Caregiver Mood Research Articles

Perceived Mood, Health, and Burden in Female Mexican American Family Cancer Caregivers

Female family caregivers of various global cultures provide basic care in health, social, emotional, and financial domains for family members with cancer and may sacrifice their own health to do so. To learn about role-related mood, health status self-perceptions, and burden of one cultural group, we used qualitative and quantitative approaches to study 34 Mexican American (MA) women who provided care for an ill family member with cancer. We report quantitative data on study variables and make comparisons with caregiver qualitative reports. Implications for health planning, service delivery, and future research with underserved, minority female caregivers are presented.

Distressing emotions in female caregivers of people with AIDS, age-related dementias, and advanced-stage cancers.

To describe and compare the depressive mood, anxiety, anger, and sleep problems of informal female caregivers of people with AIDS, age-related dementias (ARD), and cancer (CA). Caregivers recruited from clinics serving people with AIDS, ARD, and CA were interviewed using structured instruments measuring depressive symptoms, anxiety, anger, and sleep problems. Data analysis compared these emotions in the caregivers and related aspects of the caregiving situation to these emotions within each group. Caregivers did not differ significantly in depressive mood, but did differ in anxiety and anger and sleep problems. Individual items on each scale were compared to provide more descriptive detail. In each group, distressing emotions were significantly related to each other and to sleep problems. Caregivers of people with AIDS, ARD, and CA experience distressing emotions that may affect their mental and physical health. A comprehensive approach to mental health nursing therapy will best meet the needs of caregivers in relieving their distress.

Depression, distress and positive mood in late‐stage cancer: a longitudinal study

To determine whether new-onset clinical depression emerges over time, and whether positive and negative mood levels change among patients with terminal cancer. In this two-site study, 58 cancer patients seen at least twice were interviewed monthly until death or study termination. Major measures included the Patient Health Questionnaire-9, Holland System of Beliefs Inventory, and Positive and Negative Affect Schedule. At study entry, 7% of patients had major depressive disorder; another 9% had depressive symptoms but no Axis I diagnosis. Twenty-two percent were taking antidepressants. During visits ranging from 2 to 21 per patient, 76% of patients never had a depression diagnosis, 3% were always depressed, and 14% became depressed for the first time, almost exclusively at their final visit before death. Scores on positive mood were equivalent to or higher than scores on negative mood and did not change over time. Cancer site, hospice, spiritual beliefs, income, and caregiver mood were unrelated to depression. Spiritual beliefs were, however, associated with positive mood, hope, and better quality of life. In this exploratory study, terminally ill patients approaching death experienced positive as well as negative mood although a significant minority met criteria for major depression at the last visit before death. The findings suggest that major depression is not an inevitable part of the dying process in patients with terminal cancer. Further, the appropriateness of classifying sadness, loss of interest and thoughts that one would be better off dead in the last days of life as psychopathology should be reconsidered.

Factors Associated with Concordance and Variability of Sleep Quality in Persons with Alzheimer's Disease and their Caregivers

To describe the day-to-day variation in sleep characteristics and the concordance between nighttime sleep of persons with Alzheimer's disease (AD) and their family caregivers. N = 44 community-dwelling older adults with probable or possible AD and their co-residing family caregivers. Participants wore an Actillume (Ambulatory Monitoring, Inc) for one week and completed an assessment battery to evaluate patient and caregiver mood, physical function, medication use, caregiver behavior management style, and patient cognitive status. Actigraphically derived sleep measures included bedtime, rising time, total time in bed, total sleep time, number of awakenings, total wake time, and sleep percent (efficiency). For each sleep parameter, total variance was determined for between-subject variance and within-subject variance from day-to-day. Sleep concordance was examined using multinomial logistic regression to compare trichotomous patient-caregiver combinations of good and bad sleepers. For both patients and caregivers, between-subject daily variability accounted for more of the variance in sleep than within-subject variability. Patient depression and caregiver management style were significant predictors both for concordant poor sleep (both patient and caregiver with sleep efficiency < or =85%) and patient-caregiver sleep discordance. This study provides data that sleep disturbances for persons with AD and their family caregivers vary considerably night to night, and that poor sleep in one member of the caregiving dyad is not necessarily linked to disturbed sleep in the other. Understanding the complex interrelationship of sleep in AD patients and caregivers is an important first step towards the development of individualized and effective treatment strategies.

