Religion, spirituality and the well-being of informal caregivers: a review, critique, and research prospectus

The Association Between Religious Belief and Postoperative Psychological Status and Quality of Life of Parents of Children with Congenital Heart Disease: A Single Center Experience in Southeast China

This study aimed to investigate the association of religious belief on the postoperative psychological status and quality of life of parents of children with congenital heart disease (CHD). This was a cross-sectional study conducted at a provincial children's hospital in Fujian Province, China. Parents of postoperative children with CHD in the early postoperative period were included in this study between January 2020 and September 2020. The parents were divided into a religious belief group (n = 39) and a nonreligious belief group (n = 42) depending on whether they had religious beliefs. The Religious Coping Questionnaire, WHOQOL-BREF scale, Self-rating depression scale (SDS), and Self-rating anxiety scale (SAS) were used to evaluate psychological status and quality of life. The results showed that the SDS and SAS scores in the religious belief group were significantly lower than those in the nonreligious belief group (P = 0.012 and P = 0.003, respectively). The WHOQOL-BREF scale results showed that the religious belief group's score was significantly higher than those in the nonreligious belief group on the subscale scores of physiology, psychology, social relations, and environment on the WHOQOL-BREF. The total score of quality of life in the religious belief group was significantly higher than that in the nonreligious belief group. Religious belief was associated with lower SDS score (β = - 0.324, P = 0.005) and SAS score (β = - 0.245, P = 0.026), while religious belief was positively correlated with the score of WHOQOL-BREF (β = 0.506, P < 0.001). In this study, we concluded that comparing to those with no religious beliefs, parents with religious belief experienced more positive emotions and higher quality of life when taking care of children in the early postoperative period after congenital heart surgery.

Spirituality moderates the relationship between cancer caregiver burden and depression

OBJECTIVES

Cancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers' burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer.

METHODS

This secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates.

RESULTS

Spirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers' spirituality on the relationship between depression and caregiver burden over time (b = -1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support.

SIGNIFICANCE OF RESULTS

Spirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients' health.

The influence of spirituality on caregiver burden and quality of life in older adult informal caregivers

BACKGROUND

Caregiver burden (CB) reduces quality of life (QOL) and causes poor health outcomes. Spirituality impacts this relationship.

AIMS

To determine prevalence of CB and investigate relationships among CB, spirituality, and QOL in older U.S. adult informal caregivers (n = 754).

METHODS

This was a cross-sectional, descriptive secondary analysis of data from the 2020 Health and Retirement Study using GLM and SEM.

RESULTS

Caregiver mean age was 65.93 (SD=8.37). Caregivers were primarily female (n = 456, 54.0%), White (n = 500, 79.5%), and married (n = 469, 65.3%). Most caregivers had moderate CB (n = 369, 49.8%). Black caregivers who were spiritual (p=.031) and caregivers with a high school diploma/GED who were spiritual (p=.021) had lower CB. Lower CB was correlated with higher QOL (p=< 0.001). SEM depicting an influencing effect of spirituality revealed good model fit (NFI=0.988; IFI=0.993; TLI=0.983; PCFI=0.397, RMSEA=0.043; χ2=9.577, p=.048, DF=4) CONCLUSIONS: Fostering spirituality in older adult caregivers could reduce CB and improve QOL.

Growing in Adversity: A Narrative Study of Resilience Generation in Chinese Families of Children with ASD

Referring to Walsh's theoretical framework of family resilience while taking into account China's own cultural and institutional context, this study discussed the process of resilience generation in Chinese families of children with ASD. A qualitative approach was taken, using narrative research on 10 Chinese families of children with ASD. Category-content analysis of the data suggests that the generation of resilience in Chinese families of children with ASD is influenced by four factors: (A) cultivating positive family beliefs; (B) adjustment of the family's organizational pattern; (C) extending external resources positively; and (D) optimizing family communication. Unlike family resilience generation mechanisms in Western countries that emphasize religious beliefs, intrinsic traits, and resources, the resilience of Chinese families of children with ASD is based on a family value system based on a sense of responsibility and the application of internal and external family resources, which is undoubtedly related to China's long-standing emphasis on collectivist culture. This study has theoretical reference value for the implementation of related social work services.

