1. Burdens of spousal caregiving alleviated by appreciation

    September 12, 2017 by Ashley

    From the University at Buffalo press release:

    The fact that spouses often become caregivers for their ailing partners is quite common in American life — and few roles are more stressful.

    Yet helping behaviors, which are at the core of caregiving, typically relieve stress, according to Michael Poulin, an associate professor in the University at Buffalo Department of Psychology.

    When discussing spousal care, the draining demands of caregiving and the uplifting effects of helping stand in apparent contrast to one another.

    But recent research shows that the time caregivers spend actively helping a loved one can improve the caregiver’s sense of well-being — and now, Poulin, an expert in empathy, human generosity and stress, is part of a research team that has published a study exploring why that’s the case.

    Their research points to the specific conditions necessary to alleviate the burdens of spousal caregiving.

    Spending time attempting to provide help can be beneficial for a caregiver’s mental and physical well-being, but only during those times when the caregiver sees that their help has made a difference and that difference is noticed and recognized by their partner,” he says.

    “These conclusions are important because we know that spousal caregiving is an enormous burden, emotionally, physically and economically,” he says. “If we can find ways for community resources to help create those conditions we might be able to make a difference in the lives of millions of people.”

    The findings of the study, led by Joan Monin, Yale School of Public Health, Stephanie Brown, Stony Brook University, Kenneth Langa, University of Michigan, and Poulin, appear in the American Psychological Association’s journal Health Psychology.

    Poulin says more than 30 years of research shows that being a caregiver is among the most stressful, emotionally burdensome and physically demanding roles a person can take on. Spouses who are caregivers show decreased immune function, increased signs of physiological stress and are at greater risk for physical and mental illness.

    Yet other studies, including much of Poulin’s own research, suggest that the act of providing help to somebody is typically stress-relieving and is associated with better emotional and physical well-being.

    “The problem is that when you’re a caregiver, not all of your time is spent helping,” says Poulin. “Sometimes all you can do is witness the person’s state while being passively on duty.”

    But previous research confirmed that the act of helping in this context was associated with improving the caretakers’ well-being, a finding that was true even when general caregiving was broken downs into tasks, like feeding or bathing.

    “This is what we wanted to get at,” says Poulin. “We knew that something about being helpful is good in these circumstances. But why? Is it just being active? Is doing something better than doing nothing? Or is it that doing something to improve another person’s well-being is what matters?”

    The research team conducted two studies with spouses caring for partners with chronic pain.

    In the first study, 73 participants reported caregiving activity and their accompanying emotions in three-hour intervals. This allowed the researchers to look at the amount of help given and how much that help pleased the spouse and subsequently affected the caregiver.

    The second study involved 43 caregivers who completed a diary at the end of the day that detailed the help they provided and the appreciation they received.

    The findings suggest that spouses caring for a partner feel happier and report fewer physical symptoms when they believe their help is appreciated.

    “Importantly, this study adds to a growing body of evidence showing that it is important to target emotional communication between spouses in daily support interactions to improve psychological well-being in the context of chronic conditions and disability,” the authors write in their paper.

    It’s an important point to consider, not just today, but for the future, notes Poulin.

    “As the baby boomers continue to age, this phenomenon of spousal caregiving will continue to increase,” he says.


  2. Depression linked to physical health decline in cancer caregivers

    July 12, 2017 by Ashley

    From the American Cancer Society press release:

    A new report finds cancer caregivers suffer a steady decline in physical health compared to controls, and that symptoms of depression were the only significant predictor of caregivers’ physical health decline. Writing in Cancer, the authors say assessing and addressing depressive symptoms among caregivers early in the cancer survivorship trajectory may help to prevent premature health decline among this important, yet vulnerable population. The study is the longest follow-up to date of caregivers’ physical health following providing care to a loved one with cancer. It was funded by the American Cancer Society.

    Cancer caregiving has been associated with worsening health among caregivers. To explore possible predictors of this decline, researchers led by Kelly M. Shaffer, Ph.D., of Memorial Sloan Kettering Cancer Center, analyzed survey data from 664 cancer caregivers in the American Cancer Society’s National Quality of Life Survey for Caregivers. They examined changes in caregivers’ physical health from year two to year eight following a family member’s cancer diagnosis to find predictors of declining health.

