Caregiver Psychological Well-being Research Articles

Psychological well-being over time among informal caregivers caring for persons with dementia living at home

ABSTRACTObjectives: To investigate informal caregivers’ psychological well-being and predicted increase in psychological well-being, when caring for persons with dementia (PwDs) living at home, related to caregiver, PwD and formal care (FC) factors.Method: A cohort study at baseline and 3 months’ follow-up in eight European countries. Caregivers included (n = 1223) were caring for PwDs aged ≥ 65 years at home. Data on caregivers, PwDs and FC were collected using standardized instruments. Regression analysis of factors associated with caregiver psychological well-being at baseline and 3 months later was performed.Results: Factors associated with caregiver psychological well-being at baseline were positive experience of caregiving, low caregiver burden, high quality of life (QoL) for caregivers, male gender of PwD, high QoL of PwD, few neuropsychiatric symptoms and depressive symptoms for the PwD. At follow-up, caregivers with increased psychological well-being experienced of quality of care (QoC) higher and were more often using dementia specific service. Predicting factors for caregivers’ increased psychological well-being were less caregiver burden, positive experience of caregiving, less supervision of the PwD and higher caregiver QoL, if PwD were male, had higher QoL and less neuropsychiatric symptoms. Furthermore, higher QoC predicted increased caregivers’ psychological well-being.Conclusion: Informal caregiving for PwDs living at home is a complex task. Our study shows that caregivers’ psychological well-being was associated with, among other things, less caregiver burden and higher QoL. Professionals should be aware of PwD neuropsychiatric symptoms that might affect caregivers’ psychological well-being, and provide proper care and treatment for caregivers and PwDs.

Caregiver Burden, Spirituality, and Psychological Well-Being of Parents Having Children with Thalassemia.

The research determined the relationship of caregiving burden, spirituality and psychological well-being of parents of Pakistani thalassemic patients in a crosssectional research design. The sociodemographic form, Montgomery-Borgatta burden measure (Montgomery et al. in Who should care for the elderly? An east-west value divide. World Scientific, River Edge, pp 27-54, 2000), Multidimensional Measure of Islamic Spirituality (Dasti and Sitwat in J Muslim Ment Health 8(2):47-67, 2014. doi: 10.3998/jmmh.10381607.0008.204 ) and Ryff Scale of Psychological Well-being (Ryff in J Pers Soc Psychol 57(6):1069-1081, 1989. doi: 10.1037/0022-3514.57.6.1069 ) were administered on a sample of 80 parents (32 fathers and 48 mothers) recruited from different Thalassemic Centers of Lahore city, Pakistan. Data were analyzed through correlation and mediational analyses. Results indicated that the caregiver burden was negatively correlated with the psychological well-being and the domains of spirituality, while the psychological well-being and spirituality were positively correlated. We identified that the caregiver burden has direct effect on the psychological well-being of the parents and it influences the psychological well-being through the pathway of the two domains of spirituality, i.e., self-discipline and meanness-generosity. These results highlighted the role of spirituality upon the psychological well-being of caregivers, which could be utilized to prevent pathological influences (such as hard feelings, hopelessness, depressed mood, anxiety, and relationship problems) of caregiver burden and enhance psychological well-being through spiritual counseling. Caregivers can work on their well-being and burden by disciplining their lives and forgoing hard feelings toward others.

Implications of stroke for caregiver outcomes: findings from the ASPIRE-S study.

