Negative Caregiving Research Articles

Experiences of family caregivers 3-months after stroke: results of the prospective trans-regional network for stroke intervention with telemedicine registry (TRANSIT-Stroke)

BackgroundLong-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC 3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke.MethodsData were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale, respectively. Multivariable logistic and linear regression analyses were performed.ResultsBetween 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4% of FC were older than 55 years, 70.1% were women and 67.5% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5%) and the privilege (70.0%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4%). Median overall self-rated burden was 30 (IQR: 0–50; range 0–100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner.ConclusionsThe majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver.Trial registrationThe study was registered at “German Clinical Trial Register”: DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011696

The Burden of Caring for Dependent Older People and the Resultant Risk of Depression in Family Primary Caregivers in Italy

Long-Term Care (LTC) for older people in need of care is a critical issue affecting the quality of life of family caregivers (as well as older people), encompassing both negative and positive caregiving experiences. Providing support to family caregivers is essential because they play a crucial role in sharing the societal burden of LTC for the growing frail older population. By presenting the results of a survey carried out in 2019–2020 in Central Italy, this study aims to describe the characteristics and estimate by a multivariate logistic model the correlates of depressive symptoms in 369 primary caregivers of dependent older people. Caregivers are mostly women who provide a high amount of care in terms of weekly hours as a result of insufficient assistance from public or private care services. More than half of the sample show depressive symptoms, indicating a fairly serious situation. Perceived burden is a strong predictor of depression. The findings offer suggestions and policy implications. The fragmentation of the care context should be addressed by allocating sufficient funding to expand the supply of public in-kind services and integrate cash-for-care schemes, thus alleviating the burden and mitigating the negative consequences of care on physical and mental health.

Using Virtual Reality to Improve the Quality of Life of Older Adults with Cognitive Impairments and their Family Members who Live at a Distance

ABSTRACT This study examines whether using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild to moderate dementia with a family member who lives at a distance can improve the quality of life of the older adult and the family member. Twenty-one older adults in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by three weekly VR sessions. The VR was associated with improvements in older adultsʻ affect and stress, relationship with their family member, and overall quality of life, compared to baseline. Family membersʻ negative affect, depressive symptoms, and caregiver burden also decreased and their mental health improved after using the VR, compared to baseline. Using the VR, however, did not change their relationship with the older adult. In addition, older adults and family members who experienced the VR sessions as more socially engaging reported better psychological and relational well-being, with older adults also experiencing greater improvements in overall quality of life. Finally, preliminary results suggest that older adults with dementia and their family members might benefit even more from using the VR than older adults with MCI and their family members.

Perceived social support and distress in carers of people with lung cancer: The serial mediation of resilience and positive aspects of caregiving.

To determine the mediating roles of resilience and positive aspects of caregiving (PAC) in the effect of perceived social support (PSS) on distress. This study, with a cross-sectional design, was conducted in a Chinese hospital. Instruments included the Multidimensional Scale of Perceived Social Support, Chinese version Connor-Davidson Resilience Scale, Positive Aspects of Caregiving, and the Depression, Anxiety, Stress Scales-21. Descriptive analysis and serial mediation analysis were conducted by SPSS 22.0. Data from 300 Chinese carers of people with lung cancer was used. The correlation analysis showed that PSS, resilience, and PAC were protective factors of distress. The mediation analysis revealed that resilience and PAC separately and serially mediated the effect of PSS on distress. Carers of people with lung cancer perceived positive and negative caregiving experiences simultaneously. PSS could alleviate distress by enhancing resilience and promoting PAC. Multicomponent interventions integrating PSS, resilience, and PAC should be designed to alleviate distress among Chinese carers of people with lung cancer.

