Caregiver Adjustment Research Articles

Adjustment and coping in spousal caregivers of cervical cancer patients in Ghana: A qualitative phenomenological study.

Cervical cancer is a common and significant health issue for women worldwide. To address the dearth of research on male partners' experiences when their significant others are diagnosed with cervical cancer, we aim to explore the unique challenges and perspectives encountered by men in these circumstances. The study adopted interpretive phenomenological analysis to qualitatively assess the experiences of males with partners diagnosed of cervical cancer. A phenomenological research design with purposive sampling technique was used to recruit and collect data from 38 participants until saturation occurred. Face to face interviews were conducted using a developed semi-structured interview guide. The data collected was analyzed using content analysis after verbatim transcription was done. The study resulted in the identification of 2 main themes, and 10 subthemes. These themes focused on the multifaceted impact of cervical cancer on spousal caregivers' lives and the coping and support mechanisms utilized by spouses of cervical cancer patients. The findings indicated that men faced several challenging experiences as a result of their spouses' condition and revealed the strategies they employed to cope with the stress of caring for their wives. Almost every man adopted a strategy to cope with the condition of their wives. This study would assist other men to understand the psychological, social, emotional, and spiritual experiences the men went through to appreciate and adopt their coping strategies whenever they go through such challenges.

A Conceptual Thematic Framework of Psychological Adjustment in Caregivers of Children with Craniofacial Microsomia.

Children with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families' treatment experiences or the impact of CFM on caregivers' well-being. To address this gap, the NIH-funded 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program sought to develop a conceptual thematic framework of caregiver adjustment to CFM. Caregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified. Components of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of "high" and "low" points throughout their journey and shared their priorities for future research. Narrative interviews provided rich insight into caregivers' experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.

Songwriting Group Music Therapy to promote psychological adjustment in informal caregivers of elderly people with dependency: a mixed methods study.

Informal caregivers of elderly people with dependency (EPD) provide intensive care that can affect their quality of life (QoL). Psychosocial interventions such as music therapy are important to work on their self-care. The aim of this study is to analyze, with a mixed method approach, the experience of participating in a Songwriting Group Music Therapy (SGMT) intervention on informal caregivers of EPD. A total of 11 groups, with a convenience sample of 61 caregivers, received 10 SGMT sessions. Quantitative information related to QoL variables (anxiety, depression, spirituality, burden, and coping) was collected before and after the intervention and at 3 months of follow-up. Regarding qualitative data, an open-ended question about the experience of participating was asked. Significant changes were shown, sustained over time, in trait anxiety and depression and subscales including inner peace, social functioning, and mental health. Three themes were generated from the thematic analysis, including that SGMT participation can enhance personal growth, bring out and enable work on emotions, and promote helpful interpersonal dynamics. The findings indicate that SGMT is a useful intervention for informal caregivers of EPD, promoting psychological adjustment, enhanced coping, emotional regulation, and social support. This study reinforces the findings with caregivers of other populations, providing new results and highlighting the benefits of SGMT for caregivers of EPD.

Challenges and facilitators in the experience of caregiving for an older adult with traumatic brain injury: A longitudinal qualitative study in the first-year postinjury.

To obtain a better understanding of the factors which complicate or facilitate the adjustment of caregivers after traumatic brain injury (TBI) in older adults. At 4, 8, and 12 months post-TBI (mild to severe), 65 caregivers answered two open-ended questions regarding facilitators and challenges linked to the injury of their loved one. A thematic analysis was performed. Participants mentioned almost as many facilitators as challenges at each time point. Among the facilitators, we found the following themes: receiving social support, having access to rehabilitation, improvement of the injured loved one's health condition, returning to live at home, having access to home services, feeling useful, effective communication, and having time for oneself. The challenges identified were: health issues in the injured loved one, psychological impact on the caregiver, assuming a new role, relationship strain, and decrease in activities and outings. During the first year following TBI in older adults, caregivers were able to identify several facilitators despite the presence of challenging factors, suggesting effective coping and resilience. This knowledge can guide potential caregivers in their adaptation after TBI in an older adult, and we propose a simple tool to support this process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Change in resilience among spousal caregivers of patients with newly-diagnosed advanced cancer over the first six months posttreatment in China

