Avoidant coping partially mediates the relationship between patient problem behaviors and depressive symptoms in spousal Alzheimer caregivers

OBJECTIVE: Caring for a loved one with Alzheimer disease is a highly stressful experience that is associated with significant depressive symptoms. Previous studies indicate a positive association between problem behaviors in patients with Alzheimer disease (e.g., repeating questions, restlessness, and agitation) and depressive symptoms in their caregivers. Moreover, the extant literature indicates a robust negative relationship between escape-avoidance coping (i.e., avoiding people, wishing the situation would go away) and psychiatric well-being. The purpose of this study was to test a mediational model of the associations between patient problem behaviors, escape-avoidance coping, and depressive symptoms in Alzheimer caregivers. METHODS: Ninety-five spousal caregivers (mean age: 72 years) completed measures assessing their loved ones' frequency of problem behaviors, escape-avoidance coping, and depressive symptoms. A mediational model was tested to determine if escape-avoidant coping partially mediated the relationship between patient problem behaviors and caregiver depressive symptoms. RESULTS: Patient problem behaviors were positively associated with escape-avoidance coping (beta = 0.38, p < 0.01) and depressive symptoms (beta = 0.26, p < 0.05). Escape-avoidance coping was positively associated with depressive symptoms (beta = 0.33, p < 0.01). In a final regression analysis, the impact of problem behaviors on depressive symptoms was less after controlling for escape-avoidance coping. Sobel's test confirmed that escape-avoidance coping significantly mediated the relationship between problem behaviors and depressive symptoms (z = 2.07, p < 0.05). CONCLUSION: Escape-avoidance coping partially mediates the association between patient problem behaviors and depressive symptoms among elderly caregivers of spouses with dementia. This finding provides a specific target for psychosocial interventions for caregivers.

Patients benefit--partners suffer? The impact of heart transplantation on the partner relationship

Terminal heart disease affects not only the patient, but also members of the patient's family, and especially the spouse. The aim of this prospective study of 26 couples was to collect information about the impact of heart transplantation on the partner relationship. Data were collected from patients and spouses when the patients were placed on the waiting list for transplantation, 1 year postoperatively, and 5 years postoperatively. The Family Assessment Measure (FAM III), a self-report instrument that provides quantitative indices of family functioning on seven interacting dimensions, was used. In the course of the transplant process, both patients and spouses reported a significant deterioration in the partner relationship in general. While patients perceived only one clear-cut point of conflict communication about emotions - as crucial, the spouses reported a significant worsening in role performance, communication, emotional involvement, and values and norms. These changes were discernible 1 year after transplantation and persisted for at least 5 years. We conclude that heart transplantation has a significant negative impact on the partner relationship 1-5 years after transplantation. Consequently, more attention should be paid to all aspects of the partner relationship in a holistic approach to the treatment of heart transplant recipients and their partners.

Effects of gender and dementia severity on Alzheimer's disease caregivers' sleep and biomarkers of coagulation and inflammation

BACKGROUND: Being a caregiver for a spouse with Alzheimer's disease is associated with increased risk for cardiovascular illness, particularly for males. This study examined the effects of caregiver gender and severity of the spouse's dementia on sleep, coagulation, and inflammation in the caregiver. METHODS: Eighty-one male and female spousal caregivers and 41 non-caregivers participated (mean age of all participants 70.2 years). Full-night polysomnography (PSG) was recorded in each participants home. Severity of the Alzheimer's disease patient's dementia was determined by the Clinical Dementia Rating (CDR) scale. The Role Overload scale was completed as an assessment of caregiving stress. Blood was drawn to assess circulating levels of D-dimer and Interleukin-6 (IL-6). RESULTS: Male caregivers who were caring for a spouse with moderate to severe dementia spent significantly more time awake after sleep onset than female caregivers caring for spouses with moderate to severe dementia (p=.011), who spent a similar amount of time awake after sleep onset to caregivers of low dementia spouses and to non-caregivers. Similarly, male caregivers caring for spouses with worse dementia had significantly higher circulating levels of D-dimer (p=.034) than females caring for spouses with worse dementia. In multiple regression analysis (adjusted R(2)=.270, p<.001), elevated D-dimer levels were predicted by a combination of the CDR rating of the patient (p=.047) as well as greater time awake after sleep onset (p=.046). DISCUSSION: The findings suggest that males caring for spouses with more severe dementia experience more disturbed sleep and have greater coagulation, the latter being associated with the disturbed sleep. These findings may provide insight into why male caregivers of spouses with Alzheimer's disease are at increased risk for illness, particularly cardiovascular disease.

