Longitudinal impact of interhousehold caregiving on adult children's mental health

The wear-and-tear hypothesis of caregiving (the longer care provided, the more psychological strain on caregivers) was examined using panel survey data from 112 adult children providing interhousehold care to an impaired elderly parent. Measures included subjective caregiving stress and perceived caregiving effectiveness ("wear") and depression and affect balance ("tear"). Contrary to the hypothesis, data revealed variability in children's adaptation to caregiving, improvement rather than deterioration being the norm. In a recursive path model, both subjective stress and perceived effectiveness were significant predictors of changes in depression. Depression was not significantly related to duration of caregiving. Discussion suggests that future researchers consider other types of caregivers and care settings, factors predicting variability in caregivers' adaptation over time, and changes as well as stability in care arrangements.     

Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers

A stress and coping model was used to study predictors of individual differences in caregiver adaptation. A total of 54 family caregivers of elderly dementia patients completed interviews and questionnaires assessing the severity of patient impairment and caregiving stressors; caregiver appraisals, coping responses, and social support and activity; and caregiver outcomes, including depression, life satisfaction, and self-rated health. Correlational and regression analyses supported the utility of the stress and coping model. Appraisal, coping responses, and social support and activity were significant predictors of caregiver outcome, even when severity of caregiving stressors was statistically controlled. The importance of a multidimensional approach to assessing caregiver outcomes was supported by regression analyses indicating that each caregiver outcome was predicted by different patterns of stressors, appraisal, coping, and social support and activity. Results are discussed in terms of a stress and coping model of caregiving, and clinical implications for work with caregiving families.     

Stress risk factors and stress-related pathology: neuroplasticity, epigenetics and endophenotypes

This paper highlights a symposium on stress risk factors and stress susceptibility, presented at the Neurobiology of Stress workshop in Boulder, CO, in June 2010. This symposium addressed factors linking stress plasticity and reactivity to stress pathology in animal models and in humans. Dr. J. Radley discussed studies demonstrating prefrontal cortical neuroplasticity and prefrontal control of hypothalamo-pituitary-adrenocortical axis function in rats, highlighting the emerging evidence of the critical role that this region plays in normal and pathological stress integration. Dr. M. Kabbaj summarized his studies of possible epigenetic mechanisms underlying behavioral differences in rat populations bred for differential stress reactivity. Dr. L. Jacobson described studies using a mouse model to explore the diverse actions of antidepressants in brain, suggesting mechanisms whereby antidepressants may be differentially effective in treating specific depression endophenotypes. Dr. R. Yehuda discussed the role of glucocorticoids in post-traumatic stress disorder (PTSD), indicating that low cortisol level may be a trait that predisposes the individual to development of the disorder. Furthermore, she presented evidence indicating that traumatic events can have transgenerational impact on cortisol reactivity and development of PTSD symptoms. Together, the symposium highlighted emerging themes regarding the role of brain reorganization, individual differences, and epigenetics in determining stress plasticity and pathology.     

Development of a Measure of Coping with Multiple Sclerosis Caregiving

Development of a self-report measure of coping specific to multiple sclerosis (MS) caregiving is needed to advance our understanding of the role of coping in adaptation to caring for a person with MS and to contribute to a lack of empirical data on MS caregiving. A total of 213 MS caregivers and their care recipients completed a Coping with MS Caregiving Inventory (CMSCI) and measures of adjustment (psychological distress), appraisal and illness. A subsample ( n = 64) also completed the Ways of Coping Checklist (WCC) and additional adjustment measures (depression, caregiving impact, dyadic adjustment, and relationship conflict and reciprocity). Factor analyses revealed 5 factors: Supportive Engagement, Criticism and Coercion, Practical Assistance, Avoidance, and Positive Reframing. Subscales had internal reliabilities comparable to similar scales and were empirically distinct. Preliminary construct validation data are consistent with recent MS caregiving research that links passive avoidant emotion-focused coping with poorer adjustment, and relationship-focused coping caregiving research that links greater reliance on positive relationship-focused coping and less reliance on criticism with better adjustment. Results extend this research by revealing new relations between coping and adaptation to MS caregiving. Convergent validation data suggest that although the inventory differs from the WCC, it does share certain conceptual similarities with this scale.     

