Caregiving in the close relationships of cardiac patients: Exchange,power, and attributional perspectives on caregiver resentment

Individuals with a cardiac condition and their spousal caregivers were recruited from cardiac rehabilitation centers and interviewed separately. Based on exchange theory, it was expected that greater caregiver resentment would be associated with feeling underbenefited in the relationship and with an orientation to relationships that did not focus on the needs of the partner (communal), but did focus on “tit-for-tat” reciprocity (exchange). It was also expected that those caregivers who were more likely to get their needs satisfied in the relationship before the cardiac incident would be more resentful at giving care. Finally, based on attributional theory, it was predicted that caregivers who thought that their spouses were not taking responsibility for improving their health would be more resentful. As predicted, more resentful caregivers were those who felt underbenefited, were more exchange oriented, and judged that their partners were not working toward improving their health. In addition, only those with a low communal orientation toward their spouse showed a relationship between feeling underbenefited and resentment. The needs centrality prediction was not supported. The findings illustrate the utility of applying theories developed in the close relationship area to the understanding of caregiving with chronically ill populations.     

Narrating the negative consequences of elder care and familial obligation in Atlantic Canada

At a time when renewed emphasis is being placed on the role of the family in providing care for elderly people, shifts in family structures and the demographic profile of societies such as Atlantic Canada are impacting on community structures foundational to familial caregiving practices. Research shows that family members who attempt to provide familial care without adequate support risk negative health and interpersonal consequences. Hence many find it necessary to reflect upon their familial obligations. This article investigates the storytelling processes through which caregivers, aged between 45 and 55 years (N = 26), make sense of their efforts to provide care. We explore the ways in which participants in four focus groups and 12 interviews refer to negative consequences of caring in order to navigate dilemmas arising from their enactment of familial obligations in the absence of adequate support. Copyright © 2003 John Wiley & Sons, Ltd.     

Perceived cultural attitudes toward homosexuality and their effects on Iranian and American sexual minorities

This study examined the relationship between three mental health constructs and perceived cultural attitudes toward homosexuality among lesbian, gay, and bisexual individuals. Specifically, differences in perceived cultural attitudes and depression, self-esteem, and perceived stress between 49 Iranians and 47 Americans were compared. It was hypothesized that (a) perceived cultural attitudes toward homosexuality would be more negative among Iranians than Americans; (b) perceived cultural attitudes would be related to depression, self-esteem, and perceived stress; and (c) that Iranian participants' scores on the depression, self-esteem, and perceived stress measures would reflect poorer mental health than that of their American counterparts. Results indicated more negative perceptions of cultural attitudes toward homosexuality among Iranians. Contrary to prediction, however, no difference was found in levels of depression, self-esteem, and perceived stress among American and Iranian participants. Findings are discussed in terms of cultural and familial differences with regard to sexual orientation disclosure.     

Substance abusers: role of personal and professional role traits in caregivers' causal attributions

Substance abuse continues to be a major health problem compounded by caregivers' negative attitudes toward these patients. We investigated attributions 55 primary care physicians and 315 senior medical students make toward substance abusers. Half of both groups expressed negative causal attributions, with women slightly less negative than men. Mental models based on LISREL regression coefficients showed that higher negative attributions by both physicians and students were related to their increased authoritarianism and depressed mood. Medical students choosing careers in primary care specialties, including psychiatry, expressed a less negative attributional style toward substance abusers than those students entering nonprimary careers. Health professional educators may find that using attribution theory to redefine successful outcomes in management of substance abuse can result in better attitudes for caregivers.     

The relationship between attitude,assertiveness and condom use

The Australian study investigated condom-specific assertiveness and condom use as a means of prevention infection from sexually transmitted diseases. 211 men participated including 83 homosexual men (aged 19-62 years) and 128 heterosexual men (aged 17-49) who completed a questionnaire that comprised demographic details such as age, monogamy, and sexual activity as well as attitudinal and assertiveness measures. General assertiveness was measured by the Rathus Assertiveness Schedule (RAS) which had been widely used across a wide range of social situations. Assertiveness relating specifically to situations involving condoms was measured by the Condom Assertiveness Scale (CAS). Intention to use condoms was positively related to favorable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. For both groups, the condom-specific measure of assertiveness was positively correlated with attitudes toward condoms. Condom-specific assertiveness was positively related to general social assertiveness as measured by the Rathus Assertiveness Schedule for the homosexual, but not for the heterosexual men. The negative relationship between general assertiveness and attitude to condoms among the heterosexual men implies that the risk reducing behavior of condom use did not seem to accord with the perceptions of masculinity and social assertiveness among heterosexual men. Thus, female partners of such heterosexual men exhibiting negative attitudes toward condom use combined with assertiveness would have to overcome resistance to insist on the use of condoms. Recently some advertising campaigns have been directed at women. The promotion of condom use among heterosexual men has to deal with the perceptions of condom use as unmasculine behavior.     

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.     

Interaction dynamics of cooperative learning groups in Trinidad's secondary schools.