Higher emotional distress in female partners of cancer patients: prevalence and patient-partner interdependencies in a 3-year cohort

OBJECTIVE: Assessment and treatment of psychological distress in cancer patients was recognized as a major challenge. The role of spouses, caregivers, and significant others became of salient importance not only because of their supportive functions but also in respect to their own burden. The purpose of this study was to assess the amount of distress in a mixed sample of cancer patients and their partners and to explore the dyadic interdependence. METHODS: An initial sample of 154 dyads was recruited, and distress questionnaires (Hospital Anxiety and Depression Scale, Symptom Checklist 9-Item Short Version and 12-Item Short Form Health Survey) were assessed over four time points. Linear mixed models and actor-partner interdependence models were applied. RESULTS: A significant proportion of patients and their partners (up to 40%) reported high levels of anxiety, depression, psychological distress, and low quality of life over the course of the investigation. Mixed model analyses revealed that higher risks for clinical relevant anxiety and depression in couples exist for female patients and especially for female partners. Although psychological strain decreased over time, the risk for elevated distress in female partners remained. Modeling patient-partner interdependence over time stratified by patients' gender revealed specific effects: a moderate correlation between distress in patients and partners, and a transmission of distress from male patients to their female partners. CONCLUSIONS: Our findings provide empirical support for gender-specific transmission of distress in dyads coping with cancer. This should be considered as an important starting point for planning systemic psycho-oncological interventions and conceptualizing further research.

Cohort and Gender Differences in Psychosocial Adjustment to Later-Life Widowhood

Objectives. Despite the large body of literature on bereavement, little is known about the impact of sociohistorical context on individual reactions to spousal loss. This study examines the effect of marital status, time period and gender on physical and mental health, and whether reported difficulties following spousal loss differ at 2 distinctive time periods. Method. Two cohorts of older bereaved persons (n = 753) in Switzerland, surveyed in 1979 and 2011, were compared regarding their reports of difficulties related to marital loss. The bereaved spouses were also compared with a group of married contemporaries (n = 1,517) regarding subjective health and depressive symptoms. Results. Marital status and gender each have independent effects on subjective health and depressive symptoms. The effects of widowhood on subjective health differed significantly at both time points. Widowed individuals in 2011, especially women, reported fewer social and financial difficulties than their counterparts in 1979. However, the effect of widowhood on depressive symptoms and psychological difficulties did not differ significantly across time points. Discussion. Social changes in the late 20th century may be protective for older adults’ physical, social, and financial well-being in the face of spousal loss, yet these changes do not alleviate widow(er)s’ psychological distress.

Why does placement of persons with Alzheimer's disease into long-term care improve caregivers' well-being? Examination of psychological mediators.

Caregiving for individuals with Alzheimer's disease is associated with chronic stress and elevated symptoms of depression. Placement of the care receiver (CR) into a long-term care setting may be associated with improved caregiver well-being; however, the psychological mechanisms underlying this relationship are unclear. This study evaluated whether decreases in activity restriction and increases in personal mastery mediated placement-related reductions in caregiver depressive symptoms. In a 5-year longitudinal study of 126 spousal Alzheimer's disease caregivers, we used multilevel models to evaluate placement-related changes in depressive symptoms (short form of the Center for Epidemiologic Studies Depression scale), activity restriction (Activity Restriction Scale), and personal mastery (Pearlin Mastery Scale) in 44 caregivers who placed their spouses into long-term care relative to caregivers who never placed their CRs. The Monte Carlo method for assessing mediation was used to evaluate the significance of the indirect effect of activity restriction and personal mastery on postplacement changes in depressive symptoms. Placement of the CR was associated with significant reductions in depressive symptoms and activity restriction and was also associated with increased personal mastery. Lower activity restriction and higher personal mastery were associated with reduced depressive symptoms. Furthermore, both variables significantly mediated the effect of placement on depressive symptoms. Placement-related reductions in activity restriction and increases in personal mastery are important psychological factors that help explain postplacement reductions in depressive symptoms. The implications for clinical care provided to caregivers are discussed.