Positive aspects of caregiving and adaptation to bereavement

This study examined how positive aspects of caregiving affect adaptation to bereavement among older adults who cared for a family member with dementia. The sample consisted of 217 caregivers who were part of the Resources for Enhancing Alzheimer's Caregiver Health Study. Using pre- and postloss data, hierarchical regressions were carried out to examine the effects of positive aspects of caregiving (caregiving benefit) on postloss depression and grief. Findings show that preloss caregiving benefit was associated with higher levels of postloss depression and grief, even after controlling for caregiver demographic characteristics, contextual factors, and caregiving burden. This effect was particularly strong for the relation between benefit and grief. Results demonstrate the importance of studying both positive and negative aspects of caregiving and their relation to bereavement outcomes.     

Relationship between chronic stress and carotid intima-media thickness (IMT) in elderly Alzheimer's disease caregivers

The stress associated with providing care for a spouse diagnosed with Alzheimer's disease can have adverse effects on cardiovascular health. One potential explanation is that chronic caregiving stress may contribute to the development of atherosclerosis. The purpose of this study was to determine whether the duration that one has provided care is associated with the degree of atherosclerotic burden, as measured by carotid artery intima-media thickness (IMT). One hundred and ten Alzheimer caregivers [mean age 74?±?8 (SD) years, 69% female] underwent in-home assessment of carotid artery IMT via B-mode ultrasonography. Data regarding medical history, blood pressure, and multiple indicators of caregiving stress were also collected. Multiple regression indicated that duration of care was positively associated with IMT measured in the internal/bifurcation segments of the carotid artery (β?=?0.202, p?=?0.044) independent of risk factors such as age, gender, body mass index, smoking history, sleep quality, hypertension status, and caregiving stressors. Duration of care was positively associated with IMT in the common carotid artery, but the relationship was not significant. These findings provide more evidence of the link between chronic caregiving stress and cardiovascular disease and indicate that enduring the experience of caregiving over a period of years might be associated with atherosclerotic burden.     

A comparison of primary stressors, secondary stressors, and depressive symptoms between elderly caregiving husbands and wives: the Caregiver Health Effects Study

The present study examined gender differences in the experience of primary and secondary caregiving stressors, depressive symptoms, and their interrelationships using a sample of 283 elderly spouse caregivers (145 women, 138 men). Two primary stressors, two secondary stressors, and depressive symptoms were assessed. In general, t-tests indicated that caregiving husbands experience fewer stressors and depressive symptoms than their female counterparts. Multiple group analysis revealed that the primary stressors were more useful in explaining variance associated with the secondary stressors for women than men and that the path coefficients linking amount of caregiving assistance to caregivers' activity restriction was significantly different across men and women. Other paths linking primary stressors, secondary stressors, and depressive symptoms, however, were statistically equivalent across men and women. Hence, although caregiving women and men may vary in their reports of caregiving stressors, the complexity of the caregiving experience appears to be quite uniform for both groups.     

An examination of the impact of harsh parenting contexts on children's adaptation within an evolutionary framework

The current study tests whether propositions set forth in an evolutionary model of temperament (Korte, Koolhaas, Wingfield, & McEwen, 2005) may enhance our understanding of children's differential susceptibility to unsupportive and harsh caregiving practices. Guided by this model, we examined whether children's behavioral strategies for coping with threat and challenge cohered into 2 broad, phenotypic dimensions--hawk and dove--that have been maintained by frequency-dependent selection throughout our ancestral history: Hawk-like strategies are characterized by approach, dominant-negative affect, and activity, whereas dove-like strategies are evidenced by avoidance, inhibition, and vulnerable affect. In turn, we examined the moderating effect of hawk or dove profile membership on children's physiological and psychological adaptation to harsh rearing environments. Participants included 201 2-year-old toddlers and their mothers. Consistent with the Korte model, latent profile analyses extracted 2 profiles that cohered into hawk and dove strategies. Children were classified within hawk or dove profiles and separately examined in a process model of harsh caregiving. As predicted, associations between harsh caregiving practices and children's basal cortisol, parasympathetic nervous system, and sympathetic nervous system activity were moderated by profile membership. In turn, basal physiological levels were differentially predictive of children's psychological adaptation over time. Collectively, findings highlight the potential value of translating the study of evolutionary models to understanding developmental outcomes associated with harsh caregiving.     

