Caregiver Relationship Quality Research Articles

A Scientometric Review of Infant Cry and Caregiver Responsiveness: Literature Trends and Research Gaps over 60 Years of Developmental Study.

Infant cry is an adaptive signal of distress that elicits timely and mostly appropriate caring behaviors. Caregivers are typically able to decode the meaning of the cry and respond appropriately, but maladaptive caregiver responses are common and, in the worst cases, can lead to harmful events. To tackle the importance of studying cry patterns and caregivers' responses, this review aims to identify key documents and thematic trends in the literature as well as existing research gaps. To do so, we conducted a scientometric review of 723 documents downloaded from Scopus and performed a document co-citation analysis. The most impactful publication was authored by Barr in 1990, which describes typical developmental patterns of infant cry. Six major research thematic clusters emerged from the analysis of the literature. Clusters were renamed "Neonatal Pain Analyzer" (average year of publication = 2002), "Abusive Head Trauma" (average year of publication = 2007), "Oxytocin" (average year of publication = 2009), "Antecedents of Maternal Sensitivity" (average year of publication = 2010), "Neurobiology of Parental Responses" (average year of publication = 2011), and "Hormonal Changes & Cry Responsiveness" (average year of publication = 2016). Research clusters are discussed on the basis of a qualitative inspection of the manuscripts. Current trends in research focus on the neurobiology of caregiver responses and the identification of factors promoting maternal sensitivity. Recent studies have also developed evidence-based strategies for calming crying babies and preventing caregivers' maladaptive responses. From the clusters, two topics conspicuously call for future research: fathers' responsiveness to infant cry and the impact of caregiver relationship quality on cry responsiveness.

Frailty and caregiver relationship quality in older patients diagnosed with transthyretin cardiac amyloidosis.

Aim of the study was to explore frailty and quality of the relationship with the caregiver in a cohort of older patients with transthyretin cardiac amyloidosis (ATTR-CA). Sixty-eight consecutive ATTR-CA patients were recruited and assessed for frailty, depressive symptoms, quality of the relationship in terms of social support, or conflict toward caregivers, New York Heart Association Class (NYHA), and National Amyloid Center score (NAC Score) for grading disease severity. Results showed that 10% of patients were frail. Depressive symptoms were present in 46% of patients. Regression analyses showed that both mFI and depression were associated with worse perception of social support, and that mFI and NAC score were associated with higher levels of conflict perceived in the caregivers' relationship. Overall, the mFI score was associated with worse perceived social support and caregiver relationship quality. Tertiary care heart failure clinics should actively support the patient-caregiver relationship to improve quality of life.

Family Life During and Beyond COVID-19: The Impact of Relationship Quality on Caregivers’ Management of Paid Work, Caregiving, and Self-Care

This multi-method project examined how Australian caregivers navigated family life during the COVID-19 pandemic in 2020 and subsequent impact on family health behaviours. Participants were invited to complete all three phases. In phase 1, 115 caregivers completed an online survey, focussed on 2020 experiences of COVID-19. In phase 2, 96 of the participants completed a use-of-time recall and 80 completed a dietary recall examining participants’ health behaviours including how they spent their time, their physical activity, and diet quality. Phase 3 involved 24 of the participants completing an online story completion task, focussed on understanding participants’ sense-making of COVID-19. Through triangulating analyses of the three phases, this project identified how poor relationship quality negatively affected families’ experiences of significant disruptions and transitions. This project provides a nuanced picture of how COVID-19 in 2020 impacted family life and highlights the importance of caregiver relationship quality for family health and wellbeing.