Widows may have fewer social and financial problems than in the past (Interview von Shereen Lehman mit Prof. Pasqualina Perrig-Chiello zu finanziellen und sozialen Problemen von Verwitweten)

(Reuters Health) – - A new Swiss study says that widows and widowers still mourn their spouses as much as ever, but compared to 35 years ago, everyday life is easier, especially for women. Widows, at least in Switzerland, have fewer financial troubles and more social connections than their counterparts in 1979, but widowers still complain of loneliness, researchers found.

Human Capital and Interethnic Marriage Decisions

Despite a longstanding belief that education importantly affects the process of immigrant assimilation, little is known about the relative importance of different mechanisms linking these two processes. This paper explores this issue through an examination of the effects of human capital on one dimension of assimilation, immigrant intermarriage. I argue that there are three primary mechanisms through which human capital affects the probability of intermarriage. First, human capital may make immigrants better able to adapt to the native culture thereby making it easier to share a household with a native. Second, it may raise the likelihood that immigrants leave ethnic enclaves, thereby decreasing the opportunity to meet potential spouses of the same ethnicity. Finally, assortative matching on education in the marriage market suggests that immigrants may be willing to trade similarities in ethnicity for similarities in education when evaluating potential spouses. Using a simple spouse-search model, I first derive an identification strategy for differentiating the cultural adaptability effect from the assortative matching effect, and then I obtain empirical estimates of their relative importance while controlling for the enclave effect. Using U.S. Census data, I find that assortative matching on education is the most important avenue through which human capital affects the probability of intermarriage. Further support for the model is provided by deriving and testing some of its additional implications.

Familial component of epilepsy in cleft lip and palate

It is well recognized that offspring of women with epilepsy who are taking anticonvulsant medications have an increased incidence of clefting abnormalities. This increase has been attributed to the teratogenic effects of anticonvulsant medications but an alternative explanation involving a genetic association of epilepsy and clefting has also been proposed. Five family studies attempting to resolve this controversy have been inconclusive either because of study design or analytic limitations. This family study was designed to determine whether epilepsy aggregates in families ascertained by an individual with a clefting disorder. The Mayo Clinic medical linkage registry was used to identify individuals with cleft lip with or without cleft palate and cleft palate in southeast Minnesota from 1935-1986. Only those cases who were 15 years or younger during this period were included in the study. The proband's parents and descendants of their parents, including the proband's sibs, children, grandchildren, niece/nephews, grandnieces/nephews, halfsibs and spouses were also identified and all of their medical records were reviewed for seizure disorders. The standardized morbidity ratios for epilepsy of 0.9 (95% CI 0.2-2.6) observed for first degree relatives (excluding parents) and 0.0 for second degree relatives were not increased. The SMRs ranged from 0.7-2.2 for the individual relative types (parents 1.5, sibs 0.7, children 2.2, probands 1.1, spouses 2.0) and were also not increased. These results do not support the suggestions of some that clefting and epilepsy aggregate together in families. ^

Attitudes About Predictive MEN1 Genetic Testing in Minors

Multiple Endocrine Neoplasia type 1 (MEN1) is a hereditary cancer syndrome characterized by tumors of the endocrine system. Tumors most commonly develop in the parathyroid glands, pituitary gland, and the gastro-entero pancreatic tract. MEN1 is a highly penetrant condition and age of onset is variable. Most patients are diagnosed in early adulthood; however, rare cases of MEN1 present in early childhood. Expert consensus opinion is that predictive genetic testing should be offered at age 5 years, however there are no evidence-based studies that clearly establish that predictive genetic testing at this age would be beneficial since most symptoms do not present until later in life. This study was designed to explore attitudes about the most appropriate age for predictive genetic testing from individuals at risk of having a child with MEN1. Participants who had an MEN1 mutation were invited to complete a survey and were asked to invite their spouses to participate as well. The survey included several validated measures designed to assess participants’ attitudes about predictive testing in minors. Fifty-eight affected participants and twenty-two spouses/partners completed the survey. Most participants felt that MEN1 genetic testing was appropriate in healthy minors. Younger age and increased knowledge of MEN1 genetics and inheritance predicted genetic testing at a younger age. Additionally, participants who saw more positive than negative general outcomes from genetic testing were more likely to favor genetic testing at younger ages. Overall, participants felt genetic testing should be offered at a younger age than most adult onset conditions and most felt the appropriate time for testing was when a child could understand and participate in the testing process. Psychological concerns seemed to be the primary focus of participants who favored later ages for genetic testing, while medical benefits were more commonly cited for younger age. This exploratory study has implications for counseling patients whose children are at risk of developing MEN1 and illustrates issues that are important to patients and their spouses when considering testing in children.

