Carer Depression Research Articles

Depends on whom you ask: Discordance in reporting spousal care between older women and men across European welfare states

PurposeWe aim to investigate systematic differences in reporting spousal care between caregivers and cared-for persons and their possible effects for the analysis of care regimes and correlation of care with health. Materials and methodsUsing information on care provided/received from the Survey on Health, Ageing and Retirement in Europe (SHARE), we estimate the prevalence of spousal care and discordance between caregivers and cared-for persons in the reporting of care among caregiving dyads. Multinomial regressions are used to estimate systematic differences in reporting spousal care. We then use multivariable logistic regressions to assess the association between discordance in reporting informal care and carer's self-rated health (SRH) and depression using the EURO-D scale. ResultsOnly 53.9 % of dyads report care that is confirmed by both spouses. Multinomial regressions show that agreement on care being provided/received is more common when women are caregivers, while men are likely to underreport when providing or receiving personal care. Prevalence of spousal care across care regimes is sensitive to who reports care. There is no effect on the association of care with SRH regardless of who identifies the carer, while the magnitude and statistical significance of the association between depression symptoms and care varies according to the choice of respondent. ConclusionsInformal care may be understated across Europe when relying solely on carer self-identification through description of tasks in surveys. From a policy standpoint, relying on self-identification of carers to access support or social benefits may potentially reduce the take-up of such benefits or support.

Predictors of depression in young carers: a population based longitudinal study

ABSTRACT Caregiving in adolescence, specifically when directed towards a parent, is associated with increased depression. This study examines whether young carers caring for their parents are more likely to be depressed than those caring for other family members and non-caring youth. Using data from two waves of the Growing Up in Ireland study (N = 3,312), the above associations were examined cross-sectionally (Aged 17; T1), and longitudinally (Aged 20; T2). The role of parent and peer relationship quality in predicting depression was also examined. Compared to non-carers, carers of parents were 3.67 times more likely to be depressed at T1, but not at T2. Moreover, young carers of parents who were depressed reported lower peer attachments, as well as lower quality relationships with their parents. Logistic regression analyses showed these relationships to be predictive of depression. This research is discussed in terms of supporting young carers from a family-based perspective.

Predictor of depression and anxiety among caregivers of hospitalized patients with mental illness

Purpose The study aims to identify the predictors of depression and anxiety among carers of hospitalized patients with mental illness in Eradah Complex for Mental Health Hospital. Design/methodology/approach A descriptive correlational study design was conducted using a convenient sample of family carers of patients with mental illness (N = 216). The study used the Beck Depression Inventory and Anxiety Inventory scales. Findings The results of regression models revealed that the socio-demographic characteristics of the family carers showed that age is a statistically significant predictor of family carers depression and anxiety scores. In addition, the age of the family carers explained 36% of the variance in the family carers depression and anxiety scores, while marital status explained 64% of the total variance in the family carers’ depression and anxiety scores. Furthermore, having received support in caring significantly predicted depression and anxiety scores, and this was the case for occupation status and being diagnosed with any form of chronic illness. Practical implications Based on the findings of this study, the authors opine that evaluations of carers’ cognitive strategies and social support are needed to determine the risk of depression in carers of mental patients. Originality/value This study is the one of the limited studies conducted in Saudi Arabia to identify predictor of depression and anxiety among caregivers of hospitalized patients with mental illness. The study has used a validated scales to assess the main study outcomes.

Health of Indigenous Orphans and Carers in Perú: A Mixed Methods Case Study of Hogar de Niñas Virgen de Fatima

