Positive Aspects Of Caregiving Research Articles

The relationship of caregiver self-efficacy to caregiver outcomes: a correlation and mediation analysis

Objectives Caregivers of individuals with Alzheimer’s disease and related dementias experience significant burden and adverse outcomes. Enhancing caregiver self-efficacy has the potential to mitigate these negative impacts, yet little is known about its relationship with other aspects of caregiving. This study examined the relationship between self-efficacy and outcomes; identified factors associated with self-efficacy; examined the mediating role of self-efficacy; and analyzed whether there were racial/ethnic differences. Methods Data from caregivers (N = 243) were collected from the Caring for the Caregiver Network study. Participants’ level of self-efficacy, depression, burden, and positive aspects of caregiving was assessed using validated measures. Results Two self-efficacy subscales predicted caregiver depression, burden, and positive aspects of caregiving. Being White, a spouse, or having a larger social network predicted lower self-efficacy for obtaining respite. Higher income and lower preparedness predicted lower self-efficacy for controlling upsetting thoughts and responding to disruptive behaviors. Self-efficacy for controlling upsetting thoughts mediated the relationship between preparedness and depression along with the relationship between preparedness and burden. Race/ethnicity did not improve model fit. Conclusion Self-efficacy plays an important role in caregiver outcomes. These findings indicate that strategies to improve caregiver self-efficacy should be an integral component of caregiver interventions.

Informal Caregivers' Attitude Toward Dementia: The Impact of Dementia Knowledge, Confidence in Dementia Care, and the Behavioral and Psychological Symptoms of the Person with Dementia. A Cross-Sectional Study.

Background:Dementia is rapidly increasing worldwide due to demographic aging. More than two-thirds of patients are cared by family members. The quality of care depends on the caregivers’ attitude toward dementia influencing patient care decisions.Objective:The aim of this study is to examine the factors that influence the caregivers’ attitude and whether there is an association between participation in a psycho-educational program and attitude.Methods:We performed a cross-sectional study using a structured closed-ended questionnaire to retrieve socio-demographic information from caregivers and the persons with dementia (N = 86). The study included validated scales such as the Dementia Attitude Scale, the Dementia Knowledge Assessment Tool 2, the Positive Aspects of Caregiving, the Zarit Burden Interview, the Confidence in Dementia Scale, and Spielberger’s State-Trait Anxiety Inventory, as well as a neuropsychological battery to assess the condition of people with dementia.Results:Our final model explains 55.6% of the total variance and shows a significant correlation of five factors with attitude toward dementia: confidence, behavioral and psychological symptoms of dementia, anxiety as a trait, positive aspects of caregiving, and dementia knowledge. The caregivers who participated in a psycho-educational program showed a significantly more positive attitude toward dementia, better dementia knowledge, higher confidence in dementia care, and lower anxiety as a state.Conclusion:The strong correlation of attitude and knowledge, as well as confidence in dementia care, supports the tripartite model of attitude, which hypothesizes the interrelation of affect, cognition, and behavior.

A Home-Based Dyadic Music-with-Movement Intervention for People with Dementia and Caregivers: A Hybrid Type 2 Cluster-Randomized Effectiveness-Implementation Design.