Attitudes toward aging as a psychological resource among caregivers of persons living with dementia

Although there are a number of existing interventions to support caregivers in managing the behaviors and functioning of care recipients with dementia, less attention has focused on caring for caregivers and understanding how their characteristics may contribute to distress or wellbeing Positive psychological resources can promote health and well-being among caregivers and may also serve as protective factors that buffer negative caregiving experiences and minimize burden and stress. Informal dementia caregivers (N = 99, mean age = 54) answered survey questionnaires related to psychological resources (e.g., Brief Aging Perceptions Questionnaire, Caregiver Self-efficacy for Managing Dementia, Positive Affect and Negative Affect Scale) to explore the connection to their emotional health. After controlling for caregiver factors and care recipient factors, caregivers’ aging attitudes and caregiving self-efficacy were predictive of both caregivers’ positive and negative affect. Caregivers’ aging attitudes also directly affected their emotional health and indirectly influenced emotional health through self-efficacy for caregiving. Future caregiver outreach and education should highlight positive aspects of caregiving, provide accurate dementia information, and improve psychoeducation regarding typical/atypical aging experiences while dispelling negative age stereotypes, which may foster better adaptation and resilience to a dementia caregiver role and strengthen positive mental representations of dementia caregiving.

Psychometric Testing of the BRI Unmet Need Instrument: A Comprehensive Measure of Dementia Caregivers' Needs

Compared to non-dementia caregivers, family/friend caregivers of individuals with dementia experience more negative caregiving consequences. One reason is the myriad of negatively impacted life domains including: managing symptoms; family communication; financial and legal matters; and finding and coordinating services. Few psychometrically tested measures exist for assessing the range of potential unmet needs of dementia caregivers. Such a measure would describe the frequency and correlates of unmet needs and provide a key outcome for intervention research. This study tested the psychometric properties of a comprehensive measure of unmet needs, the BRI Unmet Need Instrument. Data from 192 family/friend dementia caregivers was used to test reliability and four validity types. Results showed total unmet needs, as well as its nine subscales, had good reliability (Cronbach’s alpha .70 - .95). Discriminant validity was confirmed through factor analyses of the 45 unmet needs and items in measures of depression and care-related strain. Unmet need items loaded on separate factors that were deemed acceptable (.72-.38). Predictive validity was assessed by the association with depression, which was significant and an acceptable range (r = .22, p < .01). Convergent validity was confirmed by significant associations with three caregiver strain measures, mastery (r = .40, p <.01), emotional strain (r = .19, p < .01), and relationship strain (r = .15, p <.05). Good structural validity for nine predetermined unmet needs subscales was found using principal component analysis (loadings = .82-.39). Results suggest the BRI Unmet Needs Instrument is a ready-to-use, reliable and valid comprehensive measure.

Caregiving Appraisals and Emotional Valence: Buffering Effect of Activity Participation

Caregiving activities often lead to positive and negative appraisal for caregivers. Caregivers may limit social participation due to caregiving activities. Changes in level of activity participation could have profound consequences for caregiver’s valence. However, little is known about how activity participation could moderate the association between these caregiving appraisals and emotional valence. Data came from the National Study of Caregiving (Round 1 and 2), a nationally representative study of caregivers. Referencing Lawton’s two-factor model (1990), we examined both the level and changes in activity restriction interacting with positive and negative caregiving appraisals to predict both valence across two waves. Consistent with two factor models, findings revealed level and changes in activity restriction moderated the relationship between caregiving appraisal and outcomes for both valences. These findings highlight the role of activity restriction as a target to reduce negative valence and improve positive valence for caregivers.

Caregivers' Medical Care Provision at Patient End-of-Life: Associations with Emotional Difficulty and Gains

