Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden.

INTRODUCTION: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time. DESIGN: Prospective longitudinal study. METHODS: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time. RESULTS: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping. CONCLUSIONS: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers. CLINICAL RELEVANCE: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.

Relación entre acontecimientos vitales estresantes y depresión posparto. Revisión sistemática y metaanálisis / Relationship between stressful life events and postpartum depression. Systematic review and meta-analysis

Introducción: La depresión posparto es una enfermedad perinatal muy frecuente en el mundo. Su etiología multifactorial ha sido ampliamente abordada. El principal objetivo de este trabajo es revisar la información existente y analizar si hay relación entre los acontecimientos vitales estresantes y la depresión posparto. Métodos: Se llevó a cabo una revisión sistemática mediante búsqueda bibliográfica en las bases de datos PubMed y CINAHL, hasta abril de 2022. Se incluyeron trabajos que analizaban la relación entre acontecimientos vitales estresantes y depresión posparto. Tras el proceso de selección y revisión, los estudios fueron sometidos a metaanálisis. El modelo de análisis utilizado fue de efectos aleatorios, y el tamaño de efecto fue expresado en odds ratio. Resultados: Solo seis estudios cumplieron los criterios de inclusión y calidad metodológica. Cuatro de los estudios presentan diseño longitudinal, y solo uno utiliza muestreo probabilístico. Los trabajos fueron desarrollados en diferentes países de Europa y Asia, donde la prevalencia de depresión posparto oscila entre el 6,4 y el 26,9 %. El resultado del metaanálisis muestra un tamaño de efecto combinado expresado por la OR de 2,794, con un IC del 95 % (2,21-3,52) y una significación estadística p <0,0001. Conclusiones: La presencia de acontecimientos vitales estresantes durante el año anterior al parto supone un factor de riesgo en un rango mínimo-moderado para la aparición de depresión posparto. Los resultados obtenidos podrían servir para desarrollar un sistema de cribado de la depresión posparto específico para mujeres que hayan experimentado acontecimientos vitales estresantes durante el año anterior al parto. (AU)

Introduction: Postpartum depression is a very common perinatal illness worldwide. Its multifactorial aetiology has been widely addressed. The main objective of this paper is to review the existing information and to analyse whether there is a relationship between stressful life events and postpartum depression. Methods: A systematic review was carried out through a literature search of PubMed and CINAHL databases until April 2022. Papers analysing the relationship between stressful life events and postpartum depression were included. After the selection and review process, the studies were subjected to meta-analysis. The analysis model used was random-effects, and the effect size was expressed as Odds Ratio. Results: Only six studies met the inclusion and methodological quality criteria. Four of the studies had a longitudinal design, and only one used probability sampling. The studies were conducted in different countries in Europe and Asia, where the prevalence of postpartum depression ranges from 6.4% to 26.9%. The result of the meta-analysis shows a pooled effect size expressed by the OR of 2.794, with a 95% CI (2.21 to 3.52) and a statistical significance < 0.0001. Conclusions: The presence of stressful life events in the year prior to childbirth is a strongly associated risk factor for the onset of postpartum depression. The results obtained could be used to develop a specific postpartum depression screening system for women who have experienced stressful life events during the year prior to childbirth. (AU)

Perceptions, Motivations, and Empowerment Strategies of Midwives in Rural and Remote Areas of Northern Morocco.

The shortage of midwives is a problem in rural and remote areas. This is mainly the consequence of job insecurity and difficult living conditions. The present study aimed to identify and analyse the perceptions and motivations of midwives in rural and remote areas of northern Morocco on the quality of their working life and the motivational factors and empowerment strategies they use to maintain and develop their work. It is a qualitative study that follows Van Manen's hermeneutic phenomenology approach. Three focus groups and in-depth interviews were conducted with 15 midwives from rural and remote areas. The results indicate that midwives in rural and remote areas have a negative perception of the quality of the work and their personal life because of the scarcity of basic resources, unfavourable working conditions, and the personal sacrifices they have to make to support themselves. However, some factors favour their efforts. Therefore, there is a need to promote intersectoral policies that focus on improving material and human resources, as well as the working and personal conditions of midwives and the factors that support and empower them.

Relationship between sense of coherence and health-related behaviours in adolescents and young adults: a systematic review.