ObjectiveA longitudinal observational study was conducted and aimed to examine the change in resilience among spousal caregivers of newly-diagnosed advanced cancer patients over the first six months after initial treatment. MethodsIn total, 312 Chinese spousal caregivers who were taking care of their patients with newly-diagnosed advanced cancer were recruited. The level of resilience was measured using the Connor–Davidson Resilience Scale at the first month post-initial treatment (T1), three-month post-initial treatment (T2), and six-month post-initial treatment (T3). Latent growth modeling analyses were performed to examine changes in resilience using Mplus 8.3. ResultsThe mean scores of resilience in spousal caregivers were 54.01 ± 7.68 at T1, 56.20 ± 6.38 at T2, and 57.97 ± 6.70 at T3, respectively. Results of latent growth modeling indicated that spousal caregivers showed a significant increase in their resilience scores over the first six months post-treatment (Mean slope = 1.98, p < 0.001). Furthermore, a significant individual variation in the rate of changes in resilience scores allowed spouses to be categorized into two groups: 42.9% participants with fast growth and 57.1% participants with slight growth. ConclusionOur findings highlight the importance that new knowledge about change patterns of resilience in the nursing field is beneficial to reveal different psychosomatic health. Acknowledging that resilience is a dynamic process that changes over time, it is crucial for healthcare providers to monitor the psychological adjustment and focus of vulnerable caregivers, particularly spouses.

Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study.

Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time. Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury. Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale). In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI]=0.971; Incremental Fit Index [IFI]=0.986; Tucker-Lewis Index [TLI]=0.971; Comparative Fit Index [CFI]=0.985 and Root Mean Square Error of Approximation [RMSEA]=0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2. The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.

Risks and mitigating factors in psychosocial adjustment of spousal caregivers of people with dementia

AbstractBackgroundWe are living in an era when the world’s aging population is rapidly expanding. The importance of family caregivers has been receiving increasing attention since last decade. With longer lifespans and limited caregiving resources from the affected ones’ own children, some of whom are even childless, caregiving for older adults has become the main responsibility of their spouses. Caring for older adults with dementia has always been a family endeavor and spousal caregivers play a crucial role in caring for people affected by dementia in the communityMethodBy applying the Stress Process Model to examine the characteristics of people with dementia and their spousal caregivers, this study aims to identify the potential risk and mitigating factors of psychosocial adjustment among the spousal caregivers. We recruited 80 care recipient‐caregiver couples in Hong Kong and examined the relationships of socio‐economic, care recipient’s, and caregiver’s factors with spousal caregivers’ psychosocial adjustment through the use of questionnaire survey.ResultIt was found that care recipients’ cognitive functions were associated with caregivers’ reported frequencies of their behavioral and psychological symptoms of dementia (BPSD) (r = .30, p = .008), and caregivers’ perceived burden of caregiving (r = ‐.54, p = .008). Caregivers’ quality of life was associated with their perceived caregiving burden (r = ‐.82, p = .001) and self‐efficacy (r = .32, p = .001). Upon further examining the caregiving model with these parameters, a significant multivariate general linear model was found with (F (1, 12) = 13.06, p = .001, partial eta square = .70, observed power = .99). Moreover, female caregivers reported higher sense of caregiving stress and poorer quality of life than male caregivers.ConclusionThis study found that the cognitive functions and BPSD of care recipients with dementia and perceived level of caregiving burden are strongly associated with degrees of psychosocial adjustment among their spousal caregivers. The self‐perceived caregiving role in a family is also a possible confounding factor contributing to the perceived caregiving burden. To support in‐home caregiving of people with dementia, strategies to empower spousal caregivers to execute their caregiving roles are recommended.

Culpa y bienestar en cuidadores familiares de personas mayores dependientes institucionalizadas

Introduction and objectiveThe experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons. Materials and methodsTwo hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed. ResultsGuilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461). ConclusionsPaying attention to family caregivers’ feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

