ObjectiveThis study aimed to preliminarily evaluate the impacts of narrative-based palliative care on psychological stress, end-of-life acceptance, and quality of life in elderly terminally ill cancer patients and their family caregivers.MethodsThis single-center, small-sample randomized controlled study enrolled 50 elderly terminal cancer patients. Patients were randomly assigned to either the observation group or the control group (n = 25 each). The observation group received narrative-based palliative care, while the control group received routine standard care. Family psychological stress was assessed using the Relative Stress Scale (RSS), and patients' perceived stress was evaluated with the Perceived Stress Scale-10 (PSS-10). Caregiver satisfaction was measured using a hospital-developed questionnaire. Patients' quality of life was evaluated using the SF-36, Chinese Version of the Death Attitude Profile (DAP-C), and Pittsburgh Sleep Quality Index (PSQI), respectively.ResultsBaseline characteristics did not differ significantly between the two groups (P > .05). Post-intervention, the observation group demonstrated significantly lower psychological stress among family members and higher caregiver satisfaction (P < .05). Patients in the observation group reported better quality of life, improved sleep, and greater acceptance of death than those in the control group (P < .05).ConclusionAs a small-sample, single-center study, these findings offer preliminary evidence that narrative-based palliative care may reduce psychological stress in elderly terminal cancer patients and caregivers while enhancing patients' quality of life, sleep quality, and acceptance of death. However, the limited sample size, single-site design, and narrow inclusion criteria restrict generalizability. Larger multicenter trials are needed to confirm these results.

This study measured experiences of parenting stress and stressful life events in caregivers of families with a toddler who has either an autistic or non-autistic older sibling(s). Caregivers of toddlers (12-18 months old) with older autistic siblings (Sibs-autism; n = 58) and toddlers with older non-autistic siblings (Sibs-NA; n = 46) completed questionnaires assessing stress related to parenting their toddler and their exposure to stressful life events since their toddler's birth. We compared levels of parenting stress and stressful life events between caregivers of Sibs-autism and Sibs-NA and examined the association between these measures. Caregivers of Sibs-autism reported significantly higher levels of parenting stress and stressful life events relative to caregivers of Sibs-NA, with small to moderate effects. Parenting stress and stressful life events were moderately correlated. Across these groups of caregivers, parenting stress and stressful life events appear to be related, but partially distinct aspects of caregiver stress. These findings highlight the importance of assessing multiple aspects of stress to better understand how stress may influence both caregiver wellbeing and the development of children with autistic siblings.

With the rapidly aging Hispanic/Latino population in the United States and the traditional caregiving roles of women in this culture, it is critical to study caregiving stress in the largest yet understudied subgroup—women caregivers of Mexican origin. This descriptive feasibility study aimed to adapt a research protocol to examine the impact of long-term caregiving stress on coronary heart disease risk among women caregivers of Mexican origin, using the allostatic load model and the Framingham Risk Score. A purposive sample of 20 women providing family care to a dependent older relative for at least 24 hours per week over the past 6 months was recruited through community networks, home health care agencies, promotoras , the local chapter of the Alzheimer’s Association, and hospital outpatient services in a U.S.–Mexico border city. Multiple approaches were employed, including structured interviews and the collection of biological samples. Key adjustments included refining terminology to align with participants’ preferences, managing complex data collection, and adjusting recruitment criteria to reflect cultural norms. COVID-19-related delays necessitated further adaptations, including proactive licensing management and alternative recruitment strategies. Inclusion and exclusion criteria were revised multiple times to better reflect family caregiving dynamics, ensuring continuity despite staff turnover and rising costs due to the study’s extended duration and inflation. By addressing these challenges, we laid the groundwork for research on long-term caregiving among women of Mexican origin. Future research will focus on developing preventive interventions to reduce caregiving stress and coronary heart disease risk, ultimately supporting aging-in-place for dependent older adults in their care.