BackgroundIntegrating evidence-based music-with-movement into routine practices for people with dementia requires effective implementation strategies. The objectives of this study were to evaluate the clinical efficacy of the intervention and to examine the effectiveness of the implementation strategies in promoting home-based adoption.MethodsThis was a cluster randomized controlled trial adopting a clinical effectiveness-implementation hybrid design. The 12-week music-with-movement intervention aims to promote the well-being of people with dementia and their caregivers. Clinical outcomes were assessed to evaluate the efficacy of the intervention. These included the symptoms of anxiety and depression of people with dementia; caregivers’ perception of their stress and the positive aspects of caregiving; and the quality of the dyadic relationship. Caregivers, staff, and volunteers were interviewed and objective figures on reach and adoption were collected to reflect the outcomes of the implementation.ResultsCompared to the waitlist control, there was a significant reduction in the anxiety and the symptoms of depression of those in the intervention group. There was also a significant reduction in the perceived stress level of the caregivers. Six focus group interviews were conducted. The intervention and the appropriateness of the implementation strategies were perceived positively by the dyad participants, the staff of the centres, and volunteers. Of the collaborating centres, 57% continued to use the intervention and, after six months, served six times more people than were recruited in this study. Over half of the participating families continued to use the intervention for at least six more months.ConclusionMusic-with-movement interventions showed promise for improving the well-being of people with dementia and their caregivers. Effective strategies facilitated the implementation process, such as integrating communication technology to provide instant support and involving volunteers in engaging the collaborating centres and families. This study sheds light on perceptions of the intervention, and on its scalability for a broader population.Trial RegistrationNCT03575026, Registered 2 July 2018.

Two sides of the same coin? Revisiting the relationship between burden and positive aspects of caregiving in dementia.

Studies have shown that items on the Zarit Burden Interview (ZBI) purported to measure self-criticism do not correlate well with the other items. Examination of item content suggests they may be measuring mixed sentiments-both positive and negative-about caregiving. This study examined whether self-criticism is related to positive aspects of caregiving (PAC) in a way that is different from caregiver strain, and if so, which types of PAC. The baseline data of two Alzheimer caregiver intervention studies were merged (N=225). Based on previous factor analysis, 2 ZBI items formed the self-criticism measure while 16 ZBI items measured global strain. PAC was assessed by coding caregivers' narratives about positive gains into seven themes (relationship gains, growth, insights, competence/mastery, purpose, emotional rewards, and miscellaneous). Global strain was mildly associated with fewer total PAC, in a way consistent with the literature, and with less competence/mastery. However, self-criticism was associated with stronger relationship gains and purpose. Younger caregivers reported more relationship gains but less emotional rewards. Longer caregiving duration was associated with more growth, but the reverse was true for chronic illnesses. Additionally, relationship closeness was associated with more emotional rewards, whereas care-recipient neuropsychiatric symptoms and functional impairment were associated with fewer relationship gains and emotional rewards respectively. Thinking one is not doing enough may indicate feelings of inadequacy/guilt but may also signal devotion to the relative and a sense of purpose in the caregiving role. Analyzing total burden and PAC scores may obscure the relationships between their components.

Caregiving burden and positive aspects of caregiving among family caregivers of people living with schizophrenia: Two sides of the same coin

BackgroundCaring for a family member with schizophrenia is associated with a significant burden, but may also bring about positive transformation among caregivers, which were rarely studied simultaneously. AimsThe current study aims to investigate the association between caregiver burden and positive aspects of caregiving (PAC), as well as explore and compare the correlates of each. MethodsA cross-sectional study was conducted on a representative urban sample of schizophrenia family caregivers in China (N = 406). Participants were interviewed individually to complete questionnaires regarding socio-demographics, caregiver burden, PAC, and psychosocial factors that included social support, coping, and family functioning. ResultsThe caregivers reported moderate levels of both caregiver burden (mean:43.05 ± 18.26, range: 0–88) and PAC (mean: 25.88 ± 9.59, range: 0–36), which were not significantly associated with each other (r = −0.06, p = 0.25) and had different correlates. Parent caregivers, middle and high school education, additional dependents, lower level of social support, and frequent endorsement of active and passive coping were all associated with more caregiver burden. Higher levels of social support, active coping, and family functioning were associated with higher PAC. ConclusionsCaring for a family member with schizophrenia can be both burdensome and rewarding. Caregiver burden and PAC coexist yet are unrelated with different correlates. Future research and intervention programs should not only focus on mitigating caregiver burden but also enhancing PAC, which may be realized through the improvement of social support, active coping, and family functioning while paying special attention to various socio-demographics.

