Mental Health Experiences of Home Hospice Caregivers: A Qualitative Study of Their Lived Experiences.

The vital role played by primary caregivers in caring for cancer patients is well-recognized, but the caregiver burden and impact on family functioning to caregivers' mental health is poorly understood. This study examined the prospective and reciprocal relationships between family functioning, caregiver burden, and mental health. We aimed to determine whether inferior family functioning and heavy caregiver burden act as risk factors for mental health, as consequences of mental health, or both. Participants were 187 primary caregivers of cancer patients. They completed questionnaires with standardized measures assessing family functioning, caregiver burden, and mental health. A quantitative longitudinal design and a cross-lag model were used to test the reciprocal relationships between variables at three time points with 6-month intervals during the first year of early-stage cancer diagnosis and treatment. Family functioning did not predict participants' future mental health, but their mental health state predicted future caregiver burden and family functioning. Caregiver burden also predicted participants' future mental health. There was a dynamic reciprocal relationship between caregiver burden and mental health over time. The findings of this study emphasize the adverse effects of caregiver burden and may contribute to shedding light on the distinct mechanisms that underlie the relationships between caregiver burden, family functioning, and mental health. Our findings indicate the necessity of developing interventions to reduce the burden of caregiving and to facilitate family functioning. They will provide direction for family-centered nursing to meet primary caregivers' mental health needs in the care of cancer patients.

The purpose of this study was to create a path model linking cognitive functioning in individuals with dementia, caregiver burden and mental health, and quality of care provided for the individual with dementia in Argentina. One hundred and two dementia caregivers from San Lucas, Argentina completed questionnaires assessing these constructs. Regressions found that caregiver burden, depression, anxiety, and satisfaction with life explained 18.8% of the variance in quality of care-respect and 14.7% of the variance in quality of care-provide. A structural equation model with generally adequate fit indices uncovered that cognitive functioning in individuals with dementia was inversely associated with caregiver burden, caregiver burden was inversely associated with mental health, and mental health was positively associated with quality of care. Further, patient cognitive functioning yielded a significant indirect effect on caregiver mental health through caregiver burden, as did burden on quality of care through mental health. Despite this negative cascade, these relationships may also be reversed with the development and use of dementia caregiver interventions that improve caregiver burden and mental health and as a result, the quality of care for individuals with dementia in Latin America.

Informal caregivers are critical in the care of individuals with Parkinson's disease (PD) and spend substantial time providing care, which may be associated with negative caregiver outcomes such as burden and mental health issues. Although research in the United States and Europe has generally supported these relations, there is very limited research on PD caregiving in Latin America. The current study examined the following connections in a sample of PD caregivers from the United States (N = 105) and Mexico (N = 148): (a) PD-related impairments (motor and nonmotor symptoms) and caregiver burden, (b) caregiver burden and caregiver mental health, and (c) PD-related impairments and mental health through caregiver burden. Study results uncovered significant relations among PD-related impairments, caregiver burden, and caregiver mental health. Further, caregiver burden fully mediated the relation between PD-related impairments and caregiver mental health at both study sites. Findings highlight a number of important intervention targets for caregivers and families, including caregiver burden and mental health.

This study estimated how patterns of substance use are related to work status, public program use, and well-being among a sample of female caregivers and children. This study assessed work, public program use, and well-being measures as a function of substance use among 1,623 female caregivers of children aged zero to four or ten to 14 who participated in the Welfare of Children and Families study and lived in low- and moderate-income neighborhoods in Boston, Chicago, and San Antonio. Data were analyzed from baseline interviews that were conducted from March through December 1999 and from follow-up interviews that were conducted 11 to 26 months after baseline (average of 16 months). Substance use patterns were placed into three categories: light or no substance use reported in both interviews, moderate or heavy substance use (that is, moderate or heavy use in both interviews or increased substance use during the study period), and reduced substance use during the study period. Among caregivers who reduced their substance use, measures of work status, receipt of income assistance, mental health symptoms, and reports of child behavior problems were not significantly different at follow-up from those of caregivers with light or no substance use. At follow-up, compared with caregivers with light or no substance use, those with moderate or heavy substance use were significantly less likely to experience improvements in mental health symptoms and to see improvements in their children's behavioral problems. Caregivers with moderate or heavy substance use were more likely to be "detached" (p=.051)--that is, neither working nor collecting income assistance--although this difference was only marginally significant. Caregivers with increased substance use fared poorly on measures of well-being and work. Policies that promote, rather than impede, reductions in substance use are more likely to promote self-sufficiency and well-being.

