Professional support for family caregivers of people with serious and persistent mental illnesses.

1. Professional support for family caregivers of people with serious and persistent mental illnesses is essential to ensuring the well-being of the caregivers and maximizing the functioning of the ill person. 2. Significant percentages of family caregivers had never received critical elements of instrumental and affective support from mental health care professionals. 3. The role of psychiatric nurses encompasses the responsibility to address these deficits, as well as multiple opportunities to do so.     

Caregiver burden, dementia, and elder abuse in South Korea

The purpose of this study is to identify characteristics that would increase the likelihood that a Korean older adult with dementia being cared for by a family caregiver is at risk of being abused. This analysis was based on a sample of 481 primary family caregivers from the data of Comprehensive Study for the Elderly Welfare Policy in Seoul (2003). Multiple regression analysis was used to examine predictors among the demographic characteristics of caregivers and care recipients, the severity of cognitive impairment, functional ability, caregiver burden, and social support for the degree of elder abuse. The degree of elder abuse was significantly associated with caregiver burden, mental impairment, dependency of daily living of care recipient, and use of formal services.     

A mixed methods inquiry of caregivers of U.S. veterans with sustained “invisible” injuries from Iraq/Afghanistan

ABSTRACT

An exploratory study of caregiver burden associated with family caregivers enrolled in the VA Caregiver Support Program who assist veterans with serious invisible injuries sustained post September 11, 2001. A mixed methods analysis was completed with a retroactive chart review of already collected data (172 participants) in addition to a phenomenological query of 16 participants. Results: T-tests resulted in a significantly higher caregiver burden score with caregivers who had children in the home (M = 6.84; SD = 3.21) versus those who did not (M = 5.57; SD = 2.75), t (160) = ?2.36, p = .02. An ANOVA across caregiver role (parent, spouse, significant other and other) and the Zarit Burden Inventory (ZBI) resulted in a significant difference (F [3, 159] = 1.59, p < .01, with spousal caregivers having a significantly higher ZBI score (M = 6.83; SD = 3.10) than parental caregivers (M = 4.46; SD = 2.70). The phenomenological research resulted in 22 major themes (family adjustment, subjective demands, coping techniques, social support, VA/DOD, self-care, intimacy, role strain, financial resources, life course, obligation, rewards, isolation/loss of self, reciprocity, stigma, community resources, spiritual support, tools, hope, uncertainty, guilt, leash syndrome) which supported quantitative findings. Conclusions: Caregivers and their families had a difficult time adjusting post injury. Caregivers relied heavily on their own coping mechanisms to adapt to their new role and did not find social support to be helpful with caregiving. Spousal caregivers and caregivers with children in the home had more difficulty adjusting when compared with parental caregivers.     

Predictors of Burden of Family Caregivers of Women with Substance Use Disorders or Co-Occurring Substance and Mental Disorders

ABSTRACT

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden. Having a dual disorder did not predict family member burden. Implications of findings for treatment are discussed.     

Culture‐ and Immigration‐Related Stress Faced by Chinese American Families with a Patient Having Schizophrenia

The impact of culture and immigration on the experience of Chinese American families with a member having schizophrenia is explored within the frameworks of family systems and stress and coping. This qualitative study was conducted within an intervention study of family psychoeducation using therapists’ session notes from 103 family sessions and 13 relatives’ group sessions from nine patients and 19 relatives. The high stigma attached to mental illness leading to social isolation, and families’ devotion to caregiving exacerbated caregiver burden. Taboo against discussing dating and sexuality and the consideration of arranged marriages caused unique stress. The insecurity as immigrants and shortage of bilingual services were related to greater enmeshment within these families. Implications on research methodology and practice are discussed.     

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.     

PERCEPTIONS OF SOCIAL SUPPORT AVAILABILITY AND COPING BEHAVIORS AMONG GAY MEN WITH HIV

Analyzing face-to-face, semistructured interviews, we discuss how perceptions of social support availability are formed among gay men coping with HIV. Experiences of receiving support increased perceived availability for specific types of support from specific individuals, but receiving support also gave these men a general sense that someone would be available for assistance. Other aspects of social relationships, such as closeness and role expectations, contributed to gay men's perceptions of support availability. The results suggest that when people with common problems cope together, collective knowledge of support availability may emerge from observations of others' support exchanges as well as from discussions of support experiences. Individuals or groups of individuals may actively create and modify their perceptions of support availability when they cope with anticipated problems. Thus, the study provided an opportunity to integrate concepts of coping and social support into the collective action and social constructionist frameworks.     

