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

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

Till depression do us part? Examining the prospective associations between depression and marital adjustment in older adults

IntroductionThe association between marital adjustment and depression in young couples is well established. However, little is known about the longitudinal associations between marital adjustment and depression in older adults.ObjectiveTo explore if such associations are significant in older adults and determine their direction of effects.MethodThe cross-sectional and 12-month prospective associations between diagnostic depression and marital adjustment in a representative sample of community-dwelling older adults (age ≥ 65 years, n = 847) from Quebec, Canada, were assessed through cross-lagged, multiple regression analyses.ResultsData suggest a cross-sectional association between marital adjustment and depression. As for longitudinal associations, marital adjustment predicted subsequent diagnostic depression but there was no support for the inverse path, suggesting a unidirectional relation between these variables.ConclusionWhile significant, the association between initial marital adjustment and later depression was weak. Based on our and previously reported findings, the importance of the prospective relations between marital quality and depression in older adults is discussed.     

Optimism as a mediator between resilience and affective states in older adults / El optimismo como mediador entre la resiliencia y estados afectivos en adultos mayores

Abstract

The purpose of this study was to explore whether resilience is associated with and a predictor of depression, anxiety, negative and positive affect, life satisfaction and subjective happiness in older adults, and whether these relationships are mediated by optimism. To analyse this, different scales were administered to a sample of 240 elderly people and correlational and mediational analysis was carried out. The results showed relationships between all the variables. Similarly, we found that optimism is a partial mediator of the relationship between resilience and the aforementioned variables. Our results evidenced that increasing resilience and optimism in elderly people could be favourable to successful ageing.     

Social support,coping, and psychological adjustment among caregivers of head-injured patients

Abstract

The purpose of this study was to test a mediational model of risk and protective factors associated with the psychological adjustment of caregivers of head-injured patients. Forty-three caregivers of patients who had suffered a head injury participated in the study. Findings strongly supported hypotheses. Caregiver burden was associated with poorer psychological adjustment. Social support and a higher percentage of approach coping strategies relative to overall coping strategies were associated with better psychological adjustment. As predicted, caregiver burden showed a direct relationship to psychological adjustment, while social support showed an indirect relationship to adjustment mediated by percentage approach coping.     

Multiple approaches to the treatment of violent couples

Abstract

The relationship of the discrepancy between couple's actual level of intimacy and desired level of intimacy and marital adjustment was explored using data from 185 randomly selected couples who completed the Personal Assessment of Intimacy in Relationships and the Marital Adjustment Test. Multivariate and univariate regression analyses indicated that the discrepancy between actual and desired intimacy of husbands and wives was highly predictive of marital adjustment (R²=.665). Particularly interesting was that couples with low intimacy scores who did not desire more intimacy had good marital adjustment. The relationship between intimacy and marital adjustment was curvilinear, and wives' marital adjustment was more affected by intimacy than husbands'. Implications for marital therapy are discussed.     

Interpersonal loss in the context of family caregiving: Implications of communal relationships theory

Abstract

Much is known about the emotional costs of providing care to an ill or disabled family member. However, surprisingly little attention has been devoted to investigating how caregiver distress is related to interpersonal loss (i.e., reactions to changes in the typical day-to-day support behaviors that formerly characterized the caregiver–care recipient relationship). Drawing on the theory of communal relationships (e.g., Clark & Mills, 1979, 1993), this study proposes that the magnitude of interpersonal loss that caregivers experience, as well as its contributions to depressed affect, both directly and indirectly (through impact of interpersonal loss on perceived caregiving burden) are likely to depend on the type of relationship that existed between caregiver and care recipient prior to the onset of illness or disability. In this context, several hypotheses and directions for further research are proposed. It is hoped that future researchers will incorporate loss measures into their research and consider how aspects of preexisting relationships influence associations among interpersonal loss and variables (e.g., burden, social support) known to predict caregiver well-being.     

Relationship Patterns and Role of Religion in Elderly Couples with Chronic Illness

ABSTRACT

This study was designed to explore the various relationship patterns and the role religion plays as a coping resource for elderly couples in which at least one spouse has a chronic illness. Elderly couples were interviewed and also completed marital satisfaction and couple communication inventories. Five different relationship patterns emerged from the data: active couples, short-term caregivinjg couples, long-term caregiving couples, survival couples, and live-in caregiver couples. Various aspects of religion emerged as an important coping resource among the different relationship patterns. Ideas and questions for research and practice, generated by the study, are presented.     

