Gender,Spousal Caregiving,and Depression: Does Paid Work Matter?

Studies have shown that spousal caregiving leads to psychological distress, but few have analyzed the moderating effect of paid work. Using the 2000 to 2012 Health and Retirement Study and two‐stage least squares regression models, this study found that caregiving increased women's and men's depressive symptoms. Ordinary least squares models showed that caregiving had more adverse effects on women's mental health than on men's, but these differences were eliminated in two‐stage least squares models that accounted for the bidirectional effects of depression and caregiving. The current study also found that for women, part‐time work attenuated the depressive effect of spousal caregiving, whereas for men, part‐time work exacerbated it. These gender differences persisted even for intensive spousal caregivers. The authors suggest that caregiving women who work part‐time may benefit from work‐related resources. Caregiving men who work part‐time, however, may feel distressed, as their work–family experiences conflict with traditional gender norms.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

Sexual and Relationship Satisfaction associated with Shifts in Dyadic Trajectories of Depressive Symptoms in German Couples across Four Years

Depression is a pervasive mental health concern; thus, it is important to identify modifiable factors associated with reducing depressive symptoms across time. Using 1,876 heterosexual couples assessed annually across 4 years from the Panel Analysis of Intimate Relationships and Family Dynamics (Pairfam) study, time‐varying covariate growth models tested if sexual and relationship satisfaction were linked with shifts in trajectories of depressive symptoms across time. For both men and women, higher sexual and relationship satisfaction scores were significantly associated with decreasing their own depressive symptom trajectories, but only relationship satisfaction was linked with their partners’ depressive symptom trajectories. Potential clinical implications include the treatment of depressive symptoms by making changes across time in their own relationship satisfaction and sexual satisfaction.     

Real and assumed sexual minority status: Longitudinal associations with depressive symptoms

Sexual minority status persists in being linked to poorer adolescent mental health. Using a longitudinal sample (N = 845), we examined how youth's own same-gender attraction and their perceptions of peers' beliefs about their same-gender attraction (i.e., assumed attraction) were associated with trajectories of depressive symptoms from grade eight (when students are typically 13–14 years old) to grade 10. Reporting either same-gender attraction, assumed same-gender attraction or both were associated with higher initial levels of depressive symptoms that persisted over time compared to youth with real and assumed other-gender attraction only. These links were partially mediated by experiences of discrimination. Findings suggest the importance of understanding adolescent perceptions of peer beliefs in the association between same-gender attraction and depressive symptoms.     

The Long‐Term Effects of Caregiving on Women's Health and Mortality

Caregivers experience numerous mental and physical health effects from the stress of providing care, but we know little about whether these problems persist in the long term and whether long‐term effects differ across caregiving contexts. Using the National Longitudinal Survey of Mature Women, we examined the relationship between caregiving and long‐term patterns of depressive symptoms, functional limitations, and mortality. We also explored the health effects of caregiving in‐home versus out‐of‐home and by caregiver/care‐recipient relationship. Analyses show that in‐home spousal and parental caregiving predict increased depressive symptoms and functional limitations in the long term but are unassociated with mortality, whereas caregiving outside the home is unassociated with later depression and functional limitations but predicts a lower risk of mortality. This study highlights the usefulness of approaching stressful experiences such as caregiving from the life course perspective, viewing them as processes that unfold over time within specific contexts that may carry delayed or cumulative consequences.     

Longitudinal growth of post-traumatic stress and depressive symptoms following a child maltreatment allegation: An examination of violence exposure,family risk and placement type

Few longitudinal studies have analyzed how traumatic experiences (e.g. home removal, violence exposure) influence both depressive and Post-Traumatic Stress (PTS) symptoms in children involved with Child Protective Services (CPS). This study investigated the change trajectories of both depressive and PTS symptomatology as well as their associations over time, focusing on the effect of complex trauma. Data were obtained from the National Survey of Child and Adolescent Well-Being (1999–2007), a nationally representative study of children and adolescents who were referred to child protective services for alleged maltreatment. The Children's Depression Inventory (CDI) scale measured depressive symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model. The participants' initial levels of depressive and PTS symptomatology were significantly and positively related; furthermore, any changes in these two outcomes were also correlated longitudinally. The initial assessment of PTS symptoms significantly contributed to the advancement of more severe depressive symptoms over time. No significant differences were found between youth who remained in the home and those removed from the home. However, violence exposure, sexual abuse, gender and age were significant predictors of level and rate of change in both PTS and depressive symptoms. PTS growth factors mediated the longitudinal relationship between witnessing severe violence and depressive symptoms. The findings suggest a complex developmental association between depressive and PTS symptomatology among CPS-involved youth that is rooted in early childhood experiences with complex trauma.     