Harris County Medical Society, Woman's Auxiliary Year Book 1926-1927

Partnering with the Texas Medical Association Alliance "to improve the health of all Texans," the Harris County Medical Society (HCMS) Alliance was organized in 1919 as the HCMS Woman’s Auxiliary. Current membership consists of the spouses of physicians, as well as physicians, in Harris County. http://hcmsa.org/ accessed 11/20/2012 This booklet lists the members of the Auxiliary, officers, programs for September, 1926 – May, 1927, and the organization’s constitution and by-laws. Booklet is 7 1/8 x 4 ½ inches and contains 18 pages.

Knowledge and Expectations of Support People in Prenatal Genetic Counseling Sessions

Prenatal genetic counseling patients have the ability to choose from a myriad of screening and diagnostic testing options, each with intricacies and caveats regarding accuracy and timing. Decisions regarding such testing can be difficult and are often made on the same day that testing is performed. Therefore, it is reasonable to consider that the support people brought to an appointment may have a role in the decision-making process. We aimed to better define this potential role by examining the incoming knowledge and expectations of support people who attended prenatal genetic counseling appointments. Support people were asked to complete a survey at one of seven Houston area prenatal clinics. The survey included questions regarding demographics, relationship to patient, incoming knowledge of the appointment, expectations of decision-making and perceived levels of influence over the decisions that would be made during the counseling session. The majority (79.4%) of the 252 participants were spouses/partners. Overall, there was poor knowledge of the referral indications with only 33.5% of participants correctly identifying the patient’s indication. Participants had even poorer knowledge of testing options that would be offered during the session, as only 17.7% were able to correctly identify testing options that would be discussed during the genetic counseling session. Of participants, just 3.6% said that they did not want to be included in discussions about screening/testing options. Only a few participants thought that they had less influence over decisions related to the pregnancy than over non-pregnancy decisions. Participants who reported feeling like they had a higher level of influence were likely to attend more of the pregnancy-related appointments with the patient. Findings from this study have provided insight into the perspective of support persons and have identified gaps in knowledge that may exist between the patients and the people they choose to bring with them into the genetic counseling session. In addition, this study is a starting point to assess how much the support people think that they impact the decision-making process of prenatal genetic counseling patients versus how much the prenatal patients value the input of the support people.

Intersecciones : Política social e inserción laboral : Un estudio de caso sobre la informalidad de subsistencia en un barrio del Conurbano Bonaerense

La política social y el mercado de trabajo son dimensiones del sistema social mutuamente implicadas en las sociedades industriales capitalistas. Sin embargo, una interpretación apresurada sobre el mundo social podría opacar los procesos que hacen que en un grupo de la población se yuxtapongan: una inserción laboral precaria dentro del mercado de trabajo informal junto con la (re) construcción de ese grupo como sujeto-objeto de políticas sociales. El artículo tiene por propósito problematizar las representaciones dominantes sobre el trabajo y su relación con las prácticas de organización de los hogares, considerando que en su interior la dimensión laboral se articula con otros recursos (provenientes de las políticas sociales). De modo más específico, el objetivo se orienta a la descripción y análisis de prácticas y representaciones sobre la situaci162n ocupacional de jefas/es y cónyuges que realizan actividades laborales en la informalidad de subsistencia. Se plantea como hipótesis exploratoria que en el período actual las condiciones de trabajo y representaciones de los trabajadores ocupados en ese tipo de actividades expresarían la existencia de un tipo de informalidad fuertemente segregada respecto de las actividades productivas, un en un contexto de crecimiento del empleo. También se sostiene que las formas bajo las cuales estas inserciones laborales se articulan con los planes sociales (como un nivel específico de política social) evidenciarían el carácter de la contribución estatal a la reproducción de las condiciones de vida de los trabajadores insertos en este tipo de informalidad. Los hallazgos presentados constituyen un avance de investigación sobre la reproducción de la marginalidad urbana en el Conurbano Bonaerense. Parte del trabajo de campo se realizó durante el año 2008, en un barrio del Partido de Almirante Brown. Se organizaron dos grupos de discusión: uno con mujeres perceptoras de planes y otro con hombres que realizaban changas como actividad principal. Con el objeto de aportar datos acerca de las condiciones materiales de los hogares, se aplicó un cuestionario a los participantes. Junto con esta información, se analizaron registros de campo tomados en observaciones realizadas en diversos espacios del barrio