Informal caregivers are vital to the long-term care and rehabilitation of stroke survivors worldwide. However, caregiving has been associated with negative psychological outcomes such as anxiety and depression, which leads to concerns about caregiver as well as stroke survivor well-being. Furthermore, caregivers may not receive the support and service provision they require from the hospitals and community. This study examines caregiver psychological well-being and satisfaction with service provision in the context of stroke. Caregiver data were collected as part of the ASPIRE-S study, a prospective study of secondary prevention and rehabilitation which assessed stroke patients and their carers at six-months post stroke. Carer assessment included measurement of demographics, satisfaction with care (UK Healthcare Commission National Patient Survey of Stroke Care), psychological distress (Hospital Anxiety and Depression Scale), and vulnerability (Vulnerable Elders Scale). Logistic regression analyses and chi-squared tests were performed using stata version 12. Analyses from 162 carers showed substantial levels of dissatisfaction (37·9%) with community and hospital services, as well as notable levels of anxiety (31·3%) and depressive symptoms (18·8%) among caregivers. Caregiver anxiety was predicted by stroke survivor anxiety (OR = 3·47, 95% CI 1·35-8·93), depression (OR = 5·17, 95% CI 1·83-14·58), and stroke survivor cognitive impairment (OR 2·35, 95% CI 1·00-5·31). Caregiver depression was predicted by stroke survivor anxiety (OR = 4·41, 95% CI 1·53-12·72) and stroke survivor depression (OR = 6·91, 95% CI 2·26-21·17). Findings indicate that caregiver and stroke survivor well-being are interdependent. Thus, early interventions, including increased training and support programs that include caregivers, are likely to reduce the risk of negative emotional outcomes.

Social, Psychological and Financial Burden on Caregivers of Children with Chronic Illness: A Cross-sectional Study.

To explore social, psychological and financial burden on caregivers of chronically diseased children. Participants were recruited from ambulatory and hospital areas in pediatrics department following informed consent. Parents who were caregivers of children 18 y or below in age with chronic illness were included. Socio-demographic details were collected using a semi structured questionnaire, adapted from Family Burden Interview Schedule (FBIS). The psychological well-being of caregivers was assessed using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7). Descriptive analysis and ANOVA was done for comparing mean scores of responses to analyze financial, psychological and social burden across different diagnosis. A total of 204 (89 females:115 males) participated. Only 27% were receiving some benefits from government or hospital side. No depressive symptoms were reported by 25% caregivers, while 37% reported mild and 38% moderate to severe depressive symptoms. No anxiety symptoms were reported by 33%, while 50% reported mild and 17% moderate to severe anxiety symptoms. No association was seen between gender of the caregiver and depressive or anxiety symptoms. Significantly higher financial and social burden was seen in cerebral palsy and cancer groups vis-a-vis other diseases, being least in thalassemia. Disruption of routine life was highest in cancer group caregivers followed by those in cerebral palsy group. Most caregivers reported moderate depressive symptoms and mild to moderate anxiety symptoms. Cerebral palsy caused more social and financial burden on family vis-a-vis thalassemia. Social and financial burden on families of remaining diseases was comparable.

The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study.

To describe the associations between positive and negative reactions of informal caregivers of people with dementia and health outcomes across eight European Countries. Caring for someone with dementia may have implications for the caregiver's own health and for the care recipient. These consequences could be associated with caregivers' reactions to the process of care. Association study based on cross-sectional data. Participants were people with dementia and their informal caregivers living at home or in long-term care institutions. Data were collected between November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems, disrupted schedule and health problems) and associations were sought with informal caregiver burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric symptoms, comorbidity and dependency in activities of daily living using correlation coefficients. Data from 2014 participants were used. Variability across countries was noted, as well as differences between care at home and in long-term care institutions. In general, self-esteem and lack of family support correlated with caregiver burden and psychological well-being. Associations were also found between disrupted schedule and caregiver burden, psychological well-being and quality of life. Health problems were clearly associated with caregiver burden, psychological well-being and quality of life. Study results support links between the reactions of informal caregivers of people with dementia and health outcomes. These may have implications in terms of how services are addressed.

