parenting skill knowledge of alternatives to corporal punishment increased similarly for both ages. No age or interactive effects were related to improvement in safety or use of community services.     

非亲密关系中的礼物赠予：礼物偏好的不一致

礼物赠予是由于不同的事件和动机,在不同的关系背景中赠予者和接收者的物质和非物质产品交换的过程,具有重要的个人和社会意义。但是诸多研究表明,非亲密关系（非恋爱关系和夫妻关系）的赠予者和接收者在礼物类型偏好、礼物价值偏好及双方关系结果的知觉等方面均存在不一致性。可以从赠予者-接收者的认知差异、动机差异及社会规范的约束差异来解释这一现象,并提出了可供借鉴的礼物赠予策略。未来研究还可以从礼物成败的线索反馈、礼物选择的决策过程、采取更符合现实的研究方法及认知神经科学技术等方面对礼物偏好现象进行深入探究。