Intersecciones : Política social e inserción laboral : Un estudio de caso sobre la informalidad de subsistencia en un barrio del Conurbano Bonaerense

La política social y el mercado de trabajo son dimensiones del sistema social mutuamente implicadas en las sociedades industriales capitalistas. Sin embargo, una interpretación apresurada sobre el mundo social podría opacar los procesos que hacen que en un grupo de la población se yuxtapongan: una inserción laboral precaria dentro del mercado de trabajo informal junto con la (re) construcción de ese grupo como sujeto-objeto de políticas sociales. El artículo tiene por propósito problematizar las representaciones dominantes sobre el trabajo y su relación con las prácticas de organización de los hogares, considerando que en su interior la dimensión laboral se articula con otros recursos (provenientes de las políticas sociales). De modo más específico, el objetivo se orienta a la descripción y análisis de prácticas y representaciones sobre la situaci162n ocupacional de jefas/es y cónyuges que realizan actividades laborales en la informalidad de subsistencia. Se plantea como hipótesis exploratoria que en el período actual las condiciones de trabajo y representaciones de los trabajadores ocupados en ese tipo de actividades expresarían la existencia de un tipo de informalidad fuertemente segregada respecto de las actividades productivas, un en un contexto de crecimiento del empleo. También se sostiene que las formas bajo las cuales estas inserciones laborales se articulan con los planes sociales (como un nivel específico de política social) evidenciarían el carácter de la contribución estatal a la reproducción de las condiciones de vida de los trabajadores insertos en este tipo de informalidad. Los hallazgos presentados constituyen un avance de investigación sobre la reproducción de la marginalidad urbana en el Conurbano Bonaerense. Parte del trabajo de campo se realizó durante el año 2008, en un barrio del Partido de Almirante Brown. Se organizaron dos grupos de discusión: uno con mujeres perceptoras de planes y otro con hombres que realizaban changas como actividad principal. Con el objeto de aportar datos acerca de las condiciones materiales de los hogares, se aplicó un cuestionario a los participantes. Junto con esta información, se analizaron registros de campo tomados en observaciones realizadas en diversos espacios del barrio

Intersecciones : Política social e inserción laboral : Un estudio de caso sobre la informalidad de subsistencia en un barrio del Conurbano Bonaerense

La política social y el mercado de trabajo son dimensiones del sistema social mutuamente implicadas en las sociedades industriales capitalistas. Sin embargo, una interpretación apresurada sobre el mundo social podría opacar los procesos que hacen que en un grupo de la población se yuxtapongan: una inserción laboral precaria dentro del mercado de trabajo informal junto con la (re) construcción de ese grupo como sujeto-objeto de políticas sociales. El artículo tiene por propósito problematizar las representaciones dominantes sobre el trabajo y su relación con las prácticas de organización de los hogares, considerando que en su interior la dimensión laboral se articula con otros recursos (provenientes de las políticas sociales). De modo más específico, el objetivo se orienta a la descripción y análisis de prácticas y representaciones sobre la situaci162n ocupacional de jefas/es y cónyuges que realizan actividades laborales en la informalidad de subsistencia. Se plantea como hipótesis exploratoria que en el período actual las condiciones de trabajo y representaciones de los trabajadores ocupados en ese tipo de actividades expresarían la existencia de un tipo de informalidad fuertemente segregada respecto de las actividades productivas, un en un contexto de crecimiento del empleo. También se sostiene que las formas bajo las cuales estas inserciones laborales se articulan con los planes sociales (como un nivel específico de política social) evidenciarían el carácter de la contribución estatal a la reproducción de las condiciones de vida de los trabajadores insertos en este tipo de informalidad. Los hallazgos presentados constituyen un avance de investigación sobre la reproducción de la marginalidad urbana en el Conurbano Bonaerense. Parte del trabajo de campo se realizó durante el año 2008, en un barrio del Partido de Almirante Brown. Se organizaron dos grupos de discusión: uno con mujeres perceptoras de planes y otro con hombres que realizaban changas como actividad principal. Con el objeto de aportar datos acerca de las condiciones materiales de los hogares, se aplicó un cuestionario a los participantes. Junto con esta información, se analizaron registros de campo tomados en observaciones realizadas en diversos espacios del barrio