The Impact of Caregiving Intensity and Religiosity on Spousal Caregivers' Health and Mortality in the US (2004-2014)

OBJECTIVES

Despite adverse physical and mental health outcomes related to caregiving, family caregivers also experience lower mortality rates compared to noncaregivers. However, research has not yet examined the role of caregiving intensity and religiosity with health and mortality among spousal caregivers.

METHODS

Data include spousal caregivers (n=5,214 person-wave observations) and noncaregivers (n=50,311 person-wave observations) from the Health and Retirement Study (2004-2014 waves). Multinomial logistic regression was used to explore how caregiving intensity and religiosity were associated with health and mortality among spousal caregivers, compared health and mortality between caregivers and noncaregiving peers, and examined gender differences in these mechanisms.

RESULTS

Greater religious salience and attending religious services, although dependent on gender and caregiving intensity, are protective for caregivers' health and mortality.

DISCUSSION

Religiosity may buffer adverse effects of caregiving on health and mortality for spousal caregivers. Continuation of prior religiosity may enhance positive aspects of caregiving and decrease caregiver burden.

Religious coping and psychological well-being in Latino Alzheimer's caregivers

OBJECTIVES

Prior research has demonstrated the benefits of religion on caregiver well-being; however, less research exists on the processes underlying this relationship, particularly in Latino Alzheimer's disease (AD) families. This study's aim was therefore to explore the direct and indirect influences of positive religious coping (RC-P) and negative religious coping (RC-N) on caregivers' experiences of depression and anxiety.

METHODS

The data are from the Circulo de Cuidado Study baseline interviews; participant eligibility criteria were that the person identifies as being Latino, providing at least 5 h of care weekly, and their relative has an AD diagnosis and neuropsychiatric symptoms. In person at-home interviews were conducted in Spanish with 67 caregivers. Religious coping was assessed with the Brief RCOPE; depression and anxiety were measured with the Center for Epidemiological Studies Depression Scale-Spanish version and State Anxiety Inventory. Multivariate regression analyses, controlling for caregiving stressors, were used to test our core hypotheses.

RESULTS

As hypothesized, RC-N had significant direct effect on depression (p < 0.001) and anxiety (p < 0.001) as well as partially mediated the relationship between caregiver subjective stressor and depression (p < 0.01) and anxiety (p < 0.01). However, contrary to our hypothesis, RC-P did not have a direct or indirect effects on psychological well-being.

CONCLUSIONS

Our findings are consistent with other studies linking RC-N to poorer caregiver outcomes. Caregivers who questioned God's power, perceived God punishing them, or felt abandoned by God reported greater levels of depression and anxiety. The results suggest that caregivers experiencing religious distress may feel overwhelmed and view a more hopeless future.

Caregiver Characteristics and Outcomes Associated With Level of Care Complexity for Older Adults

Care in the home is increasingly complex, with family caregivers now expected to take on aspects of care previously managed by nurses and other health professionals. In a national sample of caregivers of older adults, we examined predictors and outcomes of level of care (low, medium, high) based on caregiving hours and counts of activities of daily living (ADLs) and instrumental ADLs supported. Characteristics associated with high level of care include Hispanic or "other" race/ethnicity, being unemployed, and specific care recipient conditions (e.g., Alzheimer's disease/dementia, cancer, mobility limitations). High compared to low level of care is also associated with caregiving difficulty and unmet needs. These findings underscore the need for targeted interventions and nursing research to further understand the features and dynamics of care complexity. Such research can inform family-centered interventions, health care system redesign, and health policies to support family caregivers of older adults engaged in complex care. [Research in Gerontological Nursing, 14(3), 117-125.].