LIFE AFTER LOSS: EMERGING INSIGHTS ON GRIEF ADJUSTMENT AND HEALTH IN LATE LIFE

Abstract Recent scholarship recognizes that grief adjustment is not a staged, linear process. In late life, the loss of close others is common and dynamic. However, little is known about the ‘ripple effects’ from loss experiences. As people are living longer, it is important to gain insight regarding how loss is processed, carried, and used for self-direction. This symposium responds to GSA’s 2022 meeting theme of “Reimagining Aging” by presenting emerging research which reimagines grief adjustment across diverse populations. To begin, Sara Hackett, PhD will share her work on the continuing bonds of older conjugally bereaved women and how they shape perceptions about repartnering. Following, Emily Mroz, PhD will present on affective sequences in final memories from past spousal loss and demonstrate how sequences predict future caregiving confidence in these widowed older adults. Danielle McDuffie, MA will add to this rich discussion by shedding light on predictors of bereavement and grief outcomes specific to Black adults. Last, Holly Prigerson, PhD will outline unmet psychological needs of family caregivers of patients who die in ICU settings and present her work on EMPOWER, an intervention aimed to reduce psychological distress and foster caregiver adjustment across the loss experience in this setting. Stephanie Wladkowski, PhD, our discussant, will tie these perspectives together, facilitating an important dialogue regarding classic and newly-considered impacts of grief in late life. Further, she will discuss how through more closely examining peoples’ experiences during and after loss, we can recognize late-life bereavement as shaping self-perceptions, relationships, and mental health.

The effect of a virtual child disease management programme on burden and social adjustment of caregivers of children with coagulation factor deficiencies.

The use of virtual interventions is of interest to patients with chronic disease and healthcare professionals. This study aimed to determine the effect of virtual child disease management programme on burden and social adjustment of caregivers of children with coagulation factor deficiencies. Moreover, the effect of this intervention on children's acute pain and bleeds was assessed. This clinical trial was conducted on 80 caregivers of children with coagulation factor deficiencies. The subjects were randomly assigned into the intervention and control groups. A comprehensive virtual child disease management programme was conducted for 8weeks and caregiver' burden and their social adjustment were assessed with the HEMOCAB and social adjustment subscale of Bell Adjustment Inventory, respectively. Data were analysed using ANCOVA and Wilcoxon test. Before the intervention, both groups were similar regarding the caregivers' burden and social adjustment and children's acute pain and bleeds. However, a significant difference was observed between groups in concern to caregivers' burden (P<.001), women's and men's social adjustment (P=.001, P=.03), and children's acute pain and bleeds (P<.001) after the virtual disease management programme. This study showed that using a virtual child disease management programme reduced burden and improved social adjustment of caregivers of children with coagulation factor deficiencies. This intervention decreased frequencies of acute pain and bleeds in children. Therefore, using this effective intervention in clinical practice is warranted to decrease the caregivers' burden as well as acute pain and bleeds in children.

REACH-ASD: a UK randomised controlled trial of a new post-diagnostic psycho-education and acceptance and commitment therapy programme against treatment-as-usual for improving the mental health and adjustment of caregivers of children recently diagnosed with autism spectrum disorder

BackgroundAutism is a neurodevelopmental disability affecting over 1% of UK children. The period following a child’s autism diagnosis can present real challenges in adaptation for families. Twenty to 50% of caregivers show clinically significant levels of mental health need within the post-diagnostic period and on an ongoing basis. Best practice guidelines recommend timely post-diagnostic family support. Current provision is patchy, largely unevidenced, and a source of dissatisfaction for both families and professionals. There is a pressing need for an evidenced programme of post-diagnostic support focusing on caregiver mental health and adjustment, alongside autism psycho-education. This trial tests the clinical and cost-effectiveness of a new brief manualised psychosocial intervention designed to address this gap.MethodsThis is a multi-centre two-parallel-group single (researcher)-blinded randomised controlled trial of the Empower-Autism programme plus treatment-as-usual versus usual local post-diagnostic offer plus treatment-as-usual. Caregivers of children aged 2–15 years with a recent autism diagnosis will be recruited from North West England NHS or local authority centres. Randomisation is individually by child, with one “index” caregiver per child, stratified by centre, using 2:1 randomisation ratio to assist recruitment and timely intervention. Empower-Autism is a group-based, manualised, post-diagnostic programme that combines autism psycho-education and psychotherapeutic components based on Acceptance and Commitment Therapy to support caregiver mental health, stress management and adjustment to their child’s diagnosis. The comparator is any usual local group-based post-diagnostic psycho-education offer. Receipt of services will be specified through health economic data. Primary outcome: caregiver mental health (General Health Questionnaire-30) at 52-week follow-up. Secondary outcomes: key caregiver measures (wellbeing, self-efficacy, adjustment, autism knowledge) at 12-, 26- and 52-week follow-up and family and child outcomes (wellbeing and functioning) at 52-week endpoint. Sample: N=380 (approximately 253 intervention/127 treatment-as-usual). Primary analysis will follow intention-to-treat principles using linear mixed models with random intercepts for group membership and repeated measures. Cost-effectiveness acceptability analyses will be over 52 weeks, with decision modelling to extrapolate to longer time periods.DiscussionIf effective, this new approach will fill a key gap in the provision of evidence-based care pathways for autistic children and their families.Trial registrationISRCTN 45412843. Prospectively registered on 11 September 2019.

