Mental Health Of Family Members Research Articles

The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.

ObjectiveTo examine the effects of maternal death on the health of the index child, the health and educational attainment of the older children, and the mental health and quality of life of the surviving husband.MethodsA cohort study including 183 households that experienced a maternal death matched to 346 households that experienced childbirth but not a maternal death was conducted prospectively between June 2009 and October 2011 in rural China. Data on household sociodemographic characteristics, physical and mental health were collected using a quantitative questionnaire and medical examination at baseline and follow-up surveys. Multivariate linear regression, logistic regression models and difference-in-difference (DID) were used to compare differences of outcomes between two groups.FindingsThe index children who experienced the loss of a mother had a significantly higher likelihood of dying, abandonment and malnutrition compared to children whose mothers survived at the follow-up survey. The risk of not attending school on time and dropping out of school among older children in the affected group was higher than those in the control group during the follow-up. Husbands whose wife died had significantly lower EQ-5D index and EQ-VAS both at baseline and at follow-up surveys compared to those without experiencing a wife’s death, suggesting an immediate and sustained poorer mental health quality of life among the surviving husbands. Also the prevalence of posttraumatic stress disorder (PTSD) was 72.6% at baseline and 56.2% at follow-up among husbands whose wife died.ConclusionsMaternal death has multifaceted and spillover effects on the physical and mental health of family members that are sustained over time. Programmes that reduce maternal mortality will mitigate repercussions on surviving family members are critical and needed.

Prevalence and Predisposing Factors for Depressive Status in Chinese Patients with Obstructive Sleep Apnoea: A Large-Sample Survey.

Background and ObjectiveRecently, there are few studies reporting on depressive status and obstructive sleep apnoea (OSA) in China. A large-sample survey was to be performed to explore the prevalence of depressive status and related factors in Chinese patients with OSA.MethodsFrom among a randomly-selected group of OSA patients, 1,327 met inclusion criteria. After screening with the Symptom Checklist 90 (SCL-90) and Self-Rating Depression Scale (SDS), patients were assigned to OSA without depressive status (control group, n = 698) and OSA with depressive status (n = 629) groups. Using chi-squared testing, the correlation analyses between the depressive status and OSA patient demographic and clinical variables were tested. Then depression-related risk factors in OSA patients were analysed using stepwise linear regression analysis. The effects of family and social factors on depressive status in OSA patients were investigated using Mann-Whitney U (one of nonparametric test).ResultsThe prevalence of depressive status was 47.4% in OSA patients. Depressive status was significantly associated with female gender, single status, Family Burden Scale of Disease (FBS), Family APGAR Index (APGAR), apnoea-hypopnea index (AHI), and Perceived Social Support Scale (PSSS). Stepwise linear regression analysis further indicated that single status, hypoxemia, APGAR, AHI, PSSS, AHI, and FBS were all risk factors for depressive status in OSA patients. The total of the FBS score and three of its sub-factors scores (family daily activities, family relationships and mental health of family members) were higher, and the total of the APGAR score and two of its sub-factors scores (adaptability and affection) were lower in OSA with depressive status compared with the control group. Besides, the total score for the PSSS and scores for its two sub-factors (family support and social support) were all lower in OSA patients with depressive status than those of the control group.ConclusionsDepressive status has high comorbid rate in Chinese OSA patients and is significantly associated with single status, apnoea-hypopnea index, hypoxemia, family and social supports.

Editorial: Psychosocial Advances in Neuro-Oncology.

Editorial: Psychosocial Advances in Neuro-Oncology.

Research on risk factors of depression symptoms in 1 327 patients with obstructive sleep apnea-hypopnea syndrome

