Rosa Romero-Moreno

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.

Multiple mediators of the relations between caregiving stress and depressive symptoms

Objective: This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimers disease. It was hypothesized that more depressive symptoms would be significantly correlated with both ‘primary’ caregiver stressors (i.e., care recipient problem behaviors) and ‘secondary’ stress (i.e., role overload), but that this relationship would be significantly mediated by four variables: (1) personal mastery, (2) coping self-efficacy, (3) activity restriction, and (4) avoidance coping. Method: We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway. Results: Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms. Discussion: These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.

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).

Pleasant Events, Activity Restriction, and Blood Pressure in Dementia Caregivers

OBJECTIVE A combination of high engagement in pleasurable activities and low perceived activity restriction is potentially protective for a number of health and quality of life outcomes. This study tests the newly proposed Pleasant Events and Activity Restriction (PEAR) model to explain level of blood pressure (BP) in a sample of elderly dementia caregivers. METHODS This cross-sectional study included 66 caregivers, ≥55 years of age, providing in-home care to a relative with dementia. Planned comparisons were made to assess group differences in BP between caregivers reporting high engagement in pleasant events plus low perceived activity restriction (HPLR; n = 22) to those with low pleasure plus high restriction (LPHR; n = 23) or those with either high pleasure plus high restriction or low pleasure plus low restriction (HPHR/LPLR; n = 21). RESULTS After adjustments for age, sex, body mass index, use of antihypertensive medication, physical activity, and number of health problems, HPLR participants (86.78 mm|Hg) had significantly lower mean arterial pressure compared with LPHR participants (94.70 mm|Hg) (p = .01, Cohens d = 0.89) and HPHR/LPLR participants (94.84 mm|Hg) (p = .023, d = 0.91). Similar results were found in post hoc comparisons of both systolic and diastolic BP. CONCLUSIONS This study extends support for the PEAR model to physical health outcomes. Differences in BP between the HPLR group and other groups were of large magnitude and thus clinically meaningful. The findings may inform intervention studies aimed at investigating whether increasing pleasant events and lowering perceived activity restriction may lower BP.

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.

Psychometric properties of the Valued Living Questionnaire Adapted to Dementia Caregiving

ABSTRACT Objectives: Caring for a relative with dementia is associated with physical and emotional health problems in caregivers. There are no studies analysing the role of personal values in the caregiver stress process. This study aims to analyse the psychometric properties of the Valued Living Questionnaire Adapted to Caregiving (VLQAC), and to explore the relationship between personal values and stressors, coping strategies and caregiver distress. Method: A total of 253 individual interviews with caregivers of relatives with dementia were conducted, and the following variables were assessed: personal values, stressors, cognitive fusion, emotional acceptance, depression, anxiety, and satisfaction with life. An exploratory factor analysis and hierarchical regression analyses were carried out. Results: Two factors were obtained, Commitment to Own Values and Commitment to Family Values which explain 43.42% of variance, with reliability coefficients (Cronbachs alpha) of .76 and .61, respectively. Personal values had a significant effect on emotional distress (depression and anxiety) and satisfaction with life, even when controlling for socio-demographic variables, stressors and coping strategies. Conclusion: Results suggest that the personal values construct of dementia caregivers is two-dimensional. The personal values of the caregivers play an important role in accounting for distress and satisfaction with life in this population.

Frequency of leisure activities and depressive symptomatology in elderly people: the moderating role of rumination

BACKGROUND The positive effects of leisure activities on depressive symptomatology are well known. However, the extent to which emotional regulation variables moderate that relationship has scarcely been studied, especially in older people. The aim of this study is to analyze the moderating role of rumination in the relation between leisure activities and depressive symptoms. METHODS Participants in this study were 311 people, aged 60 to 90 years (mean age: 71.27 years; SD: 6.99; 71.7% women). We evaluated depressive symptomatology, frequency of leisure activities, and rumination. We carried out a hierarchical regression analysis to confirm the moderating role of rumination. RESULTS We obtained a model that explains 39.4% of the variance of depressive symptomatology. Main effects were found for the frequency of leisure activities (β = -0.397; p < 0.01) and for rumination (β = 0.497; p < 0.01). Moreover, we found a significant effect of the interaction between frequency of leisure activities and rumination (β = 0.110; p < 0.05), suggesting that rumination plays a moderating role in the relation between leisure activities and depressive symptomatology. CONCLUSIONS A risk profile of elderly people may consist of those who engage in low levels of leisure activities but also use more frequently the dysfunctional emotional regulation strategy of rumination.

Rumiación y fusión cognitiva en el cuidado familiar de personas con demencia

INTRODUCTION Rumination has been described as a dysfunctional coping strategy related to emotional distress. Recently, it has been highlighted from the Acceptance and Commitment Therapy therapeutic approach, the negative role that cognitive fusion (the extent to which we are psychologically tangled with and dominated by the form or content of our thoughts) has on the explanation of distress. The aim of this study is to simultaneously analyze the role of rumination and cognitive fusion in the caregiving stress process. MATERIAL AND METHODS The sample of 176 dementia caregivers was divided in four groups, taking into account their levels of rumination and cognitive fusion: HRHF=high rumination+high cognitive fusion; HRLF=high rumination+low cognitive fusion; LRHF= low rumination+high cognitive fusion; and LRLC=low rumination and low cognitive fusion. Caregiver stress factors, frequency of pleasant events, experiential avoidance, coherence and satisfaction with personal values, depression, anxiety and satisfaction with life, were measured. RESULTS The HRHF group showed higher levels of depression, anxiety, experiential avoidance and lower levels of satisfaction with life, frequency of pleasant events, coherence and satisfaction with personal values, than the other three groups. CONCLUSIONS Considering simultaneously rumination and cognitive fusion may contribute to a better understanding of caregiver coping and distress.