Raising a Child with Craniosynostosis: Psychosocial Adjustment in Caregivers.

While knowledge of the psychosocial impact of craniofacial conditions is growing, literature regarding the impact on parents remains limited. Parents of children born with a health condition may be at risk of experiencing a range of psychosocial challenges. This study conducted an initial investigation of psychosocial adjustment of parents of individuals with craniosynostosis to inform support provision for families. An online UK-wide mixed-methods survey was distributed to members of Headlines Craniofacial Support. Quantitative data including standardized measures were analysed using descriptive statistics and independent samples t-tests, and inductive content analysis was used for open-ended questions. Mothers (n = 109) and fathers (n = 9) of individuals ages 3 months to 49 years with single suture (63%) or syndromic (33%) craniosynostosis participated. Compared to the general population, parents of individuals with craniosynostosis reported higher levels of stress, anxiety, and depression; lower levels of resilience and optimism. Qualitative responses provided insight into parents' experiences of birth, diagnosis, healthcare provision, familial wellbeing, and relationships. Parents reported several unmet information and support needs, alongside a range of positive outcomes. This study illustrates the potential long-term psychosocial implications for parents raising children with craniosynostosis. There is a need for routine psychological screening for family members and provision of appropriate psychological support for those at risk for distress. Non-specialist health professionals may benefit from additional training about craniofacial conditions so they are better equipped to support and refer families.

Enteral nutrition support for infants with pulmonary hypoplasia: A qualitative evaluation of caregiver and provider perspectives.

Enteral nutrition is a critical intervention that supports the growth of children with pulmonary hypoplasia (PH). We explored the experiences of caregivers and providers caring for children with PH to better understand gaps in knowledge transfer and identify barriers and facilitators to caregiving to inform interventions that may improve support. This qualitative study included 10 interviews with caregivers and 10 clinical team members at a single integrated care program for children with PH. An inductive and iterative coding strategy was employed to produce a codebook. After cluster analysis, themes were generated to capture participant sentiments. Themes were defined along a care continuum (1) initiation, (2) adaptation, and (3) maintenance that represented distinct phases of adjustment to enteral nutrition support (1) in the perinatal period and initial neonatal intensive care unit (NICU) admission, (2) from discharge planning through the family's first days at home and establishment of a stable feeding regime, and (3) through long-term follow-up and weaning. Notable subthemes included uncertainty, partnerships in training, and obstacles to adaptation. Among children with PH, the caregiver-provider relationship during the perinatal and NICU course is critical to promoting caregiver adaptation to the needs of the child. Ongoing considerations to support resource alignment and transition to a stable feeding regimen may facilitate caregiver adjustment to a "new normal," culminating in successful growth and/or weaning. These findings will inform interventions focused on training curricula, discharge planning, and the provision of follow-up in the context of an integrated care program for PH.

Use of quality-of-life-related (QoL) eHealth interventions with Latino cancer patients during the pandemic: Findings from Latin America, United States, and Spain.