This quantitative study examines the relationship between the frequency of texture-modified food intake, ease of use, perceived usefulness, and caregiver strain in Hong Kong. A total of 102 caregivers participated in the study. Results showed that perceived usefulness significantly predicted texture-modified food consumption, while ease of use did not. Higher intake frequency was associated with increased caregiver stress, especially among older caregivers managing complex health conditions of their care recipients. Findings highlight the need for holistic support systems to alleviate caregiver burden and improve elderly nutrition, emphasizing the need to render additional support and resources to address the challenges faced by caregivers.

Dementia is a global public health concern, with prevalence projected to reach 78 million individuals by 2030 and 139 million by 2050. Most persons living with dementia reside in community settings and are supported by family caregivers. As caregiving demands grow, caregivers experience significant psychosocial, emotional, and financial burden, including high rates of stress, social isolation, and depressive symptoms. Access to effective support services remains limited, highlighting the urgent need for innovative and accessible caregiver interventions. This pilot study first aims to assess the feasibility, acceptability, and tolerability of VR-SIM Carers, a virtual reality (VR)-based psychoeducational training program for family caregivers or care partners of people living with dementia. Second, it will aim to provide a preliminary evaluation of potential impact on caregiver outcomes, including caregiver competence, stress, resilience, empathy, and quality of life. The study is not designed to support causal inference regarding the effectiveness of VR-SIM Carers. A mixed methods design will be used with a sample of 30 family caregivers of people living with dementia. Participants will complete 3 immersive, self-paced VR caregiving scenarios-Managing Apathy, Crisis Response, and Refusal of Care-receiving real-time feedback from simulated characters, including clinician and person living with dementia avatars. Primary outcomes (feasibility and educational impact) include recruitment, retention, adherence, usability, acceptability, and tolerability and caregiver competence (Pearlin Caregiving Competence Scale), perceived stress (Cohen Perceived Stress Scale), resilience (Connor-Davidson Resilience Scale), and empathy (Empathy Assessment Scale). Secondary outcomes (preliminary efficacy) include caregiver quality of life (Adult Carer Quality of Life Questionnaire), caregiver burden (Burden Questionnaire), and behavioral symptoms (Neuropsychiatric Inventory, Center for Epidemiologic Studies Depression Scale Short Form) assessed at baseline, postintervention, and 1-month follow-up. Feasibility and user engagement will be evaluated via the 18-item Gaming Use Engagement and Severity Scale, Igroup Presence Questionnaire, qualitative interviews, reflection notes, and open-ended feedback. Quantitative data will be analyzed using repeated-measures ANOVA and paired 2-tailed t tests, while qualitative data will be analyzed using an inductive thematic coding framework. Data analyses are descriptive and exploratory only, and no causal claims regarding intervention effectiveness will be made. Consistent with CONSORT (Consolidated Standards of Reporting Trials) guidance for pilot and feasibility studies, caregiver outcomes (eg, competence, stress, resilience, empathy) are treated as exploratory. The findings from this study will inform the feasibility, acceptability, and educational value of immersive VR for caregiver training, while providing preliminary evidence regarding the efficacy of VR-SIM Carers as a training tool to improve psychoeducation outcomes for family caregivers of people living with dementia and reduce caregiving burden. Data collection commenced in March 2024 with a projected end date of March 2026. As of the submission of the manuscript (December 2025), 21 participants have been enrolled. Data analysis will be completed in April 2026, and the results are expected to be published in fall 2026. VR-SIM Carers represents an innovative, scalable intervention designed to enhance caregiver preparedness, psychosocial outcomes, and sustainable community-based dementia care. This pilot study will provide critical evidence to guide further development and implementation of VR-based caregiver support programs.

Personality factors have been shown to be associated with death anxiety, but sensory processing sensitivity (SPS), has yet to be examined in this context. Given the ubiquity of death-related media, it is proposed that SPS predisposes individuals to death anxiety in response to daily, death-related stimuli. As death and dying are ranked as prevalent stressors for caregivers, this study compared caregivers and non-caregivers in examining whether SPS and its subscales; low sensory threshold, ease of excitation and aesthetic sensitivity, were differentially associated with death anxiety across them. In the overall sample and in caregivers, SPS, low sensory threshold and ease of excitation predicted death anxiety, after controlling for related variables. Only ease of excitation predicted death anxiety in non-caregivers. Future research may expand on these findings, by qualitatively examining the experience of death anxiety for those high in SPS, and in experimentally testing mechanisms linking SPS, and its subscales, with death anxiety.

