Maria da Graça Pereira

Burden, Coping, Physical Symptoms and Psychological Morbidity in Caregivers of Functionally Dependent Family Members

OBJETIVOS: investigar a sobrecarga, enfrentamento, sintomas fisicos e morbidade psicologica em cuidadores de familiares dependentes funcionais. METODOS: cinquenta cuidadores de membros da familia completaram medidas autorrelatadas de sobrecarga, sintomas fisicos, morbidade psicologica e estrategias de enfrentamento. RESULTADOS: foi observada correlacao negativa significante entre estrategias de enfrentamento e as diversas variaveis clinicas, bem como correlacao positiva significante entre estrategias de enfrentamento e tempo de cuidado. Pode-se notar que o vinculo mais forte entre cuidador e familiar leva ao menor uso de estrategias adaptaveis de enfrentamento. Pode-se, tambem, notar que a deterioracao da relacao compartilhada entre eles e a mais baixa percepcao da autoeficacia sao mais proeminentes em cuidadores de familiares com deficiencia cognitiva, indicando que cuidadores de familiares que nao apresentam deficiencias cognitivas enfrentam menos dificuldades. CONCLUSAO: esses resultados enfatizam a necessidade de intervencoes que incluam estrategias de enfrentamento, uma vez que essas sao importantes para a reducao da sobrecarga, morbidade psicologica e sintomas fisicos dos cuidadores.

Family variables as moderators between beliefs towards medicines and adherence to self-care behaviors and medication in type 2 diabetes.

This study analyzed whether family variables such as marital adjustment, partner support, family coping, and family stress moderated the relationship between negative beliefs about medicines and adherence to self-care behaviors (diet, glucose monitoring, exercise, foot care, and medication), in Type 2 diabetes patients. The sample was composed of 387 individuals with Type 2 diabetes, diagnosed in the past 12 months. Patients were assessed on self-care behaviors in diabetes, medication adherence, beliefs about medicines, family coping, family stress, marital adjustment, and partner support. The results showed marital adjustment, family coping, partner support, and family stress as moderators in the relationship between negative beliefs and adherence. Patients with negative beliefs regarding medicines, but who reported good marital adjustment and family coping were more likely to test their blood glucose; and if they reported low support from their partners were less likely to adhere to their prescribed diet. Finally, patients with negative beliefs about medicines, but who reported high family stress, were less likely to take their medication. The results emphasize the importance of family variables on adherence to self-care behaviors and medication. This study revealed the importance of including partners on interventions regarding Type 2 diabetes because they seem to play an important role in patients adherence.

Psychological morbidity, burden, and the mediating effect of social support in adult children caregivers of oncological patients undergoing chemotherapy

This study examines the association between psychological morbidity, social support, and demographic and clinical variables in adult children of cancer patients undergoing chemotherapy. Special attention was given to the variable level of parental dependency. The main predictors of caregiving burden were tested, as well as the mediating role of social support in the relationship between psychological morbidity and burden.

Sociodemographic and clinical characteristics of patients with diabetic foot ulcer

INTRODUCTION Diabetic foot is one of the most serious complications of diabetes affecting about 15% of all diabetes patients, and it is the leading cause of nontraumatic lower limb amputations. This study presents a sociodemographic and clinical characterization of patients with diabetic foot ulcer indicated for amputation surgery. METHODS A cross-sectional study with 206 patients with type 2 diabetes and a diabetic foot ulcer indicated for amputation surgery. Patients were assessed on sociodemographic and clinical characteristics, pain intensity and pain interference, after answering the Brief Pain Inventory, and on pain descriptors according to the Douleur Neuropathique 4. RESULTS Most patients were male, with little formal education and a mean age of 66 years. They had been diagnosed with type 2 diabetes for 18 years in average, and diagnosed with diabetic foot ulcer in average 3 years prior to the assessment. About 59% of patients experienced pain in the lower limb that significantly interfered with all areas of their functioning. CONCLUSION The social demographic variables play an important role in diabetic foot ulceration. Given that the neuropathic ulcers are more easily preventable, systematic monitoring of patients with neuropathy is important. In patients with neuroischemic foot, strategies to cope or manage more efficiently the pain are paramount. Intervention should be multidisciplinary and take into account sociodemographic and clinical factors, as well as the presence, intensity and interference of pain in the patients daily life activities and whether the patient has family or caregiver support.

Qualidade vida, sobrecarga, suporte social, ajustamento conjugal e morbidade psicológica em cuidadores de idosos com dependência funcional

