Caregiving Relationship Research Articles

Promoting Women's Well-Being: A Systematic Review of Protective Factors for Work-Family Conflict.

Work-family conflict is a prominent issue, especially in our society, where people are expected to fulfil many roles simultaneously. Work and family life demands significantly impact an individual's overall well-being, especially for women, since they typically balance caregiving for children and elderly relatives with careers. Therefore, highlighting which factors might protect women from experiencing work-family conflict is essential to enhance women's and their family's well-being. Thus, the main aim of the present study was to systematically review previous research on women's coping strategies and protective factors which can reduce the negative effects of work-family conflict. Following the PRISMA guidelines, we conducted a literature search of three databases (PubMed, PsycINFO, and Scopus). After the screening and the eligibility phases, we included a final set of 13 studies. Most of these studies adopted a cross-sectional design (N = 10), and a few adopted a longitudinal one (N = 3). Results highlighted the role of different personal (e.g., hardiness, self-esteem, locus of control) and relational factors (e.g., family and work support) that significantly reduce the negative effects of work-family conflict in women's lives. Findings, practical implications, and future research directions are discussed.

'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships.

Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition. A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis. Participants were 35 healthcare recipients and 37 carers (n = 72 total). Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts. The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships. The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.

Interaction Model of Client Health Behavior for Informal Caregivers: A Theoretical Analysis.

Background: Reliance on informal caregivers is expected to increase, yet there are not many studies examining their characteristics and behaviors. Purpose: The aim of this review is to relate the interaction model of client health behavior (IMCHB) to informal caregiver outcomes. Methods: The literature associated with the IMCHB was examined for current usage to determine use in guiding theories related to informal caregiver outcomes. Cumulative Index to Nursing and Allied Health Literature, Cochrane, EBSCO, Google Scholar, Journals@Ovid, Medical Literature Analysis and Retrieval System Online, and ScienceDirect databases were searched for peer-reviewed literature. Walker and Avant's method guided this theoretical analysis. Results: Seven articles were retained for discussion in this theoretical analysis. Implications: The IMCHB has been used in past health promotion research and can guide future nursing research that supports interventions for informal caregivers. The model's inclusion of the client-professional interaction component allows for further caregiver behavioral associations and relationships that influence optimal outcomes.

Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity.

Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent-infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full-term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad-specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration.

Impact of caregiver relationship on self-care in patients with Parkinson's disease: A cross-sectional study using Riegel's theory of self-care of chronic illness.

To explore how the characteristics of patients and caregivers affect self-care in patients with Parkinson's disease (PD). A multicentre cross-sectional study. We followed the STROBE checklist. Parkinson's disease patients aged 50 years and older and their caregivers were recruited from two tertiary hospitals and the Korean Parkinson's Disease Association website. Patient characteristics, including social support, relationship quality with caregivers, self-care efficacy and self-care, were analysed. Caregiver characteristics were also evaluated, including caregiving duration, social support, relationship quality with patients, contribution to patients' self-care efficacy and contribution to patients' self-care. The characteristics of patients and caregivers (103 pairs) were hierarchically regressed into patient self-care domains (maintenance, monitoring and management). Most patients and caregivers gave a self-care efficacy and self-care management rating of moderate. In three regression models, patient self-care efficacy was positively related to three domains of patient self-care. Self-care maintenance decreased as patients' disease duration increased. Self-care monitoring was positively related to the education level of patients and caregiving duration. Self-care management showed an inverse relationship with caregiving duration and a positive relationship with caregiver contribution. Self-care efficacy was important in promoting PD patients' self-care maintenance, monitoring and management. The contributions of caregivers were also critical in increasing PD patients' self-care management. To increase patients' self-care efficacy and self-care, educational interventions containing information about the disease, symptom management, and problem-solving should be implemented. Since caregivers are deeply involved in patients' self-care, educational interventions for caregivers should also be provided. This study closed the literature gap by examining the self-care efficacy and self-care of Korean PD patients. Findings demonstrated the importance of caregiver roles on patients' self-care and health. Two tertiary hospitals and the Korean Parkinson's Disease Association assisted during the recruitment process.