Gazing at Medusa: Alzheimer's dementia through the lenses of spirituality and religion

Although religious and spiritual issues regarding Alzheimer’s Dementia (AD) were not thoroughly investigated in the past, this review presents the most recent findings that can provide some scientific evidence about the experience and clinical usage of religious and spiritual beliefs from the perspective of the diagnosed patient, the caregiver-family members, and the health professional. Majority of the papers reviewed (50 out of 51) identified a positive influence of religiousness and spirituality. Thus, this review examines through a detailed analysis the possible pathways of the influence of these perceptions in cognitive, emotional, and behavioral aspects of AD. Findings support the paramount importance of religion and spirituality in coping with the diagnosis of this specific type of dementia. Future experimental research should consider these observed benefits with caution and include them in everyday life.

Family Caregiving in Serious Illness in the United States: Recommendations to Support an Invisible Workforce

Family caregivers provide the vast majority of care for individuals with serious illness living in the community but are not often viewed as full members of the healthcare team. Family caregivers are increasingly expected to acquire a sophisticated understanding of the care recipient's condition and new skills to execute complex medical or nursing tasks, often without adequate preparation and support, and with little choice in taking on the role. This review draws on peer-reviewed literature, government reports, and other publications to summarize the challenges faced by family caregivers of older adults in the context of serious illness and to identify opportunities to better integrate them into the healthcare workforce. We discuss promising approaches such as inclusion of family caregivers in consensus-based practice guidelines; the "no wrong door" function, directing consumers to needed resources, regardless of where initial contact is made; and caregiver-friendly workplace policies allowing flexible arrangements. We present specific recommendations focusing on research, clinical practice, and policy changes that promote family-centered care and improve outcomes for caregivers as well as persons with serious illness. J Am Geriatr Soc 67:S451-S456, 2019.

The Mediating Effect of Coping Strategies on Religious/Spiritual Struggles and Life Satisfaction

A growing number of researchers are testing potential problematic forms of religiousness that denote anxieties regarding sacred matters. However, only a few studies have assessed how religious/spiritual struggle is associated with positive outcomes. Because people’s coping responses to stressors are key determinants of their well-being, we expected that different coping strategies could be potential mediators between religious problems/tensions and life satisfaction. The research was conducted on a group of 744 Roman Catholics. We used the Religious Comfort and Strain Scale, Satisfaction with Life Scale, and Brief Coping Orientation to Problems Experienced (COPE) questionnaire. The outcomes show that religious comfort correlated positively with life satisfaction, while fear/guilt, negative emotions toward God, and negative social interactions surrounding religion correlated negatively with life satisfaction. Our research amplifies the understanding of the religious/spiritual struggles and life satisfaction relationship, mediated by “secular” coping strategies. It confirms that both religious and secular methods of experiencing different strains seem to coexist with multiple other strategies in the context of broadly understood life satisfaction.

A cohort study of quality of life in partners of young breast cancer survivors compared to partners of healthy controls

BACKGROUND

Partners of young breast cancer survivors (BCS) are at increased risk for deficits in quality of life (QoL). To intervene effectively, it is important to understand how the breast cancer experience impacts partners. The purpose of this study was to compare QoL between partners of young BCS and partners of healthy acquaintance controls.

METHODS

Partners of young BCS (3-8 years post treatment and ≤ 45 years old at diagnosis) and partners of age-matched healthy acquaintance controls completed questionnaires on overall, physical (physical function, sexual difficulty), social (personal resources, sexual enjoyment, marital satisfaction, partner social support, social constraints, parenting satisfaction), psychological (depressive symptoms), and spiritual (behaviors, beliefs, and activities) QoL. Analyses included descriptive statistics and one-way ANOVA to compare partner groups on all study variables.