How common is depression among ALS caregivers? A longitudinal study.

Our objective was to assess the impact of personal, situational and patient characteristics on mood, and changes over time, among ALS caregivers. Seventy-one patient-caregiver pairs were interviewed once and 51 (72%) monthly until endpoints of death or tracheostomy for long-term mechanical ventilation (LTMV). Depressive symptoms and DSM-IV disorders, coping strategies, caregiver burden, satisfaction with care-giving, and patient disease severity were assessed. At baseline, 13% of caregivers had major depression, and 10% had minor depression. Rates declined at last visit before death or LTMV (median interval three months), as did depressive symptoms. Correlates of caregiver depression included reliance on avoidance, perceived burden, fatigue, and feeling that the patient was critical and unappreciative. Half of the 14 caregivers of patients who planned LTMV were depressed at baseline, declining to 8% at endpoint, versus 16% (9/57) among caregivers of patients who died, declining non-significantly to 11%. While few personal or situational factors were correlated with caregiver distress, patients' plans and degree of supportiveness influenced caregiver mood. Verbal comments of caregivers clarified the distinction between sadness and psychiatric depression. The high baseline rate of depression among caregivers of patients who planned tracheostomy decreased as caregivers instituted major changes in patient care or personal counseling.

Reduced awareness of executive dysfunction in Alzheimer's disease is associated with increased carer burden

Previous research has shown that the presence of behavioral and psychological symptoms (BPSD) can increase the burden of care in dementia (e.g. Donaldson et al., 1998). Impaired executive functions, also called “dysexecutive syndrome” (Wilson et al., 1996), are frequent in dementia and can adversely affect social behavior in everyday life. Reduced awareness of cognitive deficits is associated with impaired executive functions, and may play a significant role in the onset and maintenance of BPSD. A recent paper by Davis and Tremont (2007) demonstrated that dysfunction of frontal systems is associated with increased burden of care in dementia, even after controlling for clinical severity and caregiver mood. In this letter, we report results that support this finding.

Depressed mood in informal caregivers of individuals with mild cognitive impairment.

This study estimates the prevalence of depressed mood in caregivers of individuals with mild cognitive impairment (MCI) and assesses whether demographics, stressors, intrapsychic strain, and gain are associated with depressed mood. A secondary analysis of baseline data from the Alzheimer's Disease Cooperative Study MCI trial was conducted using a cross-sectional, correlational design. Descriptive statistics to estimate the prevalence of caregiver depressed mood and univariate and block-wise logistic regression analyses were used. The prevalence of depressed mood in 769 caregivers was 24.6% (95% confidence interval, 21.5-27.7). The odds of being depressed were significantly higher in younger, nonspousal caregivers with less education, who cared for MCI patients with lower activities of daily living functioning, and who perceived greater relational deprivation, higher levels of self-loss, and personal gain. Controlling for relevant variables, relational deprivation and caregiver education continued to be significantly associated with depressed mood. Relational deprivation may be important for future interventions.

General mood of professional caregivers in child care centers and the quality of caregiver–child interactions

The present study is the first to relate professional caregivers’ general mood to the observed quality of their interactions with the children in their care. A total of 238 female caregivers from 133 child care groups in 64 centers completed the General mood scale of Bar-On’s Emotional Quotient Inventory (1997) and was observed while playing with small groups of children. Factor analysis on the General mood scale yielded five general mood factors, one negative and four positive. Two positive mood factors in particular, i.e., positivity and optimism, were found to contribute positively to the quality of professional caregivers’ behavior toward the children and, through their caregiving behavior, to the children’s well-being.

Premorbid relationship satisfaction and caregiver burden in dementia caregivers.

Dementia caregiver appraisal of the quality of their current and premorbid relationship with the care recipient is associated with caregiving behaviors, caregiver mood, and the decision to end home care. This study examined the contribution of premorbid relationship satisfaction to caregiver burden in dementia caregivers. Live-in dementia caregivers (n = 72) completed several psychosocial measures. Caregiver responses were used to divide them into low premorbid relationship satisfaction group (low) versus high premorbid relationship satisfaction group (high). Results indicate that premorbid relationship satisfaction is negatively associated with caregiver burden and quality of family functioning. Caregivers with high satisfaction demonstrated significantly less burden and less reactivity to memory and behavior problems, and better problem solving skills and more effective communication compared with the low caregivers. Findings are independent of length of caregiving, disease severity, care recipient daily functioning, and relationship type. Relationship satisfaction may be an important contributor to caregiver burden.