The impact of caregiving on the emotional well-being and health of family caregivers.

Family caregivers, who take care of older relatives, bear a heavy burden that can detrimentally affect their physical health and emotional well-being. This study aims to explore the subjective perceptions of family caregiving's impact on physical health and emotional well-being, the experience of feeling overburdened by caregiving responsibilities, and the subjective perceptions of health among caregivers of older relatives. Data from three waves of online questionnaire surveys conducted in 2018, 2020, and 2022 were analyzed. The COPE Index items were used to measure subjective perceptions of the impact of caregiving on physical health and emotional well-being and perceptions of being overburdened by caregiving. We present descriptive statistics and chi-square test analyses. In all three waves, the majority of respondents frequently or always perceived a negative impact of caregiving on their emotional well-being and physical health, with more than half always or often experiencing caregiver overburdening. A significant correlation was observed between the perceived impact of caregiving on physical health and emotional well-being, over 70% of respondents provided similar responses to both questions. Furthermore, a significant relationship is between the prevalence of caregiver overburden and subjective perceptions of health, with those experiencing caregiver overload being more likely to report poor or very poor health. Over 60% of participants indicated frequent or constant overburden of care, with this subgroup exhibiting a higher likelihood of perceiving their health as poor or very poor. Our results demonstrate that the caregiving burden affects both physical and emotional well-being. A significant proportion of family caregivers experience detrimental effects on their physical health and emotional well-being due to caregiving responsibilities. These negative effects were reported simultaneously by the majority of respondents. Caregiving can have negative consequences on the health of family caregivers. Our research underscores the importance of preventive measures. Orv Hetil. 2023; 164(40): 1583-1591.

A - 62 Caregiver Relationship Type Significantly Moderates Association among NPI-Q Symptoms: a Moderated Network Analysis.

We investigated the influence of caregiver type (CT; ex. spouse, child, etc.) on the association among neuropsychiatric symptoms using the caregiver-endorsed Neuropsychiatric Inventory Questionnaire (NPI-Q) and a sample from the National Alzheimer's Coordinating Center database. The selected sample (n = 12,337) includes those aged 50+ with complete baseline data for the NPI-Q and caregiver relationship. Included participants had ≥1 NPI-Q symptom(s) endorsed and a diagnosis of mild cognitive impairment or dementia with Alzheimer's disease as the primary or contributing cause. A Moderated Network Model approach estimated whether associations among NPI-Q items depend on CT (moderator variable). Spouse was used as the reference group for all comparisons. CT significantly moderated the NPI-Q. Interaction effects were found between 3 moderated node pairs: agitation/aggression and disinhibition (edgeweight = 0.02), hallucinations and nighttime behaviors (edgeweight = 0.01), and depression/dysphoria and appetite/eating problems (edgeweight = 0.01). The edgeweights for these node pairs were reduced in the final model due to variance being accounted for by the addition of CT. The association between agitation/aggression and disinhibition was smaller for spouses than children, and larger for spouses than friends and paid caregivers. The association between hallucinations and nighttime behaviors was smaller for spouses than children, and larger for spouses than friends and paid caregivers. The association between depression/dysphoria and appetite/eating problems was smaller for spouses than siblings and friends. The pairwise dependency between neuropsychiatric symptoms differs as a function of CT. Future research is needed to identify factors that influence symptom reporting, including interpersonal dynamics, amount of time spent together, and overall burden of symptoms.

Burden of Care of Family Caregivers for People Diagnosed with Serious Mental Disorders in a Rural Health District in Kwa-Zulu-Natal, South Africa.

An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities.