Parent-Child Contact during Incarceration: Predictors of Involvement among Resident and Nonresident Parents Following Release from Prison

Despite promising evidence that family contact during incarceration may reduce recidivism, less is understood about its role in postrelease parental involvement with children. Drawing on data from the randomized controlled trial of the Parent Child Study, this article examines in-prison parent-child contact in relation to postrelease parent-caregiver relationships, residence, and nonresidential contact. Predictors of contact include measures of visits, calls, and letters. We use ordinary least-squares regression, logistic regression, and multivariate negative binomial models to assess the outcomes. We show that in-prison visits and calls are associated with caregiver relationship quality and that more frequent visits increase the odds of both postrelease parent-child residence and nonresidential visits. Parent-child visits in prison predict parent involvement after release and may be vital to children and families over and above contact in general. Findings have implications for social workers, criminal justice practitioners, policy makers, and nonprofit agency staff working with incarcerated parents.

The Mediating Effect of Caregiving Relationship Quality on the Association Between Caregiving Stressors and Mental Health Problems Among Older Spousal Caregivers.

Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect = .14, p = .016). Moreover, role overload was positively associated with caregiver mental health problems, which was mediated by negative relationship quality (indirect effect = .13, p = .002). Findings suggest that caregiving stressors can adversely affect mental health by exacerbating negative relationship quality. Interventions that limit negative exchanges and increase compassionate communications between older spousal caregivers and their care-receiving partners are needed.

Relationship quality and psychophysiological distress for underserved breast cancer patients and their caregiver before treatment.

Breast cancer patients and caregivers experience biobehavioral reactivity (e.g., depression, anxiety, pain, fatigue) during breast cancer treatment which predicts cancer recurrence and mortality. High quality patient-caregiver relationships can mitigate this distress during treatment, but this association is unclear pre-treatment. Identifying early interventions that target high risk Appalachian patients could impact biobehavioral reactivity. We recruited 55 breast cancer patient-caregiver dyads to complete a self-report survey after diagnosis but before treatment. We used a series of Actor-Partner Interdependence Models to test the hypotheses that both patient and caregiver relationship quality would be linked to their own and their partners' biobehavioral reactivity. Caregiver reported marital quality lower caregiver anxiety, patient anxiety, caregiver depression, patient depression, caregiver pain, and caregiver fatigue. Interestingly, patient-reported marital quality was linked with higher caregiver anxiety, higher patient anxiety, lower patient depression, and lower patient pain. Patients reported family quality was linked to lower patient and caregiver pain. This study demonstrates that pre-treatment marital and family quality levels are directly related to psychophysiological measures in both the caregiver and the patient, though sometimes in unexpected directions. Additionally, our findings potentially reveal an opportunity to intervene at the time of diagnosis to improve relationship quality, impacting patient and caregiver psychophysiological outcomes.

"When She Says Daddy": Black Fathers' Recidivism following Reentry from Jail.

We report on the findings of a mixed methods longitudinal study of 84 African American fathers of young children who were enrolled into the study during the father’s jail stay. Participants were assessed using interviews, self-report measures, and administrative records on frequency of father–child contact, father–caregiver relationship quality, family support, paternal pre-incarceration employment, fathers’ plans to live with the child upon reentry, history of substance abuse, and new convictions one year following release from jail. Qualitative analysis revealed three primary identities of fathers during incarceration: father as nurturer, father as protector, and father as provider. Qualitative analysis of interview data detailed the ways in which the context of incarceration and the presence of the criminal justice system interacts with these identities to impact family structure, parent–child visits, plans for release, and motivation for desistance. Quantitative analysis indicated heterogeneity among fathers, with links between parent–child contact and desistance conditional on fathers’ plans for coresidence with children as well as family support and relationship quality. Taken together, the findings highlight the strengths of African American fathers and their families despite the risks associated with incarceration, including the importance of family support and children as motivation for desistance. The results have implications for how the justice system weighs the bidirectional influences of fathers and families.