Rural Arab Families Coping with Caregiving

SUMMARY

This research examines the coping patterns of the rural Arab family in caring for a chronically ill elderly relative. The Arab community in Israel is in transition as a result of modernization with changes occurring in the traditional family structure, family norms and living arrangements. This study was conceptualized within the framework of intergenerational solidarity versus ambivalence and utilized a qualitative approach based on the phenomenological paradigm. Data were collected from 10 family units with a chronically ill homebound elder, by means of in-depth interviews. Four people were selected from each unit including the elder, his/her spouse-the primary caregiver-and two other secondary caregivers, usually sons and daughters-in-law. The data indicate the uniqueness of coping patterns among these caregivers in regard to two main components, which are contradictory to findings in the family caregiving literature: differences in the gender of child caregivers and the family readiness to use assistance from formal support systems.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

Family caregivers of the elderly: quality of life and coping in Estonia

The purpose of the study was to analyse the assessments of elderly people aged 65 and more about family caregiving as a factor influencing their quality of life and coping. The study is based on the project SUFACARE—‘Supporting family carers and care receivers in Estonia and in Finland’—in the framework of which the Institute of Social Work of Tallinn University carried out postal surveys in 2010. The Estonian survey was conducted in Tallinn and Lääne-Viru County. The total number of respondents was 581 (70% female and 30% male), of whom 98 (n=74 female and n=24 male) were family caregivers. Caregiving has not influenced the physical and mental health of caregivers, the reason being that many people who receive care are not of very ill health or suffer from dementia. People mostly take care of their spouses. Based on the Estonian Family Law Act (RT I 2009, 60, 395), adult descendants are required to provide maintenance if their relatives are not able to care for themselves. Caregivers whose health is below average consider caring to be physically demanding. We cannot speak of the social isolation of respondents who have care duties—they communicate actively and do not feel lonely. Women report caregiving to be physically strenuous more often than men. The mental health of male caregivers is better—fewer male respondents claimed to feel unhappy or depressed compared to female respondents.     

Family Therapy for a Korean Son with Schizophrenia

In recent decades the treatment of schizophrenia has focused primarily on pharmacotherapy with an emphasis on respite for family caregivers, support groups, and compliance regimens to sustain and maintain the affected client and family members. The use of family therapy models to intervene effectively with families affected by a diagnosis of schizophrenia is less common in the professional literature. This case study draws on the Mental Research Institute's communication theory and Bowen Family Systems Theory in therapeutic work with a Korean family.     

Caregiving for relatives with Alzheimer's disease: feelings of Chinese-Canadian women

Chinese-Canadian female caregivers were asked about their feelings of providing care for relatives with Alzheimer's disease. Using an adapted version of the conceptual model of Alzheimer's caregivers' stress by Pearlin et al. [Gerontologist 30 (1990) 583] to guide data collection, 12 in-depth interviews were conducted in Cantonese. Qualitative analysis was inductive and done manually. Despite anticipating and accepting their caregiving role as a cultural obligation, they, like most caregivers, felt overwhelmed, anxious, and fearful of the future. Against their stated cultural and personal values, all caregivers had made applications to nursing homes, and six were ready to institutionalize their relatives when a place became available. While coping mechanisms and social support appeared to mediate their stress, participants' concerns about the influence of western culture on traditional values and in particular, intergenerational issues regarding caregiving provided an added burden. Findings are particularly relevant given the rapid growth of the Chinese population in North America.     

Military Caregivers

Military caregivers provide essential services for their veteran or military service members who have serious injuries or illness. Of the estimated 39.8 million Americans who provide care for an adult, 1.1 million care for a post 9/11 veteran or service member. Caregivers may experience greater physical or mental health concerns including stress, depression and/or chronic illness, and have greater financial burden than their non-caregiving counterparts. Policy shifts such as the Caregivers and Veterans Omnibus Health Services Act of 2010 (2018) have created and expanded programs to support caregivers. Practitioners working with injured or ill military service members or veterans and their families should include a comprehensive biopsychosocial assessment of the whole family, utilizing several interventions, such as support groups, peer support, psychoeducational programs, training, individual and family counseling, and/or respite care services, to improve family function and reduce caregiver burden.     