Positive experiences in dementia care-giving: findings from the IDEAL programme

AbstractThere is a growing evidence base that identifying positive experiences in providing care can have a beneficial influence on carer wellbeing. However, there is a need to better understand what carers identify as the positive aspects of care-giving. The aim of this study is to explore the satisfying aspects of providing care to people with dementia. This study utilised Time 1 data from 1,277 carers of people in the mild-to-moderate stages of dementia taking part in the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort study. Responses from 900 carers who answered the open-ended question ‘What is your greatest satisfaction in caring for your relative/friend?’ were analysed using thematic analysis. From the responses, 839 carers detailed satisfactions. Eight themes were identified, pertaining to three groups of beneficiaries: carers, people with dementia and the dyad. Perceived benefits for carers included identifying aspects of personal growth, seeing glimpses of the person, feeling they were making a difference and doing their duty. For the person with dementia, these included retaining independence, receiving good quality care and being happy. Dyadic benefits concerned the continuation of the relationship between carer and person with dementia. The findings highlight the need to take a dyadic approach when conceptualising positive experiences in providing care. Further research is needed to understand the role these positive experiences play and to develop interventions. Professionals working with carers should identify and validate these experiences.

Multi-family therapy for eating disorders across the lifespan: A systematic review and meta-analysis.

Eating disorders (EDs) have an estimated prevalence rate of 1%-5% across Europe. Effective adjunct interventions are needed to support the 20%-40% of families whose recovery requires additional support to first line approaches. This systematic review and meta-analysis aimed to establish whether multi-family therapy (MFT) improves the physical and psychological health of patients and family members. Searches were conducted in PsycINFO, MEDLINE, PubMed, EMBASE, CINAHL, and the Cochrane Library in March 2021. 15 studies (850 patients) met the inclusion criteria. Meta-analysis demonstrated MFT resulted in significant benefits in weight gain, ED symptoms, patients' and parents' depression symptoms, and parents' negative experiences of caregiving. However, significant improvements were only evident when comparisons were drawn before and after the intervention; these dissipated when MFT was compared to another intervention. There was no evidence MFT improves family functioning, positive aspects of caregiving, nor patient and parental anxiety. Intervention completion rates ranged from 86% to 100% indicating a high level of acceptability. Studies varied with regard to intervention length and structure, follow-up period, and outcome measures utilised; most were rated as moderate or weak in methodological quality. More rigorous and large scale randomised controlled trials are needed to fully assess the effectiveness of MFT.

Caregiver burden and its associated factors among family caregivers of persons with dementia in Shanghai, China: a cross-sectional study

ObjectiveTo assess the level of caregiver burden and factors associated with it among family caregivers of persons with dementia (PWD) living in communities of Shanghai, China.DesignCross-sectional study.SettingCommunities in Hongkou District...

The impact of having foreign domestic workers on informal caregivers of persons with dementia \u2013 findings from a multi-method research in Singapore

BackgroundInformal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers’ experiences of engaging FDWs.MethodsA multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. Inductive thematic analysis was conducted.ResultsThe quantitative sub-study confirmed that engaging FDWs did moderate the depressive symptoms of informal dementia caregivers (marginal effect = -3.35, p = 0.0497). However, such support did not affect their caregiving burden, self-efficacy, and perceived positive aspects of caregiving. The qualitative sub-study suggested that engaging FDWs is an ambivalent experience, which entails both support and challenges.ConclusionsThe current study confirmed previous research findings, that engaging FDWs moderated depressive symptoms among caregivers of PWDs, and it could be through their physical support such as in daily caregiving activities. Policy-makers may consider providing more subsidies to caregivers caring for PWDs with mobility issues to hire FDWs. They may also consider providing training to FDWs on dementia caregiving skills and improving the intake of such training as this might be helpful for both FDWs and caregivers during this journey.