    At two years after diagnosis, caregivers’ health was slightly higher than the national mean. But over the following six years that advantage dissipated, as caregivers experienced a small yet notable decline in health. Investigators found having elevated depressive symptoms was the only predictor of the physical health decline; caregivers with high depressive symptoms showed twice the rate of physical health decline of caregivers with an average level of depressive symptoms.

    “Adverse effects of depression on physical health have been well-documented in the general population,” write the authors. “These findings extend evidence to the cancer caregiving context, known to have many psychosocial stressors and challenges, and highlight the importance of depression specifically to caregivers’ premature physical health decline.”

    The authors say caregiver distress screening could be more widely adopted hand-in-hand with efforts to implement similar screening for patients, including technology-based assessment using brief and straightforward questions to assess whether a caregiver has been experiencing depression.

    “Identifying caregivers in need, and connecting these caregivers to effective and accessible psychosocial services, are imperative next steps to improve comprehensive care for families facing cancer,” said Dr. Shaffer.


  3. Study measures communication in couples affected by dementia

    May 20, 2017 by Ashley

    From the Florida Atlantic University press release:

    In marriage, good communication is key to a fulfilling and enduring relationship. For people with dementia, communicating needs, emotions and interacting with others becomes increasingly difficult as communication deteriorates as dementia progresses. Problems in communicating lead to misinterpretations and misunderstandings, which often cause considerable stress for family members, especially the spouse caregivers as well as the patient.

    But all is not lost according to the first study to look at and measure communication outcomes in both the caregiver spouse and the patient with dementia. In fact, researchers from Florida Atlantic University have found that “practice makes perfect” with the right intervention and a tool that can accurately measure couples’ communication. Results from the study are published in the journal Issues in Mental Health Nursing.

    “There has been very little focus on the patient with dementia’s role in maintaining spousal relationships through conversation,” said Christine L. Williams, DNSc, principal investigator of the study and a professor and director of the Ph.D. in Nursing Program in FAU’s Christine E. Lynn College of Nursing, who designed the intervention program and developed the first tool that measures couples’ communication. “Maybe it’s because researchers assume that the patient can’t have a positive influence on communication because of dementia. We wanted to explore this issue further, especially for couples with a history of special memories shared over decades of marriage.”

    For the study, Williams videotaped and later analyzed and measured 118 conversations between 15 patients with varying degrees of dementia and their spouses — married an average of 45 years — to evaluate the effects of a 10-week communication-enhancement intervention on participant’s communication and mental health.

    Caregivers were taught to communicate in a manner that was clear, succinct and respectful, and to avoid testing memory and arguing. Spouses with dementia were given the opportunity to practice their conversation skills with a member of the research team who was trained in communication deficits associated with dementia as well as the intervention. Conversations were recorded at the couples’ homes. After setting up the video camera, Williams conducted the intervention and then left the room for 10 minutes. Couples were instructed to converse on a topic of their choice for 10 minutes.

    “There are very few studies that have looked at actual communication between couples in these circumstances and tried to analyze it,” said Williams. “For instance, I’ve seen studies where they have taught communication strategies to caregivers, but then what they measure is the caregivers’ knowledge about communication, which doesn’t tell you anything about whether or not they were able to communicate.”

    Unlike other measures of patient communication, the Verbal and Nonverbal Interaction Scale-CR (VNIS-CR) tool developed by Williams takes into account nonverbal behaviors, which account for more than 70 percent of communication, as well as verbal behaviors. VNIS-CR delineates social and unsociable behaviors, characterizes patient behaviors (not through the lens of a caregiver), and is targeted to spousal relationships in the home. Consisting of 13 social and 13 unsociable communication behaviors with both verbal and nonverbal items, the tool helps to describe sociable and unsociable communication in patients with dementia as they engage in conversations with their spouses.

