Alma Au

Social support and well-being in dementia family caregivers: The mediating role of self-efficacy

Objectives: The study investigated self-efficacy as a possible mediator of the relationship between the social support and depressive symptoms of primarily informal caregivers, mainly family members, of patients with dementia in Hong Kong. Method: One hundred and thirty-four caregivers were interviewed. Path analyses were conducted using a self-efficacy scale that consists of three subscales assessing three domains of caregiving self-efficacy. Self-efficacy for obtaining respite, responding to disruptive patient behaviours, and controlling upsetting thoughts about caregiving were measured. Results: Results showed that self-efficacy acted as a partial mediator between social support and depressive symptoms of these caregivers. Conclusion: Findings suggest that self-efficacy may function as a mechanism through which social support influences depressive symptoms, and the importance of this self-efficacy mechanism can be domain-specific.

International Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review

This review begins by highlighting the fact that dementia is truly a global problem at this time, with incidence and prevalence rates rising rapidly in most parts of the world and only expected to increase. Along with this comes the growing demand for programs and services targeted to support both the person with dementia and his or her family caregivers. Around the globe such programs are being developed, evaluated, and put into practice, with government funding and needed infrastructures to support them. However, the many pressing needs of family caregivers for services to reduce their burden and improve quality of life for themselves and their relative far outstrip available programs—even in highly developed countries such as the United States, United Kingdom, and Australia. This is even more so the case in less developed countries and regions such as China, India, Africa, and South and Central America. We conducted an extensive search of existing databases and publications related to this topic, and in this article we both review and critique existing programs and service models. There are descriptive sections on evidence-based programs and practices, as well as discussion of promising areas for future research. In addition, we discuss some of the formidable barriers that prevent or delay access to care in even the more developed countries. Finally, we conclude with a set of recommendations that we believe will enhance growth and productivity in this field.

Cognitive-behavioral group treatment program for adults with epilepsy in Hong Kong.

A subjective sense of uncertainty is a common theme in the experience of patients with epilepsy. Lack of control has also been implicated as an etiologic factor in the development of psychosocial problems in epilepsy. Cognitive-behavioral interventions emphasizing the mediating role of thoughts and self-control appear to be particularly relevant for patients with epilepsy because anxiety and depression are the most common problems. Despite its apparent importance, very little systematic research has been published on the effectiveness of psychological treatment of epilepsy. The purpose of the present study was to conduct a seminal outcome evaluation of psychological intervention for adult patients in Hong Kong. Using a waitlist control group, the treatment program focused particularly on cognitive restructuring and seizure control. Results indicated significant gains by the treatment group in overall quality of life and self-efficacy. In particular, marked improvements were noted for emotional well-being, seizure, and stress management. The clinical implications are discussed in the context of developing specific intervention programs and outcome measures specific to the various needs of adult patients with epilepsy.

Cognitive-behavioral group program for Chinese heterosexual HIV-infected men in Hong Kong

Abstract This study explored the effects of cognitive-behavioral program (CBP) using a wait-list control group in 16 Chinese heterosexual HIV-infected men. Participants in the treatment condition underwent a 7-week group based CBP, which addressed various HIV-related issues. Relevant cognitive and behavioral strategies were taught as well. The aim of treatment was to improve the quality of life and to reduce psychological distress in a sample of heterosexual symptomatic HIV-infected men. Prior to intervention, baseline measures showed that our sample had a lower quality of life in comparison with the local general population. They also experienced a significant level of psychological distress. Following intervention, men in the CBP group demonstrated significant improvement in the mental health dimension of quality of life and a significant reduction in depressed mood. These preliminary findings suggested that short-term cognitive-behavioral therapy can be effective in improving the quality of life and mood of Chinese heterosexual HIV-infected men.

Stress and health-related quality of life among HIV-infected persons in Hong Kong.

This study examines the relationships among illness-related factors, stress, health-related quality of life (HRQOL), and psychological distress in persons infected with the human immunodeficiency virus (HIV) living in Hong Kong (N = 55). Participants completed questionnaires including a Symptom Checklist, Modified HIV Stressor Scale (HIVSS), Medical Outcomes Study Short-Form 36 (SF-36), and the Hospital Anxiety and Depression Scale (HADS). In addition, CD4 count information was obtained. Multiple regression analyses were used to model the SF-36 and HADS scores as a function of illness-related factors as well as the stress count and intensity. The number of symptoms was found to be inversely related to SF-36 general health and positively related to the HADS anxiety score. However, CD4 count did not have any significant association with any of the scales on the HRQOL or psychological distress. After controlling for the effect of symptoms, the HIVSS stress count still accounted significantly for additional variance in both HADS anxiety and depression as well as the SF-36 social functioning and role-emotional scores. The study supports the possible contribution of psychosocial factors to the HRQOL and psychological distress after controlling for illness-related factors. Results are discussed in the context of characteristic social factors and services in Hong Kong.