The COVID-19 pandemic dealt a devastating blow to the social fabric of Perú, with the highest orphans per death (OPD) ratio of any country in Latin America. Therefore, 260,000 orphans now require care because of 216,000 parent, custodial grandparent, and caregiver deaths between 2020 and 2022. The purpose of this research is to examine whether the practice of Transcendental Meditation, an established technique for improving the mental and physical health of children, can reasonably be expected to alleviate the symptoms of trauma associated with this surge in orphanhood. Adolescent indigenous female orphans and their carers at Hogar de Niñas Virgen de Fatima de Chejoña, a residential care shelter near Puno in the country’s southeast, participated voluntarily in this mixed methods case study. Following a Type-2 case study structure, the research design details the context, case, embedded units of analysis, and methodological approaches used to measure them. Three research modules were designed to explore: 1) orphan and carer health, personal relations, behavior, sense of safety and security, and view of the future; 2) health and school performance of orphans; and 3) depression, anxiety, and stress of both orphans and carers. The mixed methods approach used to gather and interrogate data derived from these orphans and carers before and after instruction in Transcendental Meditation included: structured interviews to determine the direction before and after change (qualitative module one); a vernacular paper-and-pencil test to measure physical, cognitive, and emotional health and school performance after instruction (quantitative module two); and a standardized test instrument to measure depression, anxiety, and stress in orphans and carers after instruction (quantitative module three). Findings include self-report changes in orphans from feelings of fear, nervousness, and hopelessness to feelings of greater confidence, assurance, and a sense of achievement (module one); a significant difference between the number of orphans who reported improvements in health and school performance and those who did not receive Transcendental Meditation (module two); and higher levels of depression, anxiety, and stress in orphans than other comparative girls (module three). Despite limited carer data, the diverse sources of evidence for orphans, when considered in combination, suggest Transcendental Meditation may have salutarily improved both the present and future lives of girls in Perú.

P80: Implicit emotional ambivalence and emotional distress in family carers of people with dementia: Exploratory study.

Objective:Caring for a relative with dementia is a chronic stress situation related to negative consequences such as elevated depressive and anxiety symptoms. A possible mediator variable explored to explain pathways from chronic stress to emotional distress is emotional ambivalence towards the care-recipient (the simultaneous experience of positive and negative feelings towards the care-recipient). Emotional ambivalence, measured with questionnaires, presents significant associations with depression and anxiety in family carers of people with dementia. However, the self-report of emotional ambivalence is susceptible to being influenced by social desirability. The aim of this study is to present preliminary results that analyze implicit ambivalence and its association with emotional distress in family carers of people with dementia.Methods:54 caregivers participated in the study (mean age = 61.2, SD = 12.92, 81.5% women). To explore implicit emotional ambivalence, we adapted a sequential priming paradigm developed to measure implicit ambivalence about significant others (Zayas & Shoda, 2015). Two priming stimuli were used: a) neutral (e.g., RRR) and b) valenced prime (i.e., the name of the care-recipient). The targets were positive and negative words that participants have to categorize as positive or negative.Results:A facilitation-inhibition indexes for positive and negative targets were calculated by subtracting the mean reaction time (RT) for valenced prime from the mean RT for neutral primes. Positive values show a facilitation effect of the valenced prime (i.e., the name of the care-recipient), and negative values inhibition. Participants were classified depending on their results of this indexes: a) positive (facilitation of positive information, inhibition of negative information), b) negative (facilitation of negative information, inhibition of positive information), c) flat (inhibition of positive and negative information), and d) ambivalence (facilitation of positive and negative information). ANOVAS were performed to explore differences between groups in emotional distress. The preliminary results showed that the ambivalence group might present more depressive symptoms compared with the positive group.Conclusion:This is the first study that analyzed implicit ambivalence in family carers of people with dementia. The preliminary results show the relevance of exploring implicit processes to explain emotional distress in this population.

The Unmet Needs of Pancreatic Cancer Carers Are Associated with Anxiety and Depression in Patients and Carers.

Pancreatic cancer has one of the lowest survival rates, and patients experience debilitating symptoms. Family carers provide essential daily care. This study determined the prevalence of and risk factors for unmet supportive care needs among carers for pancreatic cancer patients and examined which carer needs were associated with anxiety and depression in carers and patients. Eighty-four pancreatic cancer patients and their carers were recruited. The carers completed a needs survey (SCNS-P&C). Both carers and patients completed the Hospital Anxiety and Depression Scale. Log binomial regression was used to identify associations between carer needs and anxiety and depression among carers and patients. The top 10 moderate-to-high unmet needs reported by ≥28% of carers were related to healthcare (e.g., discussing concerns with doctors) and information need domains (e.g., information about a patient's physical needs), plus one other item related to hospital parking. Being male or caring for a patient within 4 months of their diagnosis were associated with greater unmet needs. Some unmet needs, including 'accessing information about treatments' and 'being involved in patient care', were associated with both carers and patients having anxiety and depression. Carers should be involved in health care consultations and provided with information and opportunities to discuss concerns.