e18542 Background: The use of ehealth digital interventions (DI) can have a great potential to improve adjustment of cancer patients and caregivers. However, limited information is available about use of ehealth with Spanish and Portuguese speaking cancer patients from US, Spain, and Latin America. This study sought to explore the use of ehealth or DI by mental health providers (MHP) with Spanish and Portuguese speaking cancer patients and to determine the impact of the national income levels (World Bank Classification) on the use of this technology. Methods: An online survey was conducted from March to July 2021, publicized through social media and an organization Listserv. MHP (psychologists, psychiatrists) who treated Latino or Hispanic cancer patients in Latin America, Spain and the US, were invited to participate. The survey obtained demographic and professional information, The survey included questions about the use of eight DI (mobile apps, internet videos, websites, virtual conferences, virtual support groups, text messages, social networks, and emails) during the pandemic. For the purposes of this analysis, we excluded telehealth. Results: Among the 114 MHP (97% psychology related) from 18 countries, 25% were from high income countries (HIC; US, Spain, Puerto Rico, Chile, and Uruguay), and 75% were from middle income countries (MIC; other Latin American countries predominantly Mexico, Argentina, Peru). They were all Hispanic/Latino and 82% females. The majority, 77% of MHP, reported using at least 1 of the 8 DIs with cancer patients, average of two DIs (M = 2.3, SD = 1.9). Half of the MHP use internet-based videos with patients, 44% websites, 37% mobile apps, 29% virtual conferences, 19% virtual support groups, 19% text messages, 18% social networks, and 11% emails. Apps were recommended to improve emotional well-being (55%), anxiety/stress (53%), sleep disturbance (37%), depression (20%), fatigue (17%), pain (16%), loneliness/social support (13%), communication problems (12%), and other physical symptoms (8%). Comparing the country's income level across the use of the 8 DIs, only the use of mobile apps (62% HIC vs. 28% MIC) and email support (24% HIC vs. 6% MIC) were found significant. Conclusions: Previous research (with predominantly North American and European samples) has found that DIs can help cancer patients with side effects, improving self-management and wellbeing. DIs were largely used by MHP to mitigate emotional and physical symptoms and to improve the QoL of Latino cancer patients and only MHP from MIC (compared to HIC) differed in their use of mobile apps and email support. These findings support the potential for DI to improve care, and symptom management in Latino cancer patients from Latin America, the US, and Spain.

Impact of Sleep Deprivation and Coping Abilities on The Psychological Adjustment of Caregivers of The Elderly

Objective: To examine the impact of sleep deprivation and coping abilities on the psychological adjustment of caregivers of elderly.&#x0D; Study Design: Cross sectional analytical study.&#x0D; Place and Duration: Department of Psychology, University of Gujrat, Gujrat Pakistan, from Jan to Jul 2018.&#x0D; Methodology: The caregivers of the elderly were recruited in the study with the caregiving experience of 6 months to 2 years. The respondents with any physical or psychological problems were excluded from the study. The sleep deprivation, coping and psychological adjustment were measured using the Pittsburgh sleep quality index, coping styles scale, scale of adjustment for adults respectively.&#x0D; Results: The data of 200 caregivers of the elderly was analyzed using structure equation modeling. The model fit was established with the p-value of &lt;0.001. It was found that caregivers' sleep deprivation and coping abilities affected their psychological adjustments. The overall model confirmed that sleep deprivation and coping ability affected the psychological adjustment. The individual relationship between sleep deprivation predicted psychological adjustment with the value of regression estimate as 5.808 (p-value &lt;0.001). Furthermore, the role of coping abilities on psychological adjustment had a regression value of 0.151 (p-value 0.7013).&#x0D; Conclusion: The sleep deprivation affected the psychological adjustment of caregivers of the elderly, whereas the coping abilities did not affect the psychological adjustment.

Territorial and Gender Differences in the Home Care of Family Members with Dementia

The increasing prevalence of dementia is threatening the capacity of health and social service systems to provide long-term care support at the territorial level. In both rural and urban areas, specific family members (gendered care) are responsible for the daily care of their relatives. The aim of this work is to explore gender and territorial implications in the provision of in-home care by family members. To this end, family caregivers in Navarre, Spain, were administered the Psychosocial Adjustment to Illness Scale (PAIS-SR) and a semi-structured interview. The results show the good psychosocial adjustment of caregivers of relatives with dementia but the negative impacts of caregiving in the domestic, relational, and psychological domains. Moreover, the feminization of psychological distress was found to predominate in rural areas since mainly women are responsible for instrumental and care tasks, while men seek other complementary forms of support. Place of residence (rural vs. urban) was found to exert a strong effect on the respondents’ conception, life experience, and provision of care. Consequently, territorial and gender differences in coping with and adjusting to care require the design of contextualized actions adapted to caregivers’ needs.