Changes in medical practice resulted in shorter hospitalization and in the search for substitute caregivers leading families to assume care. Family members who become caregivers need to deal with changes in their lives on several levels, particularly when caregiving falls upon a dependent family member. This study focused on the implications of caregiving on burden, life activities, quality of life, satisfaction with social support, dyadic adjustment, depression and anxiety. 109 informal caregivers of functionally dependent elders participated in the study. The instruments used were: Barthel Index, Zarit Burden Interview, WHOQOL-BREF, Satisfaction with Social Support Scale, Revised Dyadic Adjustment Scale, Beck Depression Inventory and State Trait Anxiety Inventory. The results revealed that quality of life was inversely related with burden and psychological morbidity and positively with satisfaction with friends. Burden and quality of life were correlated with social support. In turn, marital adjustment was found to be a moderator in the relationship between depression and quality of life (physical and psychological dimensions) but not between burden and quality of life. Caregivers that were partners of those they cared for showed lower quality of life and adult children caregivers 370 Pereira, M.G., & Carvalho, H. revealed more psychological morbidity. Caregivers who received support in caregiving tasks showed more marital satisfaction. Results emphasize the importance of intervention with this population particularly regarding psychological morbidity and burden, in order to increase caregivers’ quality of life.Changes in medical practice resulted in shorter hospitalization and in the search for substitute caregivers leading families to assume care. Family members who become caregivers need to deal with changes in their lives on several levels, particularly when caregiving falls upon a dependent family member. This study focused on the implications of caregiving on burden, life activities, quality of life, satisfaction with social support, dyadic adjustment, depression and anxiety. 109 informal caregivers of functionally dependent elders participated in the study. The instruments used were: Barthel Index, Zarit Burden Interview, WHOQOL-BREF, Satisfaction with Social Support Scale, Revised Dyadic Adjustment Scale, Beck Depression Inventory and State Trait Anxiety Inventory. The results revealed that quality of life was inversely related with burden and psychological morbidity and positively with satisfaction with friends. Burden and quality of life were correlated with social support. In turn, marital adjustment was found to be a moderator in the relationship between depression and quality of life (physical and psychological dimensions) but not between burden and quality of life. Caregivers that were partners of those they cared for showed lower quality of life and adult children caregivers

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors, in type 2 diabetes

Abstract The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.

The mediator role of psychological morbidity on sleep and health behaviors in adolescents

OBJECTIVE This study examined the mediation role of psychological morbidity, defined in this study as depression/anxiety, in the relationship between excessive daytime sleepiness and sleep quality, and between sleep habits and health behaviors, in adolescents. METHODS A total of 272 students, between 12 and 18 years old, underwent a psychological protocol assessing excessive daytime sleepiness, sleep quality, sleep habits, health behavior, and psychological morbidity. RESULTS Psychological morbidity was not associated with the relationship between excessive daytime sleepiness and sleep quality, but was associated, with statistical significance, in the relationship between sleep habits and health behaviors. These results emphasize the role of psychological morbidity in adolescent health behaviors. CONCLUSION Analyzing the symptoms of depression and anxiety in pediatric patients may help in a more accurate diagnosis, especially in relation to sleep problems and health behaviors.

Psychological morbidity and autonomic reactivity to emotional stimulus in parental cancer: a study with adult children caregivers

Literature suggests that parental cancer can provoke aversive emotional arousal in adult children, who may perceive caregiving as a traumatic experience. Limited research has been conducted on emotional and physiological impact of family caregiving for cancer patients undergoing chemotherapy. The aim of the present study was to examine psychological and physiological responses in parental cancers caregivers. Two matched groups of adult children, with 78 participants each (parental cancer vs. control), completed psychological measures of distress, post-traumatic stress disorder (PTSD) symptoms, and burden. Additionally, each participant visualised standardised pictures with different emotional valences, while cardiovascular (heart rate) and electrodermal responses (skin conductance) were recorded. Between-group analysis showed significant differences on all psychological variables, and on skin conductance for all types of pictures. However, for the heart rate responses, differences were found only for pictures with unpleasant emotional arousal. In the parental cancer group, the heart rate peak response stood out as a predictor of PTSD symptoms, after controlling for distress and burden. This study highlights the important role of psychophysiological measures of family caregiving in oncology. Physiological responses may explain a higher prevalence of PTSD symptoms. Therefore, biofeedback combined with targeted psychosocial interventions for relaxation could be of great clinical value for this population.

Validação do questionário crenças acerca da medicação em pacientes diabéticos tipo 2

The present paper focused on the validation of the Questionnaire on Beliefs about Medication, which assesses both General Beliefs and Specific Beliefs. The psychometric properties of the instrument were analyzed on a sample of 387 type 2 diabetic patients. The validity study for General Beliefs found a unifactorial solution, with an alpha of .76, and for Specific Beliefs, a two-factor solution - Necessities and Concern -, with an alpha of .77 and .69, respectively. In terms of construct validity, a relationship between General Beliefs, subscale Necessities from Specific Beliefs, and adherence to medication, as evaluated by Medical Adherence Rating Scale, was found. The instrument presents good psychometric qualities to be used in type 2 diabetic patients.

Impacto do câncer parental no desenvolvimento psicológico dos filhos: uma revisão da literatura

O presente artigo engloba uma extensa revisao da literatura sobre a tematica do câncer parental e as consequencias pessoais e familiares desta vivencia. Nesse sentido, sao abordadas as principais consequencias medicas e psicossociais do diagnostico e tratamento do câncer e, usando o modelo sistemico, e descrita a influencia (negativa e positiva) deste acontecimento no doente e noutros membros da familia. E dado especial enfoque ao desenvolvimento psicologico dos filhos, incluindo os resultados dos estudos referentes ao stress traumatico e crescimento pos-traumatico, em particular no câncer da mama. Sao tecidas algumas implicacoes para a investigacao nesta area, bem como sugestoes para futuras investigacoes.