Occurrence and correlates of anxiety and depression in carers of autistic children across three nations

Purpose Caring for an autistic child is associated with elevated stress, anxiety and depression. Although some data suggest that ‘child’ or ‘carer’ factors may moderate the severity of carer distress, relatively few international comparisons have been made, limiting the generalizability of previous findings. This study aimed to address this issue. Method A survey-based comparison was made of carers from three nations (Australia, Denmark, Greece), and the effects of demographic, child, and carer variables upon carer anxiety and depression were investigated. Results Only limited cross-nation consistency was found for nation, child, or carer variables and their effects upon carer anxiety or depression. Conclusion The application of universal treatment models for carer anxiety and depression may be of differing value across nations.

Primary Caregivers of Patients with Psychoactive Substance Use Often Suffer from Depression & Anxiety

Objective: To determine the frequency of depression and anxiety in carers of psychoactive substance use patients. Study Design: Cross sectional study Place and Duration of Study: Department of Psychiatry, Baluchistan Institute of Psychiatry & Behavioural Sciences, Quetta from June 2020 to December 2020. Methodology: One hundred and twenty caregivers of psychoactive substance use patients were enrolled. Detailed demographics of patients and caregivers were recorded after taking informed written consent. Patients were aged between 18-70 years. Depression and anxiety were calculated in primary caregivers of patients of psychoactive substance use. A DASS-21 criterion was used to examine the depression. Data was analysed by SPSS 22.0. Results: Mean age of patients was 35.27±15.43 years. 90 (75%) patients were males while 25% were females. Among caregivers 78 (65%) were females while 42 (35%) were males with mean age 36.86±16.48 years. Among caregivers, 12.5% of the patients had mild, 37.5% showed moderate and 18.33% caregivers showed severe depression while 38 (31.67%) had no depression. Anxiety among caregivers was mild in 12 (10%), 26 (21.7%) had moderate and 15 (12.5%) caregivers had severe anxiety while 67 (55.83%) caregivers had no anxiety. Conclusion: The frequency of anxiety and depression was high in primary caregivers of patients with psychoactive substance abuse. Keywords: Anxiety, Depression, Substance use, Caregivers

Family Carers of People with Dementia in Japan, Spain, and the UK: A Cross-Cultural Comparison of the Relationships between Experiential Avoidance, Cognitive Fusion, and Carer Depression.

Objective and research design This study investigated whether the relationship between experiential avoidance and carer depression is mediated by cognitive fusion using path analysis and whether this model differs between family carers from Japan, Spain, and the UK using multi-group path analysis. Results The whole sample model (N= 745) showed a good fit to the data. The direct effect of experiential avoidance on carer depression (β= .10) and its indirect effect on carer depression through cognitive fusion (β= .15) were significant. Examined variables accounted for 45% of the variance of depression. Multi-group path analysis confirmed the same pattern of indirect path across 3 countries, while the direct path was no longer significant in Spanish and UK samples.Conclusion These findings suggest that targeting cognitive fusion may be particularly critical in culturally diverse carers and pre-emptive efforts to reduce experiential avoidance using psychological techniques may be beneficial among family carers prone to cognitive fusion regardless of cultural differences.

Factors affecting the quality of life of family carers of people with dementia: the role of carer anxiety

ABSTRACT The role of anxiety on the quality of life of family carers of people with dementia is somewhat neglected in the carer literature. The current study aimed to investigate the impact of common risk factors (i.e., care recipient’s neuropsychiatric symptoms, carer depression, and burden) and anxiety on QoL. This cross-sectional study recruited 89 family carers. Most of the participants were looking after a spouse with Alzheimer’s or mixed dementia. A multiple regression analysis was conducted with carer QoL as a dependent variable. All risk factors (i.e., people with dementia’s neuropsychiatric symptoms, carer depression, anxiety, and burden) were entered into the model simultaneously as independent variables. The model’s R2 was 33%. The results demonstrated that anxiety was the only significant independent variable predicting carer QoL (β = – 0.34, p = 0.03, 95% CI: – 0.64 to – 0.04). These results indicated that having more symptoms of anxiety was associated with worse QoL as measured by the ICEpop CAPability measure for Older people (ICECAP-O). These findings suggested that improving carer’s anxiety may be particularly important in promoting QoL among family carers of people with dementia. Future interventions should target this variable to achieve the desired result of improving carer QoL.

Practical and emotional preparation for death: A mixed methods study investigating experiences of family carers of people with dementia.