Caring for a Family Member With Mild Dementia: Perceptions, Connections, and Relational Dynamics With the Sacred

Researchers define spirituality as the search for or connection with the “sacred”, which is transcendent and considered blessed, holy, or revered. For some, the sacred is connection with a divinity (e.g., God, gods) and for others, a close relationship with something else bigger than themselves (e.g., the Universe, Nature, a life philosophy). Current research reports that family caregivers with a strong connection to the sacred, as compared with those who do not, have fewer symptoms of depression, more positive perceptions of the caregiving experience, improved coping, and bolstered resilience. However, there is limited research on the impact of spirituality on the perceptions of familial caregivers whose loved ones have recently been diagnosed with dementia. In this study, 27 family caregivers of persons with mild dementia (CDR=1) were interviewed using the Dimensions of Caregiving Interview (DCI, McGee & Carlson, 2013). The DCI identified positive psychological aspects of the caregiving experience, including spirituality. Three heuristic themes emerged from Directed Content Analysis: perceptions about the sacred reflect variability in the early part of the caregiving journey; specific characteristics, traits, and functions of the sacred shape caregiver coping and adjustment; and the relational dynamics between caregivers and the sacred inform adaptation. Recommendations for clinical practice and additional research are provided.

Factors moderating the link between early childhood non-parental care and ADHD symptoms

IntroductionThere is little known about the association between non-parental care in early childhood and attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers. Therefore, we examined the association between childcare from grandparents/babysitters during infancy/preschool and ADHD symptoms in preschoolers. MethodsUsing stratified random sampling, we developed a sample comprising 1597 parents of children aged 1.6–7 years who were enrolled in preschool in rural and urban areas of China. Parental reports of ADHD symptoms were assessed using the preschool version of the ADHD Rating scale-IV. A regression analysis was used to examine the association between childcare from grandparents/babysitters and ADHD symptoms. ResultsChildcare from grandparents during infancy was associated with ADHD symptoms in childhood (β = 1.03, P < 0.0001). Significant associations between grandparental care and ADHD symptoms were also observed in children from families with more than one child (β = 0.64, P = 0.0035) and children living in rural areas (β = -0.78, P = 0.0032). A babysitter as the primary child caregiver in preschool was especially strongly correlated with ADHD symptoms in girls (β = 7.95, P = 0.0042). Moreover, region was strong factor associated with ADHD symptoms without adjustment for the non-parental caregivers’ age and education, whereas family income was not strongly associated with ADHD symptoms. ConclusionNon-parental caregiving (i.e., from grandparents or babysitters) in early childhood was associated with more ADHD symptoms in children. Certain characteristics in children, such as female gender and the existence of siblings, were stronger moderating factors than were family income and region.

Informal caregivers' self-identified roles in facilitating health-promoting behaviours for weight management in community-dwelling care recipients living with spinal cord injury in the United States.

Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health-promoting behaviours of healthy eating and physical activity among community-dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post-injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health-promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi-structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis. Participants included informal caregivers of individuals with SCI living in the community (n=24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and (8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health-promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self-identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health-promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested.

Relationship Between Caregiver Uncertainty, Problem-Solving, and Psychological Adjustment in Pediatric Cancer.

The current study examined the roles of constructive and dysfunctional problem-solving strategies in the relationships between illness uncertainty and adjustment outcomes (i.e., anxious, depressive, and posttraumatic stress symptoms) in caregivers of children newly diagnosed with cancer. Two hundred thirty-eight caregivers of children (0-19 years of age) newly diagnosed with cancer (2-14 weeks since diagnosis) completed measures of illness uncertainty, problem-solving strategies, and symptoms of anxiety, depression, and posttraumatic stress. A mediation model path analysis assessed constructive and dysfunctional problem-solving strategies as mediators between illness uncertainty and caregiver anxious, depressive, and posttraumatic stress symptoms. Dysfunctional problem-solving scores partially mediated the relationships between illness uncertainty and anxious, depressive, and posttraumatic stress symptoms. Constructive problem-solving scores did not mediate these relationships. The current findings suggest that illness uncertainty and dysfunctional problem-solving strategies, but not constructive problem-solving strategies, may play a key role in the adjustment of caregivers of children newly diagnosed with cancer. Interventions aimed at managing illness uncertainty and mitigating the impact of dysfunctional problem-solving strategies may promote psychological adjustment.