PurposeTo understand general COVID-19 pandemic-related stressors among caregivers of children ages 3-15, and describe institutional, interpersonal, and personal protective factors used to cope with pandemic-related stress.DesignSemi-structured, in-depth interviews.SettingMaryland.ParticipantsCaregivers of children enrolled in the COVID-19 Family Study; 38 caregivers during 2020 (T1) and 22 caregivers during repeat interviews in 2021 (T2).MethodThe research team developed interview guides informed by the Family Stress Model (FSM) for T1 and T2 interviews. Interviews were analyzed using content coding to later construct themes related to how stressors and protective factors changed over time.ResultsThe thematic analysis is described across four concepts: caregiver stressors, institutional protective factors, interpersonal protective factors, and personal factors. In T1 interviews, stressors included viral exposure, remote work and school, and social distancing. During T2 interviews, caregivers described re-opening of work, school, and businesses and shifting back into pre-pandemic routines as continuing stressors. In both rounds of interviews, caregivers described a variety of institutional, interpersonal, and personal protective factors to cope with stress. Commonly mentioned protective factors included government aid (i.e., stimulus checks, free school lunches), family time, and hobbies.ConclusionFindings highlight the necessity of multi-tiered (institutional, interpersonal, personal) approaches to support caregivers navigating stressful experiences during times of extraordinary duress, especially emphasizing interventions that incorporate various levels of the socioecological model.

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent deficits in social communication and interaction, as well as restricted, repetitive patterns of behaviour, interests, or activities. Despite advancements in our understanding of ASD, identification, screening, diagnosing, and treating this condition present significant challenges. This review article comprehensively examines the current diagnostic and treatment landscape for ASD, addressing key issues and opportunities for improvement. The diagnostic criteria for ASD, as outlined in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), provide a framework for identifying the condition. Still, the heterogeneity of presentation and the presence of comorbidities contribute to diagnostic complexity. Early intervention is crucial for improving outcomes in individuals with ASD; however, accessing timely and appropriate interventions can be challenging. A diverse range of interventions exists for individuals with ASD, including behavioural therapies, pharmacological treatments, gene expression, and alternative therapies. However, the efficacy and accessibility of these treatments vary, and navigating the treatment landscape can be daunting for caregivers and clinicians alike. Moreover, due to the persistence of healthcare disparities, , underserved populations face barriers to diagnosis and treatment. Transitioning to adulthood poses unique challenges for individuals with ASD, including finding employment and accessing support services. Additionally, ASD affects not only individuals diagnosed with the condition but also their families and caregivers. Addressing caregiver stress and burnout is essential for providing holistic care to individuals with ASD and their families. This review also identifies areas needing further research, such as personalized medicine and healthcare disparities, and discusses policy implications for enhancing ASD care and support. By highlighting research needs and policy considerations, this review aims to inform future efforts to improve ASD Screening, diagnosis, and treatment, ultimately striving to enhance outcomes for individuals with ASD and their families.

Quality of life, productivity loss, and mental health service utilization among parents of children with neuroinflammatory disorders: A cross-sectional study.

Family caregivers of individuals with intellectual and developmental disabilities often experience chronic stress and poor mental and physical health. This study examined the feasibility of a 12-week single-arm intervention to reduce caregiver stress. The caregiver intervention included a yoga class and informational support group. Feasibility measures included recruitment, attendance, retention, fidelity and acceptability (interviews). Exploratory impacts on perceived and physiological stress (salivary cortisol), social support, caregiver strain, family empowerment, sleep, physical activity and body mass index were assessed by percent change across the intervention. Twenty caregivers enrolled (95% retained) and participants attended 67% of sessions. Intervention fidelity was 95%. Semi-structured interviews revealed high acceptability of the intervention. Perceived stress decreased by 5.8% and cortisol decreased by 24.1%. Changes in all but one exploratory outcome were in desirable directions. The intervention was feasible and acceptable among participants with positive initial effects on the majority of exploratory outcomes.