Caregiver strain, age, and psychological well-being of older spousal caregivers in Hong Kong

Summary With the social policy movement, smaller family size, longer lifespan, confined living conditions, and limited caregiving resources, informal caregiving for older adults in Hong Kong has become the main responsibility of the spouse. Their psychological well-being becomes a major concern as they may experience immense strain from undertaking the caregiving role while suffering from age-related declines. To examine whether psychological well-being differs by caregiver strain and age, 112 spousal caregivers aged 55 and over were recruited from 13 caregiver resource centres in Hong Kong. Participants responded to a structured questionnaire on multiple dimensions of psychological well-being. Findings Of the respondents, 22.9% reported high levels of strain and 9.9% reported high levels of depression. Results from t-tests revealed that caregivers who perceive low levels of strain are more likely to report lower caregiving distress, higher general mental health, lower depressive symptoms, higher subjective well-being, higher life satisfaction, and higher purpose in life. Old-old caregivers are more likely to report lower caregiving distress, lower depressive symptoms, and higher subjective well-being than young-old caregivers. Applications Findings are discussed in relation to the transactional model of stress and coping, selective optimization with compensation theory, and socio-cultural context in Hong Kong. It is suggested that culturally sensitive intervention programs should be custom-tailored for older spousal caregivers by honouring their contributions, affirming their strengths, enhancing their SOC strategies, and educating on successful ageing.

Informal caregiving of hospice patients.

Informal caregivers play a critical role in the provision of care to hospice patients. The care they provide often impacts their physical and psychological well-being. This study synthesized 58 articles pertaining to informal hospice caregiving, focusing on caregivers' satisfaction with hospice services, the physical and psychological well-being of caregivers, the predictors of caregivers' well-being, the direct impact of hospice services on caregivers, and the effectiveness of targeted interventions for hospice caregivers. A systematic literature review of journal articles published between 1985 and 2012 was conducted. The studies reviewed found hospice caregivers to experience clinically significant levels of anxiety, depression, and stress; however, results for caregiver burden and quality of life were mixed. Caregivers' perceptions regarding the meaningfulness of care as well as their levels of social support were associated with enhanced psychological outcomes. Beyond satisfaction with hospice services, the direct impact of standard hospice care on caregivers remains uncertain. Caregiver intervention studies have demonstrated promising outcomes signifying a need for additional investigations into hospice-specific interventions that improve caregiver outcomes. Additional research and resources are needed to assist hospice caregivers, with the ultimate goal of minimizing their psychiatric and physical morbidity and enhancing their caregiving and subsequent bereavement processes.

Predictors of psychological distress in caregivers of older persons with wet age-related macular degeneration

Objectives: Several studies have investigated the biopsychosocial impacts of age-related macular degeneration (AMD) in regards to the older patient, little is known about the impacts associated with caring for individuals with AMD. We aimed to determine the predictors of subjective caregiver distress and other negative outcomes associated with caring for someone with advanced AMD.Methods: Cross-sectional, self-complete survey involving 500 caregivers of persons with advanced AMD. Respondents were identified from the Macular Disease Foundation of Australia client database. Logistic regression tested the independent effects of care recipient and caregiver characteristics on study outcomes, including: caregiver psychological well-being, participation in recreational/social activities and retirement plans.Results: Around one third of caregivers self-reported a high level of care recipient dependence. Over one in two caregivers reported a negative state of mind. Comorbid chronic illnesses in the care recipient were associated with the caregiver reporting psychological distress, multivariable-adjusted odds ratio, OR, 1.45 (95% confidence intervals, CI, 1.14–1.86). If the care recipient was highly dependent on the caregiver, there was 99% greater likelihood of caregiver distress, OR 1.99 (95% CI 1.01–3.93). Comorbid chronic conditions in the care recipient was associated with 49% and 31% higher odds of the caregiver reporting disruption to other areas of their life and retirement plans related to the caregiving experience, respectively.Conclusions: A high prevalence of caregiver distress related to caring for persons with advanced AMD was observed. Level of dependence on the caregiver and presence of comorbid chronic illnesses were independent predictors of the caregiver experiencing psychological distress.