African American adolescent mothers and grandmothers: A multigenerational approach to parenting

This study is an adaptation and extension of Apfel and Seitz’s (Family Relations, 40(4), 421–429, 1991) models of adolescent parenting and adolescent-grandmother relationships to a sample of 148 African American, first-time adolescent mothers and their 6-month-old infants. The Parental Supplemental model, in which adolescent mothers and grandmothers shared caregiving, described 63% of Apfel and Seitz’s (1991) sample and 66% of the current sample. Shared caregiving was not associated with conflict in the adolescent mother–grandmother relationship. Adolescent mothers who had caregiving responsibilities and a supportive adolescent-grandmother relationship also reported competence in their parenting role. Findings provide support for Apfel and Seitz’s Parental Apprentice model, in which young mothers gain competence through direct caregiving experience in the context of a supportive relationship.     

Environmental stress, psychological stress and allostatic load

The mechanism by which chronic caregiving stress results in poor health is not well understood. The objective was to determine whether such a mechanism may be allostatic load, a novel concept specifying physiological systems that may suffer cumulative wear and tear following chronic stress, leading collectively to poor health. The study examines the association of allostatic load with environmental and psychological stress in the contexts of dementia caregiving and relinquishment of care, and is a 2-year longitudinal comparison of three groups: 80 new dementia spouse caregivers, 120 veteran caregivers, and 60 non-caregivers. Data comprised allostatic load markers and environmental and psychological stress measures. Cross-lagged analyses produced a statistically significant association between psychological stress and one allostatic load component (primary mediators). Psychological stress was a better predictor of primary mediators than environmental stress. Primary mediators rose with time for caregivers, but not for non-caregivers. A greater rise was evident for caregivers who had relinquished their role by the second year, although the level of psychological stress actually declined. Primary mediators are a key component of the relationship between allostatic load and prior stress. When allostatic load is treated as an outcome of stress, it is important to distinguish environmental and psychological stress.     

Food meanings in HIV and AIDS caregiving trajectories: ritual, optimism and anguish among caregivers in Lesotho

The article describes the caregiving responsibility to provide food for chronically ill family members and the meanings attached to food and eating when ill created stress for family caregivers. The results come from a qualitative phenomenological study using in-depth interviews with 21 family caregivers of chronically ill HIV and AIDS patients in one district in Lesotho. Analysis of the interview data showed that the caregivers attached profound meanings to food and feeding care recipients. Their perceptions about food as part of family life and caring, the role of food and eating in curbing disease progression, the link between food and medical efficacy and the link between food and life led to ritualized behaviour around food, and moments of optimism and anguish in caregiving. Patients' behaviour in relation to food was in most instances inconsistent with the caregivers' goals, thus leading this aspect of caregiving to induce stress. Services intended to support home-based caregivers and patients could contribute to the reduction of stress associated with food through suitably tailored food assistance and professional support to caregivers to enhance their competences and understanding of the dynamics of food intake as AIDS progressed.     

Ordinary variations in maternal caregiving influence human infants' stress reactivity

ABSTRACT— We sought to extend earlier work by examining whether there are ordinary variations in human maternal caregiving behavior (MCB) that are related to stress reactivity in infants. We observed 185 mother-infant dyads and used standard coding systems to identify variations in caregiving behavior. We then created two extreme groups and found that infants receiving low-quality MCB showed more fearfulness, less positive joint attention, and greater right frontal electroencephalographic asymmetry than infants receiving high-quality MCB. Group differences in stress reactivity were not a result of measured infant temperament. However, infants receiving low-quality MCB manifested significantly more negative affect during caregiving activities than did infants receiving high-quality MCB. The results suggest that ordinary variations in MCB may influence the expression of neural systems involved in stress reactivity in human infants.     