This study examines the relationship between community volunteer visitation frequency and caregiver burden among Chinese family caregivers of disabled elderly individuals, with a focus on the moderating role of caregivers’ mental health. A six-month longitudinal study was conducted in 30 communities (Langfang and Tai’an) with 582 primary caregivers (intervention: n = 388, control: n = 194). Caregiver burden (Zarit Burden Interview) and mental health (GHQ-12) were measured at baseline and after six months. Results revealed a U-shaped relationship: changes in caregiver burden (T2–T1) were minimized overall at 2.931 weekly visits. However, the turning points varied by caregivers’ mental health status: those with poorer mental health (GHQ-12 ≥ 3) reached the minimum change in burden (ΔZBI) at 3.615 weekly visits, whereas healthier caregivers reached it at 2.607 weekly visits. Community volunteer support showed a “double-edged sword” effect: moderate visitation alleviated burden, while extremes increased stress. Caregivers’ mental health moderated this effect, with those in poorer mental health benefiting from more frequent visits. The findings suggest customizing visitation frequency based on caregivers’ mental health and integrating psychological support into volunteer programs.

Potential Long Coronavirus Disease 2019 Gastrointestinal Symptoms 6 Months After Coronavirus Infection Are Associated With Mental Health Symptoms

The COVID-19 pandemic is impacting communities worldwide, with direct effects of illness and mortality, and indirect effects on economies, workplaces, schools/daycares, and social life. However, we understand very little about the effects of this pandemic on families of young children. We used a risk and resilience model to evaluate the effects of the pandemic on mental health in diverse caregivers (N = 286) with children ages birth to 5. We evaluated the hypotheses that (a) pandemic stress and caregiver-reported child psychosocial concerns correlate with caregivers’ mental health symptoms and (b) caregivers’ pandemic-related self-efficacy and coping mediate these relationships. Caregivers completed surveys in April–May 2020 assessing pandemic stress (e.g., health, finances, and housing), child psychosocial problems, coping strategies, and self-efficacy to manage family needs. Our primary outcome was caregivers’ self-reported changes in mental health symptoms since the outbreak. Path analysis revealed that higher pandemic stress was associated with caregivers’ reduced confidence in meeting their family’s needs related to COVID-19, which correlated with worse caregiver mental health symptoms. Greater child psychosocial problems also predicted worse caregiver mental health symptoms. Findings suggest that pandemic stress, child psychosocial problems, and caregiver self-efficacy are interrelated in their influence on caregivers’ mental health. While further research is needed to examine strategies to foster resilience and buffer the pandemic’s effects on caregiver mental health, this is a first step in evaluating the psychosocial effects of this pandemic in families of young children. Clinical implications are discussed for a tiered response to mitigate the pandemic’s impacts on family functioning.