RESULTS

Although partners of young BCS (n = 227) reported fewer social constraints (p < .001), they reported lower overall QoL (p < .001), fewer personal resources (p < .001), more sexual difficulty (p = .019), less sexual enjoyment (p = .002), less marital satisfaction (p = .019), more depressive symptoms (p = .024), and fewer spiritual behaviors (p < .001), beliefs (p = .001) and activities (p = .003) compared to partners of healthy acquaintance controls (n = 170). Additional analysis showed that perceptions that the relationship changed for the better since cancer, social constraints, partner social support, and depression predicted marital satisfaction among partners of young BCS.

CONCLUSIONS

Partners of young BCS are at risk for poorer overall, physical, social, psychological, and spiritual QoL compared to partners of healthy women. Interventions targeting QoL domains may enable partners to effectively support their partner and improve their QoL.

Qualitative Analysis of Faith Community Nurse-Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers

This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.

Variables associated with the life satisfaction of elderly caregivers of chronically ill and dependent elderly relatives

Abstract Objective: to compare the life satisfaction of family caregivers, taking into account their gender, age, time since starting care, health, religion, perceived burden and quality of life, and the level of physical and cognitive dependence of the elderly person receiving care, and to investigate the associations between these variables and low life satisfaction. Methods: a total of 148 caregivers in Indaiatuba and Campinas, in the state of São Paulo, Brazil, selected using the convenience method, were interviewed at home, in private medical clinics and outpatient units, using questionnaires about the sociodemographic characteristics, health conditions, time since starting care, scales of life satisfaction, religiosity, perceived burden and quality of life of the caregiver, and the physical and mental health of the elderly person receiving care. Descriptive, Multivariate and Univariate Logistic Regression analysis were used. Results: caregivers who exhibited low life satisfaction included more frail individuals, with three or more chronic diseases and depression, greater perceived burden and lower self-fulfillment and pleasure, and control and autonomy, scores, which are factors of the Perceived Quality of Life Scale. Elderly caregivers who scored low in self-fulfillment factor and pleasure (OR=101.29; CI=28.68 - 357.73) and who scored high in perceived burden (OR=5.89, CI=2.13 to 16.24) had a greater chance of having low life satisfaction scores. Conclusions: The assessment of caregivers of their satisfaction with life is more influenced by subjective than objective variables, and low satisfaction seems to be strongly associated with poor quality of life, high burden, and caregiver frailty.

Influence of Religion on Later Burden and Health of New Black and White Caregivers

Objective: We assessed the relationship between positive aspects of religiosity and reduced stress in caregivers, and negative aspects of religiosity and increased caregiver burden. Method: Using data from the Biopsychosocial Religion and Health Study, we performed multiple linear regression analysis on 584 caregivers. Results: Mental health, but not physical health, was predicted by caregiver burden. Caregivers who viewed God as loving and not controlling and felt a sense of community with their church family had less burden. Caregivers who engaged in negative religious coping had a greater decline in mental health than those who saw God as loving and not controlling and who gave emotional support to others. Discussion: Some aspects of religion appear to play an important role in alleviating the mental stresses of being a caregiver.

Religion involvement and quality of life in caregivers of patients with schizophrenia in Latin-America

The aim of the study was to explore the relationship between religious involvement (RI) and quality of life (QoL) in caregivers of patients with schizophrenia, while adjusting for key confounding factors such as socio-demographic and clinical characteristics. This study was conducted in the public mental health services in Bolivia, Peru and Chile. The data collected included RI, socio-demographic information, clinical characteristic of the patients and caregiver's QoL using the S-CGQoL questionnaire. A multivariate analysis using multiple linear regressions was performed to determine variables potentially associated with QoL levels. Two hundred and fifty-three patients with their caregivers participated in the study. Caregivers' RI was not significantly associated with overall QoL nor its individual components. The only exception was an unexpected modest inverse association between RI and one QoL dimension (psychological and physical well-being). In contrast, the following caregivers' socio-cultural and economic factors were significantly associated with low QoL level of caregivers: being a mother, identifying with Aymara ethnicity and having lower family income. Among patients, the clinical characteristics of being woman, younger, and having lower age of onset and more severe symptoms was associated with lower QoL. Our study found that socio-cultural, economic and clinical factors were associated with caregivers' QoL.