Perceived Stigma in Caregivers of Persons with Dementia and its Impact on Depressive Symptoms

Objective: To examine the relationship between perceived stigma and depressive symptoms among caregivers of persons with dementia (PwD). Methods: A descriptive longitudinal study of 51 caregivers of persons with dementia and 47 PwD, recruited from memory disorders and diagnostic centers and the VA Healthcare system. Modified Labeling Theory served as the organizing framework. Data were collected at baseline, 6, 12 and 18 months to assess changes in perceived stigma and depressive symptoms over the early-mid disease stages as part of a multisite study. Caregivers provided information on ethnic background, geographic location (rural/urban), knowledge of dementia, perceived stigma, depressive symptoms, and the PwD’s behavioral symptoms and their reactions to the behaviors. PwD were assessed on their mental ability and disease stage. Inclusion criteria for PwD included a physician-confirmed dementia diagnosis within the last 12-18 months, a Mini Mental State Examination score >15 (to target early-mid disease stage participants), and residence in the community or assisted living facility. Caregivers were non-paid primary caregivers who had ≥ 3 contacts weekly with the PwD, and were ≥21 years old. A linear mixed model analysis was used to determine the relationship between variables, and to examine missing data. Results: Caregivers’ perceptions of stigma were significantly associated with depressive symptoms both at baseline (r=0.36, p=0.017) and over 18 months (p=0.004). Results also indicated that caregivers of PwD felt more depressed when they perceived more stigma (p=0.016), despite differences in ethnicity/race, geographic location as well as different levels of cognitive impairment of the person with dementia, and caregiver reactions in response to PwD memory and behavior problems. We also found that perceived stigma minimally mediated the effect between caregivers’ reaction toward PwD’s memory and behavior problems and depressive symptoms (13.7% decrease in the coefficient). Conclusions: Caregivers of persons with dementia felt more depressed when they perceived more stigma after adjusting for other covariates in the model. Perceived stigma minimally mediated the effect between caregivers’ reactions toward the PwD’s memory and behavior symptoms and depressive symptoms. Results underscore the effects of stigma in relation to caregiver depressive symptoms. Effective interventions to combat caregiver perceived stigma are needed to enhance caregiver psychological well-being and to increase positive responses to PwD behaviors.

PERSEPSI AKAN TEKANAN TERHADAP KESEJAHTERAAN PSIKOLOGIS PADA PASANGAN SUAMI-ISTRI DENGAN STROKE

Abstract
 This study was conducted to determine the effect of perceptions of caregiver strain and psychological well-being of wives or husbands as providers of care for his partner who had a stroke. Field studies in this research lasted from April to June 2013. This study using quantitative methods with ex post facto research design and using accidental sampling techniques. Participants in this study amounted to 37 wives or husbands of stroke patients who have taken role as spouse caregiver for at least 3 months. The participants were found at the clubs stroke and stroke rehabilitation center in Jakarta. The data was collected using a measuring instrument that has been adapted into Indonesian. The Modified Caregiver Strain Index is consisting of 13 items and Ryff's Psychological Well-being Scale consisting of 54 items. Based on the results of the data, obtained value of F = 0.085, p = 0.772> 0:05 (not significant) and the value effect (Adjusted R Square) 2.6%. So that it can be concluded that there is no significant effect of Perception Towards Caregiver strain on psychological well-being by by wives or husbands who became spouse caregiver for their partner who had suffered from stroke.
 Keywords: Caregiver strain, Spouse caregiver, Stroke patients, Psychological well-being.

Social support, coping strategies and health‐related quality of life among primary caregivers of stroke survivors in China

To examine the relationships of social support and coping strategies to health-related quality of life among primary caregivers of stroke survivors in China. Caring for a stroke survivor is highly stressful, which can negatively affect a caregiver's physical and psychological well-being. Stroke caregivers generally report more somatic symptoms, depressive symptoms, sleep disorders and social isolation. They generally have poorer quality of life than the general population. A cross-sectional, descriptive, correlational study. A quasi-random, point of reference sample of 121 survivor-caregiver dyads was recruited from three community health centres and six health service stations in a city in central China. Data were collected in face-to-face interviews at participants' homes using structured questionnaires. Higher educational levels, planning and active coping were positively associated with health-related quality of life. The number of chronic conditions, hours of care per day and functional dependence of the survivor were negatively related to quality of life. Active coping strategies predicted better health-related quality of life. Findings suggest that intervention programmes should be developed to enhance caregivers of stroke survivors' coping skills and improve social support for these caregivers in China. Community healthcare providers may need to help caregivers strengthen strategies that are effective (planning, active coping, seeking instrumental and emotional support) and change those that are not helpful (venting, denial and self-blame).