    Nonverbal, non-sociable items in the tool included aloofness, staring into space and being nonresponsive; nonverbal, sociable items included looking or gazing at the spouse, being affectionate and joking. Social verbal behaviors included using coherent conversation, responding to questions, and addressing their partner by name or endearment. Unsociable verbal behaviors included shouting, cursing and unintelligible communication. The 13-item scores were summed up to obtain the final score.

    “Using this new tool, I was able to confirm that the intervention I used actually worked and that communication improved in both the spouse caregiver and the patient over time,” said Williams. “I was ecstatic because I originally thought that maybe the caregiver’s communication would improve and that would be great. However, to have positive changes in a person who is continuing to decline over 10 weeks, which is a long time, was something I really did not expect. This intervention worked for both the caregiver and the patient and we now have a tool to demonstrate it.”

    Globally, Alzheimer’s disease (AD) and related dementias affected 35.6 million individuals in 2010 and it is expected to grow to 115.4 million by 2050. The prevalence of dementia will increase as longevity increases and future family caregivers are likely to be predominantly spouses. In the United States, most people with dementia are cared for by their spouses.

    “As patients progress with dementia, couples don’t have to lose everything especially if they are engaged, if they can still relate to one another and if they focus on the here and now,” said Williams.

    The VNIS-CR could be used in clinical practice to describe changes in social communication abilities over time, as well as to educate spousal caregivers about the importance of encouraging sociable communication. Knowledge gained from using this tool could better guide the development of interventions to support intimate relationships and ultimately measure changes following those interventions.


  4. Study looks at caregiver grief

    September 20, 2012 by Sue

    From the Pennsylvania State University press release via EurekAlert!:

    Depressed SeniorFamily members who care for terminally ill patients at home can be helped by nurses throughout the course of the illness and particularly after the patient’s death, according to Penn State nursing researchers.

    The death of a loved one can be particularly hard for those who were involved in the day-to-day care of the person. This transition can be eased by existing support from nurses and other medical professionals.

    “What we know is that the caregiver’s primary contact with the health care system is during brief office visits [for the patient],” said Janice L. Penrod, professor of nursing and director of the Center for Nursing Research. “Our goal is to develop an assessment that is fast and efficient to give us a snapshot of that caregiver so that we can at least identify needs, and if not intervene during that brief office visit, give them information and a referral to help them smooth the course.”

    Penrod and colleagues compared their own theory of caregiving through the end of life to a theory specifically about bereavement by G. A. Bonnano, a clinical psychologist and pioneer in the field of bereavement. That theory suggests grief oscillates, and eventually the grieving caregiver will “return to a state of equilibrium.”

    Penrod breaks her theory into four stages — sensing disruption, challenging normal, building a new normal and reinventing normal. The comparisons focus on the last stage, “reinventing normal,” which is traditionally known as the bereavement period.

    The process of restructuring their lives after their loved one has died is a cyclical one for the caregivers, the researchers theorize. They believe that support from nurses is important to help the family caregiver grieve.

    By comparing these two theories, Penrod and colleagues found significant conceptual similarities, which helps validate both theories. The researchers reported their results to attendees at the Council for the Advancement of Nursing 2012 State of the Science Congress today (Sept. 15) in Washington, D.C.

    “In order to intervene, we have to have a theoretical base,” said Penrod. “And understand the red flags and the cues to understand when a caregiver is approaching a state of distress so that we can intervene in a timely fashion.”

    Penrod and her colleagues interviewed 14 caregivers after the death of the family member they were caring for about how each was coping with the loss. They found that caregivers fit well into both theories. This fit was much better than the traditional five stages of grief — denial, anger, bargaining, depression and acceptance. Coping with the death of a loved one isn’t something moved through step by step, but instead in a way similar to riding a roller coaster — some moments better than others, some much worse.

    This comparison has verified the assertions the researchers have made, encouraging them to move forward in exploring ways for nurses to help and support family caregivers.

    We need to understand the phenomenon well, before we can intervene to change the course of someone’s life,” said Penrod. ” This is the groundwork for understanding how caregiving proceeds over a trajectory of time so that we can better intervene to support caregivers across that trajectory.”


  5. Study suggests mothers can be stressed when caregiver is not their preferred choice

    August 27, 2012 by Sue

    From the Purdue University press release via HealthCanal:

    Older mothers are more likely to be stressed when they receive help from an adult child who is not their preferred caretaker, according to new research from Purdue University.