Factors Associated with Depressive Symptoms Among Latino Family Dementia Caregivers

ABSTRACT

Caregiving to a person affected with an irreversible, late onset dementia can be an arduous challenge. Utilizing Pearlin and colleagues' (1990) and Lawton and colleagues' (1989; 1991) stress process model of caregiving, the factors associated with depressive symptoms among Latino¹ family dementia caregivers were examined. Problematic behavior of the dementia-affected person was found to be the most important factor associated with depressive symptoms, followed by poor self-reported health of the caregiver. Human service providers are advised to include depression screening tools at the time of assessment of Latino caregivers and to offer behavioral management interventions and self-care strategies.     

Well-Being and Family Role Strains Among Cuban American and Puerto Rican Mothers of Adults with Mental Retardation

Abstract

This article examines predictors of depressive symptoms and caregiving burden in a sample of Cuban American and Puerto Rican caregivers of an adult child with mental retardation. Using a stress process model of caregiving, the focus of this analysis was on family role strains that result from the caregiving process, which were hypothesized to be particularly strong predictors of maternal well-being in Latino families. Findings indicate that Cuban American mothers of adults with mental retardation had higher socioeconomic status than Puerto Rican mothers, yet there was a substantial amount of within-group heterogeneity in family socio-demographic characteristics, linked closely with immigration patterns for the Cuban American mothers. However, taking into account socio-demographic diversity and ethnicity, findings demonstrate that mothers whose family had more problems had higher levels of burden and depressive symptoms, supporting the hypothesized importance of family functioning to Latina mothers with a non-normative parenting challenge.     

Self-efficacy and social support for psychological well-being of family caregivers of care recipients with dementia with Lewy bodies,Parkinson’s disease dementia,or Alzheimer’s disease

The study identified factors associated with depressive symptoms in family caregivers of persons with dementia with Lewy bodies, Alzheimer’s disease, or Parkinson’s disease dementia. An Internet-based survey generated 606 response sets. Regression analysis indicated that care recipients’ memory and behavioral problems, caregivers’ self-efficacy, grief, and tangible, emotional, and affectionate support were significantly associated with caregivers’ depressive symptoms. Self-efficacy mediated caregiver burden to improve psychological well-being. Social support mediated the association between caregiver grief and psychological well-being. Social workers can provide psychoeducational interventions to help caregivers to manage emotional distress and improve capacity to manage tasks related to the dementia.     

All Shook Up: Sexuality of Mid- to Later Life Married Couples

The authors integrate theoretical work on the performance of gender with a life course perspective to frame an analysis of in-depth interviews with 17 long-term married couples. The findings indicated that couples' sexual experiences are characterized by change over time, yet that change is shaped by the intersection of gender and age. Midlife couples (ages 50 - 69) were distressed by changes in their sex lives likely because they impede couples from performing gendered sexuality. The source of this distress stems from age-related physical changes; however, it manifests in different ways for husbands and wives. In contrast, later life couples (ages 70 - 86) were more likely to emphasize the importance of emotional intimacy over sex as they age. Marital sex is a source of conflict for many midlife couples because of husbands' and wives' incongruent experiences, but later life husbands and wives tend to have more congruent experiences of marital sex.     

Adult Protective Services workers' experiences with serious illness and death

This study examined the emerging issue of experiences with end-of-life issues in adult protection. A national survey of adult protective services (APS) workers (N=508) examined encounters with serious illness, injury, death, and bereavement and how these situations were handled professionally and personally. APS workers often encountered clients and caregivers with life-threatening illnesses, and clients receiving hospice services. About three-quarters had worked on at least one case involving a client's death. Overall, more education and training about serious and terminal illness, death, grief, and bereavement is needed to prepare APS workers to work with clients and their families facing a variety of end-of-life situations.     