Burden and benefit-A mixed methods study of informal Amyotrophic Lateral Sclerosis caregivers in Ireland and the Netherlands.

ObjectivesAmyotrophic Lateral Sclerosis (ALS) is a systemic and terminal disorder of the central nervous system which causes paralysis of limbs, respiratory and bulbar muscles, impacting on physical, communication, cognitive and behavioural functioning. Informal caregivers play a key role in the care of people with ALS. This study aimed to explore experiences of burden along with any beneficial aspects of caregiving in ALS. An understanding of both burden and benefit is important to support the informal caregiver and the person with ALS.Methods/DesignThis exploratory mixed methods study characterizes two groups of informal caregivers in Ireland (n = 76) and the Netherlands (n = 58). In a semi‐structured interview, quantitative data were collected in the form of standardized measures assessing psychological distress, quality of life and burden. Qualitative data were collected from an open ended question, in which caregivers identified positive aspects in their caregiving experience. These data types were purposefully mixed in the analysis and interpretation stages, to provide a greater depth of evidence through diverse research lenses.ResultsThe caregiver cohorts were predominantly female (69%) and spouse/partners (84%) of the person with ALS. Greater levels of self‐assessed burden were found among the caregivers in the Netherlands (p < 0.05), and higher levels of quality of life among the cohort from Ireland (p < 0.05). Themes generated through qualitative analysis identified caregiver satisfaction, ability to meet the patient's needs and the (re) evaluation of meaning and existential aspects of life as positive aspects of caregiving. Existential factors were identified frequently by the caregivers in Ireland, and personal satisfaction and meeting their care recipient's needs by caregivers in the Netherlands. Three percent of all respondents reported there was nothing positive about caregiving.ConclusionsBased on our findings, we suggest that both burden and the presence of positive factors should be evaluated and monitored. The possibility of concurrent positive and challenging experiences should be considered in the design and delivery of supportive interventions for informal caregivers.

Stress, coping, and positive aspects of caregiving among caregivers of children with rare disease

Objective Caregivers of children with rare diseases often consider caregiving to be a rewarding experience, despite high levels of burden. The present study examined associations between caregiver stress and positive aspects of caregiving (PAC); investigated associations between interpersonal coping strategies and PAC; and determined whether coping strategies moderated associations between stressors and PAC. Design Survey data came from a study on caregivers across different caregiving conditions, including caregivers of children diagnosed with inherited metabolic conditions (n = 167), undiagnosed diseases (n = 23), and caregivers of typically-developing children (n = 74). Main outcome measures Positive Aspects of Caregiving (PAC) scale. Results Results from generalized linear models indicated that perceived burden was not associated with PAC. Venting was negatively associated with PAC (b= −0.09, p=.03), whereas emotional support was associated with increased PAC for caregivers of children with undiagnosed conditions (b = 0.15, p=.02). Care needs were associated with greater PAC among caregivers engaged in high levels of emotional support coping (b = 0.10, p=.01) and venting (b = 0.09, p=.03). Conclusion These findings illuminate important differences in PAC based on the caregiving condition, and aspects of the caregiver stress process model that might be universal to caregivers. Results inform stress process theory and highlight the potential of support-based interventions for promoting PAC. Supplemental data for this article is available online at

Longitudinal trajectories of caregiving experiences among primary informal caregivers of patients with metastatic solid cancer (stage IV).

