María Márquez-González

Psychosocial factors and caregivers’ distress: Effects of familism and dysfunctional thoughts

Introduction: Caring for a relative with dementia is linked with negative psychological and physical consequences for the caregiver. The number of studies analyzing the influence of specific values and thoughts on caregivers’ distress remains sparse. Objectives and method: The aim of this study is to analyze the influence of both familism dimensions and dysfunctional thoughts specific to caregiving on depression in a sample of 334 dementia caregivers. Results: The results of this study suggest that familism can have positive influences on caregiving distress when the family is perceived as a source of support. However, the dimensions of familism pertaining to a strong adherence to values regarding both feelings of obligation to provide support as well as behaviors and attitudes that should be followed by different members of a family were linked with caregivers’ distress through their influence on dysfunctional thoughts. Conclusion: This study provides support for the importance of conceptualizing familism as a multidimensional construct with both positive and negative effects on caregivers’ emotional distress and suggests that familism affects emotional distress through dysfunctional thoughts rather than through burden appraisals. Clinical implications include attending to both the positive and negative effects of familism values and the potential value of targeting dysfunctional thoughts in cognitive-behavioral interventions with caregivers.

Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme

Among the diverse group of interventions developed to help dementia family caregivers cognitive-behavioural approaches show especially promising results. Objectives: This study describes a cognitive-behavioural group intervention aimed principally at the modification of dysfunctional thoughts associated with caregiving (MDTC). The efficacy of the MDTC intervention in reducing caregivers’ depressive symptomatology, together with the frequency and appraisal of problem behaviours, is compared to that of a waiting-list control group (WL). Furthermore, the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers’ depressive symptomatology is analyzed. Of the 74 dementia caregivers who were randomized to one of two conditions (MDTC and WL), 39 completed the post-intervention assessment. Statistical analyses were performed on an intention-to-treat basis, using last observation carried forward. The results reveal that the MDTC intervention is successful in reducing caregivers’ level of depressive symptomatology and dysfunctional thoughts about caregiving, as well as in modifying their appraisal of their relatives problem behaviours. Furthermore, a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology. The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted.

Analysis of the moderating effect of self-efficacy domains in different points of the dementia caregiving process

Introduction: Studies analyzing the moderator role of self-efficacy have centered their attention on the relationship between stressors and distress. However, drawing upon the stress and coping model, the moderator effects of self-efficacy may appear in the relationship between other key elements of the stress process. Objectives and method: The purpose of this study was to analyze, in a sample of 167 dementia family caregivers, (1) the moderating effect of self-efficacy for managing behavioral problems on the relationship between frequency of behavioral problems and burden; and (2) the moderating effect of self-efficacy for controlling upsetting thoughts on the relationship between burden and caregivers’ distress (depression and anxiety). Results: While no support has been found for the hypothesis that self-efficacy for managing behavioral problems moderates the relationship between frequency of behavioral problems and burden, our findings support the moderator role of self-efficacy for controlling upsetting thoughts in the relationship between burden and distress. No differences in distress measures are found between caregivers with high and low scores on self-efficacy for controlling upsetting thoughts when they report low levels of burden. However, when the levels of burden are high, caregivers with high self-efficacy for controlling upsetting thoughts report significantly lower levels of distress than caregivers with low self-efficacy for controlling upsetting thoughts. Conclusion: Self-efficacy for controlling upsetting thoughts may be particularly effective for caregivers who report high burden scores, attenuating the impact of burden on caregivers’ distress (depression and anxiety).

Loneliness and Mental Health in a Representative Sample of Community-Dwelling Spanish Older Adults

ABSTRACT Research seems to support loneliness as a risk factor for mental health problems in the elderly. Most studies analyzing the effects of loneliness on older adults’ mental health have relied on convenience samples. In this study, the prevalence and predictors of feelings of loneliness were studied in a representative sample of 272 community-dwelling Spanish older adults. The potential of feelings of loneliness to significantly contribute to the explanation of mental health of the elderly was also explored. The percentage of people reporting feelings of loneliness was 23.1%. Being a woman, being older, living alone, having fewer economic resources, having lower perceived health, and being dissatisfied with the frequency of contact with relatives and friends were found to be significant predictors of feelings of loneliness. Loneliness contributed significantly to the explanation of mental health, even when other significant variables were statistically controlled. The results of this study suggest that loneliness is a relevant factor for the analysis and understanding of mental health in the elderly.

Reliability and Validity of the Spanish Version of the Revised Scale for Caregiving Self-Efficacy

This study investigated the reliability and convergent validity of the Revised Scale for Caregiving Self-Efficacy (RSCSE) in a Spanish sample of 180 caregivers of relatives with dementia. The self-efficacy scales were examined in relation to help-seeking behaviors, behavioral problems of the relative, dysfunctional thoughts about caregiving, and depressive symptoms. Good internal consistency indices were found for the RSCSE subscales. Those caregivers with higher scores on the RSCSE reported more help-seeking behaviors, a higher frequency of behavioral problems of their relative, fewer dysfunctional thoughts about caregiving, and less depression. The clinical implications of these results are discussed.