    “Most mothers have a preference for which child they turn to in a crisis, confide in and prefer as their future caregivers,” said Jill Suitor, a professor of sociology. “And when mothers received care from the adult child who was not their first choice, they reported more depressive symptoms, such as sadness, loneliness and sleep disturbances. Although mothers appreciated and acknowledged efforts from caregivers who were not their first choices, these children were less likely to share the mothers’ values and to have the personal characteristics important to the mothers in selecting preferred caregivers. This incompatibility can have some strong negative effects.”

    Research by Megan Gilligan, from left, a Purdue doctoral student, and Jill Suitor, a professor of sociology, found that older mothers are more likely to be stressed when they receive help from an adult child who is not their preferred caretaker.

    On the flip side, receiving care from a mother’s preferred child did not affect the mom’s psychological well-being, she said.

    “We expected having that preferred child care for a parent would make a positive difference, but surprisingly it didn’t,” Suitor said. “And we also found that mothers’ depressive symptoms were higher when they received care from the non-preferred child than when they received no care from their offspring.”

    Suitor, also a faculty member in Purdue’s Center on Aging and the Life Course who studies parental favoritism with adult children, collaborated on this research with Megan Gilligan, a Purdue doctoral student, and Karl Pillemer, professor and director of the Cornell Institute for Translational Research on Aging at Cornell University. The research was funded by the National Institute on Aging and is online in The Gerontologist.

    The findings were based on in-person interviews with 234 older mothers as part of a larger study of 566 multigenerational families that began in 2001 when the mothers were 65-75 and had at least two adult children still living. All of the mothers were interviewed again seven years later; the new research is based on the 234 women who reported they needed care within the previous two years because of serious injury or illness.

    During the initial interviews, 75 percent of the mothers named a particular child they would prefer provide care if they became ill or disabled. This was compared to the children’s actual roles seven years later after the mothers needed help. The reasons why preferred children sometimes could not care for their moms were because they moved away or had medical problems themselves.

    Researchers also controlled for family size, and no differences were found based on number of children.

    The researchers found that being cared for by a non-preferred child is stressful because the alternate caregivers did not possess the social and emotional characteristics that the mothers expected.

    “This matters because it makes people comfortable, and this is especially important when people are under a lot of stress and in situations where they relinquish control to another person,” Suitor said. “And who do you want to give up control to? To someone who has the same outlook on life and who you think is very much like you, and, therefore, can respond to your needs and be a source of reassuring support.”

    For example, one of the moms in the study said that her preferred caregiver, who lives far away, was her preference because they “can talk about anything. I think she understands me best.” And while the mom acknowledged the daughter caring for her was helpful and reliable, she couldn’t talk with her as openly. She “would get annoyed with me. Although, she’s my rock here because she’s the one that’s here.”

    These findings are similar to previous work by Suitor and Pillemer that shows these factors are critical in relationships for spouses and adult siblings.

    This connection also can be amplified as someone ages.

    “As people become older and their health declines, they start placing greater emphasis on relationships with family and friends with whom they have a personal history or an especially close and comfortable relationship, and reducing contact with people with whom they are less comfortable,” Gilligan said.

    When asked about the implications of these findings, Suitor said making assumptions about which children mothers want as their caregivers may be problematic. Her previous studies on adult children and mothers show that the children accurately predict whether their mothers favor some children over others about 80 percent of the time, but they are correct only about half the time in identifying which child the mom favors regarding closeness, confiding in or for future care.

    “We are not clinicians, but I think there are lessons that can be learned from this research that can be put to use in conversations that families have about advanced care planning,” Suitor said. “Perhaps these conversations can be expanded to include which children mom would prefer provide her with care. Geography often plays a role in preventing the preferred child from providing care, but perhaps the adult children stepping into the role can call their brother or sister and say, ‘I’m thinking about doing this for mom, what do you think?’ Ideally, they can coordinate and avoid conflict.”