Using an Emic lens to understand how Latino families cope with dementia behavioral problems

Focus group data collected for a larger project to develop a fotonovela for Latino caregivers was used to conduct a meaning-centered thematic analysis in order to elicit Latino family caregiver perspectives on how behavior problems occurring in the context of dementia are perceived and managed. A sample of 42 Spanish-speaking Latino caregivers were recruited from organizations affiliated with the Alzheimer's Association near San Diego, California. Caregivers were queried on challenging behaviors, coping strategies, as well as other daily challenges. Focus group sessions were conducted in Spanish, translated and transcribed into English, and analyzed using qualitative, grounded anthropological methods. In addition to a range of behavior problems, five indigenous approaches to managing challenging behaviors were identified: acceptance, love, patience, adaptability, and establishing routines of care. Additionally, participants identified persistent challenges which deter effective coping. These include: issues with providers, problems with family members, limited knowledge of resources, emotional distress, and financial strain. To our knowledge, this is one of the few qualitative studies to report indigenous coping strategies for dementia behavioral problems. These findings have the potential to inform culturally-tailored intervention.

Workplace spirituality as a moderator in relation between stress and health: An exploratory empirical assessment

The present study explores the role of workplace spirituality in moderating the relationship between occupational stress and the health of managerial personnel in India. A sample of 150 managers working in different public and private organizations was used to measure workplace spirituality, occupational stress, and health using the Spirituality at Work scale, the Occupational Stress Index and the 28-item General Health Questionnaire, respectively. The findings reveal that workplace spirituality moderates the negative relationship of stress and health. The study also found that stress has a negative impact on health while workplace spirituality positively correlated with health. The findings also support the practical importance of spirituality in the workplace for improving health conditions by providing a healthy atmosphere and meaningful work for employees. This exploratory study encourages future research to understand the role of spirituality in the workplace.

Religious Coping in Caregivers of Family Members With Dementia

The degree of depression experienced by caregivers of individuals with dementia was examined in relation to religious coping strategies, religious practice, and spirituality in the framework of the stress and coping model. Caregivers of 191 persons with dementia completed the Religious Coping Scale, self-report measures of religious practices and spirituality, burden, and depression. There was no evidence that any religious coping strategy or religious practice moderated the relationship between caregiving stress and depression. Certain types of religious coping strategies had a direct effect on depression. Higher levels of religious coping working with God were associated with decreased depression, whereas higher levels of religious coping working through God were associated with increased depression. Higher burden, lower overall caregiver health rating, and worse reactions to memory and behavior problems were associated with higher levels of depression. Frequency of prayer and the importance of spirituality were weakly associated with lower levels of depression.

Resolving to go forward: the experience of Latino/Hispanic family caregivers

Little is known about the experiences and needs of family caregivers of Latino/Hispanic individuals with spinal cord injury (SCI) during the early years of recovery. The purpose of this grounded theory study was to describe the experiences and identify the informational, decisional, interpersonal, and resource support needs of family caregivers of newly injured Latino/Hispanic individuals with SCI during the first 2 years after undergoing rehabilitation. "Resolving to go forward" was the core category that emerged from two simultaneous processes of "learning to care for" and "getting through" during the initial years as the primary informal caregiver. Most caregivers felt alone and abandoned after the injured person returned home, and experienced barriers to services and resources primarily because of language issues and economic status. We recommend that researchers develop and evaluate culturally appropriate, informal caregiving models to improve outcomes for both Latino individuals with SCI and their family caregivers.