Reactive Attachment Disorder: A Biopsychosocial Disturbance of Attachment

The etiology, differential diagnosis, and treatment of Reactive Attachment Disorder (RAD) are discussed utilizing a psychodynamically-informed biopsychosocial approach. Early trauma in childhood attachment experiences alters the structures, neuro-chemicals, and connectivity of the brain. The neurobiological effects of childhood neglect equal and even surpass the impact of abuse and related trauma. This paper discusses structures in the brain involved in early emotional and attachment experiences and how they are affected by pathogenic caregiving, the absence of caregivers, or the disruption of the early caregiving environment. All three types of neglect affect the ability of the Hypothalamic-Pituitary-Adrenal (HPA) axis to regulate the body and brain’s response to stress in a significant and enduring way.     

Marital Conflict Trajectories and Associations With Children's Disruptive Behavior

We seek to identify heterogeneous trajectories of marital conflict during the early childhood period, identify predictors associated with these trajectories, and examine associations between trajectory group membership and children's disruptive behavior. Participants were 469 families examined 4 times when the children were 2 to 54 months of age. Maternal reports of marital conflict, adverse childhood experiences, depressive symptoms, and sociodemographic characteristics were collected, and averaged maternal and paternal reports of child disruptive problems were used. Using growth mixture modeling, 3 trajectories of marital conflict were identified: high increasing (21.8%), high decreasing (7%), and low stable (71.2%). Maternal adverse childhood experiences predicted increased risk of belonging in the high‐increasing group, whereas depressive symptoms predicted increased risk of belonging in the high‐decreasing group. Importantly, children of mothers in the high‐increasing group exhibited higher levels of disruptive behavior at 54 months when compared with children of mothers in the high‐decreasing and low‐stable groups.     

The influence of caregiving stressors, social support, and caregiving appraisal on marital functioning among African American wife caregivers

Using a stress and coping framework, we examined the influence of caregiving stressors, social support, and caregiving appraisal on the marital functioning of 100 African American wife caregivers. Results of separate multivariate analyses revealed received church support, caregiving burden, and caregiving satisfaction significantly predicted wives' marital functioning, when caregivers' background characteristics (age and education), length of caregiving, whether first marriage, and urban versus rural location were controlled. Receiving church support was associated with increased marital functioning. Lower levels of caregiving burden were associated with increased marital functioning. Higher levels of caregiving satisfaction were associated with increased marital functioning. Findings illuminate wives' caregiving and marital experiences, and have implications for family therapy and future research.     

Traumatic Bereavement and Mindfulness: A Preliminary Study of Mental Health Outcomes Using the ATTEND Model

This article presents a quasi-experimental study of a mindfulness-based intervention for traumatically bereaved individuals using a single group with pre-test and post-test design. The intervention consists of the ATTEND model, which is comprised of the following elements practiced by the clinician: attunement, trust, therapeutic touch, egalitarianism, nuance, and death education. The study is based on the charts of 42 clients seeking grief counseling at a mental health agency viewed retrospectively. Participants’ intake scores on the Impact of Event Scale-Revised (IES-R), which measures trauma symptoms, and 25-item Hopkins Symptom Checklist (HSCL-25), which measures depressive and anxious symptoms, were compared to their scores after an average of 14.64 hours of counseling. Paired samples t tests showed a statistically significant decline in trauma symptoms on the IES-R, and in anxious and depressive symptoms on the HSCL-25. These results provide preliminary support for the use of this mindfulness-based approach for difficulties associated with traumatic bereavement, though more extensive research is needed to determine the effectiveness of this approach.     

Caregiving transitions: Developmental and gendered perspectives

Providing care for family members is a life event that both reflects and influences family dynamics. Caregiving careers, or the length of time a person provides care, are characterized by a series of transitions to which they must continuously adapt. Women are more likely than men to assume the caregiver role and this role encompasses gender inequalities associated with work and caregiving expectations. This article presents qualitative data from interviews conducted with caregivers who participated in a community-based supportive services program. The experiences of these women provide insight into how caregivers transition into their role, strategies for supporting new and experienced caregivers, and their concerns for their future. Developmental and gendered perspectives of caregiving were used as a context to analyze their experiences.     