This study examined Black caregivers’ affective responses to racial discrimination (i.e., the extent to which they reported being bothered by discriminatory experiences) and how these responses were associated with stress associated with navigating racial socialization practices (i.e., stress during conversations about race and racism with children). We further tested whether coping self-efficacy beliefs (i.e., problem-focused coping, suppressing unpleasant emotions and thoughts, and seeking support from family and friends) moderated the association between racial discrimination and racial socialization stress. The sample included a socioeconomically diverse sample of 680 Black caregivers (Mage = 37, 55% mothers). A significant interaction indicated that among caregivers who reported being highly bothered by racial discrimination, higher levels of problem-focused coping were associated with greater racial socialization stress, whereas lower levels of problem-focused coping were associated with lower stress. Being highly bothered by racial discrimination and reporting high levels of stopping unpleasant emotions and thoughts as a coping strategy was associated with the lower levels of racial socialization stress in comparison to those with lower levels of stopping unpleasant emotions and thoughts. Black caregivers, under the conditions of reporting being bothered by racism, with higher levels of family and friend support had lower levels of racial socialization stress in comparison to those with lower levels of family and friend support. The findings highlight the need to support Black caregivers in building effective coping strategies and social support networks.

In Malaysia, the shift toward community-based psychiatric care has placed increased caregiving responsibilities on family members, particularly parents of adolescents with mental health conditions. Despite their central role, parental caregivers often face psychological, emotional, and social challenges, yet limited research explores their lived experiences in this context. This study aimed to explore the challenges encountered by parental caregivers of adolescents with mental health conditions and the coping strategies they employ to manage caregiving stress. An exploratory descriptive qualitative study design was employed using semi-structured interviews with 11 parental caregivers recruited through purposive sampling. Participants were mothers of adolescents receiving psychiatric treatment at public hospitals in Malaysia. Interviews were transcribed and analysed using thematic analysis. Across the sample of mothers, five major themes related to caregiving challenges emerged, namely strained family relationships, stigma, time constraints, emotional distress, and low public awareness of mental health. In response, caregivers adopted diverse coping strategies, including support-seeking, emotional regulation, distraction, religious practices, and recreational activities. Mothers caring for adolescents with mental health conditions face significant emotional, relational, and societal challenges that affect their well-being. Nevertheless, many caregivers demonstrated resilience through the use of diverse coping strategies. These findings highlight the urgent need for structured support systems, mental health education, and caregiver-focused interventions to enhance both caregiver welfare and patient outcomes.

The present study examines the behavioural trajectories and spatial utilisation of elderly caregivers within intergenerational families, set against the backdrop of China’s accelerating ageing population and the widespread prevalence of dual-income households. Existing studies predominantly rely on static data, which makes it difficult to capture the dynamic relationship between behaviour and space. The present study employs lagged sequence analysis in combination with non-participatory observation and video recording techniques to conduct a 14-day behavioural tracking and sequence analysis of two typical dual-income families in Beijing (totaling 2137 behavioural events), thereby establishing a research framework of “behavioural observation, sequence analysis, and design translation.” The identification of three typical behavioural sequence patterns was achieved through the implementation of behavioural coding, spatio-temporal trajectory modelling, and sequence correlation testing. The identified sequence patterns are as follows: a simple “cooking–eating” sequence, a complex “child-centred” sequence, and a cyclical “housework–rest–communication” sequence. These patterns exposed fundamental contradictions with prevailing spatial functions. The study proposes synergistic spatial and furniture design strategies to support elderly caregivers’ behavioural flow, alleviate caregiving burdens, and foster intergenerational integration. This research not only validates the methodological value of lag sequence analysis in behaviour-driven design but also provides theoretical and empirical foundations for sustainable residential environments that promote intergenerational cohesion and reduce caregiving stress.

