Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

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

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

Burden,Interdependence, Ethnicity,and Mental Health in Caregivers of Patients with Schizophrenia

Caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health. Using a sample of 176 caregivers of patients with schizophrenia, the present study examined how two components of burden (objective and subjective) interacted with interdependence and ethnicity to influence relatives' overall mental health. In line with study hypotheses, and with the stress‐appraisal‐coping model developed by Lazurus and Folkman (1984), we found that subjective burden mediated the relationship between objective burden and mental health. In other words, subjective appraisals of caregiving appeared to partially underlie the association between the concrete costs of caregiving and psychological outcomes in schizophrenia caregivers. Also as hypothesized, we found that interdependence, or the perceived interconnectedness of individuals within a group, moderated the relationship between objective burden and subjective burden. In other words, when levels of interdependence were high, the objective components of burden appeared to have a weaker relationship with subjective burden. When interdependence was low, on the other hand, objective burden was more likely to be associated with subjective burden. This finding suggests that helping caregivers to value harmony and connection with others over individual self‐interests may reduce the likelihood that objective stressors (which are often inevitable in schizophrenia) will result in subjective distress. On the basis of prior research, we also tested several hypotheses regarding the role of ethnicity and its association with burden, interdependence, and mental health. However, contrary to expectations, no ethnic patterns were observed.     

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross‐sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis–stress perspective. Goodness‐of‐fit indices (χ²/df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis–stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.     

Self-reported stress and psychophysiological reactivity in paramedics

Background: As an important group of health care professionals, paramedics accomplish sophisticated and frequently stressful tasks.

Design: The study investigated self-reported stress burden, self-reported health status, coping strategies, personality traits and psychophysiological reactivity in paramedics.

Methods: 30 paramedics were compared with 30 professionals from other disciplines, in terms of self-reported stress, physical complaints, coping strategies, personality traits and psychophysiological reactivity during aversive visual and acoustic stimuli, and cognitive challenge. Regression analyses were performed for the prediction of stress burden and physical complaints in paramedics according to coping and personality factors.

Results: Paramedics reported lower stress and less somatic complaints, and exhibited reduced electrodermal activity and heart rate responses to experimental stimuli, as well as higher respiratory sinus arrhythmia. They indicated less negative coping strategies, reduced empathy, and higher conscientiousness and sensation seeking. Higher self-reported stress burden and more physical symptoms were associated inter alia with more negative coping strategies, less conscientiousness and lower empathy.

Conclusion: The findings support the notion of reduced self-reported stress burden, and improved general health and stress resistance in paramedics. In addition to health benefits, stress tolerance may contribute to the prevention of performance decline during situations in which health and life are at stake.     

Impact of Stress Reduction Interventions on Hostility and Ambulatory Systolic Blood Pressure in African American Adolescents

This study examined the impact of breathing awareness meditation (BAM), life skills (LS) training, and health education (HE) interventions on self-reported hostility and 24-hour ambulatory blood pressure (ABP) in 121 African American (AA) ninth graders at increased risk for development of essential hypertension. They were randomly assigned to BAM, LS, or HE and engaged in intervention sessions during health class for 3 months. Before, after, and 3 months following intervention cessation, self-reported hostility and 24-hour ABP were measured. Results indicated that between pre- and postintervention, BAM participants displayed significant reductions in self-reported hostility and 24-hour systolic ABP. Reductions in hostility were significantly related to reductions in 24-hour systolic ABP. Between postintervention and follow-up, participants receiving LS showed a significant reduction in hostility but not in 24-hour ABP. Significant changes were not found for the HE group in 24-hour ABP or self-reported hostility, but these change scores were significantly correlated. The implications of the findings are discussed with regard to behavioral stress reduction programs for the physical and emotional health of AAs.     

Latent growth models of the longitudinal effects of dementia caregiving: a comparison of African American and White family caregivers

Self-report measures of depression, physical health symptoms, and life satisfaction were collected over a 2-year period from 197 family caregivers of dementia patients and 218 noncaregivers (controls). Latent growth models were used to compare changes across time for African American and White caregivers, with gender, age, and socioeconomic status serving as covariates. Results indicated that White caregivers sustained higher levels of elevated depression and decreasing life satisfaction over time compared with African American caregivers. Both groups of caregivers reported increases in physical symptoms over time. These results indicate worsening difficulties over time for many White caregivers. African American caregivers show more resilience on measures of depression and life satisfaction but are still vulnerable to increases in physical symptoms over time. Implications for additional research and clinical intervention are discussed.     