Magnitude and Causes of Bias Among Family Caregivers Rating Alzheimer Disease Patients

Objective Family caregivers generally underestimate the health and well-being of Alzheimer disease (AD) patients when compared to patients’ self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias. Methods One hundred five patients with AD, along with their family caregivers, were assessed twice by trained interviewers 1-year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver–patient discrepancies. Results Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver–patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy. Conclusions Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers’ ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver’s own well-being is compromised. Family caregivers generally underestimate the health and well-being of Alzheimer disease (AD) patients when compared to patients’ self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias. One hundred five patients with AD, along with their family caregivers, were assessed twice by trained interviewers 1-year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver–patient discrepancies. Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver–patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy. Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers’ ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver’s own well-being is compromised.

Effects on caregiver burden of education related to home care in patients undergoing hemodialysis

Caring for a patient undergoing hemodialysis is highly stressful and can negatively affect a caregiver's physical and psychological well-being. This study was conducted to examine the effect of educational support concerning caregiver burden and given to the caregivers of hemodialysis patients. This experimental study was performed with 122 caregivers. Patients' data were collected by means of Personal Information Form and Zarit Caregiver Burden Scale (ZCBS). Characteristics of caregivers of hemodialysis patients were analyzed descriptively in terms of frequencies and percentages for categorical data, means, and standard deviations. Mann-Whitney U test, Kruskall-Wallis test, and percentages were used in the data analysis. The mean ZCBS score was 52.1 ± 8.6 (range, 0-88). Among the caregivers, the mean score of the ZCBS was significantly higher in women, single, young, family relatives as "daughter/sister/brother/daughter-in-law and town/district, high educational level (P < 0.05). Moreover, the mean score of the ZCBS was significantly higher in caregivers who have health problems/diseases. In addition, this study explored the educational needs of home-based such as nutrition (35.2%), dialysis (27.8%), fistula care (20.4%), catheter care (18.8%), the information about chronic kidney disease (18.0%), blood pressure (17.2%), weight control (17.2%), hygiene (3.1%), and travel/exercise (6.5%). The post-educational mean scores (55.0 ± 7.6) of caregiver burden were observed to be lower than the pre-educational scores (43.9 ± 5.2), and the difference was found to be statistically significant. The home-based educational program demonstrated a decrease in the burden of hemodialysis caregivers.

Caregivers’ relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers’ physical health and psychological well-being

Closer relationships between caregivers and care recipients with dementia are associated with positive outcomes for care recipients, but it is unclear if closeness is a risk or protective factor for the health and psychological well-being of caregivers. We examined 234 care dyads from the population-based Cache County Dementia Progression Study. Caregivers included spouses (49%) and adult offspring (51%). Care recipients mostly had dementia of the Alzheimer's type (62%). Linear mixed models tested associations between relationship closeness at baseline or changes in closeness prior to versus after dementia onset, with baseline levels and changes over time in caregiver affect (Affect Balance Scale, ABS), depression (Beck Depression Inventory, BDI), and mental and physical health (components of the Short-Form Health Survey, SF-12). After controlling for demographic characteristics of the caregiver, number of caregiver health conditions, and characteristics of the care recipient (type of dementia, functional ability, and behavioral disturbances), we found that higher baseline closeness predicted higher baseline SF-12 mental health scores (better mental health) and lower depression. Higher baseline closeness also predicted greater worsening over time in ABS and SF-12 mental health. In addition, caregivers who reported a loss of closeness in their relationship with the care recipient from pre- to post-dementia displayed improved scores on ABS and SF-12 mental health, but worse SF-12 physical health over the course of the study. These results suggest that closeness and loss of closeness in the care dyad may be associated with both positive and adverse outcomes for caregivers, both cross-sectionally and over time.