A situational analysis of the relationship between spouse-specific assertiveness and marital adjustment

This study examined the relationship between marital adjustment and spousespecific assertiveness, conceptualized in terms of defense of rights, in a sample of 115 married women, 27 of whom were in a distressed marriage. Subjects indicated their likely behavioral responses in 11 commonly occurring marital conflict situations and provided ratings of the expected effectiveness of their responses, the amount of resentment they would experience in the situations, and the frequency of occurrence of the situations in their marage. Marital adjustment was found to be directly related to response effectiveness and level of assertive responding and inversely related to situational resentment and frequency of transgression by spouse. Surprisingly, the level of assertive responding was less strongly related to marital adjustment than were any of the other principal variables. A multiple regression analysis indicated that the set of experimental variables accounted for 45% of the variance in marital adjustment. All of the principal variables uniquely accounted for significant levels of variance in marital adjustment. Viewed collectively, the results of this study indicate that (1) parameters of marital conflict situations have considerable importance for the marital adjustment of women and (2) explication of the relationship between marital conflict and marital adjustment requires investigation of a variety of behavioral, affective, and contextual variables.     

Adult Children’s Caregiver Burden and Depression: The Moderating Roles of Parent–Child Relationship Satisfaction and Feedback from Others

The issue of elderly care has generated great interest because today, most of us live in an aging society. It has been found that caring for one’s elderly parents is a stressful experience that is related to negative outcomes. In addition, accompanied with the decline in fertility may make adult children feel heavier caregiver’s burden. Therefore, the current study investigates moderators that may help reduce the caregiver burden. Following the conservation of resources theory (COR), we hypothesized that feedback from others and a good parent–child relationship serve as resources that may help the individual manage the stress associated with caring for his or her elderly parents. To examine our hypotheses, we collected data from 502 adult children who were primary caregivers for their elderly parents. All participants completed the Burden Assessment Scale (BAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Feedback from Others Scale, and the Parent–Child Relationship Satisfaction Scale. Supporting our prediction, we found a positive correlation between the caregiver’s burden and the caregiver’s levels of depression. Furthermore, both moderation effects were significant. Consistent with our hypotheses, the relationship between caregiver burden and his or her level of depression was weaker when participants had high feedback from others or had a better parent–child relationship. Our findings highlight the view that possessing more resources may help the individual manage the stress associated with caring for elderly parents. Implications for issues related to elderly care are discussed.     

Comparison of reciprocity and discussion-type counseling for marital problems

Abstract

Reciprocity counseling had previously been found to increase reported marital happiness in a study using a within-subject design. Fifty-five couples served in the present study using a between-subjects design, additional response measures, and additional positive communication training. The reciprocity counseling provided behavioral contracting, communication training and instruction in mutual reinforcement, whereas the control procedure encouraged discussion of the problems. The reciprocity counseling produced significantly more improvement than the discussion-type counseling for the three marital adjustment measures after four sessions. The improvement was maintained during the 24 months of follow-up.     

Indirect pathways between depressive symptoms and marital distress: the role of conflict communication, attributions, and attachment style

Previous studies have focused on concomitants of depression and marital distress in order to help explain the relationship between the two, suggesting that several variables, such as conflict communication, attributions, and attachment style, are associated with depression, marital distress, or both. Our contention is that the selected variables may be important mediators (hypothesis 1) or moderators (hypothesis 2) of the concomitance between depression and marital adjustment, exploring the direct and indirect ways in which depressive symptoms and marital adjustment are related. In total, 415 heterosexual couples were recruited, and a series of regression analyses was conducted to test our hypotheses separately for men and women. Results indicated that demand-withdrawal, avoidance, causal attributions, and secure, ambivalent, and avoidant attachment mediated the relation between depressive symptoms and marital adjustment in the female sample, whereas constructive communication and causal and responsible attributions were significant mediators of men's levels of depressive symptoms and marital adjustment. In addition, avoidance and secure attachment moderated the association between depressive symptoms and marital adjustment in the female sample, and causal attributions were significant moderators of the association between depressive symptoms and marital adjustment for men. Several conclusions and implications for theory and future research are discussed.     

The relationship of sexual adjustment and related sexual behaviors and attitudes to marital adjustment

Abstract

This paper examines the extent of relationship between sexual adjustment and marital adjustment for 30 married couples followed for 3–6 months. Sexual adjustment was assessed by means of the LoPiccolo-Steger Sexual Interaction Inventory, and two other measures termed a Couple Interaction Scale (CI) and a Couple Compatibility Ratio (CCR). Marital adjustment was assessed by means of the Locke-Wallace Marital Adjustment Scale (L-W MAS) and a clinically-devised instrument based on the extent of support between the marital partners. The two marital adjustment instruments agreed closely. A high degree of association was obtained between most of the sexual adjustment measures and the two marital adjustment measures; using the most reliable of these measures, it is estimated that sexual adjustment contributed between 40 % and 55 % of the variance in marital adjustment. This association was not due to a specific stage of. the human sexual response cycle of desire, excitement, orgasm and gratification. Intercorrelation of measures of each of these stages with the marital adjustment measures generally yielded significant relationships.     