Neuropsychiatric symptoms and caregiver relationship quality for older Mexican Americans

Objectives Caregivers play a key role in supporting older Mexican Americans, who are less likely to enter nursing facilities than other racial/ethnic groups in the US. However, there is little research on how Neuropsychiatric symptoms (NPS) affect relationship quality between caregivers and care recipients. Method Using data from the 2015 wave of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) (n = 416) study of older (age 85+) Mexican Americans, we examined relationship quality and NPS with ordered logistic regression. Relationship quality was measured using positive (enjoyment, appreciation) and negative (nerves, argue) assessments. NPS were categorized into hyperactivity, affective, and psychosis symptoms. Results Hyperactivity symptoms were associated with appreciation, arguing, and nerves. Psychosis symptoms were associated with arguing and nerves. Spousal caregivers were more likely to report arguing and nerves and less likely to report feeling appreciated. Enjoyment assessments were not associated with NPS. Conclusion Relationship quality is related to behavioral changes in late life. Mexican American caregivers negatively evaluate their relationships, not in response to care tasks per se, but when the older person exhibits behavioral problems. The relationship between NPS and negative relationship assessments may be due to unanticipated behavior changes in late life and stigma around psychiatric symptomatology.

Organizational social context and psychopathology of youth in residential care: The intervening role of youth–caregiver relationship quality

AbstractDrawing on an ecological approach with multiple informants, this study investigated the mediating role of youth–caregiver relationship quality in associations between different features of residential care settings' organizational social context and youth's psychopathology. Participants were 378 youth aged between 12 and 25 years old, and 54 caregivers aged between 24 and 57 years old, from 29 generalist residential youth care settings in Portugal. Given the hierarchical structure of data, analyses were performed using multilevel modeling. Results revealed that organizational social contexts characterized by higher levels of engagement, stress, and centralization, as perceived by the caregivers, were associated with lower levels of youth's externalizing problems (e.g., aggressive behavior and delinquency), reported by the caregivers, via better youth–caregiver relationship quality, perceived by the youth in care. These findings highlight the relevance of creating an organizational social context in residential care settings that supports caregivers in establishing high‐quality relationships with the youth in care, thereby promoting their mental health. This study contributes to the clarification of conflicting findings in previous studies of this field, by offering further empirical investigation of these issues.

Caregiver Relationships and Distress Moderated by Collectivism

The number of older populations raising their grandchildren has increased. Past research has indicated the distress custodial grandparents’ experience is related to their family relationships (Hayslip, Shore, & Emick, 2006). Family relationships are also influenced by a variety of factors such as social history, culture, family structure, and individual differences (Uhlenberg & Kirby, 1998). The current study evaluated the influence of culture on the relationship between caregiver relationship quality and mental health by examining 885 children (18-25 years; M=18.93). This study also compared the difference in cultural impact between custodial grandparents-grandchildren and biological parents-children. Measures included the Network of Relationships Inventory, Hofstede Cultural Questionnaire, and Adult Behavior Checklist. Path analysis was conducted using AMOS 26.0 which resulted in an interaction between relationship closeness and collectivism to predict custodial grandparent depressive symptoms. Custodial grandparents who reported a lower level of closeness with their grandchildren in a higher collectivistic culture reported a significantly higher level of depression symptoms than those in a more individualistic culture, particularly for custodial grandmothers. However, custodial grandparents who reported a higher level of closeness with their grandchildren in a higher collectivistic culture reported significantly lower levels of depressive symptoms than those in a more individualistic culture. Furthermore, compared to biological parents, custodial grandparents reported significantly lower levels of depressive symptoms when reporting higher collectivistic culture. These findings will inform the need for more research to assess factors of cultural features that reduce psychological problems and support family relationships to adapt psychological therapies in older adults.