Family caregivers play crucial roles in patient care and medical decision making, especially at end-of-life (EOL). Yet, most research focuses on caregivers’ burden, with little attention to rewards that make for a fulfilling EOL care experience. We consider caregiver involvement at EOL and associations with caregiver stress and gains. Data are drawn from the 2017 National Study of Caregiving’s last month of life and core interviews which includes caregivers (n=283) for a nationally representative sample of Medicare eligible older adults, and questions caregivers about their care provision and EOL experience. We consider indicators of caregivers’ involvement in medical decision making and support received from providers as predictors of caregivers’ emotional difficulty and gains at EOL utilizing linear regressions controlling for demographic characteristics. Caregivers were 60.7 years of age on average, 72.5% female, 21.3% non-white, and 11% were spousal partners. Making medical decisions was associated with increased emotional difficulty at EOL (B=0.93, SE=0.24, p<.001). In contrast, more caregiving gains were associated with having care decisions align with the CG’s wishes (B=-0.64, SE=0.30, p<.05), being more informed by providers (B=0.41, SE=0.16, p<.05), helping the care recipient with anxiety or sadness (B=0.69, SE=0.28, p<. 05), and surprisingly, feeling that care decisions were made without their input (B=0.82, SE=0.29, p<.01). Being more involved and informed in care was associated with both positive and negative caregiver outcomes at EOL. Understanding caregiver emotional difficulty and gains at EOL are critical for identifying how clinicians can better support caregivers at EOL and improving the caregiving experience.

Effects of the COVID-19 Pandemic on Caregivers of Young Children with Sickle Cell Disease Enrolled in the Engage-HU Trial

Effects of the COVID-19 Pandemic on Caregivers of Young Children with Sickle Cell Disease Enrolled in the Engage-HU Trial

Associations Between Children's Telomere Length, Parental Intrusiveness, and the Development of Early Externalizing Behaviors.

Shorter telomeres mark cellular aging and are linked to chronic stress exposure as well as negative physical and psychological outcomes. However, it is unclear whether telomere length mediates associations between early stress exposure and later externalizing problems, or whether boys and girls differ in pathways to these concerns. We therefore examined associations between telomere length, early stress via negative caregiving, and children's externalizing symptom development over time in 409 three-year-old children and their parents. Telomere length mediated the association between early parental intrusiveness and later rule-breaking behavior; however, this association was moderated by children's biological sex such that parent intrusiveness was related only to boys' rule-breaking. Findings support the notion that children's telomere length may mark individual differences in responses to negative early caregiving, and highlight a potential mechanism contributing to the development of rule-breaking problems in boys.

Identifying the carers’ profiles of health literacy, eHealth literacy and caregiving concepts

Abstract Background Carers of people with dementia (PwD) undertake the role of supporting their relatives in everyday life and caring tasks, sometimes without adequate knowledge of the progression of the disease, practical advice and support mechanisms or services. This study aims to describe the Health Literacy (HL) and eHealth Literacy (eHL) profiles of carers of PwD in Greece and Cyprus and to explore associations with dimensions influenced by the delivery of care. Methods This descriptive correlational design study measured HL (HLS-EU-Q16 tool), eHL (eHeals-Carer) and dimensions of care (Brief-COPE, caregiving self-efficacy, COPE index and Multidimensional Perceived Social Support). In total, 174 primary carers of PwD and 67 secondary carers participated in a face-to-face survey. Correlation and regression analysis were performed to explore associations between the concepts of interest and cluster analysis (N = 123) to identify profiles of carers. Results Carers, primary and secondary, reported high scores of eHL and HL. HL scores were associated with eHL and both variables with the two dimensions of caregiving self-efficacy: “obtain respite” and “behavior management”. Three carers' profiles were identified: 1) carers with high levels of HL, eHL, Self-Efficacy and low coping strategies, 2) carers with problematic coping, negative caregiving perceptions, and lower HL and eHL, and 3) carers with high HL and eHL, with strong Social Network, high emotional-focused coping strategies and low problematic coping. Conclusions Understanding the role of HL and eHL in the caregiving process and identifying carers' profiles could assist healthcare professionals in their educational role with families and planning of care. There is a need to develop more ways to assess these concepts for this population and to develop training courses focusing on enhancing the HL skills of carers and healthcare professionals. The COST action NET4AGE-friendly supported the conference participation. Key messages HL and eHL are related to the caregiving role and may not only influence health-related decisions made by the carers on behalf of their relatives but also their own self-efficacy and coping. HL and eHL should be appropriately assessed and taken into consideration by healthcare professionals in management plans for PwD and their families.

Family Caregivers' Experiences and Changes in Caregiving Tasks During the COVID-19 Pandemic.