To investigate the comorbidity rate of depression symptoms in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) in Henan province and to ascertain the risk factors. One thousand three hundred and twenty-seven patients with OSAHS determined by overnight polysomnogram (PSG) were enrolled in this study. After screening the Symptom Checklist 90 (SCL-90) and Self-rating Depression Scale (SDS), the patients were divided into two groups: OSAHS (control group, n = 698) and OSAHS+depression (n = 629). The correlation was explored between the depression symptoms in patients with OSAHS and the sociodemographic variables and health status including smoking, drinking, marital status, apnea hyponea index (AHI), anoxicity, Family Burden Scale of Disease (FBS), Family APGAR Index (APGAR), Perceived Social Support Scale (PSSS) and so on. Furthermore, In-depth analyses were carried out between the depression symptoms in patients with OSAHS and the social and family factor items (FBS, APGAR and PSSS). The comorbidity rate of depression symptoms in patients with OSAHS in Henan province was 47.4%, and was correlated with the gender, marital status, FBS, APGAR, AHI, PSSS and anoxicity. Logistic regression analysis indicated that single marital status, APGAR, AHI, PSSS, hypoxemia and heart disease were all independent risk factors for depression in OSAHS patients. The total of the FBS score and three of its subfactors scores (family daily activities, family relationships and mental health of family members) were higher, and the total of the APGAR score and two of its subfactors scores (adaptabilith and affection) were lower in OSAHS with depression compared with the control group (P < 0.05). Besides, the total score for the PSSS AND Scores for its two subfactors (family support and social support) were all lower in OSAHS patients with depression than those of the control group (P < 0.05). In patients with OSAHS, depression symptoms are common and are associated with marital status, AHI, anoxicity, concomitant diseases (hypertension, heart disease), concerns and supports from the family and society.

An Emerging Concept: Peaceful Letting Go

The concept of peaceful letting go emerged to describe the emotional, transitional and decision making processes that family members experience in losing an older adult loved one with a life-limiting illness. As many older adult patients due to their extreme morbidity are unable to express their end of life (EOL) preferences; families are facedwith having to make difficult decisions regarding their loved ones' care (Thelen, 2005). These decisions are often fraught with upheaval that takes a toll on the mental health of family members. Because EOL situations are multidimensional and complex they elucidate perplexing phenomena that are significant to the field of mental health nursing (Lowey, 2008). This paper highlights application of Liehr and Smith's (2014) concept building process in defining the emerging concept of peaceful letting go and includes implications for nursing research and practice.

A Family Affair: Job Loss and the Mental Health of Spouses and Adolescents

Examines the impact of involuntary job loss on the mental health of family members. Abstract This study examines the impact of involuntary job loss on the mental health of family members. Estimates from fixed-effects panel data models, using panel data for Australia, provide little evidence of any negative spillover effect on the mental health of husbands as a result of their wives' job loss. The mental well-being of wives, however, declines following their husbands' job loss, but only if that job loss results in a sustained period of non-employment or if the couple experienced financial hardship or relationship strain prior to the husband's job loss. A negative effect of parental job loss on the mental health of co-resident adolescent children is also found, but appears to be restricted to girls.

A Family Affair: Job Loss and the Mental Health of Spouses and Adolescents

This study examines the impact of involuntary job loss on the mental health of family members. Estimates from fixed-effects panel data models, using panel data for Australia, provide little evidence of any negative spillover effect on the mental health of husbands as a result of their wives' job loss. The mental well-being of wives, however, declines following their husbands' job loss, but only if that job loss results in a sustained period of non-employment or if the couple experienced financial hardship or relationship strain prior to the husband's job loss. A negative effect of parental job loss on the mental health of co-resident adolescent children is also found, but appears to be restricted to girls.

Psychologic effects of automated external defibrillator training: A randomized trial

Objective The objective of this study was to test whether an automated external defibrillator (AED) training program would positively affect the mental health of family members of high-risk patients. Methods A total of 305 patients with ischemic heart disease and their family members were randomized to 1 of 4 AED training programs: 2 video-based training programs and 2 face-to-face training programs that emphasized self-efficacy and perceived control. Patients and family members were surveyed at baseline and 3 and 9 months postischemic event on demographic characteristics, measures of quality of life (Short Form-36), self-efficacy, and perceived control. For this study, family members were the focus rather than the patients. Results Regression analyses showed that family members in the face-to-face training programs did not score better on any of the mental health status variables than family members who participated in the other training programs except for an increase in self-efficacy beliefs at 3 months after training. Conclusion The findings suggest that a specifically designed AED training program emphasizing self-efficacy and perceived control beliefs is not likely to enhance family member mental health.

Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide

BackgroundDespite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends. MethodsA cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale–Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss. ResultsOf the 85 participants, 13% met the criteria for full PTSD (cut-off≥35), 6.5% met the criteria for subthreshold PTSD (cut-off≥25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%. ConclusionA higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.

Corrleation of health-related quality of life (HRQL) of cancer patients and the mental component parameters of their family members

e20619 Background: It is widely experienced that health-related quality of life (HRQL) is greatly influenced in the family members of cancer patients. The aim of this study was to find the correlation of the HRQL parameters in cancer patients with the main mental component parameters of patients’ relatives. Methods: 122 cancer patients undergoing chemotherapy in our department (49 men and 73 women) of mean age 56.6 ±15.4 1SD and their 122 relatives that accompanied them (45 men and 77 women) of mean age 48.3 ±14.5 completed the validated SF-36 health survey by personal interview. The SF-36 health survey summarizes the functional health status and general health into eight scales with higher scores (0–100 range) reflecting better-perceived health. In this study, physical functioning (PF), role physical (RP), bodily pain (BP), general health perception (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH) of the patients were correlated with the SF, RE, MH of their family members using the Spearman's test. Data analysis was performed with SPSS version 13.0 and correlations were considered statistically significant when p&lt;0.05. Results: Table 1 summarizes the results of our study. Social Functioning and Mental Health of family members are highly correlated with the HRQL parameters of cancer patients. The RE does not seem to be affected. Conclusions: HRQL of cancer patients undergoing chemotherapy is highly correlated with the SF and the MH of their relatives. This observation highlights the need to develop more oriented supportive programs for both the patients and their family memebers. Abbreviations: PF = Physical Functioning, RP = Role Physical, BP = Bodily Pain, GH = General Health, VT = Vitality, SF = Social Functioning, RE = Role Emotional, MH = Mental Health; NS=Not Significant. * = 0.05. ** = 0.01. [Table: see text] No significant financial relationships to disclose.

Practical Guidance for Evidence-Based ICU Family Conferences

Because most critically ill patients lack decision-making capacity, physicians often ask family members to act as surrogates for the patient in discussions about the goals of care. Therefore, clinician-family communication is a central component of medical decision making in the ICU, and the quality of this communication has direct bearing on decisions made regarding care for critically ill patients. In addition, studies suggest that clinician-family communication can also have profound effects on the experiences and long-term mental health of family members. The purpose of this narrative review is to provide a context and rationale for improving the quality of communication with family members and to provide practical, evidence-based guidance on how to conduct this communication in the ICU setting. We emphasize the importance of discussing prognosis effectively, the key role of the integrated interdisciplinary team in this communication, and the importance of assessing spiritual needs and addressing barriers that can be raised by cross-cultural communication. We also discuss the potential value of protocols to encourage communication and the potential role of quality improvement for enhancing communication with family members. Last, we review issues regarding physician reimbursement for communication with family members within the context of the US health-care system. Communication with family members in the ICU setting is complex, and high-quality communication requires training and collaboration of a well-functioning interdisciplinary team. This communication also requires a balance between adhering to processes of care that are associated with improved outcomes and individualizing communication to the unique needs of the family.