Psychometric properties of the Spanish version of the Geriatric Anxiety Inventory

BACKGROUND The Geriatric Anxiety Inventory (GAI) was developed for assessing anxiety in older adults. The objectives of this work were: (a) to analyze the psychometric properties of the Spanish version of the GAI, and (b) to explore the associations between anxiety and other variables related to emotional distress (depression) and emotion regulation (rumination, experiential avoidance, and emotion suppression). METHODS Three-hundred-and-two people (75.5% female) aged 60 years and over living in the community participated in this study. Anxiety, depression, rumination, suppression and experiential avoidance were measured. RESULTS Three factors explaining 50.11% of the variance were obtained. The obtained internal consistency for the total scale was 0.91, with alphas ranging between 0.71 and 0.89 for the factors. Significant associations between all the GAI factors, the GAI total score, and depression, rumination, and experiential avoidance were found (all p < 0.01). Women reported higher scores than men for both the GAI total score and for all of the subscales. However, no significant gender differences were found between people with scores higher than the cut-off score for the GAI. CONCLUSIONS The results of this study suggest that the Spanish version of the GAI displays good psychometric properties. Further, our data suggest that the scale can be recommended for measuring anxiety in non-clinical older Spanish persons, and may be a useful instrument to be used in research studies aimed at analyzing anxiety and its correlates among older adults.

Anger, Spiritual Meaning and Support from the Religious Community in Dementia Caregiving

This study explores the relationships between spiritual meaning and social support from the religious community and problem behaviors, anger and depression in 128 dementia caregivers. The results suggest a mediating role of anger in the relationship between the appraisal of problem behaviors and depression. Support from the religious community is directly and negatively associated with anger, but the relationship between spiritual meaning and anger is mediated by caregivers’ appraisals of problem behaviors, suggesting that spiritual beliefs might help caregivers to find meaning in caregiving experiences and thus appraise care recipients’ behavioral problems as less stressful.

Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers

Introduction: Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers. Method: The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patients frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD. Results: We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers’ distress. Conclusions: The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems – both disruptive and depressive – and the distress they cause in caregivers.

Behavioral correlates of anxiety in well-functioning older adults

BACKGROUND Research on the behavioral correlates of anxiety in older adults is sparse. The aim of this study was to explore the association of anxiety with behavioral patterns defined by health, activity, emotional and social variables. METHODS A convenience sample of 395 older adults completed measures of health, activity, emotions, social variables and experiential avoidance. Cross-sectional data were analysed using cluster analysis. RESULTS Five clusters were identified: active healthy, healthy, active vulnerable, lonely inactive and frail lonely. Participants in the active healthy and healthy clusters showed the highest scores on health variables (vitality and physical function), and adaptive scores on the rest of variables. They also reported the lowest scores on anxiety and included the lowest number of cases with clinically significant anxiety levels. Active vulnerable showed high scores on social support, leisure activities and capitalization on them but low scores in vitality and physical functioning. Participants in the lonely inactive cluster reported the highest mean score in experiential avoidance and high scores on boredom and loneliness, and low scores on social support, leisure activities capitalizing on pleasant activities and health variables. Frail lonely represent a particularly vulnerable profile of participants, similar to that of lonely inactive, but with significantly lower scores on health variables and higher scores on boredom and hours watching TV. CONCLUSIONS Anxiety in older adults is not only linked to poor health, but also to dysfunctional social behavior, loneliness, boredom and experiential avoidance. Maladaptive profiles of older adults with regard to these variables have been identified.

Behavioral Intervention for Reducing Resistance in Care Recipients to Attending Adult Day Care Centers: A Pilot Study

The aim of the present study was to analyze the efficacy of an individualized intervention that trains caregivers of family members with dementia in behavioral skills to assess and modify their relative’s resistance to attending an adult day care center (ADC). Three caregivers were trained in assessment techniques for registering the behaviors related to resistance to attending the ADC, behavioral techniques for modifying antecedents and consequences of the behaviors, and implementation of those techniques. The frequency of behaviors was recorded every day. Caregivers’ depressive symptomatology and anxiety, and occurrence of care recipients’ behavioral problems related to attending the ADC, were assessed. After the intervention, frequency of behavioral problems decreased for all people with dementia, anxiety decreased for two caregivers, and depression decreased clinically for two caregivers. Behavior modification appears to be effective for helping caregivers to manage disruptive behaviors by care recipients associated with attending an ADC.