The purpose of this descriptive study was to describe family caregivers’ experiences and changes in caregiving tasks and approaches during the COVID-19 pandemic. Using web-based strategies, 69 family caregivers of adults with chronic or disabling conditions were recruited and completed an online survey about positive and negative caregiving experiences, and ways in which caregiving has changed. Data were analyzed using descriptive statistics (structured questions) and conventional content analysis (open-ended responses). Participants reported concerns about their loved one’s physical and mental health, the limited access to other caregiving sources, and the limited opportunities to maintain personal well-being. Caregiving tasks completed more than usual included providing emotional support, shopping for groceries and essentials, and contacting healthcare providers. Participants modified their caregiving approach by assuming added responsibilities, leveraging technology, and managing a new caregiving routine. Findings indicate that family caregivers experienced additional caregiving challenges and changed caregiving tasks considering the limited resources available.

Fr136 CENTER-BASED EXPERIENCES IMPLEMENTING STRATEGIES TO REDUCE RISK OF HORIZONTAL TRANSMISSION OF SARS-COV-2: POTENTIAL FOR COMPROMISE OF NEONATAL MICROBIOME ASSEMBLAGE

Perinatal transmission of COVID-19 is poorly understood and many neonatal intensive care units' (NICU) policies minimize mother-infant contact to prevent transmission. We present our unit's approach and ways it may impact neonatal microbiome acquisition. We attended COVID-19 positive mothers' deliveries from March-August 2020. Delayed cord clamping and skin-to-skin were avoided and infants were admitted to the NICU. No parents' visits were allowed and discharge was arranged with COVID-19 negative family members. Maternal breast milk was restricted in the NICU. All twenty-one infants tested negative at 24 and 48 hours and had average hospital stays of nine days. 40% of mothers expressed breastmilk and 30% of infants were discharged with COVID-19 negative caregivers. Extended hospital stays, no skin-to-skin contact, limited maternal milk use, and discharge to caregivers outside primary residences, potentially affect the neonatal microbiome. Future studies are warranted to explore how ours and other centers' similar policies influence this outcome.

Mental health and caregiving experiences of family carers supporting people with psychosis.

Family carers supporting an individual with psychosis often experience poorer mental health, however, little is known about specific risk factors among these carers. We investigated the associations between demographic, caregiving characteristics and mental health outcomes in family carers supporting an individual with psychosis and compared carers' outcomes with general population norms. We analysed baseline data from the COPe-support randomised controlled trial of online psychoeducation and peer support for adult carers supporting an individual with psychosis between 2018 and 2020. We collected carers' demographic and health outcome data, including wellbeing using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS as primary outcome), quality of life using EQ-5D-5L and caregiving experience assessed with Experience of Caregiving Inventory. We tested associations between carers' demographic and caregiving characteristics for each outcome in turn and meta-analysed carers' WEMWBS and EQ-5D-5L with Health Survey England (HSE) general population data from 2016 and 2017, respectively. The 407 carers of people with psychosis had a mean WEMWBS score of 42.2 (s.d. 9.21) and their overall weighted pooled WEMWBS score was 7.3 (95% confidence interval (CI) -8.6 to -6.0, p < 0.01) lower than the HSE general population sample, indicating carers have poorer mental wellbeing by more than double the minimum clinically important difference of 3 points on WEMWBS. Among all caring relationships, partners had poorer wellbeing compared to parents with lower WEMWBS score (-6.8, -16.9 to 3.3, p = 0.03). Single carers had significantly poorer wellbeing (-3.6, -5.6 to -1.5, p < 0.01) and a more negative caregiving experience than those who were cohabiting. Spending more than 35 h per week caregiving increased carers' negative experience significantly (p = 0.01). Carers of people with psychosis have poorer mental health than non-carers. Partners, lone carers and those spending more than 35 h per week on caring were found to be most at risk of poor mental health. Based on the results, we advocate that the details of carers for individuals with psychosis should be added to the existing carers or severe mental illness registers at all general practitioner surgeries and for their wellbeing screened routinely. Future large-scale prospective studies are needed to develop a predictive model to determine risk factors, hence to aid early identification of carers' support needs. Such understandings are also useful to inform tailored intervention development.