Controlling Personal Health Decisions for the Oldest Old

Public health practitioners help the oldest old (persons aged 75 years and older) prevent falls, protect against communicable disease threats, cope with arthritis and many other chronic ailments, and deal with the loss of loved ones and lifelong friends. Collectively, assisting the oldest old as they manage their health is a core objective of public health practice. Warren DeWitt (right), aged 76 years, moved into the Peters household in Gladesville, West Virginia, to help look after Maxine and Arden, both aged 90 years. At the time this photograph was taken (2000), Warren had lived with the couple for over a year, cooking, cleaning, and maintaining the grounds. His chores also included trimming Arden’s hair. Photograph by Ed Kashi. Printed with permission of Ed Kashi Photography. Available at http://www.EdKashi.com. When M.R.G suggested this theme issue at a Journal editors meeting, he had another set of health-related controls in mind—specifically, the legal documents that allow us to direct the course of our life when we cannot. When thinking about these controls, most people usually consider only the prospect of documents that address one’s final affairs after death, such as a last will and testament, a living trust, or an organ donor card. A will allows a person to control the distribution of his or her wealth and personal property in accordance with his or her wishes and minimizes the tax impact of those transfers. A living trust is an approach to distributing wealth after death, which is set up and funded during life to avoid the burden of probate. An organ donor card authorizes the gift of a decedent’s organs for the benefit of transplant recipients. Perhaps more important, though, are the legal documents that structure the control of one’s medical and financial affairs during a period of incapacity, whether preliminary to the end of life or as a consequence of a traumatic injury or disease. The most significant of these documents are the general durable power of attorney, which appoints someone to act as an agent for legal, financial, and sometimes health matters when the principal is unable to do so, and the advance medical directive, which is also known as a “health proxy.” A health proxy—which is often accompanied by a health care power of attorney—is a set of directions that advises family members and medical professionals about wishes for medical life-support and other intervention. Also applicable to periods of incapacity is a contract for long-term health care insurance, which provides coverage for long-term conditions not covered by or limited by more traditional health care insurance. Preparation of these documents has traditionally fallen to attorneys; accordingly, addressing the issues covered by these documents has not been a core objective of public health practitioners. Ironically—and often, tragically—the implications of not having these legal protections in place falls most heavily on health practitioners and family members. Without a general durable power of attorney or a health proxy for an incapacitated person, health providers may be placed in the uncomfortable position of choosing the type and duration of treatment, which are all too often life-and-death choices. Moreover, the court system—impersonal, bureaucratic, and expensive as it is—is often invoked to make decisions that can have unalterable impacts on the mental health of family members. We cannot understate the anguish felt by family members who argue with other members about treatment and financial matters, sometimes to the point of lawsuits and family disintegrations. Conversely, many of us have witnessed a sense of relief for the oldest old who have prepared these documents. Without question, possessing up-to-date legal documents advances the dignity and autonomy of the incapacitated and dying and enhances public health and clinical public health practice.

Commentary on Schneider RA (2004) Assessing the fatigue severity scale for use among caregivers of chronic renal failure patients. Journal of Clinical Nursing 13, 219–225

Assessing the health of family (the term family is used here very broadly to cover any partnership [spouse, child, lover and friend] within which consistent care is provided for the chronically ill individual), caregivers of people with chronic illnesses and ultimately intervening to support them and maintain their health status are an issue that will prove to be of utmost importance in health care over the next decade. Chronic illnesses, as a group, make up the largest health problem facing the western world (Mast 1995). In fact, Miller (1992) described the chronic illness as a phenomenon of the 20th century. As more diseases are controlled through medical intervention, there is an increase in survival; there is also a consequential increase in disability and a corresponding need for long-term care provision. No health system is able to sustain the cost of providing ongoing care for the chronically ill by qualified health professionals, so the burden of care falls on the patient and his/her family. The burden of care is different for family caregivers compared with formal caregivers such as nurses, doctors and other health professionals; the family caregiver is more likely to have an emotional investment in the patient’s wellbeing and faces the loss of an active spouse or parent and the consequent changes in relationship and role as well as the increased care demands as the patient becomes more dependent over time (Kinsella et al. 1998, Meyers & Grey 2001). Whereas, for health professionals, caregiving provides work that is paid and is indeed what they are there for, family caregivers gain additional workload, which increases financial strain on top of the physical and emotional demands. Whereas health professionals can go home at the end of the day and can anticipate things to do and enjoy which are different from work activities, the family caregiver has no such respite from caregiving tasks and demands. Furthermore, family caregiving is as complex as the families that are involved. The physical health of family members is only one aspect of the jigsaw in ensuring the quality of care for the chronically ill patient. Family function (or dysfunction) is also an important factor, which is intimately related to the mental health of family members along with additional financial, time and leisure constraints (Kinsella et al. 1998). An unspoken assumption of the health system’s shifting of the cost and burden of care into the community is that the family caregivers themselves are healthy and able to provide the care. In fact, this assumption is apparent in Schneider’s research where the author states that the caregivers are a non-medical population. This may not in fact be the case. Caregivers are very often elders themselves providing care for their older spouse or middle-aged children providing care for ageing parents. In fact, Desbiens et al. (2001), in a study of more than 1200 caregivers, found the typical family caregiver to be female and over 50 years old. In Schneider’s research, the average age of the caregivers was 62.2 years; there was no indication as to the sex of the respondents. Given the age of these caregivers, it is likely that they would have their own diagnoses of chronic illness and consequently some related fatigue (Toseland et al. 1995). The ability to differentiate the fatigue associated with caregiving and the fatigue related to the caregiver’s own chronic illnesses is not easy, nor is it necessarily required, but one cannot assume that all fatigue is related to caregiving alone. As this is a methodological paper focusing on the psychometrics on the Fatigue Severity Scale (FSS), Schneider does not include a full description of either the sample demographics or their responses on the fatigue questionnaire. Correspondence: Davina Porock, Professor of Nursing Practice, School of Nursing, The University of Nottingham, UK. E-mail: davina.porock@nottingham.ac.uk