Cancer is a significant cause of mortality worldwide. The diagnosis of advanced cancer affects both patients and their family caregivers. Understanding the course of both negative and positive experiences of caregiving provides a more comprehensive understanding of the caregiving experience. The study aims to identify joint trajectories of burden and esteem among family caregivers of patients with solid metastatic cancer, and to identify caregiver characteristics that predict membership for each delineated trajectory. A prospective longitudinal study of 346 informal family caregivers of patients with solid metastatic cancer were recruited between July 2016 and December 2019. Surveys were conducted every 3months for 2years. We assessed caregiver burden and positive aspects of caregiving using the modified Caregiver Reaction Assessment. We estimated the joint trajectories for these outcomes using group-based multi-trajectory modelling. We identified 4 trajectories describing caregivers with (1) low burden, moderate esteem (38.3%), (2) low burden, high esteem (20.3%), (3) high burden, low esteem (16.4%), (4) high burden, high esteem (24.9%). Compared to the 'low burden, high esteem' trajectory, male and non-spousal caregivers were more likely to experience high burden and esteem while caregivers from low socioeconomic status were more likely to belong to trajectories with a high burden. Recognising caregivers at high risk of belonging to trajectories with high burden or low esteem may enable healthcare professionals to anticipate and provide appropriate support to mitigate the impact of negative outcomes.

Feasibility of an online training and support program for dementia carers: results from a mixed-methods pilot randomized controlled trial

BackgroundiSupport is an online program developed by the World Health Organization to provide education, skills training, and social support to informal carers of persons with dementia. This pilot study examines the feasibility of the protocol for a main effectiveness trial of iSupport-Portugal and explores how the intervention and control arms compare over time on well-being outcomes.MethodsA mixed-methods experimental parallel between-group design with two arms is followed. Participants were recruited nationwide, by referral or advertising, through the National Alzheimer’s Association. Inclusion criteria are being Portuguese adults, providing e-consent, providing unpaid care to someone with dementia for at least 6 months, experiencing relevant scores on burden (≥ 21 on ZBI) or depression or anxiety (≥ 8 on HADS), and using webpages autonomously. Participants were consecutively randomized to receive iSupport-Portugal or an education-only e-book and were not blinded to group assignment. Data were collected online with self-administered instruments, at baseline, 3 and 6 months after. Outcomes comprise caregiver burden, depression, anxiety, QoL, positive aspects of caregiving, and self-efficacy. Generalized estimating equations were used to estimate group, time, and group-by-time effects. Intervention engagement data were extracted from iSupport’s platform. Semi-structured interviews were conducted.ResultsForty-two participants were allocated to the intervention (N = 21) and control (N = 21) arms. Participation (78.1%) and retention rates (73.8%) were fair. More carers in the control arm completed the study (N = 20, 95.2%) than in the intervention arm (N = 11; 52.4%) (χ2 = 9.98, p = .002). Non-completers were younger, spent less time caring, and scored higher on anxiety. Among carers in the intervention arm, the average attendance rate was of 53.7%. At post-test 38.9% of participants still used iSupport; the remainder participants interrupted use within 2 weeks (Mdn). For per-protocol analyses, significant group-by-time interaction effects favouring the intervention were found for anxiety (Wald χ2 = 6.17, p = .046) and for environmental QoL (Wald χ2 = 7.06, p = .029). Those effects were not observed in intention-to-treat analyses adjusted for age. Interviewees from the intervention arm (N = 12) reported positive results of iSupport on knowledge and on experiencing positive feelings. No adverse effects were reported.ConclusionsThis study provides information for a forthcoming full-scale effectiveness trial, as on the acceptability and potential results of iSupport-Portugal. iSupport is suggested as a relevant resource for Portuguese carers.Trial registrationClinicalTrials.gov, NCT04104568. 26/09/2019.

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.

"No One Can Tell Me How Parkinson's Disease Will Unfold": A Mixed Methods Case Study on Palliative Care for People with Parkinson's Disease and Their Family Caregivers.