Neurodevelopmental disorders (NDDs) in children, such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability, are often associated with significant sleep disturbances. These disruptions can adversely affect the child and the psychological well-being of family members. This systematic review aims to synthesize evidence on the impact of sleep disturbances in children with NDDs on the psychological outcomes of their families. A comprehensive search was conducted across PubMed, Web of Science, Embase, and PsycINFO. Eligible studies examined associations between sleep disturbances in children with NDDs and relatives' psychological outcomes, such as caregiver stress, anxiety, depression, and quality of life. The risk of bias was assessed using the STROBE Checklist, and findings were narratively or quantitatively synthesized, where appropriate. A total of 10 studies were included. Evidence indicates that sleep disturbances in children with NDDs are strongly associated with increased caregiver stress and elevated symptoms of anxiety and depression. Reduced sleep quality and duration in children are linked to poorer family functioning and lower quality of life in caregivers. Sleep disturbances in children with NDDs profoundly impact the psychological well-being of their families, highlighting the need for targeted interventions to improve sleep in children and provide mental health support for caregivers. Future research should explore longitudinal outcomes and the effectiveness of family-centered interventions to address this multifaceted challenge.

Background/Objectives: Family caregivers play a central role in the provision of long-term home-based care and often provide unpaid support over extended periods. This role is associated with substantial psychological, physical, social, and financial burden. Despite high support needs, access to psychosocial services remains limited for many family caregivers. Against this background, AI-based care companions are discussed as a potential low-threshold supplement to existing support structures. The objective of this study was to explore subjectively perceived family caregiver burden and to examine expectations, acceptance conditions, and concerns regarding a hypothetical AI-based care companion, rather than to evaluate effectiveness. Methods: An exploratory mixed-methods study was conducted using an anonymous online survey. Perceived family caregiver stress was assessed using self-developed, non-validated ordinal items, including a single-item global burden rating and categorical stress domains. The questionnaire combined closed-ended items (Likert-scale and multiple-choice) with one open-ended question to assess perceived stress, experiences with psychosocial support, and attitudes toward a hypothetical AI care companion. Participants were recruited via an online caregiving course platform. Data collection was voluntary and anonymous and took place in Germany between October and November 2025. Quantitative data were analyzed descriptively and exploratorily, and qualitative responses were analyzed using thematic analysis. Results: Fifty-five family caregivers participated in the survey. Overall, perceived family caregiver burden was high, with psychological stress most frequently identified as the dominant stress domain. Difficulties in accessing psychosocial support were reported by 58% of the respondents. Willingness to consider using an AI-based care companion varied by degree of acceptance: 36% reported clear willingness, 31% expressed conditional or tentative willingness, and 33% indicated reluctance or rejection. The most frequently selected expected functions included emotional support, early detection of overload, and caregiving-related information. Data protection, professional reliability, and concerns regarding incorrect advice were identified as the most relevant perceived risks. Conclusions: The findings reflect family caregivers' perceived burden and anticipated needs, highlighting persistent gaps in psychosocial support. From the perspective of respondents, a hypothetical AI-based care companion could represent a complementary support option if it provides personalized, non-judgmental, and reliable assistance. These results describe perceived potential and acceptance conditions, not verified efficacy. Further research, including prototype development, usability testing, and pilot studies, is required to examine feasibility, ethical implications, and real-world impact.

Caregivers of children with neurodevelopmental conditions such as intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) are routinely exposed to prolonged emotional, social, cognitive, and financial pressures, which substantially increase their vulnerability to mental health difficulties. This paper critically synthesizes secondary literature on caregiver anxiety, depression, and stress, with emphasis on four core dimensions: the extent and patterns of psychological distress, key determinants operating at child, caregiver, family, and systemic levels, the implications for caregiver and family functioning, and evidence-based strategies for prevention and support. Existing research consistently shows that caregivers of children with ASD experience markedly higher parenting stress and poorer mental health compared to caregivers of typically developing children and, in many cases, those caring for children with other disabilities. Meta-analytic evidence further reveals significantly elevated rates of anxiety and depressive symptoms among parents of children with intellectual and developmental disabilities. Studies focusing on ADHD highlight disruptive behaviors, comorbid conduct problems, and caregivers’ own mental health status as central contributors to parenting stress. Drawing on stress process and transactional coping frameworks, the synthesis demonstrates that caregiver outcomes are shaped by both objective caregiving demands such as symptom severity and care coordination and subjective appraisals influenced by coping resources, social support, stigma, and access to services. Evidence from recent intervention reviews indicates that psychological and skill-based programs can meaningfully reduce caregiver distress and enhance well-being. The paper concludes by outlining implications for clinical practice, public health, education, and policy, including routine caregiver mental health screening, stepped-care support models, accessible respite and training services, integrated child–family care systems, and stigma-reduction initiatives.