Neuropsychiatric index and relationship quality for caregivers of older Mexican Americans

AbstractBackgroundInformal caregivers play a key role in supporting older Mexican Americans, as they are less likely to enter nursing facilities than other racial/ethnic groups in the U.S, even when faced with high levels of physical and cognitive impairment. The quality of caregiving relationships is directly related to caregiver stress. However, there is little research on the correlates of caregiver assessment of relationship quality. Assessment of caregiver relationship quality is especially important for Mexican American older adult caregivers due to the high prevalence of cognitive impairment and dementia in this population.MethodsUsing data from caregiver supplement of the wave 7 of the Hispanic Established Population for the Epidemiologic Study of Elderly (HEPESE)(n=460) study of very old (Age 85+) Mexican Americans we examine the association of relationship quality with care recipient health, caregiver health, and caregiver finances. Caregiver relationship quality is measured using both positive and negative relationship assessments separately. We use linear regression to examine the correlates of caregiver relationship quality net of caregiver and care recipient demographics, care recipient physical (caregiver‐rated health, ADL and IADL disability) and mental health (caregiver‐rated NPI and care recipient MMSE), caregiver health (caregiver‐rated health and depression) caregiver finances (income and financial burden).ResultsCaregivers who were married to the care recipient reported both less positive and more negative assessments. Male care recipients, married caregivers, and caregiver depression were related to positive but not negative assessments. Both positive and negative assessments were significantly associated with IADL disability and NPI score but not MMSE score.ConclusionsRelationship quality for Mexican Americans among the very old is related to hands‐on care tasks and not financial strain. Disability status suggests that early changes in functional status are more stressful than more severe disability due to adjustment periods. Married caregivers may report higher relationship quality due to additional support from spouses in caregiving roles. NPI status is the most strongly associated correlate of both positive and negative relationship quality, while MMSE was not significantly related to either. Our results suggest that caregiver assessments of behavioral disturbances are more important to relationship quality than care recipient tested cognitive functioning.

Relations between child self-control, maternal relational frustration, and teacher-child conflict: a longitudinal study with children from dual-earner families.

This longitudinal study follows children from dual-earner families in 4 time-points, covering the early childhood period. We examined the influence of work-family conflict (WFC) on maternal relational frustration (RF) towards the child, and investigated the reciprocal relations among maternal RF, children's self-control (SC), and teacher-child (TC) conflict over time. Participants were 214 children (97 girls; M age = 4.00 years), their mothers, and teachers. Mothers reported their own WFC and RF, whereas teachers reported child SC and T-C conflict. Results from a cross-lagged panel model indicated the experience of WFC positively predicted maternal RF. Maternal RF and T-C conflict were negatively related to the child later SC abilities. Conversely, children who displayed SC difficulties were more likely to experience later maternal RF and T-C conflict. There was evidence supporting the bidirectional effects of child SC and T-C conflict across time. Moreover, maternal RF and T-C conflict were indirectly linked, via child SC. The findings are consistent with a transactional view of development, stressing the importance of contextual factors to the quality of caregiving relationships and highlighting the complex and reciprocal relations between child regulatory competence and the quality of relationships with distinct caregivers.

205 - Building and Using an Apps Library for People Living with Dementia and their Carers

205 - Building and Using an Apps Library for People Living with Dementia and their Carers

Purpose in Life Among Family Care Partners Managing Dementia: Links to Caregiving Gains.

Purpose in life is associated with better health and has been found to minimize caregiving stress. Greater purpose may also promote caregiving gains (i.e., rewards or uplifts from providing care), yet the implications of purpose for positive aspects of the care role are largely unknown. The present study determined how perceptions of purpose in life among persons with dementia (PWDs) and their family caregivers are linked to caregiving gains. This cross-sectional study examined 153 co-resident family caregivers drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate associations between caregivers' and PWDs' reports of their own purpose in life and caregivers' perceived caregiving gains, along with whether these associations vary by caregiver gender. Models controlled for caregivers' sociodemographic characteristics, relationship to the PWD, care tasks, role overload, negative caregiving relationship quality, and both care partners' chronic health conditions. Caregivers' higher purpose in life was significantly linked to greater caregiving gains. Beyond this association, PWDs' higher purpose in life was significantly associated with greater caregiving gains for women but not for men. Purpose in life is a psychological resource that contributes to positive caregiving outcomes. Interventions to improve caregiver well-being could benefit from strategies that strengthen and maintain feelings of purpose among caregivers and PWDs.