A benefit-finding intervention for family caregivers of persons with Alzheimer disease: study protocol of a randomized controlled trial

BackgroundCaregivers of relatives with Alzheimer’s disease are highly stressed and at risk for physical and psychiatric conditions. Interventions are usually focused on providing caregivers with knowledge of dementia, skills, and/or support, to help them cope with the stress. This model, though true to a certain extent, ignores how caregiver stress is construed in the first place. Besides burden, caregivers also report rewards, uplifts, and gains, such as a sense of purpose and personal growth. Finding benefits through positive reappraisal may offset the effect of caregiving on caregiver outcomes.DesignTwo randomized controlled trials are planned. They are essentially the same except that Trial 1 is a cluster trial (that is, randomization based on groups of participants) whereas in Trial 2, randomization is based on individuals. Participants are randomized into three groups - benefit finding, psychoeducation, and simplified psychoeducation. Participants in each group receive a total of approximately 12 hours of training either in group or individually at home. Booster sessions are provided at around 14 months after the initial treatment. The primary outcomes are caregiver stress (subjective burden, role overload, and cortisol), perceived benefits, subjective health, psychological well-being, and depression. The secondary outcomes are caregiver coping, and behavioral problems and functional impairment of the care-recipient. Outcome measures are obtained at baseline, post-treatment (2 months), and 6, 12, 18 and 30 months.DiscussionThe emphasis on benefits, rather than losses and difficulties, provides a new dimension to the way interventions for caregivers can be conceptualized and delivered. By focusing on the positive, caregivers may be empowered to sustain caregiving efforts in the long term despite the day-to-day challenges. The two parallel trials will provide an assessment of whether the effectiveness of the intervention depends on the mode of delivery.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org/en/) identifier number ChiCTR-TRC-10000881.

Efficacy of Hypnosis-Based Treatment in Amyotrophic Lateral Sclerosis: A Pilot Study

Background: Amyotrophic lateral sclerosis (ALS) and its devastating neurodegenerative consequences have an inevitably psychological impact on patients and their caregivers: however, although it would be strongly needed, there is a lack of research on the efficacy of psychological intervention. Our aim was to investigate the effect of hypnosis-based intervention on psychological and perceived physical wellbeing in patients and the indirect effect on caregivers. Methods: We recruited eight ALS volunteers patients as a pilot sample for an hypnosis intervention and self-hypnosis training protocol lasting 1 month. Anxiety and depression level was measured in patients and caregivers at pre and post treatment phase. Quality of life and perceived physical symptoms changes were also investigated in patients. Results: One month pre-post treatment improvement in depression, anxiety, and quality of life was clearly clinically observed and confirmed by psychometric analyses on questionnaire data. Moreover, decreases in physical symptoms such as pain, sleep disorders, emotional lability, and fasciculations were reported by our patients. Improvements in caregiver psychological wellbeing, likely as a consequence of patients psychological and perceived physical symptomatology improvement, were also observed. Conclusion: To the best of our knowledge, even if at a preliminary level, this is the first report on efficacy psychological intervention protocol on ALS patients. The findings provide initial support for using hypnosis and self-hypnosis training to manage some ALS physical consequences and mainly to cope its dramatic psychological implications for patients and, indirectly, for their caregivers.

The time perspective of the Alzheimer caregiver

Purpose of the study: Caring for a spouse diagnosed with Alzheimer’s disease holds potentially severe negative consequences for the physical and psychological well-being of the caregiver. As it is known that the maintenance of a flexible time perspective holds benefits for individual health, the main purpose of this study was to identify and describe the changes in the time perspective of persons caring for a spouse diagnosed with Alzheimer’s disease. Design and Methods: The SELE instrument was administered in order to shed light on the time perspective of a total of 40 participants. A criterion group design was used, and a mixed methods approach adopted during the collection and analysis of data. Results: The results of this research project highlighted the existence of a number of important differences regarding the time perspective of caregivers and non-caregivers. The time perspective of caregivers was severely affected by the caregiving situation and the accompanying grieving process. This proved to be one potential avenue through which the caregiving situation has its negative effect on caregivers’ well-being. Implications: Owing to the usually insufficient funding for the care of demented patients, research regarding the identification of potential cost-effective methods to enhance the resilience of caregivers is of the essence. Maintenance of a balanced time perspective might prove to be to the benefit of caregiver psychological well-being.