Background:Women who experience intimate partner violence (IPV) (versus those who have not) are less likely to engage in treatment and more likely to encounter barriers to treatment. There is inadequate research regarding the effects of substance use, mental health symptoms, and IPV severity on mental health and substance use treatment utilization and barriers to treatment utilization among women who experience IPV. The goal of the present study was to describe substance use and mental health treatment utilization and to examine the extent to which substance use disorder (SUD), mental health symptoms, and IPV severity influence treatment utilization and barriers to treatment utilization among women experiencing IPV.Methods:Participants were 275 adult women experiencing IPV and who used any amount of alcohol or drugs in the past three months recruited from the community.Results:A total of 54.5% of women engaged in treatment for substance use and/or mental health in the past 30 days. Receiving substance use treatment was associated with greater odds of having a SUD (OR=2.30, p=.01). Receiving mental health treatment was associated with greater PTSD (b=5.04, p=.002) and depressive symptom severity (b=6.45, p <.001). Receiving combined substance use and mental health treatment was associated with more severe PTSD symptoms (b=5.32, p=.03) and IPV-related injury (b=5.14, p=.04). PTSD symptom severity was correlated with confidentiality concerns (r=.40, p=.02), and depressive symptom severity was correlated with attitudinal barriers (r=.40, p=.02). Psychological IPV severity was associated with attitudinal (r=.45, p=.01) and partner-related barriers (r=.35, p=.04).Conclusions:Utilizing treatment is associated with greater mental health severity, suggesting that either greater mental health symptom severity is associated with women seeking treatment and/or that treatment is not effectively reducing symptoms. Results highlight the importance of assessing psychological IPV and mental health symptoms to understand for whom barriers to treatment utilization are most relevant.

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

PurposeTo determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans.MethodsVeterans receiving primary care from primarily rural VA community‐based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH problem(s) were randomized to receive veteran peer‐delivered feedback on MH screen results and referrals plus 4 sessions of telephone motivational coaching (intervention) versus veteran peer‐delivered MH results and referrals without motivational coaching (control). Blinded telephone assessments were conducted at baseline, 8, 16, and 32 weeks. Cox proportional hazard models compared MH clinician‐directed treatment initiation between groups; descriptive analyses compared MH treatment retention, changes in MH symptoms, quality of life, and self‐care.FindingsAmong 272 veterans screening positive for ≥1 MH problem(s), 45% who received veteran peer telephone motivational coaching versus 46% of control participants initiated MH treatment (primary outcome) (hazard ratio: 1.09, 95% CI: 0.76‐1.57), representing no between‐group differences. In contrast, veterans receiving veteran peer motivational coaching achieved significantly greater improvements in depression, posttraumatic stress disorder and cannabis use scores, quality of life domains, and adoption of some self‐care strategies than controls (secondary outcomes). Qualitative data revealed that veterans who received veteran peer motivational coaching may no longer have perceived a need for MH treatment.ConclusionsAmong veterans with MH problems using predominantly rural VA community clinics, telephone peer motivational coaching did not enhance MH treatment engagement, but instead had positive effects on MH symptoms, quality of life indicators, and use of self‐care strategies.

This cross-sectional study examined differences in family needs (informational, social, financial, health, and household support), caregiver mental health (depression, satisfaction with life, vitality, social functioning, and emotional role limitations), and caregiver burden (personal life, guilt, and psychological) among caregivers of individuals with traumatic brain injury, spinal cord injury, multiple sclerosis, and dementia from cities in Colombia and Mexico (N = 343). The study also examined the connections among family needs, caregiver mental health, and caregiver burden in the combined sample of caregivers of individuals with neurological conditions. Many significant differences were identified among groups, and implications are discussed. Family needs, caregiver mental health, and burden were all robustly associated with each other, with financial and social support needs, depression, and burden-personal life and guilt emerging as particularly important. Clinicians should focus on helping caregivers meet financial and social support needs in order to positively influence caregiver burden and mental health.