BACKGROUND: The sense of coherence is developed through the learning process and contributes to the positioning of individuals in the health-disease continuum, facilitating successful and adaptive personal outcomes. Health-related behaviours represent a health determinant of utmost importance for public health and the development of adolescent and youth health promotion policies, as they are related to the main risk factors and problems of morbidity and mortality in our society. Previous studies have analysed the relationship between sense of coherence and only some individual health outcomes such as oral health, the relationship of sense of coherence with smoking and alcohol consumption, concluding that salutogenic factors are related to quality of life and preventive behaviours. The aim of this systematic review was to describe the relationship of sense of coherence with different health-related behaviours investigated so far in the adolescent and youth population. METHODS: A systematic review was carried out in databases (PubMed, CINAHL, Scopus and PsycInfo) and in the bibliographies of the retrieved articles, without limitation of time or language. Associations between sense of coherence and health-related behaviours have been assessed. RESULTS: A total of 1214 investigations were reviewed and 21 of them were included in this systematic review. The relationship between sense of coherence and eight health-related behaviours were identified (alcohol use, physical activity, tobacco use, eating habits, rest periods, use of illegal substances, behaviours related to oral health and time spent in games on the computer). CONCLUSIONS: Our results increase the available evidence and support the solid relationship of the sense of coherence with health behaviours both as a protective factor against risk behaviours and for its positive association with preventive and health promoting behaviours of adolescents, young adults and university students.

Validity and Reliability of the Caregiver Strain Index Scale in Women during the Puerperium in Spain.

BACKGROUND: The objective of this study is to determine the validity and reliability of the Caregiver Strain Index (CSI) for women during the postpartum period. Methods: This is a validation study of a measurement instrument. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). The items of the CSI were adapted for newborn care. Content validity was measured by five experts, calculating the index of agreement (Aiken's V). Criterion validity was assessed by correlations with scores of other tools that measure constructs related to burden (Edinburgh Postpartum Depression Scale, State-Trait Anxiety Questionnaire, SOC-13 and Duke-UNC-11). Construct validity was determined by the known-groups method. Internal consistency was measured using Cronbach's Alpha, and stability was analysed using the intraclass correlation coefficient (ICC). RESULTS: Regarding content validity, an Aiken's V of 1.00 (p = 0.032) was obtained. Regarding criterion validity, the correlation analyses showed statistically significant coefficients between the scores of the questionnaire and those of the sense of coherence (r = -0.447, p < 0.001), depressive symptoms (r = 0.429, p < 0.001), social support (rho = -0.379, p < 0.001) and anxiety symptoms (r = 0.532, p < 0.001). The known-groups method showed statistically significant differences in the mean of subjective burden between the groups (depressive symptoms, anxiety symptoms, sense of coherence and social support). The total scale obtained a Cronbach's alpha value of 0.710. The ICC was 0.979. CONCLUSIONS: The adapted CSI is a valid and reliable screening tool for the subjective burden in women during the puerperium. The adapted CSI can play an important role as a guide to detect the subjective burden in women during the puerperium.

The mediating role of sense of coherence on mental health outcomes in carers of older dependent relatives: A longitudinal study.

BACKGROUND: Sense of coherence (SOC) is an important protective factor for carer well-being but research to date remains cross-sectional, focusing primarily on the direct effects of SOC on carers' mental health. The study's aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers' psychological health, and its stability over time. METHODS: Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at 1-year follow-up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care-recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. RESULTS: SOC was significantly negatively longitudinally associated with both anxiety (ß = -0.38, p = 0.001) and depressive symptoms (ß = -0.28, p = 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety, and caregiver strain and depressive symptoms (Sobel test: p < 0.001 for anxiety and p < 0.001 for depressive symptoms). Differences between baseline and 1-year follow-up SOC scores were not statistically significant (p = 0.617). CONCLUSIONS: SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non-experimental conditions over a period of 1 year in this sample. The findings suggest that interventions aimed at strengthening SOC may protect carer psychological well-being.

Personal and Family Resources Related to Depressive and Anxiety Symptoms in Women during Puerperium.

Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: This is a quantitative research design, carried out through a descriptive, cross-sectional correlation study. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). Women were selected during the immediate postpartum period. The variables analysed were postpartum depressive symptoms (Edinburgh scale), anxiety symptoms (STAI state anxiety questionnaire), perceived social support (Duke-UNC-11), family functioning (family APGAR), self-efficacy in care (Lawton), sense of coherence (SOC-13), perceived burden (Caregiver Strain Index) and stressful life events (Holmes and Rahe). The main analysis consisted of a multiple linear regression. Results: The regression model of depressive symptoms found a positive association with perceived burden (ß = 0.230, p = 0.015) and negative associations with self-efficacy in care (ß = -0.348, p < 0.001), social support (ß = -0.161, p < 0.001) and sense of coherence (ß = -0.081, p = 0.001). The regression model of anxiety symptoms obtained a positive association with perceived burden (ß = 1.052, p < 0.001) and negative associations with self-efficacy in care (ß = -0.329, p = 0.041), social support (ß = -0.234, p = 0.001) and sense of coherence (ß = -0.262, p < 0.001). Discussion: Firstly, depressive and anxiety symptoms in the puerperium period may be more prevalent than in other periods of a woman's life. Secondly, perceived social support, self-efficacy in caring for the newborn and sense of coherence may be protective factors for depressive and anxiety symptoms in the puerperium period. Finally, perceived burden in caring for the newborn may be a risk factor for these symptoms.

Design and Validation of a Questionnaire on Communicating Bad News in Nursing: A Pilot Study.