    The survey data is part of a 13-year project, the Within-Family Difference Study, led by Suitor and Pillemer to evaluate the role favoritism plays in adult and family relationships. The data for the project was collected in the Boston metropolitan area by the Center for Survey Research at the University of Massachusetts-Boston.

    In the project’s next phase, they plan to expand the study of causes and consequences of favoritism to three generations of the families they have been following. They also plan to extend the project by collecting data from several hundred multigenerational Hispanic families in the Chicago metropolitan area.


  6. Study looks at why yoga reduces stress

    July 25, 2012 by Sue

    From the UCLA press release:

    Six months ago, researchers at UCLA published a study that showed using a specific type of yoga to engage in a brief, simple daily meditation reduced the stress levels of people who care for those stricken by Alzheimer’s and dementia. Now they know why.

    As previously reported, practicing a certain form of chanting yogic meditation for just 12 minutes daily for eight weeks led to a reduction in the biological mechanisms responsible for an increase in the immune system’s inflammation response. Inflammation, if constantly activated, can contribute to a multitude of chronic health problems.

    Reporting in the current online edition of the journal Psychoneuroendocrinology, Dr. Helen Lavretsky, senior author and a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, and colleagues found in their work with 45 family dementia caregivers that 68 of their genes responded differently after Kirtan Kriya Meditation (KKM), resulting in reduced inflammation.

    Caregivers are the unsung heroes for their yeoman’s work in taking care of loved ones that have been stricken with Alzheimer’s and other forms of dementia, said Lavretsky, who also directs UCLA’s Late-Life Depression, Stress and Wellness Research Program. But caring for a frail or demented family member can be a significant life stressor. Older adult caregivers report higher levels of stress and depression and lower levels of satisfaction, vigor and life in general. Moreover, caregivers show higher levels of the biological markers of inflammation. Family members in particular are often considered to be at risk of stress-related disease and general health decline.

    As the U.S. population continues to age over the next two decades, Lavretsky noted, the prevalence of dementia and the number of family caregivers who provide support to these loved ones will increase dramatically. Currently, at least five million Americans provide care for someone with dementia.

    “We know that chronic stress places caregivers at a higher risk for developing depression,” she said “On average, the incidence and prevalence of clinical depression in family dementia caregivers approaches 50 percent. Caregivers are also twice as likely to report high levels of emotional distress.” What’s more, many caregivers tend to be older themselves, leading to what Lavretsky calls an “impaired resilience” to stress and an increased rate of cardiovascular disease and mortality.

    Research has suggested for some time that psychosocial interventions like meditation reduce the adverse effects of caregiver stress on physical and mental health. However, the pathways by which such psychosocial interventions impact biological processes are poorly understood.

    In the study, the participants were randomized into two groups. The meditation group was taught the 12-minute yogic practice that included Kirtan Kriya, which was performed every day at the same time for eight weeks. The other group was asked to relax in a quiet place with their eyes closed while listening to instrumental music on a relaxation CD, also for 12 minutes daily for eight weeks. Blood samples were taken at the beginning of the study and again at the end of the eight weeks.

    “The goal of the study was to determine if meditation might alter the activity of inflammatory and antiviral proteins that shape immune cell gene expression,” said Lavretsky. “Our analysis showed a reduced activity of those proteins linked directly to increased inflammation.

    “This is encouraging news. Caregivers often don’t have the time, energy, or contacts that could bring them a little relief from the stress of taking care of a loved one with dementia, so practicing a brief form of yogic meditation, which is easy to learn, is a useful too.”

    Lavretsky is a member of UCLA’s recently launched Alzheimer’s and Dementia Care Program, which provides comprehensive, coordinated care as well as resources and support to patients and their caregivers. Lavretsky has incorporated yoga practice into the caregiver program.

    Funding for the study was provided by the Alzheimer’s Research and Prevention Foundation in Tucson, Ariz.. Other authors of the study included David S. Black, Steve Cole, Michael R. Irwin, Elizabeth Breen, Natalie M. St. Cyr, Nora Nazarian, all of UCLA, and Dharma S. Khalsa, medical director for the Alzheimer’s Research and Prevention Foundation in Tucson. The authors report no conflict of interest.