Ethnic and Gender Differences in Distress Among Anglo American, African American, Japanese American, and Mexican American Spousal Caregivers of Persons with Dementia

Distress, coping, and social resources were compared in a sample of 202 Japanese-, Anglo-, African-, and Mexican American spousal caregivers of persons with dementia using a Stress-Coping model. Both ethnicity and gender showed differential effects on the outcome and on the moderating variables. Female caregivers in all ethnic groups reported significantly higher levels of psychiatric symptomatology. All 4 ethnic groups reported high rates of psychological distress, with Mexican Americans reporting significantly higher rates of depression than Anglo or African Americans. Ethnicity was related to (1) the kind of caregiving appraisals (spiritual, pessimistic, and lack of support), (2) coping styles (escape-avoidance and seeking social support), and (3) social support. African Americans were more likely to be spiritual appraisers, to have more positive appraisals, and to have more social support available to them. Gender differences were evident on 4 out of the 6 caregiver appraisals, but none of the coping styles. Although males tended to have more perfectionistic appraisals, they were also more likely to view caregiving with a less negative and more self-efficacious outlook.     

Coping and physical health during caregiving: the roles of positive and negative affect

The associations among coping, mood, and health variables were examined prospectively over 2 years in 86 HIV positive (HIV+) and 167 HIV negative (HIV-) gay men undergoing the stress of AIDS-related caregiving. Path models suggested that including both positive and negative mood and the men's associated coping strategies increases understanding of why some people suffer adverse health effects during times of stress. Among the HIV- caregivers, higher levels of social coping predicted increases in positive affect, which in turn resulted in lower levels of physical symptoms. In contrast, higher levels of cognitive avoidance predicted increases in negative affect, which in turn resulted in higher levels of physical symptoms. Self-injurious forms of avoidance coping predicted higher levels of physical symptoms independent of mood among the HIV+ caregivers.     

GENDER AS A MODERATOR OF THE RELATION BETWEEN RACE-RELATED STRESS AND MENTAL HEALTH SYMPTOMS FOR AFRICAN AMERICANS

The present study tested gender as a moderator of the relationship between race-related stress and mental health symptoms among African American adults. Because African American women are exposed to stressors associated with race and gender, we hypothesized that African American women would have higher levels of race-related stress and more severe mental health outcomes related to experiences of race-related stress compared to African American men. Multivariate analyses revealed that African American men had higher stress appraisals for institutional racism than did women. No significant gender differences were found for cultural and individual racism. Moderated regression analyses revealed that increases in stress appraisals for individual racism were associated with increases in anxiety and obsessive-compulsive symptoms for African American women. Race-related stress had no significant effects on mental health symptoms for African American men. The findings suggest that gender is an important factor in determining the impact of race-related stress on mental health.     

Family caregiver's self-perceived health status and its relation to burden

The study aims to analyze how health is self-perceived by a sample of caregivers of dependant relatives and how it compares with general Spanish population scores. The study also focuses on the relations between self-perceived health and burden. The sample comprised 1,257 caregivers living in Biscay who completed the protocol including sociodemographic data, measures of health-related quality of life (SF-36) and burden (Zarit Burden Inventory). Results show that the health perception of the caregivers taking part into the study reached lower scores in comparison to general Spanish population and that this perception was lower in mental than in physical health. Correlational data supports previous findings indicating that high levels of burden are associated with a worse perception of mental and physical health and provide information on how to guide interventions to improve family caregivers' quality of life.     

Optimism and pessimism as predictors of physical and psychological health among grandmothers raising their grandchildren

This study examines the role of personality in predicting psychological and physical health among grandmothers who are coping with a non-normative non-traumatic stressor, i.e. serving as primary caregivers for their grandchildren. Using the Life Orientation Test-Revised (LOT-R), a measure of personality disposition, we examine the contributions of both optimism and pessimism to health outcomes. ANOVAs and regression analyses of the LOT-R and self reports of health in 67 African American and Latino grandmothers revealed psychological (obsessive compulsive symptoms, depression, hostility) and physical (sleep disorder, hypertension) health outcomes are differentially predicted by optimism and pessimism among older and younger age-groups of grandmothers. Implications for grandmothers’ response to caregiving stress and for future studies of personality’s relation to health are discussed.     

The correlation between coping with stress and blood pressure reaction]

This study explored the relationship between individual strategies of coping and blood pressure responses during and after mental stress. Blood pressure behavior was measured noninvasively and continuously before, during and after a mental stress situation in 27 normotensive subjects. Coping strategies were assessed with the Stressverarbeitungsfragebogen (SVF; coping with stress inventory). Two extreme groups were formed on the basis of the scores in the SVF. Results were: (a) Individuals who used coping strategies characterized by controlling the situation directly and constructively, in contrast to probands not using these strategies, exhibited lower blood pressure during the stress situation and a faster return to baseline levels after cessation of stress. (b) Subjects using a coping behavior characterized by the use of defense mechanisms such as suppression and denial, also showed lower blood pressure during stress but a significantly delayed return to baseline levels of blood pressure after stress was concluded.     