A Preliminary Validation of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) in Hong Kong

The present study attempted a preliminary validation of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) in Hong Kong. In-depth assessment was conducted on 43 identified batterers and 46 control male subjects. Results suggested that the B-SAFER could correctly classify 95% of the cases. Scores relating to the current situation were found to be particularly important in predicting intimate partner violence. The concurrent validity of the B-SAFER was demonstrated by its correlation with the Conflict Tactics Scale scores. Findings were discussed in the context of developing screening tool in the community setting with the guided clinical approach.

Predicting the quality of life in Hong Kong Chinese adults with epilepsy

Epilepsy is both a medical diagnosis and a social label. The traditional care of patients with epilepsy tends to focus on seizure control and drug treatment. There is a growing concern in the West about the importance of the influence of psychosocial factors on the quality of life. The main purpose of the present study is to explore and delineate the relationships between biomedical and psychosocial predictors and the health-related quality-of-life outcomes of Chinese patients in Hong Kong. Independent measures consisted of two types of predictors: biomedical and psychosocial variables. The biomedical variables included seizure frequency and the number of years since diagnosis. The psychosocial variables included locus of control, social support, and mood. The Quality of Life in Epilepsy Scale was used as the outcome measure. Correlation and hierarchical regression techniques were used. Results showed that psychosocial variables did make a significantly independent contribution to the prediction of the quality of life of patients with epilepsy. Furthermore, results suggested that mood could act as a mediator between seizure characteristics and psychosocial factors, on the one hand, and quality of life, on the other. The statistical significance of the health locus of control and the satisfaction with social support confirmed the importance of the influence of the subjective sense of mastery of condition on quality of life. The clinical implication was discussed in the context of developing psychological interventions in increasing the self-efficacy and resourcefulness of the patients.

Subjective memory and mood of Hong Kong Chinese adults with epilepsy

Clinicians are often confronted with the self-report of memory difficulties by patients. This study explored the possible correlates of subjective memory in 67 adult Chinese patients with epilepsy in Hong Kong. These correlates include epilepsy-related factors, mood state, and actual performance on neuropsychological tests. Results suggested that there exists no significant systematic relationship between subjective and illness-related factors such as seizure frequency, age at onset, and medication. Instead, stepwise regression analysis revealed that mood (anxiety) explained about 17% of the variance of subjective memory difficulties, whereas performance on a memory test accounted for only 8% of the variance. Findings are discussed in the light of the need to attend to the anxiety of patients with epilepsy in the process of rehabilitation.

Syndromes of Self-Reported Psychopathology for Ages 18–59 in 29 Societies

This study tested the multi-society generalizability of an eight-syndrome assessment model derived from factor analyses of American adults’ self-ratings of 120 behavioral, emotional, and social problems. The Adult Self-Report (ASR; Achenbach and Rescorla 2003) was completed by 17,152 18–59-year-olds in 29 societies. Confirmatory factor analyses tested the fit of self-ratings in each sample to the eight-syndrome model. The primary model fit index (Root Mean Square Error of Approximation) showed good model fit for all samples, while secondary indices showed acceptable to good fit. Only 5 (0.06%) of the 8,598 estimated parameters were outside the admissible parameter space. Confidence intervals indicated that sampling fluctuations could account for the deviant parameters. Results thus supported the tested model in societies differing widely in social, political, and economic systems, languages, ethnicities, religions, and geographical regions. Although other items, societies, and analytic methods might yield different results, the findings indicate that adults in very diverse societies were willing and able to rate themselves on the same standardized set of 120 problem items. Moreover, their self-ratings fit an eight-syndrome model previously derived from self-ratings by American adults. The support for the statistically derived syndrome model is consistent with previous findings for parent, teacher, and self-ratings of 1½–18-year-olds in many societies. The ASR and its parallel collateral-report instrument, the Adult Behavior Checklist (ABCL), may offer mental health professionals practical tools for the multi-informant assessment of clinical constructs of adult psychopathology that appear to be meaningful across diverse societies.

Effectiveness of online cognitive behavioral therapy on family caregivers of people with dementia

Purpose Family caregivers of persons with dementia (PWD) may receive caregiver training because of logistical constraints and privacy concerns. This study evaluated the effectiveness of an online intervention for family caregivers of PWD in improving their self-efficacy in managing behavioral and psychological symptoms of dementia (BPSD), and their emotion well-being. Subjects and methods A total of 36 family caregivers of people with dementia participated in a 9-week online intervention based on the cognitive behavioral therapy model. Outcomes of the intervention were measured by the Chinese version of the Neuropsychiatric Inventory Questionnaire and two domains of the Revised Scale for Caregiving Self-Efficacy. Wilcoxon signed rank tests were used to compare the change in outcome variables. Results The severity of BPSD of PWD and BPSD-related distress in family caregivers showed a statistically significant reduction after the intervention. Subgroup analysis showed self-efficacy in controlling upsetting thoughts significantly improved in caregivers of PWD at moderate to severe stages. Conclusion Online cognitive behavioral therapy for family caregivers reduced BPSD of PWD and the related distress in their caregivers.