Exploring shared identity theory as an expanded conceptualization of Alzheimer’s caregiving

Informal caregivers provide critical support to the growing population of individuals diagnosed with Alzheimer’s disease and related dementias (ADRD). To assist caregivers, researchers’ dominant theoretical model has been a stress and coping approach for nearly four decades. Although the stress and coping approach is appropriate for many caregivers, it may be too narrow a lens for understanding caregivers who are primarily focused on maintaining their relationship with their loved one and providing the highest quality of care. This study was designed to empirically explore Shared Identity Theory, which emphasizes the inherent value of the relationship between care partners (“shared identity”) and how their shared identity relates to caregiver burden and exemplary care. This exploratory study examined Shared Identity Theory using structural equation modeling in a national sample of 263 informal ADRD caregivers. Our analyses provided support for an overall factor of Shared Identity that explained its four component factors (Communal Orientation, Communal Strength, Collective Identity, and Shared Goals). We then found that shared identity had a substantial positive relationship with exemplary care and a substantial negative relationship with caregiver burden. Shared identity seems to benefit both care recipients and the caregiving relationship. This study suggests the importance of expanding the scope of the caregiving literature to include a primary focus on this powerful relationship.

Connection abstract theory: An exercise in abstract theorizing after Bowlby

AbstractThis paper proposes connection abstract theory as a detailed abstract formulation of the volitional elements of John Bowlby's theory of child attachment and its expansion to include adult relationships. Connection abstract theory is a formal statement of causal connections within and between attachment and caregiving systems. It is so‐called to give an unambiguous name to the attachment–caregiving relationship. The analysis addresses some limitations traceable to the cultural background within which Bowlbian theory was developed. This paper rethinks these limitations by conceptualizing the emotional motivations for attachment and caregiving. In so doing, it goes beyond individual differences to focus on microfoundations of normative attachment and caregiving processes and expands the potential activators of attachment. Connection abstract theory asserts that caring is the emotion that motivates the caregiving system and that trust is the emotion that motivates the attachment system.

“So, we’ve been taken away since forever”: Indigenous Relative Caregivers’ Experiences as a Framework for Uncovering Coloniality in the Child Welfare System

This study examines to the gravity of the ongoing removal and separation of Indigenous children from their families and nations, the reality of coloniality in the child welfare system, the glaring absence of Indigenous voices and their distinct experiences in the empirical child welfare literature, and dearth of studies that implement Indigenous methodologies. Grounded in Indigenous Storywork methodology, this qualitative study sought to understand (10) Indigenous relative caregivers’ experiences with the child welfare system. Findings identified specific forms of colonial violence inflicted upon Indigenous children and families by the child welfare system, such as ongoing removal and separation, as vehicles for colonization and assimilation. Relative caregivers also exposed how the child welfare system continues to impose the modern colonial gender system, continuing a legacy of government sponsored civilizing educations programs to assimilate through racializing and genderizing Indigenous families to justify violence and maintain power and control. Relatives’ lived experiences provide a framework for uncovering coloniality in child welfare in relation to continued control over family and gender.

Effects of Caregiver Sleep Disturbances on Relationship Quality With Their Care Recipient.

Sleep problems are highly prevalent and disruptive for caregivers. Although the connection between caregivers' sleep and outcomes like caregiver burden and quality of life is well established, the potential influence of caregivers' sleep on their reported relationship quality with the care recipient is not known. The current study sought to address this gap. We analyzed data from the 2017 National Health and Aging Trends Study and linked it with data from the 2017 National Study of Caregiving. Our dependent variable was caregiver-reported relationship quality, and our predictor variable of interest was caregiver sleep problems. We also included several covariates related to the caregiver and care recipient. We used a generalized linear model to examine the relationship between caregiver sleep problems and relationship quality, controlling for other potentially influential factors. Sleep problems were significantly related to relationship quality. Compared to caregivers who reported no sleep problems, those who reported at least one sleep problem (β: -0.23, 95% CI: -0.46 to -0.01) had lower relationship quality with the care recipient. Other factors that remained related to relationship quality in the generalized linear model were negative aspects of caregiving, emotional difficulties, caregiver race, relationship type, care recipient depressive symptoms, and care recipient sex. Sleep problems are influential health behaviors that are related to relationship quality for caregivers. Therefore, it is critical that sleep is more systematically assessed and addressed in caregiving populations.

Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach.

The ageing population in China has led to a significant increase in the number of older persons with disabilities. These individuals face substantial challenges in accessing adequate activities of daily living (ADL) assistance. Unmet ADL needs among this population can result in severe health consequences and strain an already burdened care system. This study aims to identify the factors influencing unmet ADL needs of the oldest old (those aged 80 and above) with disabilities using six machine learning methods. Drawing from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2017-2018 data, we employed six machine learning methods to predict unmet ADL needs among the oldest old with disabilities. The predictive effects of various factors on unmet ADL needs were explored using Shapley Additive exPlanations (SHAP). The Random Forest model showed the highest prediction accuracy among the six machine learning methods tested. SHAP analysis based on the Random Forest model revealed that factors such as household registration, disability class, economic rank, self-rated health, caregiver willingness, perceived control, economic satisfaction, pension, educational attainment, financial support given to children, living arrangement, number of children, and primary caregiver played significant roles in the unmet ADL needs of the oldest old with disabilities. Our study highlights the importance of socioeconomic factors (e.g., household registration and economic rank), health status (e.g., disability class and self-rated health), and caregiving relationship factors (e.g., caregiver willingness and perceived control) in reducing unmet ADL needs among the oldest old with disabilities in China. Government interventions aimed at bridging the urban-rural divide, targeting groups with deteriorating health status, and enhancing caregiver skills are essential for ensuring the well-being of this vulnerable population. These findings can inform policy decisions and interventions to better address the unmet ADL needs among the oldest old with disabilities.

How Military Chaplains Strengthen the Moral Resilience of Soldiers and Veterans: Results From a Case Studies Project in the Netherlands

AbstractIn spiritual care research, studies on military chaplaincy are underrepresented, and most available studies center on moral injury. This article contributes to the existing literature on spiritual care in the military by presenting a study of 13 case descriptions of spiritual care provision by military chaplains from the Netherlands. These were analyzed using the framework method, a qualitative method of systematically searching for patterns in data sets, in order to answer the question: How do military chaplains contribute to the moral resilience of soldiers and veterans experiencing moral stress? The analytical framework was constructed on the basis of Doehring’s (Pastoral Psychology, 64(5), 635–649, 2015) conceptual understanding of moral resilience as the outcome of processes of spiritual integration of moral stress in caregiving relationships. This study shows that soldiers experience moral stress when core values associated with ‘being a soldier’ conflict with expectations or actions of soldiers themselves or of others, with the way the military organization functions, or with the spiritual notion of ‘being a good, loving and loveworthy human being’. In their responses to moral stress, chaplains contribute to moral resilience by engaging in co-creating spiritual orienting frameworks which accommodate a sense of goodness of self and others and allow for nuanced, biographically rooted moral views. Soldiers experience conversations and brief encounters with chaplains as relational ‘moments of goodness’, which may also contribute to moral resilience.

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.

Supporting and Contextualizing Pediatric ECMO Decision-Making Using a Person-Centered Framework.

AbstractThere is a critical need to establish a space to engage in careful deliberation amid exciting, important, necessary, and groundbreaking technological and clinical advances in pediatric medicine. Extracorporeal membrane oxygenation (ECMO) is one such technology that began in pediatric settings nearly 50 years ago. And while not void of medical and ethical examination, both the symbolic progression of medicine that ECMO embodies and its multidimensional challenges to patient care require more than an intellectual exercise. What we illustrate, then, is a person-centered framework that incorporates the philosophy and practice of palliative care and care-based ethical approaches. This person-centered framework is valuable for identifying and understanding challenges central to ECMO, guides collaborative decision-making, and recognizes the value of relationships within and between patients, families, healthcare teams, and others who impact and are impacted by ECMO. Specifically, this person-centered approach enables caregivers to provide compassionate and effective support in critical, and often urgent, situations where conflicts may emerge among healthcare team members, families, and other decision makers. By reflecting on three cases based on actual situations, we apply our person-centered framework and identify those aspects that were utilized in and informed this project. We aim to fill a current gap in the pediatric ECMO literature by presenting a person-centered framework that promotes caregiving relationships among hospitalized critically ill children, families, and the healthcare team and is supported through the philosophy and practice of palliative care and clinical ethics.

