Lynda L. LaMontagne

Burden experienced by caregivers of relatives with dementia in Taiwan

BACKGROUND The burden produced by caring for relatives with dementia is an increasing problem in the United States and Taiwan, necessitating a better understanding of the interrelationships of the factors that influence burden. OBJECTIVES To test a theoretical model specifying how the demands of care, filial obligation, caregiving self-efficacy, coping strategies, and caregiving involvement affect caregiver burden. METHOD A descriptive cross-sectional design with a convenience sample (n = 150) from outpatient clinics of three hospitals in Taiwan was used. The Caregiver Burden Inventory and the Cost of Care Index assessed caregiver burden. The antecedents of burden were assessed by the Physical Self-Maintenance Scale, Instrumental Activities of Daily Living, the Mini-Mental State Examination, the Revised Memory and Behavior Problem Checklist, the Montgomery obligation subscale, Cicirellis obligation scale, the Caregiving Self-efficacy Scale, the Caregiving Involvement Scale, and the Ways of Coping Questionnaire. RESULTS The original model did not fit the data well but minor respecifications produced a good model as evidenced by a chi2/df ratio of 2.1, a goodness-of-fit index of .89, and a comparative fit index of .93. Demands of care on the caregiver and filial obligation had direct positive effects on caregiving involvement. Caregiving involvement and emotion-focused coping had direct positive effects on caregiving burden. Filial obligation, caregiving self-efficacy, and problem-focused coping had direct negative effects on caregiving burden. Six of the seven original hypothesized structural relationships were confirmed in the final model. CONCLUSIONS The Burden Model tested in this study corroborates findings from other burden studies and extends our knowledge of caregiver burden. Filial obligation, self-efficacy, demands of care, involvement in care, and coping were shown to predict burden in this sample of Taiwanese caregivers. Future study is needed to evaluate interventions designed for family caregivers of persons with dementia. Especially needed is research in the area of counseling and mental health services to assist caregivers in dealing with manifestations of burden.

Coping and depressive symptoms in adults living with heart failure.

Background and Research Objective: This study used process coping theory as the basis for investigating how coping strategies are associated with depressive symptoms in individuals living with heart failure (HF). Demographic factors also were examined as correlates of depressive symptoms. Subjects and Methods: The convenience sample of adults living with HF (n = 75) who participated in this study ranged in age from 27 to 82 years (M = 55). Sixty-nine percent of the participants were men, 59% were married or partnered, with the majority being Caucasian and from the middle class. Subjects were recruited from a comprehensive HF program located within an academic health science center in the southeastern United States. A single wave of data collection occurred. All study questionnaires were verbally administered in a clinic room selected for privacy during a routine HF clinic visit. Results and Conclusion: Individuals who used more planful problem-solving and social support seeking coping strategies had fewer depressive symptoms, whereas individuals who used more escape-avoidance coping (eg, wishful thinking) had more depressive symptoms. When demographic factors also were included in a regression analysis assessing depressive symptoms, marital status, functional impairment, and the coping strategies of planful problem-solving and escape-avoidance were all statistically significant predictors of depression. Single individuals, those who used more escape-avoidance, less planful problem-solving coping, and more functional impairment had more depressive symptoms. These results suggest that psychosocial factors, in addition to physical parameters, and the ways individuals cope with the stressors of living with heart failure may be important predictors of depressive symptoms.

Cognitive-behavioral intervention effects on adolescents' anxiety and pain following spinal fusion surgery.

BackgroundCognitive-behavioral interventions, typically effective in reducing anxiety and pain, have not been applied to adolescents undergoing major orthopaedic surgery. ObjectivesTo determine the effectiveness of three cognitive-behavioral interventions for reducing adolescents’ postoperative anxiety and pain following spinal fusion surgery for scoliosis, and whether effectiveness depended on preoperative anxiety and age. MethodsA randomized controlled trial with four groups receiving a videotape intervention (information only, coping only, information plus coping, or control) used a convenience sample of 109 adolescents (88 female, 93 White), 11–18 years of age (M = 14). Speilberger’s (1983) State Anxiety scale assessed anxiety preoperatively and postoperatively on Day 2. A visual analogue scale assessed pain postoperatively on Days 2 and 4. ResultsInformation plus coping was most effective for reducing postoperative anxiety in adolescents with high preoperative anxiety. Coping instruction led to less postoperative anxiety and pain for adolescents ages 13 and younger. The control group reported the highest levels of pain on Day 4. ConclusionsCognitive-behavioral interventions designed to prepare adolescents for surgery should be tailored to individual factors and developmental needs, especially the adolescents’ preoperative anxiety level and age.

Children's locus of control beliefs as predictors of preoperative coping behavior.

This study examined the relationship between childrens locus of control beliefs (as measured by the Nowicki-Strickland Locus of Control Scale) and their preoperative coping behavior. Subjects were 51 children between the ages of 8 and 12 who were scheduled for minor elective surgery. They were interviewed and each childs mode of coping was classified along a dimension termed avoidant-active. The relationships between sex, socioeconomic status, other demographic variables, and the type of preoperative information given to the child by the parent and surgeon were also evaluated. Results showed that children rated as active copers had more internal locus of control scores than children rated as avoidant or as using a combination of avoidant-active coping modes. Children rated as active were given more detailed information about their medical problem and surgery than children rated as using avoidant or a combination of avoidant-active coping modes. Internal locus of control was significantly related to higher socioeconomic status but not to sex or other demographic variables. Regression analysis showed that parent-doctor information and locus of control were independently predictive of coping.