BackgroundWhen family carers are more prepared for the end of the life of a person they care for, they report improved bereavement outcomes. Few studies have explored how carers prepare for the death of a person with dementia. We aimed to explore how carers for people with all stages of dementia experience preparing for end of life care and death.MethodsThis was a mixed methods cross-sectional study. Family carers of people with dementia (n = 150) completed a structured interview with validated scales, alongside questions about death preparedness and advance decisions. A sub-sample (n = 16) completed qualitative interviews exploring their experiences of planning for end of life. We fitted logistic regression models to explore associations with preparedness, and thematically analysed qualitative data.ResultsWe addressed practical and emotional preparation separately for 143 participants. Fifty seven percent of participants were very practically prepared for death, while only 29% were very emotionally prepared. Male carers were more likely than female carers to report being very emotionally and practically prepared. Higher engagement with healthcare professionals was associated with feeling very practically prepared; although we found that formal discussions of end of life care issues with healthcare professionals did not impact carers’ feelings of preparation. Higher levels of dementia severity and carer depression were associated with feeling very emotionally prepared. Three qualitative themes related to practical and emotional preparation were identified: (1) ambiguity and uncertainty; (2) support from the system; and (3) how death is perceived by the carer.ConclusionsWhile most carers felt practically prepared for death, emotional preparation was much lower. Further research is needed to understand how engagement with healthcare professionals or other forms of social or emotional support could help carers, particularly female carers, to emotionally prepare for their relative’s death.

Factors Influencing Habitual Physical Activity in Parkinson's Disease: Considering the Psychosocial State and Wellbeing of People with Parkinson's and Their Carers.

Participating in habitual physical activity (HPA) may slow onset of dependency and disability for people with Parkinson’s disease (PwP). While cognitive and physical determinants of HPA are well understood, psychosocial influences are not. This pilot study aimed to identify psychosocial factors associated with HPA to guide future intervention development. Sixty-four PwP participated in this study; forty had carer informants. PwP participants wore a tri-axial accelerometer on the lower back continuously for seven days at two timepoints (18 months apart), measuring volume, pattern and variability of HPA. Linear mixed effects analysis identified relationships between demographic, clinical and psychosocial data and HPA from baseline to 18 months. Key results in PwP with carers indicated that carer anxiety and depression were associated with increased HPA volume (p < 0.01), while poorer carer self-care was associated with reduced volume of HPA over 18 months (p < 0.01). Greater carer strain was associated with taking longer walking bouts after 18 months (p < 0.01). Greater carer depression was associated with lower variability of HPA cross-sectionally (p = 0.009). This pilot study provides preliminary novel evidence that psychosocial outcomes from PwP’s carers may impact HPA in Parkinson’s disease. Interventions to improve HPA could target both PwP and carers and consider approaches that also support psychosocial wellbeing.

Life satisfaction, social participation and symptoms of depression in young adult carers: evidence from 21 European countries

ABSTRACT This study aims to examine whether the association between life satisfaction and depressive symptoms in young carers was moderated by social participation. Cross-sectional data were extracted from the 7th wave of the European Social Survey. Our sample included 673 young carers and 1606 non-carers (aged 14–18 years) drawn from 21 participating countries who completed measures of life satisfaction, social participation and depression symptoms. As expected lower life satisfaction predicted higher symptoms of depression in young carers but social participation did not. However, as predicted, social participation moderated the relationship between life satisfaction and depression, with young carers who had higher life satisfaction and higher social participation experiencing lower levels of depression symptoms. Further, this effect was strongest in those with the highest rates of social participation with peers. The implications of the link between life satisfaction, social participation and depressive symptoms in young carers is discussed.

Mindfulness-Based Cognitive Therapy for Stress Reduction in Family Carers of People Living with Dementia: A Systematic Review.

The prevalence of dementia is increasing and the care needs of people living with dementia are rising. Family carers of people living with dementia are a high-risk group for psychological and physical health comorbidities. Mindfulness-based interventions such as mindfulness-based cognitive therapy show potential for reducing stress experienced by family carers of people living with dementia. This study aims to systematically assess the efficacy of mindfulness-based cognitive therapy in reducing stress experienced by family carers of people living with dementia. Electronic databases including MEDLINE, APA PsycINFO, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, AMED, ICTRP, and ALOIS were searched for relevant studies up to August 2020. All types of intervention studies were included. Quantitative findings were explored. Seven studies were eligible for inclusion. The analysis showed that there was a statistically significant reduction in self-rated carer stress in four studies for the mindfulness-based cognitive therapy group compared to controls. One study that was adequately powered also showed reductions in carer burden, depression, and anxiety compared to control. Mindfulness-based cognitive therapy appears to be a potentially effective intervention for family carers of people living with dementia, but large, high-quality randomized controlled trials in ethnically diverse populations are required to evaluate its effectiveness.

