Family caregivers of people with dementia in the context of the sociocultural stress and coping model: An examination of gender differences

A Skill-Based multimodal intervention for dementia caregivers: impact on burden and anxiety

BACKGROUND

Dementia is a global health challenge affecting both patients and their caregivers, with family members often bearing the primary caregiving burden. In Egypt, where research on caregiver mental health is limited, interventions addressing caregiver burden and anxiety is critical.

AIM

To determine the effect of a psychoeducation and skill-based multimodal intervention on caregiver burden and anxiety.

METHODS

A randomized controlled trial (RCT) involving 84 family caregivers. Participants were assigned to either the intervention group (n = 42), which received structured psychoeducation and skill-based training over six biweekly sessions, or the control group (n = 42), which received routine outpatient care. Caregiver burden and anxiety were assessed using the Zarit Burden Interview (ZBI) and the Generalized Anxiety Disorder Scale (GAD-7). Behavioral and psychological symptoms of dementia were evaluated using the Neuropsychiatric Inventory Questionnaire (NPI-Q).

RESULTS

The sample consisted predominantly of women (79% in the intervention group, 69% in the control group), with daughters forming the largest caregiver subgroup (66.6% and 52.4%, respectively). The mean age of caregivers was 39.2 ± 4.2 years. After three months, caregivers in the intervention group exhibited a significant reduction in burden (ZBI median score: 24 vs. 34, p < 0.0001) and anxiety (GAD-7 mean score: 6.15 vs. 9.4, p < 0.0001) compared to the control group, however, NPI-Q scores remained unchanged.

CONCLUSION

A structured psychoeducation and skill-based intervention significantly reduces caregiver burden and anxiety. Implementing such programs in Egypt could improve the well-being of caregivers and individuals with dementia.

Balancing Duty, Stigma, and Caregiving Needs of People With Neurodevelopmental or Neurocognitive Disorders During a Public Health Emergency in South Asia: A Qualitative Study of Carer Experiences

OBJECTIVE

Individuals with neurodevelopmental and/or neurocognitive disorders (NNDs) have complex, long-term care needs. In Bangladesh, India, and Pakistan, informal carers shoulder the responsibility and strain of providing care for people with NNDs. Intense care demand, societal and cultural care expectations, and lack of support infrastructure often lead to psychosocial strain in this inadequately researched community, particularly during crises such as the COVID-19 pandemic. This study explored and identified specific features of the coping styles exhibited by informal carers of people with NNDs from Bangladesh, India, and Pakistan during the COVID-19 pandemic.

MATERIAL AND METHODS

Between June and November 2020, 245 carers in India, Pakistan, and Bangladesh responded to open-ended questions in the CLIC (Coping with Loneliness, Isolation, and COVID-19) survey. A reflexive thematic analysis was conducted to uncover the underlying themes and identify coping strategies and stressors. A frequency analysis was performed to examine the associations between these themes and carer nationality. Significant tests identified coping styles.

RESULTS

We identified three coping styles: religiosity (Pakistan), caregiving as a natural life path (Bangladesh), and self-care (India). The religiosity and natural life path styles reside on the fatalism/acceptance continuum and suggest an insight-oriented therapeutic approach. Self-care is a problem-solving strategy that calls for a behaviorally oriented approach. Family overreliance on the carer was a concern across all three groups.

CONCLUSIONS

The findings underscore the need for accessible support pathways to sustain care standards, ensuring the well-being of carers and care recipients.

Cross-National Analysis of the Associations Between Familism and Self-Efficacy in Family Caregivers of People With Dementia: Effects on Burden and Depression

Objectives: To examine the cross-national associations between familism and self-efficacy dimensions, and levels of burden and depression. Methods: Sociodemographic, familism, self-efficacy, depressive symptoms, and burden variables were measured in 349 dementia family caregivers from the US and Spain. Results: US sample: greater support from family was positively related to self-efficacy for obtaining respite and self-efficacy for controlling upsetting thoughts and behaviors. Both self-efficacy constructs were negatively related to depression. Similar findings were obtained for burden. Spanish sample: higher scores on family as referents were associated with lower scores on self-efficacy for obtaining respite; lower scores on self-efficacy for obtaining respite were associated with higher depressive symptomatology. Discussion: Study findings suggest that a significant interplay exists between the various facets of familism and self-efficacy, leading to differential caregiving outcomes. Unique cultural contexts and values derived from each country may exert distinct influences on how the caregiving role is perceived and appraised.

An integrated model of psychosocial correlates of insomnia severity in family caregivers of people with dementia

OBJECTIVES

Research has shown the relevance of stress and coping factors in explaining caregivers' insomnia symptoms. However, few attempts have been made to empirically test an integrative model for insomnia severity in family caregivers of people with dementia. The aim of this study was to test such a model, in which insomnia severity is proposed to be influenced by predisposing factors, precipitated by stressors, and perpetuated by behaviors to cope with these stressors.

METHODS

311 family caregivers of people with dementia were assessed for variables categorized as predisposing (e.g. female gender), precipitating (e.g. care-recipient's behavioral and psychological symptoms of dementia [BPSD]), and perpetuating factors (e.g. sleep aids). A theoretical model was developed and then statistically tested using structural equation modelling, analyzing the direct and indirect effects of the assessed variables on caregivers' insomnia severity.