An Examination of Positive and Negative Dementia Caregiving Experiences

ABSTRACT Objectives We examined associations among three measures of caregiver experiences (i.e., positive aspects of caring [PAC], caregiver burden, and mutuality) in 228 dyads involving persons with dementia (PWD) and their informal caregivers. The associations between predisposing, enabling, and need factors and each of these three measures of caregiver experiences were also examined. Methods We used baseline data from a randomized controlled trial of a psychosocial intervention aimed at preventing aggression in PWD. Associations among PAC, caregiver burden, and mutuality were examined. The Behavioral Model of Health Services Utilization guided the selection of predisposing, enabling, and need components. Results Enabling characteristics (e.g., race/ethnicity, caregiver education and employment and PWD education) and most predisposing characteristics (e.g., caregiver age, PWD age, relationship type) were not associated with any caregiving experience measures. Need characteristics (e.g., levels of memory and functional impairment, behavioral problems, depression, pleasant events) were associated with the caregiving experience. Conclusions Bivariate correlations between PAC, caregiver burden, and mutuality were between −0.20 and −0.58. Predisposing, enabling, and need factors were differentially associated with outcomes, with need characteristics being most frequently associated with various aspects of caregiving. Clinical implications Assessment of both positive and negative aspects of caregiving is important. Particular attention to depression and interventions that improve depressive symptoms may increase PAC and mutuality and reduce caregiver burden.

Overcoming Ethical Challenges in Conducting Research Among Persons With Dementia

By 2060, the number of older adults with Alzhemier’s Disease or related dementias (ADRD) is expected to encompass approximately 13.9 million Americans. Recognizing this, the federal government has prioritized research on ADRD and their effect on the physical, emotional, and psychological well-being of persons with dementia (PWD). Such research is complicated by disease-associated decline in cognitive and functional capacity among PWDs which can impair participant ability to process and communicate information, potentially increasing their exposure to negative research-related experiences and compromising the accuracy and reliability of provided data. Nevertheless, as a key stakeholder group, PWD should have the right to participate in research on ADRD. This session will present a case study of ethical issues that emerged in an NIH-funded study utilizing mixed-methods to examine caregiving and care dyad relationships between PWD and their care partners over an 18-month follow-up period. Ethical issues examined will include: (1) PWD capacity to consent to research at baseline and (2) during follow-up visits, (3) Obtaining accurate and reliable data from persons with mild to moderate dementia, (4) Assessing PWD distress while engaging in data collection processes, and (5) Reporting of negative caregiving and life experiences, such as elder mistreatment. The discussion of these topics and presentation of lessons learned holds promise for improving research methodology in studies involving PWD and enabling researchers to increase the involvement of persons with mild to moderate dementia in research on ADRD.

Childhood adversity and trajectories of multimorbidity in mid-late life: China health and longitudinal retirement study

BackgroundThe association between childhood adversity and an individual’s health in later life has been extensively studied in Western societies; however, little is known about this association for the development of...

Gaining Longitudinal Accounts of Carers' Experiences Using IPA and Photograph Elicitation.

Fluctuations in positive and negative caregiving experiences remain only partially explained as the significant variability over time of potential predictive factors themselves is understudied. The current study aims to gain considerable insight into caregiving experiences and perceptions over time by using photovoice methodology to support semi-structured interviews. A case study, longitudinal design is taken with three female caregivers who provide detailed insight into their caregivers' experiences over a 12 month period. The interview transcripts were analyzed using IPA- Interpretative Phenomenological Analysis. This innovative combination of methods resulted in the emergence of three related themes which included consuming the role, feeling consumed by the role, and letting go of the role. The idiographic approach taken allowed both within case differences to be examined over time, and also between carer differences to be highlighted. Implications of illness type and its characteristics, and of attachment and relationship quality with the care recipient were seen in terms of how and when the caregivers moved between the themes identified. The use of others' support or respite care is examined vis-a vis caregiver's own beliefs, emotions, relationship attachment and motivations to care. Caregivers self-efficacy beliefs also shifted over time and were influential in caregiver experience as the care recipient condition or needs changed. No previous studies have found that negative caregiving consequences are, in part, under volitional control and yet our data on the underlying reasons for consuming caregiving or allowing themselves to consume, would suggest this may in part be true. This is important because it suggests that interventions to support caregivers should address relational and motivational factors more fully.