Our previous research has highlighted the important link between coping behaviors and mental health symptoms in military personnel. This study seeks to extend these findings by examining each coping behavior and mental health issue individually. This study has four specific aims: (1) test cross-sectional relationships between coping and mental health at baseline and follow-up, (2) examine stability of each variable over time, (3) determine the predictive nature of baseline mental health and coping on subsequent mental health and coping, (4) assess the magnitude of each effect to evaluate the differential predictive value of coping behaviors and mental health symptoms. A convenience sample of U.S. Army platoons of the 82nd Airborne was surveyed. We used a two-wave, cross-lagged autoregression design with structural equation modeling to disentangle elements of temporality and to examine the predictive value of mental health status vis-à-vis coping behaviors and vice versa. Separate analyses were performed with each coping strategy and each set of mental health symptoms. This design allowed for the analysis of two synchronous associations (i.e., cross-sectional correlations between the coping strategy and mental health symptoms at each time point), two autoregressive effects (i.e., baseline mental health predicting mental health at follow-up and baseline coping predicting coping at follow-up), and two cross-lagged effects (i.e., baseline coping strategy predicting mental health at follow-up and baseline mental health predicting follow-up coping). Results of descriptive statistics revealed that the most frequently reported coping behavior was thinking of a plan to solve the problem, followed by talking to a friend, engaging in a hobby, and exercising or playing sports. The least often endorsed coping behaviors were smoking marijuana or using illicit drugs and thinking about hurting or killing oneself, followed by having a drink or lighting up a cigarette. We verified many cross-sectional relationships between coping behaviors and mental health symptoms. Specifically, talking to a friend, exercising or playing sports, engaging in a hobby, and thinking of a plan were associated with fewer anxiety, perceived stress, and depression symptoms, whereas smoking a cigarette, having a drink, and thinking about hurting or killing oneself were associated with more anxiety, perceived stress, and depressive symptoms. Marijuana and illicit drug use was also associated with higher depressive symptoms. Saying a prayer was not significantly related to mental health. Only four cross-lagged effects were significant. Those who reported more depressive symptoms at Time 1 reported talking to friends and family less and exercising or playing sports less as coping behaviors at Time 2. Baseline perceived stress predicted less likelihood of engaging in a hobby at follow-up, whereas exercising or playing sports as a coping behavior at baseline predicted lower perceived stress at follow-up. This study expands the evidence for the associations between coping behaviors and psychological health or distress to specific mental health symptoms, particularly in military service members, and provides comparisons of magnitude of each association. Clinically, this knowledge is critical to more efficiently target behaviors with the greatest associations to mental health in military personnel.

To identify the predictors of self-reported confidence and skills of GPs in management of patients with mental health problems. Cross-sectional survey, with questionnaire presented to 246 GPs working in 62 practices throughout Gippsland. Rural general practices in Gippsland. One hundred and thirty-four GPs across Gippsland. GPs completed a questionnaire assessing self-perception of knowledge and skills in recognition and management of common mental health problems. Of 134 GPs, 45% reported that they have a specific interest in mental health, and 39% of GPs reported that they had previous mental health training. Only 22% of GPs describe having both an interest and prior training in mental health care. Age and years since graduation are not significantly related to self-reported confidence and skills. The results of this study highlight that self-professed interest and prior training in mental health are associated. Self-professed interest in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health disorders. Similarly, prior training in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health problems. Self-professed interest in mental health issues is also associated with hours of participation in continuing medical education related to mental health care. Unfortunately, only a minority described having both interest and prior training in mental health care.