The Stability of Self-Reported Physical Symptoms in African American Mothers and Their Impact on Children

Self-reported physical symptoms are an important marker of health and well-being, particularly among African American women. The stability of African American women’s physical symptoms or the impact of their symptoms on their children, however, has yet to be examined. This longitudinal study examined the stability of maternal self-reported physical symptoms, as well as their role in shaping child-reported physical symptoms, among 137 low-income African American families. Findings revealed that mothers’ self-reported physical symptoms were stable over 2.5 years. Mothers who reported higher levels of physical symptoms were more likely to have children who concurrently reported higher levels of symptoms. Physical symptoms reported by mothers at the first assessment also predicted child-reported physical symptoms 2.5 years later, but only for boys. Physical symptoms appear to be an important, yet understudied, symptom domain that may have significant implications for the health and well-being of African American families.     

Mental and physical health of spouse caregivers: the role of personality.

Although personal resources of caregivers, such as coping skills and social support, have been shown to be important in understanding caregiver stress and health outcomes, personality traits have not previously been considered. The purpose of this study was to examine the association between the personality traits of neuroticism and dispositional optimism and mental and physical health outcomes. It was predicted that personality would have direct effects, and indirect effects through perceived stress, on health outcomes. Participants were spouse caregivers of patients diagnosed with Alzheimer's disease. Results showed that neuroticism and optimism were significantly related to mental and physical health. Furthermore, neuroticism had significant direct effects on all of the health outcomes, and substantial indirect effects, through perceived stress, on mental health outcomes. Optimism showed stronger indirect than direct effects on all health outcomes. These findings demonstrate the importance of including personality of the caregiver in theoretical and empirical models of the caregiving process.     

Relationship Between Religiosity and Conduct Problems Among African American and Caucasian Adolescents

This study investigated the relationship between religiosity and conduct problems in a racially diverse sample of high school aged adolescents (ages 13–19) who attended public schools in a large metropolitan area. The results of the study found racial and gender differences in religiosity: African American adolescents were more likely to attend church, describe themselves as very religious and use Collaborative and Deferring religious coping styles; they were less likely to use Self-Directing religious coping styles when compared to Caucasian adolescents. Females were more likely to be involved in church activities, use a Collaborative religious coping style and tended to be less likely to use a Self-Directing religious coping style when compared to males. The results of multiple regression analyses, after controlling for race, gender, and self-reported religiousness found that Self-Directing and Deferring religious coping styles were risk factors for conduct problems; there was no relationship between Collaborative religious coping and conduct problems. The findings from the study provide additional support for the importance of considering religiosity, race and gender when examining mental health outcomes in adolescents and have implications for the development of mental health interventions for adolescents.     

Coping with Family Conflict: What’s Helpful and What’s Not for Low-income Adolescents

Family conflict is exacerbated by poverty-related stress and is detrimental to adolescent mental health. Adolescent coping with family conflict has the potential to buffer or exacerbate the negative effects of family conflict on internalizing symptoms. We examined coping with family conflict among 82 low-income adolescents (53.7% female, mean age = 13.5 years at Time 1, SD = 1.98; range 11–18), and their primary caregivers (95% female, mean age = 34.9 years, SD = 7.45). Adolescents were 25.9% Caucasian, 28.4% African American, 38.3% Hispanic, and 7.4% Other (Multi-racial, Native American, or Asian). Results show that family conflict is more strongly associated with internalizing symptoms for adolescents under high levels of poverty-related stress. Regression analyses indicate that secondary control coping moderates the effects of family conflict on internalizing symptoms. In addition, analyses reveal that disengagement coping exacerbates symptoms across time for both adolescent girls and boys. Regression analyses also suggest that primary control coping is helpful for coping with family conflict, but only for girls. Results highlight the importance of examining coping concurrently and across time as well as including moderating effects of gender. Intervention efforts targeting low-income adolescents should incorporate the instruction of secondary control strategies for coping with family conflict.     

Religious coping,stigma, and psychological functioning among HIV-positive African American women

The present study examined the role of religious coping in psychological distress and adjustment both cross-sectionally and longitudinally among 141 HIV-positive African American women. Cross-sectional analyses showed that negative religious coping was associated with poorer mental health and functioning, and greater perceptions of stigma and discrimination. Longitudinal analyses revealed that greater negative religious coping at baseline significantly predicted greater changes in mental health in a negative direction 12 months later. Positive religious coping was not associated with any measures of psychological well-being, nor did it predict any mental health outcomes at 12 months. However, participants who experienced high levels of HIV-related stigma and reported high levels of positive religious coping were less depressed than those who reported lower levels of positive religious coping. These results suggest that for this population, negative religious coping was a more salient determinant of psychological distress than positive religious coping was of psychological health.