  7. Study suggests stroke caregivers at risk for depression

    July 22, 2012 by Sue

    From the Loyola University Health System press release via EurekAlert!:

    Caregivers of stroke survivors are at risk for developing depression and complications from chronic stress, according to a study published by researchers at the Loyola University Chicago Marcella Niehoff School of Nursing (MNSON) in the latest issue of Biological Research for Nursing. Stroke is one of the leading causes of long-term disability, according to the Centers for Disease Control and Prevention. The National Family Caregiver Association reports that up to 80 percent of stroke survivors are cared for by family members who help them manage their physical and cognitive dysfunction, which can include paralysis, personality changes, urinary incontinence and speech difficulties.

    “Stroke survivors can suffer significant and lasting disabilities that may require lifelong support from family and other caregivers,” said Karen Saban, PhD, RN, APRN, CNRN, lead author and associate professor, Loyola University Chicago Marcella Niehoff School of Nursing. “Many families struggle to provide 24-hour care for their loved ones. This burden places the caregivers at risk for depression, anxiety and sleep disturbances, which can harm quality of life and heighten their risk for other health problems.

    This study evaluated 45 women who were caring for a family member who had experienced a stroke during the past year. Study participants were recruited from support groups, social networking sites and two outpatient clinics. The median age of the women was 55.8 years and the average hours of care they provided was 50.7 hours per week. The women completed surveys about perceived stress, caregiver burden, social support, quality of sleep and depressive symptoms. They also provided saliva samples to test for the stress-related hormone cortisol four times throughout the day for two days.

    Results revealed that women had high levels of perceived stress and caregiver burden and poor quality of sleep. The study also found that the burden of caring for a stroke victim increases the risk of depressive symptoms and stress. This burden can include financial strain, home confinement, changes in the relationship with the care recipient, noncompliance of the stroke survivor, demands of caring for the stroke victim and having little personal time for oneself. Those who had high symptoms of depression also had decreasing levels of cortisol during the day while women with fewer symptoms of depression had higher levels. Authors suggest that lower cortisol levels may contribute to an increased risk of depression.

    Another Loyola study published in a recent issue of the Journal of Neuroscience Nursing found that female caregivers of stroke survivors grieve the life that they once shared with the stroke survivor and struggle to cope with multiple family and work demands while trying their best to interact with health-care providers to attain the best possible care for their loved one. The study also found that health-care providers can assist caregivers in identifying their needs and referring them to appropriate resources related to assistance with care, transportation, nutrition and ongoing education.

    “This was one of the first studies to look at the unique needs of women caring for stroke survivors,” Saban said. “Recognizing the challenges of these caregivers may help health-care professionals better support these women.”


  8. Study looks at health effects of cancer caregiving – even after treatment completion

    April 16, 2012 by Sue

    From the Ohio State University press release via EurekAlert!:

    Caring for a wife with breast cancer can have a measurable negative effect on men’s health, even years after the cancer diagnosis and completion of treatment, according to recent research.

    Men who reported the highest levels of stress in relation to their wives’ cancer were at the highest risk for physical symptoms and weaker immune responses, the study showed.

    The researchers sought to determine the health effects of a recurrence of breast cancer on patients’ male caregivers, but found that how stressed the men were about the cancer had a bigger influence on their health than did the current status of their wives’ disease.

    The findings imply that clinicians caring for breast cancer patients could help their patients by considering the caregivers’ health as well, the researchers say.

    This care could include screening caregivers for stress symptoms and encouraging them to participate in stress management, relaxation or other self-care activities, said Sharla Wells-Di Gregorio, lead author of the study and assistant professor of psychiatry and psychology at Ohio State University.

    If you care for the caregiver, your patient gets better care, too,” said Kristen Carpenter, a postdoctoral researcher in psychology at Ohio State and a study co-author.

    The research is published in a recent issue of the journal Brain, Behavior and Immunity.

    Thirty-two men participated in the study, including 16 whose wives had experienced a breast cancer recurrence an average of eight months before the study began and approximately five years after the initial cancer diagnosis. These men were matched with 16 men whose wives’ cancers were similar, but who remained disease-free about six years after the initial diagnosis.