Role of Early Supported Discharge in Acute Stroke Patients

Role of Early Supported Discharge in Acute Stroke Patients

Impact of Frontal Systems Behavioral Functioning in Dementia on Caregiver Burden

Impact of Frontal Systems Behavioral Functioning in Dementia on Caregiver Burden

P4-231: Depressive mood in family caregivers of persons with mild cognitive impairment

P4-231: Depressive mood in family caregivers of persons with mild cognitive impairment

Training Community Consultants to Help Family Members Improve Dementia Care: A Randomized Controlled Trial

We investigated whether community consultants could be trained to teach family caregivers a systematic behavioral approach for reducing mood and behavior problems in persons with Alzheimer's disease. This study consisted of a randomized controlled trial; we randomly assigned 95 family caregivers and care recipients with Alzheimer's disease to STAR-caregivers (STAR-C) or control groups. Masked interviewers conducted assessments at baseline, after treatment, and after 6 months. Consultants were master's-level health care professionals who were currently practicing in community settings serving older adults. We assessed the extent to which consultants were able to learn and adhere to the treatment protocol, and the relationship between adherence and measures of caregiver mood, burden, and care recipient mood and behavior. Community consultants were able to learn and adhere to the behavioral treatment protocol. Caregivers receiving STAR-C training showed significant improvements in depression, burden, and reactivity to behavior problems in the care recipient. There were also significant reductions in the frequency and severity of care recipient behavior problems, and improved quality of life. Results were maintained at 6-month follow-up. Community-based consultants successfully implemented a behavioral intervention with family caregivers of persons with Alzheimer's disease. Consequently, STAR-C seems to be a practicable and reasonable evidenced-based approach to caregiver training in actual clinical settings.

Caregiver Assessment of Patients' Depression in Alzheimer Disease: Longitudinal Analysis in a Drug Treatment Study

Caregiver input is important in the assessment of depression in Alzheimer disease (AD), but depression and subjective burden can bias this input. In a 12-week, controlled, clinical trial of sertraline in depressed AD patients, authors correlated caregiver mood and subjective burden on several patient mood measures, incorporating varied degrees of caregiver input. Caregiver variables accounted for up to 33% of the variance in patient mood ratings. Caregiver depression and burden decreased regardless of treatment assignment. Caregiver depression and burden affect their rating of AD patients' mood, but the majority of variance is due to patient characteristics.

A randomized, controlled study of an Alzheimer's caregiver skills training program.

This study was an attempt to improve the quality of the relationship between dementia caregivers and their loved ones by decreasing the gap between caregivers' expectations and patients' actual functional abilities and by teaching supportive skills. Although a group of 49 caregiver-patient dyads were recruited, the outcome measures of only those dyads (47) that completed the week seven session were used for analysis. Half of the dyads were randomized to an intervention group and the other half to a waiting list. The intervention group (N = 24) completed a four-session caregiver training program in which caregivers first watched investigators administering to their loved ones the Texas Functional Living Scale and later progressed to helping their loved ones by appropriate cueing to perform the tasks involved. Comparisons were made between baseline scores, scores at seven weeks, and scores at the end of 17 weeks on the congruence between caregiver estimates and patients' actual performance on the Independent Living Scale and measures of cognition, function, preillness quality of relationship, caregiver mood, feeling of self-efficacy, and several other measures. We were not able to increase the congruence between caregiver estimates and patients' actual performance and found no change in any other measure. We didfind the expected relationship between depression and caregiver sense of self-efficacy.

Caregiver Reports

We describe one method for comparing clinician and caregiver perspectives on dementia patients, avoiding classifying perspective either as correct (a “gold standard”). Sixty-two individuals (31 patients with formal diagnoses of dementia and each patient's primary caregiver) served as study participants. Caregivers completed questionnaires about their perceived caregiver burden, their mood state and various aspects of patients' functioning. For comparison purposes, both clinicians and caregivers completed ratings and rankings of dementia-related problems in 4 domains of functioning. A majority of clinician-caregiver comparisons were incongruent, predominately for patients with a moderate degree of dementia. Overall caregiver burden (r = .63, p < .05) and care-giver mood state (F(1,29) = 7.14, p < .05) were both significantly related to clinician-caregiver incongruence.