Adjustment of caregivers to depressed older adults.

In this research, older adults (N = 150) hospitalized for major depression and their wife, husband, daughter, or son caregivers were interviewed. The primary purpose of the research was to evaluate the ability of caregiver background characteristics, patient illness characteristics, caregiver coping, and strategies for managing the patient at home to predict caregiver adjustment. Among the caregiver characteristics, being in functional health, being male, and being a spouse caregiver were associated with better adjustment. Husbands evidenced the best adaptation to caregiving and daughters the poorest. Patient illness characteristics were not related to caregiver adjustment. Coping with caregiving stresses by using tension reduction and deliberate effort behaviors and managing the patient with criticism and guidance were related to poorer caregiver adjustment.     

Attachment,caregiving, and marital satisfaction

This research tested the proposition that attachment and caregiving are central, interrelated components of adult love relationships. A sample of 229 married couples was used to assess the association between attachment and caregiving styles and the implications of these variables for marital satisfaction. There was evidence of partner matching in terms of dimensions of attachment (Comfort with closeness, Anxiety over relationships) and caregiving (Responsive care, Compulsive care). Secure attachment (high Comfort with closeness, low Anxiety over relationships) was associated with beneficial caregiving to the spouse (high Responsive care, low Compulsive care). These associations were modest in size, however, suggesting that attachment and caregiving are separate constructs; further, these constructs were related in different ways to retrospective reports of early parenting. Marital satisfaction was higher for securely attached spouses, and for those whose partners reported more beneficial caregiving. For husbands, however, the link between caregiving and satisfaction was restricted to short-term marriages, and to those high in Anxiety over relationships. Overall, the results support the role of attachment and caregiving in marriage, but suggest that variables such as gender have important moderating effects.     

Experimentally enhancing self-compassion: Moderating effects of trait care-seeking and perceived stress

Social mentality theory suggests that the ability to be reassuring and compassionate to oneself relies on the activation of care-seeking and caregiving mentalities. In this experimental study, college students were randomly assigned to recall memories of care-seeking, caregiving, a combination of care-seeking and caregiving, having fun (active control group), or a no-treatment control group. Participants completed the memory recall task twice per day for four days and were assessed on pre- and post-test levels of self-reassurance. Findings showed a moderating effect of individual differences in trait care-seeking and perceived stress. In response to the caregiving interventions, high care-seekers exhibited increased self-reassurance whereas low care-seekers exhibited decreased self-reassurance. In response to the care-seeking interventions, highly stressed individuals showed increased self-reassurance. Findings suggest that fostering self-compassion/reassurance can be achieved for certain individuals by activating the interpersonal processes involved in care-seeking and caregiving with others.     

Mental models,pictures, and text: Integration of spatial and verbal information

In the past several years, there has been an acceleration in the publication of cognitive research on the interplay between linguistic and pictorial/spatial information. To report on and encourage this sort of research, we organized a symposium at the 1991 meeting of the Midwestern Psychological Association. The articles in this special section ofMemory & Cognition are based on the work presented at the symposium. In this introduction, we offer a suggestion forwhy the integration of linguistic and spatial information is not only a possibility, but a requirement for effective communication. Our suggestion follows the linguistic analysis of the closed-class elements that convey spatial relations, the prepositions (Talmy, 1983). The structure of language provides but a small set of prepositions to encode the vast number of spatial relations that we can perceive. Thus, to understand a situation that a speaker or a writer is conveying, the listener or reader must combine linguistic information with (perhaps metric) spatial information derived from pictures, the environment, or memory.     