Background:Palliative care for persons with Parkinson’s disease (PD) is developing. However, little is known about the experiences of patients with PD in the palliative phase and of their family caregivers.Objective:To explore needs of patients with PD in the palliative phase and of their family caregivers.Methods:A mixed methods case study design. Health care professionals included patients for whom the answer on the question “Would you be surprised if this patient died in the next 12 months?” was negative. At baseline, and after six and twelve months, we conducted semi-structured interviews with patients and caregivers. Participants completed questionnaires on quality of life, disease burden, caregiver burden, grief, and positive aspects of caregiving. We analyzed quantitative data using descriptive statistics, while we used thematic analysis for qualitative data.Results:Ten patients and eight family caregivers participated, of whom five patients died during the study period. While the quantitative data reflected a moderate disease burden, the qualitative findings indicated a higher disease burden. Longitudinal results showed small differences and changes in time. Patients reported a diverse range of symptoms, such as fatigue, immobility, cognitive changes, and hallucinations, which had a tremendous impact on their lives. Nevertheless, they rated their overall quality of life as moderate to positive. Family caregivers gradually learned to cope with difficult situations such delirium, fluctuations in functioning and hallucinations. They had great expertise in caring for the person with PD but did not automatically share this with health care professionals. Patients sensed a lack of time to discuss their complex needs with clinicians. Furthermore, palliative care was rarely discussed, and none of these patients had been referred to specialist palliative care services.Conclusion:Patients with PD experienced many difficulties in daily living. Patients seems to adapt to living with PD as they rated their quality of life as moderate to positive. Family caregivers became experts in the care for their loved one, but often learned on their own. An early implementation of the palliative care approach can be beneficial in addressing the needs of patients with PD and their family caregivers.

Factors associated with the well-being of family caregivers of people with dementia.

Improving the health and well-being of family caregivers of people with dementia has become an increasingly important public health and policy issue in China. The aims of this study were to clarify the factors associated with the well-being of family caregivers of people with dementia in China. Data were collected from a sample of 132 family caregivers who volunteered to study and live together with people with dementia who had been treated as outpatients in three hospitals in China. The survey included questions on the family caregivers' characteristics, satisfaction with family support, positive aspects of caregiving, preparedness of caregiving, and characteristics of people with dementia. Multiple linear regression analysis was carried out to identify factors associated with the well-being of family caregivers. The mean age of the family caregivers (68.2% women) was 46.8 ± 14.9 years. The results of multiple linear regression analysis indicated that positive aspects of caregiving (β=0.352, P < 0.001), satisfaction with family support (β=0.219, P < 0.01), activities of daily living of people with dementia (β=0.265, P < 0.05), and household size (β=-0.184, P < 0.05) were related to the well-being of family caregivers. The findings from this study indicated that positive aspects of caregiving, satisfaction with family support, activities of daily living of people with dementia, and household size were significant factors related to the well-being of family caregivers. These findings could be expected to aid healthcare providers in identifying the optimal solution to enhance the well-being of family caregivers in China.

You Pray for Him a Bit More”: Young Adults’ Positive Aspects of Caregiving (PAC) Towards Parental Cancer

Young adult caregivers are growing in number, yet there is a paucity of literature on their role in informal family caregiving. The Positive Aspects of Caregiving (PAC) framework has been developed within Dementia carers to indicate positive outcomes of the caring experience. The current study specifically explored the narratives of four young adult carers’ lived experience of caring towards their parents with cancer, using Interpretative Phenomenological Analysis (IPA) through the lens of PAC. Main themes developed from this study were unfolding the child-parent dyad, character building and affirmation of value systems, time reframed, and sustaining caregiving continuity with subthemes surrounding responsibility, appreciation beyond the role reversal, acceptance and sources of comfort. This small-scaled study contributes towards a new understanding of the young adult population, their perception of caregiving and briefly informs the PAC beyond a dementia population.