Examining the carer‐related and patient‐related factors predicting anxiety amongst family carers of people with dementia

AbstractBackgroundAnxiety in family carers of people with dementia has been neglected in research, although its prevalence may be similar or even greater to that of depression. The current literature has also demonstrated that existing interventions tend to be less effective for anxiety than for depression or burden in family carers. Therefore, it is important to identify factors affecting carer anxiety to inform the development of future interventions. The aim of this study was to determine which carer‐related (age, gender, hours of caring per week, comorbidities, sleep quality) and patient‐related (dementia severity based on functional deterioration, neuropsychiatric symptoms of dementia) factors known to have an impact on carer wellbeing predict anxiety amongst family carers of people with dementia.MethodThis study used a cross‐sectional design with a sample of ninety‐one family carers, with a mean age of 69.46 years old. More than 65% of carers were female and were living together with the care recipient. Most of care recipients were in the severe stages of Alzheimer’s disease. First, a single regression analysis with each potential independent variable was conducted. The independent variables that passed a certain p‐value threshold (carer age, carer gender, hours of caring per week, sleep quality, neuropsychiatric symptoms) were then included in the final multiple regression model. Due to significant multicollinearity, dementia severity was excluded from the final regression model.ResultThe final regression model (R²=0.29) demonstrated that the numbers of hours providing care (β=.24) and sleep quality (β=.28) had a significant impact on carer anxiety.ConclusionProviding more hours of care per week and having worse sleep quality seem to predict higher levels of anxiety in family carers. Studies exploring factors, which could moderate the impact of hours of caring and sleep quality, may further guide future interventions. The relationship between sleep quality and anxiety also requires attention as some studies have reported that sleep quality may be bidirectionally related to anxiety. That is, successful treatment of sleep disturbances may prevent exacerbation of anxiety and vice versa. Future research should further investigate the impact of sleep quality in family carers, ideally using a longitudinal design.

Strong Carers, Strong Communities: a cluster randomised controlled trial to improve wellbeing of family carers of older people in remote Aboriginal communities.

Unpaid carers have a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing are often impacted. There are limited data on how carer strain, depression and empowerment may be improved for carers. This was a cluster randomised controlled trial to compare the effect of a carer support program developed with a community-based participatory action research (PAR) approach to the delivery of information sessions to 100 carers of people aged 45 years or more living in four remote Aboriginal communities in Western Australia. The mean age of carers was 38.3&plusmn;14.9 years, 76% were female and 77% were children or grandchildren of the care recipient. Carer strain and empowerment measures did not change significantly between baseline and follow-up. A statistically significant decrease in depression scores was observed in the PAR group. However, decreases were observed in both the PAR and control groups, and the change in scores did not differ significantly between groups. Depression scores decreased most in those who had not attended high school. Overall, the proportion of participants meeting criteria for depression decreased from 18.8% at baseline to 8.3% at follow-up. A carer support program was of equivocal benefit, although this research demonstrates that the wellbeing of carers in remote Aboriginal communities can potentially be markedly improved by outreach strategies.

Benefits of home‐based dementia care on clinical and quality‐of‐life outcomes for persons living with dementia and their carers