    The participants completed several questionnaires measuring levels of psychological stress related to their wives’ cancers, physical symptoms related to stress, and the degree to which fatigue interfered with their daily functioning. Researchers tested their immune function by analyzing white-blood-cell activation in response to three different types of antigens, or substances that prompt the body to produce an immune response.

    The men’s median age was 58 years and they had been married, on average, for 26 years. Almost all of the participants were white.

    In general, the men whose wives had experienced a recurrence of cancer reported higher levels of stress, greater interference from fatigue and more physical symptoms, such as headaches and abdominal pain, than did men whose wives had remained disease-free.

    The subjective stress assessment used in the study, called the Impact of Events Scale, measures intrusive experiences and thoughts, as well as attempts to avoid people and places that serve as painful reminders. The scale produces a score between 0 and 75; in this case, the higher the score, the more stressed the men were in relation to their wives’ cancer.

    Overall, the men in the study produced an average score of 17.59. Men whose wives’ cancer had recurred scored 26.25 as a group, and men whose wives were disease-free scored 8.94. According to the scale, scores above nine suggest a likely effect from the events, and scores between 26 and 43 indicate an event has had a powerful effect on a person’s stress level. Scores over 33 suggest clinically significant distress.

    “The scores reported here are quite high, substantially higher than we see in our cancer patient samples outside the first year,” Carpenter said. “Guilt, depression, fear of loss – all of those things are stressful. And this is not an acute stressor that lasts a few weeks. It’s a chronic stress that lasts for years.”

    The participants also reported, on average, a total of approximately seven stress-related physical symptoms. Men with wives with recurrent cancer reported nine symptoms, on average, and those whose wives were disease-free reported fewer than five symptoms, on average. These symptoms varied, but included headaches, gastrointestinal problems, coughing and nausea.

    When the analysis took into consideration the impact of men’s perceived stress in relation to their wives’ cancer, higher stress was associated with compromised immune function: Specifically, men with the highest scores on the stress scale also showed the lowest immune responses to two of the three antigens. Previous research has suggested that people with an impaired immune response are more susceptible to infection and might not respond well to vaccines.

    “Caregivers are called hidden patients because when they go in for appointments with their spouses, very few people ask how the caregiver is doing,” said Wells-Di Gregorio, who works in Ohio State’s Center for Palliative Care. “These men are experiencing significant distress and physical complaints, but often do not seek medical care for themselves due to their focus on their wives’ illness.”

    In these men undergoing chronic stress, the researchers said that it remains unclear whether the immune dysregulation causes more physical symptoms, or stress causes the symptoms and the impaired immune response.

    Wells-Di Gregorio noted that the stress effect might have been even more pronounced than what they observed because disease-free spouses were more reluctant to participate in the study.

    “We found that many were not willing to participate because they said they didn’t want to think about cancer again,” she said.


  9. Study looks at effect of psychiatric disorder diagnoses on patients’ support networks

    April 9, 2012 by Sue

    From the SAGE Publications press release:

    Does the growing number of psychiatric disorder diagnoses have an effect on people with mental illnesses? According to a new study, as definitions of mental illnesses become broader, people who show signs of depression and other common mental illnesses are less likely to evoke a supportive response from friends and family members as are people with other severe mental disorders. This new study was released in a recent issue of the Journal of Health and Social Behavior(published by SAGE).

    Author Brea L. Perry studied interviews conducted with 165 individuals with bipolar disorder, schizophrenia, major depression, and other less severe disorders, who were undergoing mental health treatment for the first time. She found that those with more socially-accepted and commonplace mental illnesses, such as depression and mild mood disorders, did not receive strong reactions to their conditions from family members, friends, or others with whom they came in contact. Brea stated that as a result, their support networks may be less willing to take on caregiver responsibilities or to excuse them when their behavior deviates from what is considered normal.

    Perry wrote, “Perhaps because so many people are diagnosed and subsequently treated successfully, signs of depression do not alarm friends and family members to the same degree as disorders known to severely affect functioning.”

    While commonplace mental illnesses such as depression are clearly defined by professionals as legitimate medical conditions, Perry found that the public does not always deem them as justifiable grounds for taking on a “sick” role.