Children's Preoperative Coping and Its Effects on Postoperative Anxiety and Return to Normal Activity

A model was tested to assess childrens preoperative coping with major orthopedic surgery and how coping is related to two different postoperative outcomes, anxiety and return to normal activities. Ninety children, ages 8 to 17, participated. Data were collected the day before surgery, the second postoperative day, and at 3-, 6-, and 9-month recovery periods. A respecified model was not significantly different from the data (p = .90), indicating a good fit. Children who were older, more anxious, and more internal in locus of control exhibited more vigilant coping. Avoidant coping was associated with less anxiety 2 days postoperatively, and vigilant coping was associated with return to normal activities over the course of recovery.

Effects of coping instruction in reducing young adolescents' pain after major spinal surgery.

Background Enduring pain following major orthopaedic surgery is a major challenge for adolescents. Purpose To evaluate the effects of coping instruction and concrete-objective information on adolescents’ postoperative pain and focus on potential applications of these interventions for orthopaedic nursing practice. Design/Method A randomized controlled trial of 66 young adolescents (age 11–14) undergoing major spinal surgery for idiopathic scoliosis. Results The intervention that focused only on coping instruction was the most effective intervention on postoperative Day 2. On postoperative Day 4, adolescents receiving coping instruction (coping alone or coping plus information) reported less pain than those not receiving coping instruction. Discussion Interventions that direct adolescent patients’ attention to learning coping strategies they can use during recovery to lessen pain may be more efficacious than others following major spinal surgery.

Attention, Coping, and Activity in Children Undergoing Orthopaedic Surgery

The purpose of this study was to determine how childrens preoperative focus of attention on the stresses of surgery related to their preoperative coping and return to usual activities during recovery. Childrens attention was classified according to three different foci: concrete-objective, emotion, and vague. Children (N = 97) between the ages of 8 and 17 years who were undergoing major orthopaedic surgery participated in the study. Data were collected the day before surgery, and at 3, 6, and 9 months postoperatively. Children who focused on the concrete-objective aspects of surgery had the most positive activity outcomes, followed by the emotion-focused attention group. Children who were classified as having vague focused attentions had the least favorable activity outcomes. When there were significant coping by attention interaction effects, vigilant copers who had a concrete-objective focus of attention had the most favorable activity outcomes at each time of measurement. Children who were able to focus their attention on concrete aspects of the experience tended to use vigilant coping and were able to return to their usual activities sooner.

Existential well-being predicts perceived control in adults with heart failure

This study examined the relationship between spiritual well-being (SWB) and perceived control (PC) in adult patients with heart failure (HF). The sample included 75 adults ranging in age from 27 to 82 years. Participants verbally completed study questionnaires in a clinic room selected for privacy. Multiple linear regression results indicated that increased existential spiritual well-being (a subscale of SWB) predicted increased PC. Thus, patients with HF who adjust to personal changes and who also connect with others may develop meaning and purpose in life and may perceive increased control over their heart disease.

Effects of surgery type and attention focus on children's coping.

BACKGROUND How children cope with minor or major surgery is influenced by their attention focus appraisals. Although factors that predict childrens coping with surgery have been identified (i.e., age, locus of control, parent-doctor information, worry), it still is not known whether the type of surgery per se affects the coping strategies used and influences previously established predictors of coping. Furthermore, questions remain concerning the relation among type of surgery, attention focus, and coping. OBJECTIVES The purpose of this study was to determine whether the type of surgery (minor vs. major) would have a differential effect on coping, and whether coping can be predicted better if it is known what type of attention focus (appraisal) the child has. METHODS Data from three studies of children (n = 189) undergoing minor or major surgery were combined to examine the effects that type of surgery and attention have on coping. Measures included the Preoperative Mode of Coping Interview, Locus of Control Scale for Children, Parent-Doctor Information Interview, and a measure for worry. RESULTS The results showed that the factors previously found to predict coping were upheld in the combined sample and accounted for 50% of the variance in coping. Type of surgery was significantly associated with coping: Children undergoing minor surgery were somewhat more vigilant than children undergoing major surgery. The inclusion of attention in the analysis significantly improved the variance explained in coping (66%), and children who had a concrete-objective focus of attention were found to be more vigilant. Significant interactions were found between attention focus and type of surgery, locus of control, and age. Type of surgery also had a significant interaction with worry. Children who focused on the concrete-objective aspects of the situation were more vigilant if they were having minor rather than major surgery. Also, children who had an internal locus of control and a concrete-objective focus of attention were more vigilant in coping. Regardless of age, children who had a concrete-objective focus of attention were more vigilant. Furthermore, at low levels of worry, children undergoing major surgery were more vigilant than children undergoing minor surgery. CONCLUSIONS Coping with surgery is influenced by multiple factors. Childrens ability to focus attention on the concrete-objective aspects of surgery may help to reduce feelings of threat that could impede their use of vigilant coping.

Cognitive Vulnerabilities, Negative Life Events, and Depressive Symptoms in Young Adolescents

Negative patterns of thinking, termed cognitive vulnerabilities, have been identified as risk factors for the development of depressive symptoms when adolescents experience negative life events. This study evaluated the associations among three cognitive vulnerabilities (i.e., dysfunctional attitudes, negative inferential style, and ruminative response style) and negative life events with depressive symptoms in a sample of young adolescents. All three cognitive vulnerabilities were found to be significantly associated with depressive symptoms. Furthermore, ruminative response style was found to have a significant unique contribution to the number of depressive symptoms. Findings suggest that cognitive vulnerabilities, particularly rumination, may be instrumental in explaining the development of depressive symptoms in young adolescents.