Spirituality and self-efficacy in dementia family caregiving: trust in God and in yourself

BACKGROUND

Research indicates that spirituality and self-efficacy have been associated with higher levels of caregivers' well-being. However, these two concepts have rarely been examined simultaneously. The aim of this study was to analyze the combined effect of spirituality and self-efficacy on the caregiving stress process.

METHODS

The study design was cross-sectional. Dementia family caregivers (n = 122) were assessed in relation to the following variables: stressors (time since caregiving began, daily hours caring, frequency of behavioral problems, patient's functional status); appraisal (caregiver's appraisal of behavioral problems), caregiver's personal resources (self-efficacy, spiritual meaning, social support), and outcomes (depression and anxiety).

RESULTS

Participants were divided into four groups corresponding to four profiles defined by their scores on spiritual meaning and self-efficacy: LELS = Low self-efficacy and low spirituality; HELS = High self-efficacy and low spirituality; LEHS = Low self-efficacy and high spirituality; and HEHS = High self-efficacy and high spirituality. No differences were found between groups in stressors, appraisal, or personal resources. Caregivers in the HEHS group had significantly less depression compared to the LEHS group. Regression analysis showed that being a HEHS caregiver, low appraisal of behavioral problems and high social support were associated with low caregiver depression. Only high appraisal of behavioral problems was associated with high levels of anxiety.

CONCLUSION

The results of this study suggest that spirituality and self-efficacy had an additive effect on caregivers' well-being. A high sense of spiritual meaning and a high self-efficacy, in combination, was associated with lower levels of depression in caregivers.

Positive feelings of caregiving among Latino Alzheimer's family caregivers: understanding the role of spirituality

This study used structural equation modeling to examine the effects of spirituality on positive aspects of caregiving (PAC) among a sample of American Latino family members caring for a relative with Alzheimer's disease (AD). Participants consisted of 209 Latino caregivers (CGs) drawn from baseline data from the Resources for Enhancing Alzheimer's Caregivers Health II study. The findings indicate that spirituality is positively related to PAC and may partially mediate the effect of subjective stress on PAC. AD CGs typically provide better care when they perceive the caregiving experience to be satisfying and rewarding. Toward this end, gerontological practitioners should adopt a proactive stance to ensure Latino AD CGs can operationalize their spiritual strengths.

Latino Alzheimer’s Disease Caregivers and Depression

This study used stress coping theory to examine the effects of spirituality and religion on depression among a sample of Latino family members caring for a person with Alzheimer’s disease (AD) in the United States. Participants consisted of 209 Latino caregivers (CGs) drawn from baseline data from the Resource for Enhancing Alzheimer’s Caregivers Health (REACH) II clinical trial. The findings indicate that church attendance moderates the relationship between subjective forms of stress and depression in tandem with exhibiting direct effects on depression. Consistent with the central role religion plays in Latino culture, the results imply that religious involvement may play an important role in mitigating depression through indirect and direct pathways.

Anger, spiritual meaning and support from the religious community in dementia caregiving

This study explores the relationships between spiritual meaning and social support from the religious community and problem behaviors, anger and depression in 128 dementia caregivers. The results suggest a mediating role of anger in the relationship between the appraisal of problem behaviors and depression. Support from the religious community is directly and negatively associated with anger, but the relationship between spiritual meaning and anger is mediated by caregivers' appraisals of problem behaviors, suggesting that spiritual beliefs might help caregivers to find meaning in caregiving experiences and thus appraise care recipients' behavioral problems as less stressful.