Psychological impact and the burden of caregiving for persons with spinal cord injury (SCI) living in the community in Fiji

STUDYDESIGN: This study was designed as a cross-sectional one. A set of structured questionnaires was administered. The purpose of the study was to explore the psychological response of the caregivers of people with spinal cord injury (SCI) and to assess the burden of caregiving for SCI persons living in the community in Fiji. Fiji, South Pacific. A total of 30 primary caregivers of persons with SCI. The Index of Psychological Well-Being (IPWB) was used to assess the psychological impact of care giving, and Caregiver Burden Inventory (CBI) was used to evaluate the burden associated with caregiving for persons with SCI. Barthel Index (BI) scale was used to measure the functional abilities of the care recipients. The majority of the participants (n=20) were women, who had an ethnic Fijian background (n=18) and were married (n=18), and were spouses (n=13). Mean BI of the persons with SCI was 7.1 (s.d.=5.23) on a 0-20 scale, with 90% (n=27) suffering from moderate-to-very severe disability (BI<15). The mean duration of caregiving was 6.1 years (s.d.=4.23). On average, the caregivers provided 6.1 h (s.d.=2.19) of caregiving per day. The experiences of caregiving adversely affected the caregiver psychological well-being. Participants demonstrated high levels of time-dependent and development burden. Caregiving was significantly related to the number of hours spent providing care (r (s)=0.35, P<0.05), and the older caregiver age (r (s)=0.46, P<0.01). Being a primary caregiver of a SCI person contributes to caregiver burden and psychological distress. The findings indicate that the contributions of these people should be recognized and interventions should be tailored not only toward the needs of the care recipients but also to the needs of the caregivers.

Spirituality and psychological well‐being: Testing a theory of family interdependence among family caregivers and their elders

The family spirituality-psychological well-being model was developed and tested to explore how spirituality influences psychological well-being among elders and caregivers in the context of Korean family caregiving. The sample consisted of 157 Korean elder-family caregiver dyads in Seoul, Korea. The intraclass correlation coefficient and the actor-partner interdependence statistical model were used to analyze the data. There were significant correlations between elders' and caregivers' spirituality and between elders' and caregivers' psychological well-being. Elders' and caregivers' spirituality significantly influenced their own psychological well-being. The caregiver's spirituality significantly influenced the elder's psychological well-being, but the elder's spirituality did not significantly influence the caregiver's psychological well-being. Findings suggest that elders' and caregivers' spirituality should be assessed within the family to provide holistic nursing interventions.

Toward a Better Understanding of Psychological Well‐Being in Dementia Caregivers: The Link Between Marital Communication and Depression

Dementia research has frequently documented high rates of caregiver depression and distress in spouses providing care for a partner suffering from dementia. However, the role of marital communication in understanding caregiver distress has not been examined sufficiently. Studies with healthy couples demonstrated an association between marital communication and the partners' psychological well-being, depressiveness, respectively (e.g., Heene, Buysee, & Van Oost, 2005). The current study investigates the relationship between caregiver depression and communication in 37 couples in which the wives care for their partners with dementia. Nonsequential and sequential analyses revealed significant correlations between caregiver depression and marital communication quality. Caregivers whose husbands used more positive communication reported less depression and distress. Additionally, caregiver depression was negatively correlated with rates of positive reciprocal communication indicating dependence between the couples' interaction patterns. This study is one of the first to illustrate the relevance of spousal communication in understanding caregiver distress and depression.