Effects of bibliotherapy on improving caregiving appraisal and coping among informal caregivers of people with dementia: A pilot randomized controlled trial

AbstractBackgroundThe number of people with dementia is increasing worldwide, and the majority are cared for by informal caregivers in home settings. Both positive and negative caregiving outcomes have been found among informal caregivers, the essential determinant was caregiving appraisal. Improving their caregiving appraisal is important for both the caregiver and care‐recipient’s health. However, as professional support for informal caregivers are limited, self‐help approaches are needed. Bibliotherapy, a self‐help intervention requiring minimal professional support, has been proved to be effective on improving caregiving appraisal in other populations, the effect on dementia caregivers is yet to be explored. Objectives: To explore the efficacy of bibliotherapy on improving caregiving appraisal and coping among informal caregivers of people with dementia.MethodA two arm randomized controlled trial was conducted in Zhengzhou, China. Participants were randomized to either the intervention group, receiving 8 weekly bibliotherapy sessions at home without withdrawing from usual care; or the control group, receiving usual care from the community health centers. Assessors were blinded to group allocation. Generalized estimating equation was used for data analysis.ResultsSixty participants were recruited, and 24 out of 30 participants in the intervention group finished the intervention. Bibliotherapy had significant group (Wald χ2=4.98, p=0.026), time (Wald χ 2=15.27, p&lt;0.001) and group‐by‐time interaction effects (Wald χ2=16.51, p&lt;0.001) on the total score of caregiving appraisal. In terms of the subscales, there were significant time effects on subjective burden (Wald χ2=8.81, p=0.003), caregiving impact (Wald χ 2=11.31, p=0.001) and caregiving mastery (Wald χ 2=11.74, p=0.001), and significant group effects on caregiving satisfaction (Wald χ 2=7.39, p=0.007). The group‐by‐time interaction was significant on all the subscales (Wald χ2=5.38‐10.89, p=0.001‐0.020). Bibliotherapy also had significant group (Wald χ2=10.93‐15.24, p&lt;0.001), time (Wald χ 2=10.99‐33.02, p&lt;0.001) and group‐by‐time interaction (Wald χ 2=8.91‐17.80, p=0.001‐0.003) effects on the total score of coping and the positive coping subscale. However, the effects on negative coping were not significant (Wald χ 2=0.53‐3.17, p=0.075‐0.467). No adverse events were found.ConclusionBibliotherapy had significant preliminary effects on improving caregiving appraisal and positive coping. The effect on negative coping is still limited. Future randomized controlled trials with larger sample sizes and long‐term follow‐ups are encouraged.

The Influence of Familial and Peer Social Support on Post-Traumatic Stress Disorder Among Black Girls in Juvenile Correctional Facilities

Black girls bear a higher burden of juvenile justice involvement in the United States, relative to other racial/ethnic female groups. Emerging evidence suggests that system involvement is related to trauma histories and post-traumatic stress disorder (PTSD). This study investigated the associations between individual, family, and peer factors, and their relationship to PTSD among Black girls with juvenile justice involvement. Cross-sectional data were collected from 188 Black girls in detention. Measures assessed were history of abuse, negative peer norms, future orientation, caregiver support, self-esteem, age, and PTSD symptoms. Major regression findings indicated that higher rates of caregiver support, higher negative peer norms, lower self-esteem rates, and lower future orientation rates were correlated with greater PTSD symptoms. Treatment programs for this population warrant a multisystemic approach, which includes caregivers and peers, and bolstering important constructs such as self-esteem and hopefulness.