Defining 'early dementia' and monitoring intervention: What measures are useful in family caregiving?

Measures of cognition are often used to define and measure the progress of dementia and outcomes of intervention. This paper examines whether measures of psychosocial disability used with those of cognition are more useful than measures of cognition alone, particularly in early dementia. A measure of cognition and two instruments of caregiver burden, used as routine clinical outcome measures of three types of Old Age Psychiatry dementia services, were examined. All cases with dementia in a memory clinic (MC; n = 149), a community mental health service for older people (CMHT; n = 120) and a specialist dementia day hospital (DH; n = 118), in one NHS district were followed up at 12 months. Measures of cognition (MMSE), behaviour, caregiver coping (Problem Checklist; PC) and caregiver mood (Hospital Anxiety and Depression Scale; HAD) were taken at baseline (MC, n = 48; CMHT, n = 113; DH, n = 55) and at follow-up (MC, n = 35; CMHT, n = 34; DH, n = 23). At baseline, all three groups had an average MMSE score of 'mild impairment' but measures of behaviour and caregiver burden showed subtle between-group differences. At the 12-month follow-up, cognition remained stable in all groups, but the frequency of day-to-day problems increased and caregiver mood deteriorated in families receiving DH support. The use of psychosocial measures of disability in conjunction with those of cognition, are important in the definition and longitudinal measurement of intervention and support in early dementia.

Skills Training for Spouses of Patients with Alzheimer's Disease: Outcomes of an Intervention Study

The effects of a 12-week intervention on a patient-focused skills training group and a caregiver-focused skills training group were compared with those on a control group that received comparable attention, but no training. Intervention effects were monitored at the completion of the treatment phase and at 3- and 6-months postintervention. Treatment implementation was documented in a comprehensive fashion to ensure replicability. Both training groups acquired skills that enabled them to improve targeted behaviors (patient problem behaviors and caregiver mood, respectively). Weaker effects were found for more distal outcomes, such as depression, perceived stress, caregiver strain, and self-efficacy.

Apolipoprotein E epsilon4 allele affects the relationship between stress and depression in caregivers of patients with Alzheimer's disease.

We examined the effect of the apolipoprotein E (apo E) epsilon4 allele on the relationship between self-reported stress and mood in caregivers of patients with Alzheimer's disease. Eighty-six female subjects between the ages of 28 and 82 years who were community-dwelling AD patient caregivers participated in the study. A cross-sectional analysis of stress and mood was performed using the Revised Memory and Behavior Problem Checklist and the Geriatric Depression Scale. All subjects were evaluated for normal cognitive function (Mini-Mental Status Examination) and apo E genotype. The results indicated that increased levels of stress were associated with increased levels of depressive symptoms in nondemented caregivers with the epsilon4 allele. This relationship was not observed in caregivers without the epsilon4 allele. These results suggest that carriers of the epsilon4 allele may respond differently to psychological stress than do individuals without the epsilon4 allele.

Psychosocial adjustment of patients and caregivers prior to allogeneic bone marrow transplantation.

There are many studies that examine the psychosocial adjustment of survivors of bone marrow transplantation (BMT). On the other hand, there are relatively few studies that examine the psychosocial adjustment of patients prior to BMT, and even fewer that focus on the psychosocial adjustment of the patient's caregiver. The purpose of the present study was to assess performance status and psychosocial adjustment to illness, mood and stress response of patients and caregivers prior to admission for allogeneic BMT. Forty patients and their 39 caregivers were assessed using standardized measures. One-fourth of the patients reported clinical levels of psychosocial maladjustment on the Psychosocial Adjustment to Illness Scale and had greater adjustment problems than BMT survivors. Approximately one-third (35%) and one-quarter (23%) of the patients reported significant symptoms of intrusive and avoidance stress responses, respectively on the Impact of Events Scale. Caregivers reported more impairments in family relationships than patients, but overall reported similar distress to that of patients. Information about the pre-BMT process appears to be critical to understanding the psychosocial impact that BMT can have on patients and their caregivers.