David E. Biegel

Predictors of burden among lower socioeconomic status caregivers of persons with chronic mental illness

This study uses a stress-coping-support framework to examine the predictors of caregiver burden with a sample of 103 lower social class family caregivers of persons with chronic mental illness. Results of multiple regression analyses show that the greater the frequency of client behavioral symptoms and the lower the amount of perceived support from family members, the higher the level of overall caregiver burden. Examination of the predictors of specific types of burden-family disruption, stigma, strain, and dependency-reveal that different constellations of variables predict different types of burden. The need for mental health agencies to address caregiver and client concerns is addressed. Implications are presented for practice and future research.

Predictors of Depressive Symptomatology Among Lower Social Class Caregivers of Persons With Chronic Mental Illness.

This study examined the predictors of depressive symptomatology among caregivers of persons with chronic mental illness. Data were collected through in-person interviews with family caregivers of 103 adults with chronic mental illness who were served by mental health case management agencies. The results indicated that insufficiency of overall social support was the most powerful predictor of caregiver depressive symptomatology. In addition, caregiver burden had a significant unique contribution to caregiver depressive symptomatology, with higher levels of burden associated with greater levels of caregiver depressive symptomatology. Higher levels of client behavioral problems and insufficient support from family members and mental health professionals related to the caregiving role were associated with higher levels of caregiver depressive symptomatology through their associations with care-giver burden. Caregiver race was not significantly related to caregiver burden or to caregiver depressive symptomatology after controlling for other variables. Over two-fifths of White caregivers and over one-quarter of Black caregivers were at risk for clinical depression. Implications for practice and research are discussed.

Predictors of In-Home and Out-of-Home Service Use by Family Caregivers of Alzheimer's Disease Patients

Few studies have examined whether the use of different types of services is predicted by different characteristics of elderly care recipients and primary kin caregivers. Most research aggregates services into a single category, thereby assuming that different services have the same predictors. This investigation differs from the aggregation approach by comparing four groups of elderly care recipients: in-home service of users, out-of-home service users, users of both in- and out-of-home services, and those who do not use services. Data come from personal interviews with 171 family caregivers of mild to moderate dementia patients who reside in the community. Using the modified Andersen framework and multiple group discriminant analysis, results show that care recipients who do not use services and those using only in-home services have inadequate informal supports, more emotionally strained caregivers, and more functionally impaired care recipients compared with users of out-of-home or both in- and out-of-home services.

The Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence: Implementation support for evidence-based practice.

This invited article describes the establishment and function of the Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence. This center serves as a resource for programs providing care for individuals with co-occurring mental illness and substance abuse problems, through the provision of training and technical assistance and of research related to evidence-based treatment models. The center is a partnership between the School of Applied Social Sciences and the School of Medicine at Case Western Reserve University and is funded by the Ohio Departments of Mental Health and Alcohol & Drug Addiction Services.

Neighborhood networks for humane mental health care

One.- 1 In Search of a Human Scale.- 2 The Need for a Micromodel.- 3 Alienation and Community: People, Policy, and Power.- 4 Cycles and Circles: An Overview of Federal Policies in Mental Health and Human Services.- 5 Achieving Human Scale: A Policy Framework for Building Partnerships.- Two.- 6 Preliminary Assumptions and Principles.- 7 The Model: A Community Mental Health Empowerment Model.- 8 First Stages: Methodology, Organization, and Evaluative Data Prior to Empowerment.- 9 The Model in Action - Baltimore.- 10 The Model in Action-Providence and Milwaukee.- 11 Advantages of a Neighborhood Support Systems Approach.- 12 Issues and Limitations.- 13 A Direction for the Next Decade.- Appendix: Survey Instrument-Community Leader and Helper Survey.- References.

Maladaptive Coping as a Mediator of Family Stress

Family members of women substance users might be at risk for stress-related problems. Family coping responses can affect outcomes for both families and women in treatment. Eighty-two women in treatment for substance use disorders (56 with comorbid psychiatric conditions) and 82 family members were interviewed. Stressors related to womens disorders were significantly related to increased family member burden. Womens behavioral problems predicted greater family member worry, displeasure, and impact. Extent of womens drug or alcohol use predicted greater family member stigma and impact. Family member maladaptive coping partially mediated relationships between family member stressors and family member displeasure and impact. Family member maladaptive coping also functioned as a moderator between the stressors and impact.

Correlates of peer support in a clubhouse setting.

The purpose of this study was to examine the social support characteristics and correlates of peer networks for Clubhouse members. A random sample of 126 members from one Clubhouse was requested to nominate social network members and asked a series of questions about characteristics of supports provided by each network member. Respondents with both peers and non-peers in their network, three fifths of the sample, had more frequent contacts with peers than with non-peers and were more satisfied with peer relationships than with non-peer relationships. Those respondents also reported that peers were less critical than non-peers. Among all respondents, being Caucasian and having better quality of social life were correlated with having a peer network while higher degree of reliance on others and more Clubhouse visits were correlated with having a Clubhouse network. Longitudinal studies are needed to further investigate the relationship between quality and benefits of peer support.

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.

Help seeking and receiving in urban ethnic neighborhoods: strategies for empowerment.

Abstract This paper briefly reviews the literature about friendship as an informal support for older women, an at-risk population whose numbers are increasing. Data from an AOA supported study indicate that older women use their friends differentially depending both on the nature and qualities of the friendship as well as the type of help that is required. Friends are more likely to provide help with social-emotional tasks than instrumental ones. Programs should be designed that maximize interaction among older women and those who could serve as informal supports.

Trends Impacting Public Policy Support for Caregiving Families

Public policy aimed at supporting the caregiving capacity of families has risen to prominence on the public agenda in the United States. Initiatives at the state and federal levels have created some initial services. Three trends that are pushing the issue of family caregiving to the surface are discussed, including large-scale social, demographic, and economic changes. The pressures on women from increased caregiving demands are discussed, along with the taken-for-granted cultural value placed on the home as a locus of care for family members who need assistance with common daily activities. Experiments at the state level with consumer-directed care and capitated wrap-around services are described. The authors argue that support for caregiving families is likely to remain a prominent concern of the public and policy makers for the foreseeable future.