Toward a Better Understanding of Psychological Well‐Being in Dementia Caregivers: The Link Between Marital Communication and Depression

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). Dementia research has frequently documented high rates of caregiver depression and distress in spouses providing care for a partner suffering from dementia. However, the role of marital communication in understanding caregiver distress has not been examined sufficiently. Studies with healthy couples demonstrated an association between marital communication and the partners' psychological well‐being, depressiveness, respectively (e.g., Heene, Buysee, & Van Oost, 2005 ). The current study investigates the relationship between caregiver depression and communication in 37 couples in which the wives care for their partners with dementia. Nonsequential and sequential analyses revealed significant correlations between caregiver depression and marital communication quality. Caregivers whose husbands used more positive communication reported less depression and distress. Additionally, caregiver depression was negatively correlated with rates of positive reciprocal communication indicating dependence between the couples' interaction patterns. This study is one of the first to illustrate the relevance of spousal communication in understanding caregiver distress and depression.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

Post-stroke depression as a predictor of caregivers burden of acute ischemic stroke patients in China

Our aim was to explore the independent attribution of Post-stroke depression (PSD) to caregiver burden of acute ischemic stroke patients. A cross-sectional survey was performed with 271 acute ischemic stroke patients in the Huai-He Hospital and First People’s Hospital of Kaifeng City in China. PSD was assessed by Self-rating Depressive Scale, and caregiver burden was assessed by Zarit Caregiver Burden Interview. Clustered logistic regression was applied to identify the impact of PSD on caregiver burden. As results, female patients, normal muscle strength and PSD were associated with caregiver burden. PSD correlated with an independent influence of 17.2% on the risk of caregiver burden, The independent influence of PSD on caregiver burden was smaller than that of social-demographics of caregivers and clinical factors of stroke patients This study suggests that PSD may have a modest influence on caregiver burden.     

Depressive moods and marital happiness: within-person synchrony, moderators, and meaning

Recent studies using within-persons designs conceptually replicate and substantively extend prior research that has shown marital distress to be a robust risk factor for depression. The present investigation further extends this within-persons research tradition by increasing the frequency of assessments and by adding new moderators and measures in a sample of both newlywed (n = 24) and maritally distressed (n = 31) wives. In both samples, the average within-persons association between 21 daily assessments of wives' depressed mood and marital happiness approximated previous estimates of analogous effects (overall r = -.54). Wives reported worse depressive mood symptoms on days they experienced lower marital happiness, even after accounting for time and between-person variation in marital happiness. Each participant's within-persons mood and marital happiness association was then treated as a dependent variable to be predicted from theoretically relevant individual differences. Multilevel modeling showed that the negative within-person association between daily depressed mood and daily marital happiness was especially strong for women who were relatively high in depressive symptoms, who had avoidant attachment styles, and who were relatively low in marital adjustment.     

The Relationship Between Marital Satisfaction,Marital Stability,Nuclear Family Triangulation,and Childhood Depression

This study was to examine the effect of triangulation on depression in children. Clinical samples and nonclinical samples were taken from Utah and Illinois. Families were assessed for marital satisfaction and stability, family triangulation, and children's depression levels by the Marital Adjustment Test, Marital Status Inventory, Nuclear Family Triangulation, and Children's Depression Inventory. Results showed children's depressive symptoms to be most strongly linked to fathers' level of marital satisfaction, marital stability, and perceived family triangulation. Mothers' variables did not affect children's depressive symptoms .     

Hope and social support utilisation among different age groups of women with breast cancer and their spouses

Objective: Social support and hope are considered positive, important contributors to psychological well-being for women with breast cancer and their spouses. Few studies examine the role of age in relation to these variables. The current study compares the relationship between social support, hope and depression among different age groups of women with advanced breast cancer and their healthy spouses.

Design: Cross-sectional sample of 150 women with advanced breast cancer and their spouses.

Main outcome measures: Social support, hope, depression and socio-demographic data. Analysis included comparison of these variables between groups of older and younger patients and their spouses. Structural equation modelling (SEM) was used to examine hope as a mediator of the relationship between social support and depression within each group (older and younger patients and spouses).

Results: Older patients and spouses reported lower levels of depression than younger ones. SEM showed that social support related directly to depression among younger women and older spouses, while hope was directly related to depression among older women and younger spouses and acted as a mediator between social support and depression.

Conclusions: Theoretical, empirical and clinical implications regarding the understanding of the role of age in coping with cancer are discussed.     

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.     

Discovery of a Partner Affair and Major Depressive Episode in a Probability Sample of Married or Cohabiting Adults

Prior research has found that humiliating marital events are associated with depression. Building on this research, the current study investigated the association between one specific humiliating marital event—discovering that one's partner had an affair—and past‐year major depressive episode (MDE) in a probability sample of married or cohabiting men and women who were at high risk for depression based on the criterion that they scored below the midpoint on a measure of marital satisfaction (N = 227). Results indicate that (i) women were more likely than men to report discovering their partner had an affair in the prior 12 months; (ii) discovering a partner affair was associated with a higher prevalence of past‐year MDE and a lower level of marital adjustment; and (iii) the association between discovering a partner affair and MDE remained statistically significant when holding constant demographic variables and marital adjustment. These results support continued investigation into the impact that finding out about an affair has on the mental health of the person discovering a partner affair.