Instrumental learning and cognitive flexibility processes are impaired in children exposed to early life stress

Children who experience severe early life stress show persistent deficits in many aspects of cognitive and social adaptation. Early stress might be associated with these broad changes in functioning because it impairs general learning mechanisms. To explore this possibility, we examined whether individuals who experienced abusive caregiving in childhood had difficulties with instrumental learning and/or cognitive flexibility as adolescents. Fifty‐three 14–17‐year‐old adolescents (31 exposed to high levels of childhood stress, 22 control) completed an fMRI task that required them to first learn associations in the environment and then update those pairings. Adolescents with histories of early life stress eventually learned to pair stimuli with both positive and negative outcomes, but did so more slowly than their peers. Furthermore, these stress‐exposed adolescents showed markedly impaired cognitive flexibility; they were less able than their peers to update those pairings when the contingencies changed. These learning problems were reflected in abnormal activity in learning‐ and attention‐related brain circuitry. Both altered patterns of learning and neural activation were associated with the severity of lifetime stress that the adolescents had experienced. Taken together, the results of this experiment suggest that basic learning processes are impaired in adolescents exposed to early life stress. These general learning mechanisms may help explain the emergence of social problems observed in these individuals.     

A preliminary study into stress in palliative care: optimism, self-efficacy and social support

Caring for the terminally ill is a demanding, but rewarding area of health care. Stressors unique to this working environment--dealing with patient death rather than cure, and supporting entire family units, for example--put caregivers at risk from stress related illness. This study investigated the buffering effects of optimism, self-efficacy and social support against two measures of stress within the palliative setting. Comparisons were made between volunteer (n = 18) and professional (n = 18) caregivers across three caregiving settings. Data were collected retrospectively about personal control variables; use of and satisfaction with, social support; and, perceived general and occupational specific stress levels. Differences in reported stress levels were found both between settings (NHS, hospice and community-based) and between caregiver type (salary status and occupational category). Optimism was more strongly and consistently associated with low levels of perceived stress than was self-efficacy. Satisfaction with social support was highest among paid workers, and in terms of buffering stress in the whole sample, appeared mediated by optimism. Worksite interventions targeting caregiver self-efficacy and optimism are recommended as a potential source of stress management within this population.     

Caregiving Burden and Parent–Child Quality of Life Outcomes in Neurodevelopmental Conditions: The Mediating Role of Behavioral Disengagement

The aim of this study was to analyze the direct and indirect effects, via parents’ behavioral disengagement coping, of caregiving burden on the quality of life (QL) of parents and their children with neurodevelopmental conditions. Self-completion questionnaires on the target variables were administered to a sample of 156 parents who had a child with a neurodevelopmental condition, namely epilepsy (n = 65) and cerebral palsy (n = 91). Structural equation modeling was used to test a mediation model and ascertain direct and indirect effects among study variables. Significant direct effects of caregiving burden on parents’ and their children’s QL were found. Additionally, caregiving burden had a significant indirect effect on parents’ QL, via behavioral disengagement, but not on their children’s QL. Finally, this model was found to be invariant across conditions and patients’ age groups. Caregiving burden may be elected as a strategic intervention target to improve parent–child QL outcomes in neuropediatric settings. Parents should be encouraged to avoid or reduce behavioral disengagement coping in relation to their caregiving stress, and alternatively adopt active coping strategies that may positively affect their children’s QL and impede or attenuate the deleterious effects of caregiving burden on their own QL.     

Attachment,caregiving, and relationship functioning in couples: Effects of self and partner

We examined the links among attachment, caregiving, and relationship functioning in both dating (Study 1) and married couples (Study 2), assessing both partners' perspectives. We found that (1) men and women generally evidenced caregiving characteristics similar to those of their parent% especially their same-sex parent; (2) individuals who reported giving more care to their partner evidenced less fearful-avoidant attachment (Studies 1 and 2) and less preoccupation with attachment (Study 2); and (3) individuals' own attachment models and their partner's attachment models and caregiving jointly predicted relationship functioning, but individuals' own attachment models remained strong predictors even after the partner's attachment and caregiving were taken into account. The results suggest that caregiving learned in childhood attachment relationships may be carried forward into adult romantic relationships, and they support the idea that attachment and caregiving are central components of romantic love.