Developmental effects of childhood household adversity, transitions, and relationship quality on adult outcomes of socioeconomic status: Effects of substantiated child maltreatment

The degree to which child maltreatment interacts with other household adversities to exacerbate risk for poor adult socioeconomic outcomes is uncertain. Moreover, the effects of residential, school, and caregiver transitions during childhood on adult outcomes are not well understood. This study examined the relation between household adversity and transitions in childhood with adult income problems, education, and unemployment in individuals with or without a childhood maltreatment history. The potential protective role of positive relationship quality in buffering these risk relationships was also tested. Data were from the Lehigh Longitudinal Study (n = 457), where subjects were assessed at preschool, elementary, adolescent, and adult ages. Multiple group path analysis tested the relationships between childhood household adversity; residential, school, and caregiver transitions; and adult socioeconomic outcomes for each group. Caregiver relationship quality was included as a moderator, and gender as a covariate. Household adversity was negatively associated with education level and positively associated with income problems for non-maltreated children only. For both groups, residential transitions was negatively associated with education level and caregiver transitions was positively associated with unemployment problems. Relationship quality was positively associated with education level only for non-maltreated children. For children who did not experience maltreatment, reducing exposure to household adversity is an important goal for prevention. Reducing exposure to child maltreatment for all children remains an important public health priority. Results underscore the need for programs and policies that promote stable relationships and environments.

Medical Care Tasks among Spousal Dementia Caregivers: Links to Care-Related Sleep Disturbances

Medical care tasks are commonly provided by spouses caring for persons living with dementia (PLWDs). These tasks reflect complex care demands that may interfere with sleep, yet their implications for caregivers' sleep outcomes are unknown. The authors evaluated the association between caregivers' medical/nursing tasks (keeping track of medications; managing tasks such as ostomy care, intravenous lines, or blood testing; giving shots/injections; and caring for skin wounds/sores) and care-related sleep disturbances. A retrospective analysis of cross-sectional data from the 2011 National Health and Aging Trends Study and National Study of Caregiving was conducted. Spousal caregivers and PLWDs/proxies were interviewed by telephone at home. The U.S. sample included 104 community-dwelling spousal caregivers and PLWDs. Caregivers reported on their sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and sleep disturbances. PLWDs (or proxies) reported on their health conditions and sleep problems. Caregivers who performed a higher number of medical/nursing tasks reported significantly more frequent care-related sleep disturbances, controlling for sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and PLWDs' sleep problems and health conditions. Post hoc tests showed that wound care was independently associated with more frequent care-related sleep disturbances after accounting for the other medical/nursing tasks and covariates. Spousal caregivers of PLWDs who perform medical/nursing tasks may be at heightened risk for sleep disturbances and associated adverse health consequences. Interventions to promote the well-being of both care partners may benefit from directly addressing caregivers' needs and concerns about their provision of medical/nursing care.

Predictors of Secondary Role Strains Among Spousal Caregivers of Older Adults With Functional Disability.

Aging spouses commonly care for a partner with functional disability, but little is known about how spousal caregiving may impact different life domains. This study evaluated how caregiving characteristics are associated with secondary role strains among spousal caregivers. This cross-sectional study examined 367 spousal caregivers and their partners from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Hierarchical regressions were estimated to determine how caregiver background factors (sociodemographics, health conditions) along with primary objective (care activities, care recipient health conditions, and dementia status) and subjective (emotional caregiving difficulties, role overload) stressors are linked to care-related valued activity restriction, negative caregiving relationship quality, and care-related family disagreements. Gender differences were considered. After accounting for all predictors, older caregivers and caregivers providing more help with activities of daily living and health system interactions (e.g., scheduling appointments) were more likely to report activity restriction, whereas caregivers with more emotional difficulties reported higher negative caregiving relationship quality. Role overload was positively associated with all three secondary strains. For husbands only, caring for a partner with more chronic conditions was linked to higher negative caregiving relationship quality and caring for a partner with dementia was associated with a greater likelihood of family disagreements. Secondary role strains may develop through similar and unique pathways for caregiving wives and husbands. Further research is needed to identify those who could benefit from support in managing their care responsibilities alongside other life areas.