Remote Technologies and Filial Obligations at a Distance: New Opportunities and Ethical Challenges

The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent’s state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.

가족 내 아동학대의 유형화와 피해 특성

This study classified the child abuse in family focusing on heterosexual family composition and relationship of caregivers, and explored the characteristics of victims according to each type. Cluster analysis revealed five types: “family restructuring” (27.1%), occurring in newly formed relationships such as remarriage or cohabitation of caregivers; “distorted discipline” (23.5%), involving prolonged family structure with distorted discipline as the main motive; “aggressive” (18.1%), where one of the biological parents expressed anger and desires in the presence of both parents; “intimate partner violence” (15.6%), occurred with child abuse; and “care burden” (15.7%), where abuse occurred while providing care alone or without support after giving birth.
 The “aggressive” and “family restructuring” types had a higher occurrence of sexual abuse, and the “care burden” type had a higher occurrence among children under the age of one. The “distorted discipline” and “aggressive” types showed significant harm to older children. The “intimate partner violence” type had male perpetrators predominantly, while the “care burden” type had female perpetrators in the majority. These results highlight the need for proactive intervention against wife abuse, ensuring women's reproductive rights, and prevention policies that consider vulnerabilities based on child age and caregiver relationships.

Depression and the Caregiver Burden for Schizophrenia Patients

Background and objectives: Schizophrenia is a recurring psychiatric condition that severely impairs patients' ability to function in all major spheres of their lives. Since the deinstitutionalization policy, families, especially the primary caregiver who bears a heavy physical and emotional strain, are responsible for providing care. According to estimates, caregivers' rates of depression are higher than those of the general population. The primary caregivers' burden of care, their level of depression, and related caregiver factors were all examined in this crosssectional study. Methods: After gathering socio-demographic and caregiving information, 60 consenting primary caregivers of patients with an ICD-10 diagnosis of schizophrenia were evaluated for burden of care and depression using the Burden Assessment Schedule and the Patient Health Questionnaire–9. Results: A majority of the 35 female and 25 male carers reported experiencing moderate to severe depression, and all had moderate to high levels of burden. More burden was felt by spouses (p=0.0038), older carers (p=0.01), and those with lower educational levels (p=0.01). Depression and caregiving burden had a statistically significant positive connection (p=0.000). Conclusion: Despite the ease with which psychiatric therapies are accessible in one of India's largest metropolitan areas, caregivers continue to experience stress and depression. This may affect not only the caregiver but also the patient's care and the course of the sickness.

How do kinship and foster caregivers differ in their conceptualization of family connectedness?

BackgroundIn out-of-home care in Australia and internationally, there is an increasing preference to place children in kinship than foster care placements as it is assumed that kinship care promotes caregiver, family, and cultural connectedness. However, little research has examined whether and how the quality of these connections differ between kinship and foster care. ObjectiveWe utilized qualitative methodology to provide a richer, strengths-based exploration of caregivers' perspectives on the caregiver-child relationship and other connections (i.e., family, culture) in kinship compared to foster care. Participants and settingSixty-six kinship (N = 31) and foster (N = 35) caregivers of 8- to 16-year-olds in Australia. MethodsKinship and foster caregivers provided Five-Minute Speech Samples about their child and the caregiver-child relationship. Thematic analysis was used to explore the ways caregivers described family relationships and connectedness. ResultsResults highlighted the value caregivers place on strong attachment relationships with their children and the skills that help them develop a safe haven for children. Caregiver groups also differed in their discussions of commitment to the child and family and cultural connectedness, with kinship caregivers more likely to emphasize the strengths and challenges of birth family relations and the importance of cultural connectedness than foster caregivers. ConclusionsOur findings highlight the ways in which kinship and foster caregivers emphasize different aspects of family and cultural connectedness which can be used to inform policy and practice in an area currently lacking evidence.