Psychological Distress and the “Medical Student Syndrome” in Abnormal Psychology Students

We investigated psychological distress and the “medical student syndrome” in a group of undergraduate Abnormal Psychology students. Students planning to major in psychology reported more worry about their psychological health than those planning to major in some other field. Also, students who reported a history of psychological treatment were more likely to intend to pursue an advanced degree in counseling or psychotherapy. Although the process of learning about various psychological disorders decreased students' anxiety about their own mental health, it increased their anxiety about the mental health of family members. After completing course work in abnormal psychology, students were more willing to seek help from campus mental health services for personal psychological distress.

Talking to teens about family problems. An opportunity for prevention.

Most pediatricians do not screen for family problems as part of routine adolescent health care. This study documents fears, worries, and concerns about family issues expressed by 147 teenagers on a confidential questionnaire during consecutive initial visits to an adolescent medicine clinic in a university hospital setting. Among the salient findings, 44% had thought about running away from home, 42% reported having been subjected to some form of abuse, and 33% had felt like hurting themselves or someone else. Twenty-eight percent reported conflict in their home, 27% were having problems with their family, and 20% were concerned about their parent's relationship. In addition, 27% worried about the physical or mental health of family members and 22% believed that a family member had a problem with alcohol or other drugs. Twelve percent did not have a confidant with whom to discuss their innermost concerns. The data demonstrate a high frequency of stressful and anxiety-provoking family situations as reported by adolescents on a confidential questionnaire. Pediatricians who wish to provide comprehensive services to their young adult patients must be prepared to discuss such issues on a routine basis.

Living with psychiatric patients: implications for the mental health of family members.

Current treatment policy has resulted in large numbers of ex-hospitalized psychiatric patients residing with family members in the community. However, little is known about the emotional consequences for family members. This paper focusses on the relationship between level of chronic strain, as indexed by 'objective' and 'subjective' family burden, and extent of psychological distress among family members of ex-hospitalized psychiatric patients. This relationship is assessed within a multivariate model that also considers eventful experience as an additional source of stress and social support and mastery as potential stress mediators. We found the variable of mastery, or sense of personal control, to be by far the most powerful predictor of distress among family members. When mastery was considered in regression analyses the modest correlations between 'objective' and 'subjective' family burden and distress scores disappeared. However, assessment of interactions indicated that strain is independently associated with distress among those subjects who scored relatively low on the mastery scale. Our most general conclusion is that the presence of some patients tends to be associated with substantial psychological costs for some families.

Hyperactives as Young Adults: Initial Predictors of Adult Outcome

This 10–12-year prospective follow-up of hyperactives as young adults (ages 17–24 years) attempted to determine which initial factors or group of factors (at ages 6–12 years) can predict adult outcome. Results indicate that any particular adult outcome is not associated with a particular initial variable but with the additive interaction of personality characteristics, social as well as family parameters. However, certain initial predictor variables stand out as being more important. These include family parameters such as socioeconomic class and mental health of family members, personal characteristics such as IQ, aggressivity, emotional instability and low frustration tolerance.

Mental disorder in married couples.

The primary aim of family psychiatry is to demonstrate how the mental health of family members is interrelated. It is a study in which aspirations have outstripped techniques, possibly because research workers have attempted to apply the subtlety of clinical insights to details of family dynamics. Yet only confusion can follow such attempts while basic general data are still lacking; and as Post's (1962) survey illustrates so clearly, our present certain knowledge, despite great and continuing labour, remains exiguous.