This study investigated adolescent students' changes in choice of workmates before and after cooperative learning in order to identify relationships between these changes and existing friendship and clique patterns, socioeconomic status, race, and achievement perceptions. Also investigated were students' perceptions of specific preferred or nonpreferred others. From these, four cases were identified and are described. The pattern that emerged was that while actual choices changed, the principle upon which these choices were made remained the same. Therefore males continued to select others using achievement as their criterion, while females used socioeconomic status. Choices based on same race decreased, and the number of friendship groups increased. Additionally, in spite of a general lessening of negative attitudes toward others, specific students remained very popular or very unpopular for reasons that seemed context based. In all cases, however, the unpopular students did not perceive themselves as of equal status to others in the group, a situation that may well affect the interaction dynamics of the group.     

Suicide survivors' perceptions of the treating clinician

Seventy-one suicide survivors were surveyed about their perceptions of the clinicians who were treating their loved one at the time of death. Survivors provided information regarding their perceptions and attitudes toward clinician behaviors before and after the suicide and their perceptions of helpful and troubling aspects of clinician behaviors. Results indicated that survivors share a number of common opinions regarding the mental health care providers treating their loved ones. Several differences existed between survivors who consider lawsuits against mental health care providers versus those who do not. The implications of these findings for clinical practice, legal issues, surviving suicide, and future research are discussed.     

Caregivers Dependent upon Drivers with Dementia

This paper reports findings of a preliminary study of caregivers dependent upon drivers with dementia. Fifteen caregivers who perceived themselves as dependent upon their partner for transportation and 15 who perceived themselves as independent were surveyed. Dependent caregivers were significantly more likely to rely on the cognitively impaired driver for routine daily activities such as shopping, medical appointments, and visiting family and friends. Only 20% of the dependent caregivers believed that the driver with dementia should decrease or discontinue driving. Dependent caregivers were less likely than independent caregivers to take an active approach in encouraging driving cessation. Compared to the independent caregivers, the dependent caregivers believed that if the patient with dementia could no longer drive, it would significantly affect their quality of life. The authors discuss the issues and problems uniquely associated with the dependent caregiver.     

Another Side to Caregiving: Negative Reactions to Being Helped

Until recently, caregiving research focused almost exclusively on caregivers of older adults with health problems, and there was little focus on care recipients' perceptions of the care they receive. The present article reviews relevant research on reactions to caregiving assistance. Several recent studies indicate that help in these contexts can be viewed negatively by care recipients. As many as two thirds of physically impaired older adults who receive assistance with daily activities, such as preparing meals, climbing stairs, or dressing, experience negative reactions to some of the help they receive. Negative reactions seem to have important consequences for the care recipient, because they are associated with higher depression concurrently and 1 year later. Because some of the findings are inconsistent with theoretical models of negative responses to help, an alternative framework, based on social-support and social-conflict research, is briefly proposed.     

The effect of a major event on stereotyping: terrorist attacks in Israel and Israeli adolescents' perceptions of Palestinians,Jordanians and Arabs

This study examines the effect of a major event (terrorist attacks) on the stereotypic perceptions, attitudes and affects of 119 Israeli adolescents (56 males and 63 females of 5th and 8th grades) toward three target groups: (a) Palestinians, who still have conflictive relations with the Israelis (Palestinian extremists carried out the attacks), (b) Jordanians, who have peaceful relations with the Israelis and (c) Arabs, in general, who are considered a subcategory including Arabs of all nations. The questionnaires were administered to the same adolescents three times: during a relatively peaceful spell in Israeli–Palestinian relations; one day following two terrorist attacks, and three months thereafter. In the last administration adolescents' need for closure was also measured. Adolescents' perceptions, attitudes and affect toward the three target group were differentiated—relating to Palestinians most negatively and to Jordanians most positively. Also, following the terrorist attacks, stereotypic perceptions and attitudes changed in a negative direction, in relation to all the three groups; again with expressed differentiation among the three groups. In the third measurement, some measures remained negative, but some changed to be more positive. Only few effects of age were detected and several significant correlation with need for closure were found. These results indicate that stereotypes and attitudes toward outgroups are context‐dependent, influenced by events; thus they serve as ‘a seismograph’ to the quality of intergroup relations at any given time. Copyright © 2001 John Wiley & Sons, Ltd.     

Early Childhood Care Trends and Associations with Child Health Well-being in China: Evidence from the CHNS 1991 to 2011 Data

It has become increasingly common for young children to be taken care of by multiple caregivers in China after the socio-economic reforms. Complex migration patterns and high female labour force participation have led to children receiving care from various individuals in different contexts. However, little is known about how childcare arrangements are associated with child health well-being. This study examines various early childhood caregivers and their influences on children’s physical health in China. Using data from the China Health and Nutrition Survey (CHNS 1991–2011) with 3,470 children aged 2 to 6, we first identified different types of childcare arrangements in and outside of the household based on who provides the care, where they provide the care, and the intensity of the care. Then we examined the relationship between various childcare arrangements and health outcomes for children. Overall, household members undertook early childhood care tasks in China, with an increase in grandparents as primary caregivers between 1991 and 2011. The proportion of children receiving formal childcare fluctuated around 20% during this period. The findings suggest that: 1) primary caregiver in the household other than parents is not associated with undesirable physical health outcomes; 2) formal childcare outside the household is associated with higher height and lower BMI scores; 3) primary caregivers in the household, particular grandparents, moderate the association between childcare arrangements outside the household and children’s health outcomes. It yields an implication that early childhood care policies incorporating multiple caregivers would benefit children’s well-being in China.