RESULTS

Distress, sleep aids, and experiential avoidance showed a direct association with insomnia severity. Female gender, younger age, cognitive fusion, leisure activities, dysfunctional thoughts, frequency and distress caused by care-recipient's BPSD showed indirect associations with insomnia severity. The model explained 22% of the variance of caregivers' insomnia severity.

CONCLUSION

The results provide additional empirical support for the importance of predisposing, precipitating and perpetuating factors associated with caregivers' insomnia severity. The integrative model we propose may also be useful for developing interventions targeting insomnia symptoms in family dementia caregivers.

Profiles of Dementia Caregivers according to Psychosocial and Resource Variables. Importance of Kinship

The present study aims to analyze the existence of different profiles in family caregivers of people with dementia according to psychosocial and resource variables. In addition, it aims to study whether there is a greater representation of each kinship group in each of the profiles and if there are differences in emotional distress among such profiles considering the kinship with the care-recipient. Participants were 288 family dementia caregivers, divided into four kinship groups (wives, husbands, sons and daughters). Psychosocial (familism, dysfunctional thoughts and experiential avoidance), resource (leisure activities and social support) and outcomes (depressive, anxious and guilt symptomatology) variables were collected. A hierarchical cluster analysis using Ward's method, an exploratory factor analysis of two fixed factors and contingency tables were performed. Five clusters were obtained: Low psychosocial vulnerability-High resources, Low psychosocial vulnerability-Low resources, Mixed, High psychosocial vulnerability-High resources, and High psychosocial vulnerability-Low resources. Results suggested that clusters associated with lower distress were the Low psychosocial vulnerability-High resources and the High psychosocial vulnerability-High resources. Clusters associated with higher distress were the Low psychosocial vulnerability-Low resources and Mixed. High levels of dysfunctional thoughts, familism and experiential avoidance do not always have a maladaptive function. This could depend on sociocultural and resource variables such as the kinship with the caregiver or perceived social support. The identification of profiles of family caregivers potentially needing protection and vulnerable to psychological distress could help to increase the effectiveness of interventions aimed at this population.

Blessing or curse: the role of authoritarian filial piety and self-efficacy in caregiver gains among Chinese family caregivers caring for physically impaired older adults

BACKGROUND

This study investigated the effects of authoritarian filial piety (AFP) and caregiver self-efficacy on the caregiving experience of adult children of physically impaired older adults. Socio-cultural stress and coping model was applied to test the influence of AFP on caregiver gains.

METHODS

A total of 601 Chinese adult children caregivers and care-recipient dyads participated in this cross-sectional study in 2021. Four instruments were used to collect data: the 4-item Zarit Burden Interview, Positive Aspects of Caregiving Scale, Caregiver Task Inventory Scale, and Authoritarian Filial Piety Scale. All mediation and moderated mediation effects were estimated using SPSS 26.0.

RESULTS

Caregiver self-efficacy was found to not only mediate but also help family caregivers convert their burden into positive gains. AFP moderates the association between caregiver burden and self-efficacy, as well as between caregiver burden and caregiver gains.

CONCLUSIONS

This study provides valuable insights into filial piety, elucidating AFP's comprehensive impact on cognitive appraisals of caregiving. Culturally sensitive psychoeducational therapy, addressing AFP expectations and boosting caregiver self-efficacy, is recommended to enhance positive caregiving outcomes.

Burden of Care, Depression, and Anxiety Among Family Caregivers of People With Dementia

BACKGROUND

There are many challenges that entail caring for an individual with dementia, affecting not only the individual with the condition but also their caregivers. This can lead to increased burden, frustration, and depression among those taking care of them. A research gap exists concerning the care of people with dementia in Egypt, particularly regarding the mental health of caregivers. Limited studies have been conducted in Egypt, particularly focusing on the mental health of caregivers. This lack highlights the need to understand the prevalence and impact of caregiver burden in this population.

OBJECTIVES

The research aimed to evaluate the burden of dementia, levels of depression, and anxiety among family caregivers of individuals with dementia.

METHODS

A cross-sectional study was conducted at a geriatric unit clinic of a psychiatric hospital in Cairo University, Egypt. Caregiver burden, anxiety, and depression were assessed using questionnaires. These questionnaires included the Zarit Burden Interview (ZBI), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), together with demographic data on the patients and caregivers.

RESULTS

The majority of the 141 participants (73% (n = 103)) were female, mostly daughters, with an average age of 40 years. Approximately 50% (n = 71) of the subjects exhibited mild to moderate burden, whereas 30% (n = 43) showed moderate to severe burden. About 31% (n = 44) of the subjects exhibited symptoms of moderate depression, whereas 9% (n = 13) had symptoms of severe depression. Furthermore, almost 43% (n = 60) of caregivers exhibited a moderate level of anxiety. Furthermore, a significant association was seen between caregiver burden and the presence of anxiety and depression.

CONCLUSION

This study showed a substantial burden in providing care, elevated levels of despair, and anxiety among caregivers of PWD. The findings highlight how important it is to develop targeted therapies and support systems in order to lessen the load on caregivers, advance their mental health, and improve overall care for both caregivers and their patients in Egypt. Policy-makers should prioritize investing in dementia-related support systems and services to empower caregivers and improve the quality of life for both caregivers and their patients.