The Relationship Between Mutuality and Health-Related Quality of Life in Adult Child Caregivers in China.

The strain inherent in caregiving relationships between adult children and aging parents is a prominent issue in contemporary China due to a combination of demographic and socioeconomic changes. The purpose of this study was to explore how mutuality, a positive quality of caregiving relationships, contributes to the physical health and mental health (health-related quality of life [HRQoL]) of adult child caregivers [ACCs] of parent stroke survivors. A cross-sectional correlational study was conducted on a nonproportional quota sample of 126 ACCs, using questionnaires of demographics, the 15-item Mutuality Scale, and the Second Version of the Standard 12-Item Health Survey (SF-12v2). Higher mutuality was found to be correlated with better caregiver physical health and mental health. However, after adjusting for the covariates, mutuality significantly explained 4.6% of the variance of caregiver physical health (β = .22, ΔR2 = .046, p < .01) but it did not significantly explain the variance of caregiver mental health. Although multiple factors correlate with Chinese family caregivers' HRQoL, this was the first study exploring the impact of caregiver-care receiver dyadic relationships on caregiver HRQoL in mainland China by using a mutuality scale with SF-12v2. Despite the fact that the Chinese tradition of filial piety can facilitate mutuality, socioeconomic changes and legislation that require adult children to care for aging parents appear to create high stress among family caregivers. Higher levels of mutuality contribute to better physical health in Chinese family caregivers. Therefore, culturally appropriate family nursing strategies and social policies in China could enhance caregiver mutuality and potentially promote their HRQoL, in particular physical health.

Spouse cancer caregivers' burden and distress at entry to home hospice: The role of relationship quality.

High-quality relationships may be protective for family caregivers. This study focuses on relationship quality categories (supportive and ambivalent) in spouse caregivers in cancer home hospice. The goals of this article are to, first, describe relationship quality categories among end-of-life caregivers and, second, test the effects of relationship quality categories on caregiver burden and distress within a stress process model. Using questionnaire data collected at entry to home hospice, we found relationship quality categories were proportionally similar to those seen in noncaregiver older adults. Relationship quality significantly predicted caregiver burden, which completely mediated the relationship between caregiver relationship quality and distress. Caregivers whose social contexts place them at risk for greater distress may benefit from increased clinical attention or intervention.

Parent–Caregiver Relationships Among Beginning Caregivers in Canada: A Quantitative Study

Despite the importance of establishing meaningful parent–caregiver relationships, little is known about these dyadic relationships among beginning caregivers, who often feel insufficiently prepared to build successful alliances with parents. The present study examined the congruence between parents’ and beginning caregivers’ perceptions of their mutual relationship, as well as the role of five factors hypothesized to influence the quality of this relationship: type of child care center (for-profit or non-profit), caregiver teamwork, child’s age group, caregiver’s parenting experience, and caregiver’s professional experience. A sample of 166 parent–caregiver dyads reported on their perceptions of three indicators of their relationship quality: confidence, collaboration, and affiliation. Although parents and caregivers were generally satisfied with their mutual relationship, there was relatively little agreement between parents and beginning caregivers regarding relationship quality; the magnitude of the correlations between parents’ and caregivers’ perceptions of relationship quality was quite small. On average, parents reported higher levels of confidence and collaboration than did caregivers. Parents and caregivers had more similar perceptions of relationship quality in non-profit child care settings, with caregivers who were less experienced, and when caregivers did not work in teams. Additionally, parents reported closer parent–caregiver relationships in for-profit centers, when caregivers had more experience, and when caregivers worked in teams. These findings provide some insight about the factors that predict parent–caregiver relationship quality. They also highlight the need for increasing communication between parents and beginning caregivers in order to ensure parent–caregiver relationships that parents and caregivers perceive more similarly and positively.