An integrative theoretical model to predict positive aspects of caregiving in dementia

Family caregiving for dementia is the crucial informal care resource to buffer the associated disease burden. Whereas substantial research focused on ameliorating the caregiving burden through increasing their coping resources, least attention is placed on how to promotive their positive aspects of caregiving (PAC). This longitudinal exploratory study aimed at testingWhereas the perceived self-efficacy was further enriched in the context of good social sup an integrative theoretical model which attempts to explain the evolvement of PAC from the paradigm of stress and coping and existentialism. From to June 2017 to April 2020, we have recruited a total of 403 dementia caregivers from the a geriatric clinic in Hong Kong (mean age = 56.2, SD = 12.2; child-caregiver: 73.9%). About 61% of them were taking care of PwD of moderate to severe dementia. Validated instruments were used to measure the hypothesized model constructs. By using path analysis, it was found that PAC was evolved from two conditions, including i) perceived self-efficacy developed through active coping strategies for carers with good to moderate social support and ii) meaning-focused coping in the context of high religiosity, better social support and active coping. Data-model fit was evident by RMSEA = 0.023, CFI = 0.994, NFI = 0.968 and AIC = 97.762. The findings suggested that PAC was evolved from the interaction of the stress-coping and meaning-making process. Empowering carers for successful caregiving experience, facilitating them to make meaning in the process, enhancing good dyadic relationship and social support are crucial to cultivate PAC.

Self-efficacy in Thought Control , not Positive Gains, Mediates Effect of Benefit-Finding Intervention for Carers

This study examines the therapeutic mechanism of the benefit-finding therapeutic (BFT) intervention that used cognitive reappraisal and alternative thinking to construct positive aspects of caregiving (PAC), in a cluster-randomized controlled trial for Alzheimer caregivers. 42 caregivers received BFT whereas 87 received psychoeducation as control. Both interventions were held in groups. Depressive symptoms and global burden were outcomes measured at baseline, postintervention, and 4- and 10-month follow-up. Mediators considered included PAC and three self-efficacies—controlling upsetting thoughts (SE-CUT), responding to disruptive behaviors, and obtaining respite. Using mixed-effects regression, we demonstrated that benefit-finding increased caregivers’ PAC and SE-CUT, but that only SE-CUT uniquely predicted depressive symptoms and global burden longitudinally. Path analyses with bootstrapped confidence intervals showed that SE-CUT change from baseline to postintervention mediated intervention effects on depressive symptoms, but not global burden, at both follow-ups. No mediation effects were found for PAC and the other self-efficacies. As a conclusion, The BFT effect on depressive symptoms was partly accounted for by improvement in SE-CUT. The therapeutic mechanism for the effect on burden remained unknown. The study sheds light on the importance of actively promoting positive caregiver functioning.

Family Caregiving Subtypes in the Caregiving Transitions Study: A Latent Class Analysis

Family caregiving requires activities and experiences that have negative and positive features, producing stress but also providing benefits. The Caregiving Transitions Study (CTS) enrolled 283 caregivers from a national epidemiologic study, of which 32 were caregivers prior to enrollment in the parent study, and 251 became caregivers while participating in the parent study. Telephone interviewers were conducted after caregivers provided care for a minimum of 1.6 years (mean=7.7 years). Latent class analysis (LCA) was used to detect unobserved groups of caregivers. Number of problems (i.e., ADL, IADL, communication, emotional, disruptive behavior), average burden per problem, depressive symptoms, perceived stress, purpose in life, positive aspects of caregiving, hours of care, and duration providing care were used as indicators. Classes were subsequently compared on several external variables, including demographics, quality of life, leisure activities, and caregiving strain. The best-fitting model consisted of three classes (4.6% long-term, 27.6% high-distress, and 67.8% moderate-distress). Classes were similar with respect to sex, age, race, and primary caregiving status of the caregiver. Long-term caregivers had much longer caregiving durations and commonly provided care to a child. The high-distress class was noteworthy in terms of greater number of experienced patient problems; greater likelihood of caring for a person with dementia; higher levels of caregiving strain, depressive symptoms, perceived stress, and perceived burden; and lower levels of quality of life, purpose in life, positive aspects of caregiving, and leisure activities. These findings suggest that caregivers can be classified into distinct subtypes, with one subtype characterized as experiencing high distress.