Housing insecurity and disordered eating behaviors in adolescents: A cross-sectional study using 2022 National Survey of Children's Health data.

Despite comprising the largest segment of the sexual minority population and experiencing unique stressors and health disparities, bi+ dementia caregivers remain underrepresented in health and caregiving research. This secondary analysis of cross-sectional survey data from LGBTQ+ dementia caregivers (bi+, n = 125; gay[g]/lesbian[l], n = 161) examined whether associations between minority and caregiving stressors and global health differed by caregiver group. Bi+ caregivers reported significantly higher minority stress and lower family quality of life but better health than g/l caregivers. Moderation analyses revealed: higher perceived stress predicted worse health for bi+ but better health for g/l; higher family quality of life predicted better health for both groups, with a stronger effect among bi+ caregivers; and more lifetime discrimination predicted worse health for both groups, with a stronger effect among bi+ caregivers. Results underscore the need for inclusive, affirming research and interventions addressing bi+ caregiver stress experiences.

Children with advanced cancer and their caregivers experience significant stress, which can diminish quality of life (QoL). Animal-assisted interaction (AAI) is beneficial in pediatric populations but less well studied in children with advanced cancer. To (i) evaluate the effect of AAI on QoL and depressive symptoms in children with advanced cancer and on stress in their caregivers, and to (ii) evaluate the feasibility of measuring stress hormones in AAI. Longitudinal cohort study. Children (n = 29) and caregivers (n = 29) participated in up to eight weeks of AAI during routine oncology clinic visits or admissions at an academic children's hospital in Southeast United States. Child participants completed surveys to evaluate QoL and depressive symptoms at baseline and weeks 4 and 8 post-AAI. Caregivers completed surveys to evaluate parental stress, as well as proxy forms for child QoL and depressive symptoms at the same time points. Salivary cortisol and serum epinephrine and norepinephrine were obtained from child participants at baseline and pre- and post-AAI sessions at weeks 4 and 8. Child overall and physical QoL scores improved, while caregiver-proxy scores for children's QoL improved overall and within physical, psychosocial, school, and emotional domains. There was a statistically significant decrease in caregiver stress over time. Salivary cortisol and serum epinephrine levels were feasible to collect and demonstrated statistically significant decreases both over time and before and after AAI sessions. The results indicated that AAI improved child QoL over an 8-week period and reduced caregiver stress. Collecting salivary cortisol and serum epinephrine and norepinephrine was feasible during visits. While decreases in cortisol, epinephrine, and norepinephrine were demonstrated following sessions, the implication of these findings on child physiological stress requires further study.

Food insecurity is frequently reported among families of children with autism spectrum conditions (ASC), yet there is limited evidence synthesising its prevalence and impact. This systematic review aimed to examine and meta-analyse the existing literature on food insecurity in families of children and young people with ASC. A comprehensive search across nine databases identified 39 papers, of which 11 met the inclusion criteria. Studies were included if they involved autistic children or young people under the age of 25 (and/or their family members) and focused on food insecurity. Eligible studies were critically appraised, and data were synthesised using both narrative and meta-analytic approaches. Meta-analyses of nine studies estimated a pooled prevalence of food insecurity at 29% (SE: 5%; 95% CI: 17%-40%; z = 5.35, p < 0.001), which increased to 31% following adjustment for publication bias. The review also found that food insecurity worsened during the COVID-19 pandemic, contributing to increased caregiver stress and disruptions in eating behaviours. This review demonstrates the high prevalence of food insecurity among families of children with ASC and the complex interplay of social, economic and behavioural challenges they face. Addressing food insecurity in autistic households requires policy responses that extend beyond financial aid to consider the sensory, behavioural and nutritional needs specific to ASC. Future research should adopt standardised measures and prioritise the development and evaluation of inclusive, tailored food support systems that reflect the lived experiences of neurodiverse families.