The health effects of caregiving by grandparents in Taiwan: an instrumental variable estimation

Previous research on the health effects of caring for grandchildren has had variable findings, including both positive and negative effects on the health of grandparents. The estimated effects of caregiving may be affected by selection, with the health of grandparent affecting the likelihood of undertaking caregiving. The health effects of caregiving also likely differ according to the cultural motivations for caregiving by grandparents. This paper assesses whether selection into caring for grandchildren affects the estimated effects of caregiving on the health of Taiwanese grandparents. We used four waves (1993?C2003) of the Survey of Health and Living Status of the Elderly in Taiwan to estimate the effect of grandparent caregiving on self-rated health, mobility, and depression. To control for unobserved selection into caregiving, we employed time-varying instrumental variables (the number of grandchildren and marital status of adult children) in addition to person fixed effects. After adjusting for baseline differences, caregivers had better self-rated health, fewer mobility limitations, and fewer depressive symptoms compared to the non-caregivers, which suggest evidence of health improvement for grandparents. Instrumental variable analysis showed that caring for grandchildren was endogenously determined with grandparents?? mobility limitations, and grandparent caregivers benefited from a significant reduction in the number of mobility limitations. Our finding suggests that caring for grandchildren can be beneficial for the health of Taiwanese grandparents and supports our hypothesis that a culturally expected role of caregiving results in role enhancement.     

‘No one believed us: no one came to help’: caregivers' experiences of violence and abuse involving children with fetal alcohol spectrum disorder

Child and adolescent-to-parent violence and abuse (CAPVA) refers to abusive and violent behaviours by children towards their parents or primary caregivers. The abuse and harmful behaviours can include a full range of physical, emotional, verbal, financial, and material actions over prolonged periods of time, from childhood to young adulthood. Parents and caregivers of children with neuro-developmental conditions are vulnerable to CAPVA, and little research has been undertaken exploring the experiences of caregivers of children with fetal alcohol spectrum disorder (FASD). In Aotearoa New Zealand, 56 caregivers were interviewed using semi-structured interviews, and over half identified significant levels and impacts of CAPVA, including dealing with physical violence and frequent emotional abuse. Health and stress issues were present in all caregivers interviewed. Caregivers also identified how systemic ignorance and a lack of understanding from caring professionals led to parent blaming, a sense of shame and isolation. Yet, caregivers also showed resilience and implemented strategies of de-escalation and distraction. More specialised practice is needed in this emerging field of family violence and in how to support families with children who have FASD.     

Patterns of Adolescent Regulatory Responses During Family Conflict and Mental Health Trajectories

Four distinct patterns of adolescents' behavioral, emotional, and physiological responses to family conflict were identified during mother–father–adolescent (M = 13.08 years) interactions. Most youth displayed adaptively regulated patterns comprised of low overt and subjective distress. Under‐controlled adolescents exhibited elevated observable and subjective anger. Over‐controlled adolescents were withdrawn and reported heightened subjective distress. Physiologically reactive adolescents had elevated cortisol coupled with low overt and subjective distress. Regulation patterns were associated with unique mental health trajectories. Under‐controlled adolescents had elevated conduct and peer problems whereas over‐controlled adolescents had higher anxiety and depressive symptoms. Physiologically reactive adolescents had low concurrent, but increasing levels of depressive, anxiety, and peer problem symptoms. Findings underscore the importance of examining organizations of regulatory strategies in contributing to adolescent mental health.     

Greedy Spouse,Needy Parent: The Marital Dynamics of Gay,Lesbian, and Heterosexual Intergenerational Caregivers

It is well established that married heterosexual women do more intergenerational caregiving for aging parents and parents‐in‐law than married heterosexual men do. However, gay men and lesbian women's recent access to marriage presents new questions about the gendered marital dynamics of intergenerational caregiving. We use dyadic data with gay, lesbian, and heterosexual spouses to examine the marital dynamics of intergenerational caregivers. Results show that gay and lesbian spouses provided intensive time and emotional support for an intergenerational caregiver. In contrast, heterosexual women described their intergenerational caregiving as rarely supported and at times even undermined by their spouse. Dyadic data on heterosexual men corroborate women's accounts; heterosexual men rarely reported providing intergenerational caregiving, and thus heterosexual women rarely described providing spousal support. These findings provide new insight into the intermingled roles of “greedy” marriages and “needy” parents, wherein marital negotiations around caregiving vary by gender for gay, lesbian, and heterosexual marital dyads.