     

Caring for the Caregiver: Identifying the Needs of Those Called to Care Through Partnerships with Congregations

As the older adult population continues to grow, the prevalence of chronic diseases is also increasing, leading to the need for novel ways of managing this large population of patients. One solution is to focus on informal caregivers. These informal caregivers already make a substantial contribution to our nation’s healthcare finances and patient health outcomes. Caregivers also derive benefits from caring for their family member or friend; however, it is not uncommon for these individuals to experience negative health consequences, or what is often called “burden of care.” Those called to care are not without their own burdens, and they must frequently make significant lifestyle adjustments that impact their own health. Therefore, for caregivers to be effective, caring for the caregivers must be a focus of medicine in the twenty-first century.     

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.     

Endorsement of proactively aggressive caregiving strategies moderates the relation between caregiver mental health and potentially harmful caregiving behavior

This research tested the proposition that the oft-reported relation between caregiver mental health outcomes (i.e., resentment, depression) and potentially harmful caregiver behavior (PHB) would be mediated or moderated by caregiver endorsement of proactively aggressive caregiving strategies (PA). Caregiver resentment was the strongest predictor of PHB in the sample of 417 informal caregivers who resided with their care recipients; in fact, resentment mediated the impact of caregiver depression, thus suggesting that depressed affect was associated with PHB only if depressed caregivers resented their caregiving burdens. As predicted, caregiver endorsement of PA moderated the relation between resentment and PHB, such that links between these two constructs were strongest when caregivers were high in both resentment and PA. Endorsement of PA also mediated the relations between demographic or contextual variables (i.e., income, care recipient dementia) and PHB. Implications of these results for research and intervention are discussed.     

Associations among perceptions of social support, negative affect, and quality of sleep in caregivers and noncaregivers.

The authors used structural equation modeling to examine associations among perceptions of negative affect, social support, and quality of sleep in a sample of caregivers (n = 175) and noncaregiver control participants (n = 169). The authors hypothesized that caregiver status would be related to sleep quality directly and also indirectly by way of negative affect and social support. This hypothesis was partially supported in that caregiving was found to be indirectly related to sleep quality. However, after accounting for the indirect effects of negative affect and social support, the direct effect of caregiving on sleep quality was no longer statistically significant. The structural model accounted for approximately 43% of the variance in sleep quality. The present findings may be useful in the development of successful sleep interventions for caregivers.     

Rural and urban elderly construe health differently.

Samples of people aged 65 or older (N = 396) living in the metropolitan Omaha area and in the rural Sandhills counties of central and western Nebraska completed an instrument to assess health satisfaction, health behaviors, and attitudes toward health care. Few intergroup differences were found that could be attributed to the area of residence. However, factor analysis and item analysis of the attitudes toward health items indicated that older respondents in rural areas may have very different perceptions of health in general and of health care services in particular than those of elderly urban residents.     

Rural and Urban Elderly Construe Health Differently

Samples of people aged 65 or older (N = 396) living in the metropolitan Omaha area and in the rural Sandhills counties of central and western Nebraska completed an instrument to assess health satisfaction, health behaviors, and attitudes toward heath care. Few intergroup differences were found that could be attributed to the area of residence. However, factor analysis and item analysis of the attitudes toward health items indicated that older respondents in rural areas may have very different perceptions of health in general and of health care services in particular than those of elderly urban residents.     

Caregiver behavior in center and family day care

In an effort to examine relationships between variations within day care settings and adult caregiving behaviors the social experiences of 40 toddlers and their caregivers in family and center care were systematically observed. Caregivers were interviewed and conditions of caregiving recorded. Caregivers in both settings with fewer children in their care, who worked shorter hours, with less housework responsibilities engaged in more facilitative social stimulation, expressed more positive affect, were more responsive, and less restrictive and negative. Family day care caregivers who worked in spaces specifically designed to be safe and appropriate for children were less restrictive of toddler activity. Adult-child ratio and caregiver training appeared to be the best indicators of quality care in center day care, while a safe and appropriate caregiving environment and small groups appeared as quality indicators in family day care.     

Caregiver Social Problem Solving Abilities and Family Member Adjustment Following Congestive Heart Failure

Family members have a considerable impact on the health and well-being of others in the family. The characteristics of family caregivers that relate to care recipients' positive and negative outcomes associated with chronic disease have received scant empirical attention. We reasoned that family caregiver social problem solving abilities would be associated with depression and life satisfaction reported by persons with congestive heart failure (CHF). Correlational analyses found that caregiver negative orientation toward solving problems was significantly predictive of higher depression and with decreased life satisfaction of persons with CHF. These findings indicate that family caregiver problem solving abilities are important factors in adjustment following CHF. Implications for clinical interventions and theoretical models of problem solving are discussed.