Background: Cystic fibrosis (CF) is an inherited, recessive condition, primarily affecting the respiratory and digestive systems. The current median life expectancy for adults with CF is approximately 37 years. Children with CF endure an intensive daily treatment regimen including dietary requirements, pancreatic enzyme replacements, vitamin supplementation, regular antibiotics, and airway clearance, in order to maintain their health status and reduce CF symptoms. The treatment regimen is often delivered by the primary caregiver. Caregivers can encounter problems in any of these areas in addition to other behaviour problems that are not specific to CF but nonetheless common in children. This thesis follows up a cohort of 117 caregivers of children with CF, initially recruited in 2007 from three CF clinics in the states of Victoria and New South Wales (NSW), Australia. Caregivers completed a survey about child problem behaviours and their own mental health. The baseline survey indicated that child moderate/severe sleep problems and eating/mealtime problem behaviours were more common than in healthy children. Physiotherapy adherence was a problem for 50.4% of the sample and symptoms of caregiver mental health problems were two to three times more common than in caregivers of healthy children. However, the natural history of these child problem behaviours and caregiver mental health symptoms remains unknown, as do the predictors of persistent child problem behaviours, and the use of health services by caregivers of children with CF. The aims of this study were therefore to: (1) describe the natural history of child problem behaviours and caregiver mental health symptoms over time; (2) identify caregiver and child health factors associated with child problem behaviours three years on and (3) document caregiver use of health services for their child and/or their own wellbeing. Method: The 117 caregivers who completed the baseline survey were invited to participate in the three year follow up. One child was excluded at follow up and 102 of the remaining 116 (88%) participated. At follow up children were aged three to eight years (M = 5.5, SD = 1.7). Caregivers provided consent for the child’s respiratory physician to supply the child’s most recent height, weight and lung function measurements. Caregivers completed questionnaires which repeated baseline measures. Several new measures were also included at follow up (i.e. caregiver coping and measures of child health status). Results: The proportions of child sleep, eating/mealtime and internalising problem behaviours at follow up were two to three times higher than community proportions. The prevalence of caregiver mental health symptoms also remained two to three times higher than community data. 71/102 (70%) of children experienced at least one persistent problem behaviour, with persistent physiotherapy and eating/mealtime problems being the most common. Caregiver mental health difficulties at baseline predicted persistent child moderate/severe sleep problems (adjusted OR 6.5, 95% CI 1.2 to 36.2, p = 0.03) and persistent poor adherence to the physiotherapy regimen (adjusted OR 3.5, 95% CI 1.3 to 9.2, p=.01). Whilst 47/98 caregivers (48%) reported no mental health symptoms at either time point, 25/98 (25%) reported persistent mental health symptoms. Children of caregivers with persistent symptoms of depression were six times more likely to experience moderate/severe sleep problems (adjusted OR = 6.2, 95% CI 1.5 to 25.8, p = .01) and four times more likely to experience internalising problem behaviours (adjusted OR = 4.3, 95% CI 1.1 to16.9, p = .04) at follow up. Children of caregivers with persistent stress symptoms were four times more likely to experience inappropriate eating/mealtime behaviours at follow up (adjusted OR = 4.1, 95% CI 1.1 to 14.9, p = .03). The child problem behaviours were generally not associated with child illness severity. Caregivers tended to seek help for child problems which reflected more ‘medical’ issues (i.e. eating (62/102, 61%), and physiotherapy difficulties 46/101 (46%)) but less so for behaviour, emotional or sleep problems. To address their own health/wellbeing 45/102 (44.1%) caregivers sought help from a health care professional, with General Practitioners (20/45; 44.4%) and Psychologists (16/45; 35.6%) being the most common sources of help. Conclusions: Child problem behaviours are common in children with CF, persist over time and are often predicted by elevated parent mental health symptoms. Caregiver mental health symptoms are also common and persist for one quarter of the caregiver population. Routine surveillance for, and management of, child problem behaviours and caregiver mental health symptoms is urgently required. Future studies assessing the feasibility and efficacy of caregiver interventions addressing both child problem behaviour and caregiver mental health are recommended.

Although studies reveal substantial mental health treatment needs among youths in the juvenile justice system, far less is known about young offenders transferred to adult criminal court. This statewide study examined the mental health needs of young offenders who committed serious crimes and were transferred to adult court and subsequently incarcerated in a prison for adults. Sixty-four boys aged 16 and 17 years who were incarcerated in the Texas adult correctional system completed the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), a mental health screening measure widely used in the juvenile justice system. Scores from the youths in adult prison were compared with those of a matched sample of youths in juvenile correctional facilities, drawn from the MAYSI-2 normative data. Youths in adult prison reported substantial symptoms of mental health problems. Most youths surveyed (51%) scored above the highest clinical cutoff (the "warning" range) on at least one MAYSI-2 subscale. For every clinical subscale except suicide ideation, the majority of youths (54% to 70%, depending on the subscale) scored above the "caution" range. Juveniles in adult prison reported higher rates of symptoms than did those in juvenile correctional facilities (effect sizes ranged from d=.18 to d=.65, depending on the subscale). Although the mental health needs of youths in the juvenile justice system are well documented, this study reveals that mental health treatment needs appear to be even more pronounced in the small subgroup of youths transferred to the adult criminal justice system and incarcerated in adult prison.