AbstractBackgroundScalable, home‐based approaches for the delivery of comprehensive dementia care that bridge medical, social, and supportive care services are needed to improve outcomes and care value for persons living with dementia (PWD) and family carers. We present results from a CMS‐funded Healthcare Innovations Award evaluating the 18‐month impact of a comprehensive home‐based dementia care coordination program, MIND at Home, on clinical and quality of life outcomes in a racially and socioeconomically diverse group of community‐living PWD and family carers.MethodsThis is a prospective, within‐subject, study to evaluate change (baseline to 9‐months, and baseline to 18‐months) in clinical and quality of life outcomes among 342 PWD in Maryland who received MIND at Home. Within‐group changes on dementia‐related unmet care needs (59 items total, 13 domains), neuropsychiatric behaviors (NPI), quality of life (QOL‐AD), carer burden (Zarit Burden Interview), carer depression (PHQ‐9) were assessed using longitudinal mixed effects models. We also tested whether change in outcomes over time was moderated by baseline cognition, living arrangement, or race (Caucasian vs. Non‐Caucasian) in post hoc analyses.ResultsIn adjusted linear mixed models, PWD and carers had significantly fewer total percent unmet dementia‐related needs (PWD: β=‐19.95, SE 0.7, p&lt;0.001; CG: β =‐28.30 SE 0.9, p&lt;0.001) and percent unmet in all need subdomains (all p&lt;0.01), fewer behavioral symptoms (NPI) (β = ‐5.16, SE 1.4, p&lt;0.001), reduced caregiver burden (ZBI short) (β = ‐1.69, SE 0.6, p=0.005), and reduced caregiver distress with behavioral symptoms (β = ‐1.63, SE 0.8), p=0.03) from baseline to 18 months. Carer depression trended towards improvement (PHQ‐9, β = ‐0.63, SE 0.37, p=0.086). No statistically significant change in QOL‐AD scores were observed. Most interaction effects were not significant, however non‐Caucasians tended to benefit more on several outcomes compared to Caucasians.ConclusionMIND is a scalable home‐based dementia model of care that promotes evidence‐based dementia care strategies addressing range of key medical, social, and environmental determinants of health. This quasi‐experimental analysis provides new evidence of effectiveness for improving outcomes for both PWD and their caregivers over time to and contributes important new longitudinal data to support the program’s value proposition to potential adopters.

Risk and protective factors affecting the quality of life of family carers of people with dementia

AbstractBackgroundContreras conducted a comprehensive meta‐analysis on predictive factors of QoL among family carers. The findings suggested that previous studies exclusively relied on generic QoL measures (e.g., feeling satisfied with own physical health) to assess wellbeing among this population. The level of generic QoL is often considered to largely depend on physical health conditions and level of independence, which could be problematic when used with older populations. To further build the evidence base, the current empirical study aimed to investigate the impact of common risk factors (i.e., care recipient’s neuropsychiatric symptoms, carer depression, anxiety and objective burden) on old age‐specific QoL (e.g., feeling valued in the community) among family carers, considering the increasing age of this population. It also aimed to explore the role of protective factors that have been proved to predict wellbeing in other populations but have not been studied yet in carers such as psychological flexibility and self‐compassion. Other potential protective factors such as carer’s knowledge about dementia and the number of hours of support they receive from other family members were also considered in the model.MethodEighty‐five family carers (Mean age=69.5, SD=12.9; 67.1% female) were recruited in the UK. Most of the participants were looking after a spouse (67.0%) with Alzheimer’s (43.5%) or mixed dementia (18.8%). Two separate multiple regression analyses were conducted with old age‐specific QoL as a dependent variable. First, all risk factors (i.e., neuropsychiatric symptoms, depression, anxiety and objective burden) were entered to the model as independent variables. In the second analysis, psychological flexibility, self‐compassion, knowledge about dementia and the number of hours of support carers receive from other family members were entered as independent variables to assess the impact of protective factors.ResultAnxiety was the only significant risk factor predicting old age‐specific QoL (β=‐.37) and psychological flexibility was the only significant protective factor predicting QoL (β=‐.44).ConclusionThese findings suggested that improving carer’s anxiety and psychological flexibility may be particularly important in promoting their old age‐specific QoL Future interventions should target these key variables to achieve the desired result of improving carer QoL.

The mediating role of sense of coherence on mental health outcomes in carers of older dependent relatives: A longitudinal study.

Sense of coherence (SOC) is an important protective factor for carer well-being but research to date remains cross-sectional, focusing primarily on the direct effects of SOC on carers' mental health. The study's aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers' psychological health, and its stability over time. Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at 1-year follow-up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care-recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. SOC was significantly negatively longitudinally associated with both anxiety (β = -0.38, p = 0.001) and depressive symptoms (β = -0.28, p = 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety, and caregiver strain and depressive symptoms (Sobel test: p < 0.001 for anxiety and p < 0.001 for depressive symptoms). Differences between baseline and 1-year follow-up SOC scores were not statistically significant (p = 0.617). SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non-experimental conditions over a period of 1 year in this sample. The findings suggest that interventions aimed at strengthening SOC may protect carer psychological well-being.

Protocol for a definitive randomised controlled trial and economic evaluation of a community-based rehabilitation programme following hip fracture: fracture in the elderly multidisciplinary rehabilitation—phase III (FEMuR III)

IntroductionProximal femoral (hip) fracture is common, serious and costly. Rehabilitation may improve functional recovery but evidence of effectiveness and cost-effectiveness are lacking. An enhanced rehabilitation intervention was previously developed and...