Psychological distress and mental health of Thai caregivers

BACKGROUND: As the proportion of elderly people within a population increases there is an accompanying increase in the role of informal caregivers. Many studies on caregivers report negative health outcomes but very few have addressed positive aspects of caregiving. This study examines characteristics of Thai caregivers, the distribution of psychological distress and mental health among caregivers, and the association between caregiver status and psychological distress. METHODS: This report is based on an ongoing national cohort study of 60,569 Thai adults. Caregiving was common in the cohort, and in 2009 6.6% were full-time and 27.5% were part-time caregivers. Outcomes of the study were reported using an international standard Kessler 6 for psychological distress and a national Thai Mental Health Indicator. Determinants included age, sex, marital status, household income, work status and urban-rural residence. Frequency of social contacts was also included as explanatory variable. RESULTS: Among cohort members, 27.5% were part-time caregivers and 6.6% were full-time caregivers. Compared to non-caregivers, full-time caregivers tended to be older, to be married, more likely to be in the lowest household income group, to be unpaid family members, and to reside in rural areas. We noted the seeming contradiction that when compared to non-caregivers, the caregivers reported higher psychological distress but higher positive mental health (i.e., self-esteem and content with life), higher positive mental capacity (i.e., coping with crises), and higher positive mental quality (i.e., helping others). After adjusting for possible covariates, part-time and full-time caregivers were more likely to report high psychological distress (Adjusted Odds Ratios, AOR 1.33 and 1.78 among males and 1.32 and 1.45 among females). Less contact with colleagues was associated with high psychological distress both in males and females (AOR 1.36 and 1.33). Less contact with friends was also associated with high psychological distress, especially among females (AOR 1.27 and 1.42). CONCLUSIONS: This study highlights caregivers in Thailand, the strong possibility of mental health benefits, some risks of associated psychological distress, and the positive role of keeping social contacts. Early identification of vulnerable caregivers is required to target effective health promotion.

Psychological protective factors across the lifespan: implications for psychiatry

Although there are many challenges in operationally defining and measuring positive psychological constructs, there is accumulating evidence that optimism, resilience, positive attitudes toward aging, and spirituality are related to reduced risk for morbidity and mortality in older age. This article reviews the definition, measurement, associations, and putative mechanisms of selected positive psychological constructs on subjective and objective indicators of health with a focus on the latter half of the lifespan.

Cancer survivors' spiritual well-being and use of complementary methods: a report from the American Cancer Society's Studies of Cancer Survivors

We examined associations between spiritual well-being and CAM use among 4,139 cancer survivors. We also explored the classification of religious/spiritual practices (R/S) as CAMs and alternative subscale structures of the Functional Assessment of Chronic Illness Therapy--Spiritual Well-being (FACIT-Sp). We evaluated three aspects of spirituality, Faith, Peace, and Meaning, and use of 19 CAMs in 5 domains. Mind-body methods were subdivided into R/S and non-R/S. All FACIT-Sp factors were associated with CAM use, but in different directions: Meaning and Faith were positively associated; Peace was negatively associated. Peace was negatively associated with R/S CAMs, but not non-R/S CAMs. The prevalence of CAM use dropped from 79.3 to 64.8% when R/S items were excluded. These findings confirm an association between spiritual well-being and CAM use, including some non-R/S CAMs, and provide evidence of the benefits of using the three-factor FACIT-Sp solution and treating R/S CAMs as a separate category.

Religiousness is positively associated with quality of life of ALS caregivers

It has been repeatedly shown that religiousness and spirituality have positive effects on quality of life (QoL) and outcome in ALS patients. here are, however, very few data on the impact of religiousness/spirituality on ALS caregivers. We determined the impact of religiousness on caregivers and its correlation with quality of life, depression and anxiety. A total of 75 consecutive ALS patients and their informal caregivers were interviewed using tests evaluating religiousness, depression, anxiety, quality of life and satisfaction with life. Results showed that there was a significant correlation between patients and caregivers' public and total religiousness. Caregivers' private religiousness was related to their age and education level, while their public religiousness was related only to their education level. Caregivers' quality of life was related to their private religiousness and satisfaction with life with their total religiousness. We conclude that religiousness is positively associated with ALS caregivers' quality of life and satisfaction with life, in a measure similar to that observed in ALS patients. Health care professionals caring for ALS patients should consider that the needs of the caregivers include religious/spiritual concerns.