    This study also found that diagnosing someone with a severe mental illness that is more outwardly recognizable such as schizophrenia and the manic phase of bipolar disorder can lead to a higher amount of rejection and discrimination by acquaintances and strangers while at the same time creating a stronger social support system among close friends and family.

    The author wrote, “Day-to-day emotional and instrumental support is likely to play a critical role in recovery from mental illness.”


  10. Study suggests neurological basis for caregiving impulse

    March 19, 2012 by Sue

    From the NIH/National Institute of Child Health and Human Development press release via ScienceDaily:

    Distinct patterns of activity — which may indicate a predisposition to care for infants– appear in the brains of adults who view an image of an infant face — even when the child is not theirs, according to a study by researchers at the National Institutes of Health and in Germany, Italy, and Japan.

    Seeing images of infant faces appeared to activate in the adult’s brains circuits that reflect preparation for movement and speech as well as feelings of reward.

    The findings raise the possibility that studying this activity will yield insights into care giving behavior, but also in cases of child neglect or abuse.

    “These adults have no children of their own. Yet images of a baby’s face triggered what we think might be a deeply embedded response to reach out and care for that child,” said senior author Marc H. Bornstein, Ph.D., head of the Child and Family Research Section of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NIH institute that collaborated on the study.

    While the researchers recorded participants’ brain activity, the participants did not speak or move. Yet their brain activity was typical of patterns preceding such actions as picking up or talking to an infant, the researchers explained. The activity pattern could represent a biological impulse that governs adults’ interactions with small children.

    From their study results, the researchers concluded that this pattern is specific to seeing human infants. The pattern did not appear when the participants looked at photos of adults or of animals — even baby animals.

    Along with Dr. Bornstein, the research was carried out by first author Andrea Caria, Ph.D., of the University of Tuebingen, in Germany; Paola Venuti of the Department of Cognitive Science of University of Trento in Italy; Gianluca Esposito of the RIKEN Brain Science Institute in Saitama, Japan; researchers from the Max Planck Institute for Biological Cybernetics and Eberhard Karls University, in Tuebingen, Germany.

    Their findings appear in the journal NeuroImage.

    To collect the data, the researchers showed seven men and nine women a series of images while recording their brain activity with a functional magnetic resonance imaging scanner. In the scanner, participants viewed images of puppy and kitten faces, full-grown dogs and cats, human infants and adults.

    When the researchers compared the areas and strength of brain activity in response to each kind of image, they found that infant images evoked more activity than any of the other images in brain areas associated with three main functions:

    • Premotor and preverbal activity — The researchers documented increased activity in the premotor cortex and the supplemental motor area, which are regions of the brain directly under the crown of the head. These regions orchestrate brain impulses preceding speech and movement but before movement takes place.
    • Facial recognition — Activity in the fusiform gyrus — on each side of the brain, about where the ears are — is associated with processing of information about faces. Activity the researchers detected in the fusiform gyrus may indicate heightened attention to the movement and expressions on an infant’s face, the researchers said.
    • Emotion and reward — Activity deep in the brain areas known as the insula and the cingulate cortex indicated emotional arousal, empathy, attachment and feelings linked to motivation and reward, the researchers said. Other studies have documented a similar pattern of activity in the brains of parents responding to their own infants.

    Participants also rated how they felt when viewing adult and infant faces. They reported feeling more willing to approach, smile at, and communicate with an infant than an adult. They also recorded feeling happier when viewing images of infants.

    Taken together, the researchers contend, the findings suggest a readiness to interact with infants that previously has been only inferred, and only from parents. Such brain activity in nonparents could indicate that the biological makeup of humans includes a mechanism to ensure that infants survive and receive the care they need to grow and develop.

    However, signs of readiness to care for a child that appear in the brains of some or even most adults do not necessarily mean the same patterns will appear in the brains of all adults, Dr. Bornstein said. “It’s equally important to investigate what’s happening in the brains of those who have neglected or abused children,” he said. “Additional studies could help us confirm and understand what appears to be a parenting instinct in adults, both when the instinct functions and when it fails to function.”