Social Support and the Mental Health of Family Caregivers: Sons and Daughters Caring for Aging Parents in Japan

The prevalence of depressive symptoms among family caregivers has been documented as a serious social problem that could threaten the lives of the elderly and their family caregivers. Social support is considered to be a promising remedy for this problem, although a comprehensive examination of the availability and effectiveness of social support that includes both formal and informal support across multiple dimensions remains limited. In addition, little research has been conducted in Japan on gender differences in stress processes. This study tried to fill those gaps by analyzing recent survey data on sons and daughters who are caring for their elderly parents. The results indicate that sons and daughters have similar levels of formal and informal support for daily care and advice, while there are some gender differences in regard to the availability of other types of social support. It was also found that many types of informal support were significantly associated with a lower caregiver burden for daughters, although this was not necessarily the case for formal support. General instrumental support from formal sources was even associated with higher levels of distress. For sons acting as caregivers, daily caregiving support was the only formal support that was significantly associated with their lower level of distress. Issues of formal support are discussed, in order to reduce the psychological burdens borne by sons and daughters who care for their parents at home.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Compounding the trauma: the coercive treatment of voice hearers

For more than a hundred years, voice hearing has been treated as a symptom of serious mental illnesses with biological origins. Pharmaceutical companies have expanded the range of products targeted at treating these illnesses and the diagnosis of schizophrenia now underpins a multi-billion dollar, world-wide business. Throughout the western world, nation states have vested an authority in psychiatry to compulsorily treat people who meet a set of diagnostic criteria that is widely discredited. There is considerable evidence that more effective ways of responding to people experiencing psychosis can be provided without coercion. These approaches differ in essence to traditional Kraepelinian psychiatry in that they acknowledge the role of people's life experiences in creating the problems they face, and the professionals work in partnership with the service users. The approaches recognise that people have histories which often include considerable trauma and social workers are in an ideal position to work with voice hearers to help them understand their experiences and to develop ways of coping. The authority vested in psychiatry is not static and within Europe mental health professionals can contribute to changing what is meant by ‘unsound mind’ and extending the right of liberty to voice hearers. In doing this, social workers can ensure that they do not compound the trauma by devaluing and discrediting people's experience.     

Career‐Related Parent Support and Career Barriers: An Investigation of Contextual Variables

The authors used social cognitive career theory (Lent, Brown, & Hackett, 1994 ) as the basis for examining the person and contextual variables of gender, ethnicity, educational and career barriers, and career‐related parent support for incoming 1st‐year African American, Asian, Latino, and White college students. Women, as compared to men, perceived significantly higher levels of career barriers but similar levels of coping efficacy in dealing with these barriers. Women also reported receiving more career‐related emotional support from parents than did men. For all participants, career‐related parent support accounted for a significant portion of the variance for perceptions of educational and career barriers and coping efficacy with educational and career barriers.     

Mental Health of Lesbian,Gay, and Bisexual Youth and Young Adults: Differential Effects of Age,Gender, Religiosity,and Sexual Orientation

Drawing on minority stress theory, this study examined the mental health effects of the added burden of disadvantaged social status in an Israeli sample of 461 self‐identified lesbian, gay, and bisexual (LGB) youths. Bisexuality was associated with lower levels of well‐being, and, at a younger age, with higher levels of mental distress. In bisexuals, this relationship was fully mediated by family support and acceptance, internalized homophobia, and LGB social contact. Religiosity was associated with low levels of family and friends’ support and acceptance, and high levels of internalized homophobia. These findings highlight the mental vulnerability of LGB adolescents and bisexuals, as well as the social vulnerability of sexual minorities in the religious sector, and the importance of social support to increase mental health.     

Interviewing techniques for the Asian-American population

The cultures of racial and ethnic minorities influence many aspects of mental illness, including communication styles, symptoms, coping strategies, family and community support, and willingness to seek treatment. This article presents the effects of Asian American/Pacific Islanders' beliefs and behaviors related to mental health. Strategies to enhance the process and outcomes of the psychiatric interview with members of this populatior are addressed.