Individual and dyadic relations between spiritual well-being and quality of life among cancer survivors and their spousal caregivers

OBJECTIVES

There is evidence that cancer generates existential and spiritual concerns for both survivors and caregivers, and that the survivor's spiritual well-being (SWB) is related to his/her own quality of life (QOL). Yet the degree to which the SWB of each member of the couple has an independent association with the partner's QOL is unknown. Thus, this study examined individual and dyadic associations of SWB with the QOL of couples dealing with cancer.

METHODS

A total of 361 married survivor-caregiver dyads participating in the American Cancer Society's Study of Cancer Survivors-I and Quality of Life Survey for Caregivers provided complete data for the study variables. SWB was measured using 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (assessing faith, meaning, and peace) and QOL was measured using Medical Outcomes Study 36-Item Short Form Health Survey.

RESULTS

Actor and Partner Interdependence Model analyses revealed that each person's SWB was the strongest correlate of his or her own mental health (higher SWB, better mental health). Each person's SWB was also positively related to his or her partner's physical health.

CONCLUSIONS

Results suggest that the ability to find meaning and peace may be an important part of overall well-being during the cancer experience for both survivors and caregivers. Interventions designed to assist survivors and caregivers to enhance their ability to find meaning and peace in the cancer experience may help them improve mental health of their own and the physical health of partners when they are dealing with cancer beyond the initial phase of the illness trajectory.

Religious coping and caregiver well-being in Mexican-American families

OBJECTIVE

We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia.

METHODS

Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the US-Mexico border. We assessed caregivers' intrinsic, organizational and non-organizational religiosity with the Duke Religiosity Index, as well as Pargament's brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers' mental and physical health, depressive symptomatology and perceived burden.

RESULTS

Using regression analysis, we controlled for sociocultural factors (e.g. familism, acculturation), other forms of formal and informal support, care recipients' functional status and characteristics of the caregiving dyad. Intrinsic and organizational religiosity was associated with lower perceived burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping (e.g. feelings that the caregiver burden is a punishment) predicted greater depression.

CONCLUSION

Measures of well-being should be evaluated in relation to specific styles of religious and spiritual coping, given our range of findings. Further investigation is warranted regarding how knowledge of the positive and negative associations between religiosity and caregiving may assist healthcare providers in supporting Latino caregivers.

Promoting spiritual health in home healthcare

This article explores how clinicians can promote patient and family caregiver spiritual health. After a review of pertinent theory and research, clinical implications are identified, including appropriate goals for clinicians with regard to spiritual health promotion.

Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study

OBJECTIVE

Providing care to a loved one with dementia and the death of that loved one are generally considered two of the most stressful human experiences. Each puts family caregivers at risk of psychologic morbidity. Although research has suggested that religious beliefs and practices are associated with better mental health, little is known about whether religion is associated with better mental health in family caregivers. Our objective, then, is to explore the relationship between religion and mental health in active and bereaved dementia caregivers.

METHODS

A total of 1,229 caregivers of persons with moderate to severe dementia were recruited from six geographically diverse sites in the United States and followed prospectively for up to 18 months. Three measures of religion: 1) the frequency of attendance at religious services, meetings, and/or activities; 2) the frequency of prayer or meditation; and 3) the importance of religious faith/spirituality were collected. Mental health outcomes were caregiver depression (Center for Epidemiological Studies-Depression [CES-D] scale) and complicated grief (Inventory of Complicated Grief [ICG]).

RESULTS

Religious beliefs and practices were important to the majority of caregivers. After controlling for significant covariates, the three measures of religion were associated with less depressive symptoms in current caregivers. Frequent attendance was also associated with less depression and complicated grief in the bereaved.

CONCLUSIONS

Religious beliefs and practices, and religious attendance in particular, are associated with better mental health in family caregivers of persons with dementia.