Communicating bad news (CBN) is a fundamental skill in nursing; nevertheless, few instruments exist for its evaluation. This study presents a questionnaire designed to measure nurses' knowledge and ability of CBN, as well as the analysis of its psychometric properties. Based on a literature search, the initial dimensions of CBN were identified to construct the questionnaires' items, which were evaluated by experts for the validity of the items' contents. Construct validity and reliability of the resulting questionnaire was carried out in a sample of 71 nurses of an Andalusian university hospital. A questionnaire with 25 items was constructed with a high internal consistency (Cronbach's alpha 0.816). The content validity was evaluated via a literature review and additionally by the assessment of seven experts. The Kaiser-Meyer-Olkin test (KMO) obtained a score of 0.683, and the Bartlett test of sphericity a value of p < 0.001. The principal component analysis supported a construct of four dimensions. This questionnaire was found to be a valid and reliable instrument with a high internal consistency for the evaluation of CBN knowledge and skills of nursing professionals.

Motivos y percepciones del cuidado familiar de mayores dependientes / Motives and perceptions of family care for dependent elderly

Objetivo: Identificar y analizar los motivos que llevan a las personas a asumir el cuidado de un familiar mayor dependiente y sus percepciones de la situación de cuidado. Diseño: Estudio cualitativo fenomenológico. Emplazamiento: El estudio se ha realizado en el Distrito Sanitario Jaén-Norte, durante 2013 y 2014. Participantes: Participaron un total de 13 personas cuidadoras principales de familiares mayores dependientes con una experiencia mínima de un año en el cuidado, seleccionadas por muestreo intencional. Método: Análisis del discurso de entrevistas en profundidad considerando el contenido semántico y pragmático y las notas de campo. Se realizó triangulación en el análisis para favorecer la credibilidad del estudio. Resultados: Los motivos para cuidar a un familiar mayor dependiente son: el «familismo», las «ganancias materiales» y la «presión social». A su vez, el «familismo» aglutina 7 dimensiones/motivos: «obligación familiar», «afecto a la persona cuidada», «devolver lo recibido», «bienestar de la persona cuidada», «respeto a la decisión de la persona cuidada», «compromiso», «costumbre». Cuando el motivo principal para cuidar es la «obligación familiar», las «ganancias materiales» o la «presión social» las personas cuidadoras no manifiestan percepciones positivas por cuidar, y viceversa. Conclusión: Este estudio ha identificado que el «familismo», las «ganancias materiales» y la «presión social» son motivos por los que las personas cuidan a un familiar mayor dependiente en nuestro entorno sociocultural, así como su relación con la percepción de la situación de cuidado. Esto facilitará la identificación de las personas cuidadoras con mayor predisposición a padecer consecuencias negativas por cuidar y el desarrollo de intervenciones dirigidas a la prevención de dichas consecuencias

Objective: To identify and analyze the motives that lead people to take care of a dependent relative and their perceptions of the care situation. Design: Phenomenological qualitative study. Location: The study was conducted in the Jaén-Norte Sanitary District, during 2013 and 2014. Participants: A total of 13 primary caregivers of dependent elderly relatives with a minimum experience of one year in care participated, selected by intentional sampling. Method: Discourse analysis of 13 in-depth interviews considering the semantic and pragmatic content and field notes. Triangulation was performed in the analysis to favor the credibility of the study. Results: The motives for caring for a dependent relative are: 'Familism', 'Material gains' and 'Social pressure'. In turn, the 'Familism' include 7 dimensions/motives: 'Family obligation', 'Affection to the person taken care of', 'Return the received', 'Well-being of the person taken care of’ ,'Respect to the decision of the person taken care of', 'Agreement', 'Habit'. When the main motive to take care of is the 'Family obligation', the 'Material gains' or the 'Social pressure' caregivers do not manifest positive perceptions for caring, and vice versa. Conclusion: This study has identified that 'Familism', 'Material gains' and 'Social pressure' are reasons why people care for a dependent relative in our sociocultural environment, as well as the relationship with the perception of the care situation. This will facilitate the identification of caregivers with greater predisposition to suffer negative consequences for caring and the development of interventions aimed at the prevention of such consequences

Validez y confiabilidad de la escala de sentido de coherencia en estudiantes de grado de enfermería de una universidad española / Validity and reliability of the sense of coherence scale among nursing undergraduate students from a Spanish university

Objetivo: Analizar la estructura factorial de la escala OLQ-13 y estudiar la relación directa entre el sentido de coherencia y los estilos de vida en estudiantes de enfermería universitarios/as. Método: Estudio descriptivo transversal realizado en 384 estudiantes de los tres primeros cursos del Grado de Enfermería de la Universidad de Jaén (España). Se estudió la consistencia interna de la escala OLQ-13 con el alfa de Cronbach de cada dimensión y del total de la escala, la fiabilidad test-retest con el coeficiente de correlación intraclase (CCI) y la validez de constructo con el análisis factorial exploratorio, el análisis factorial confirmatorio y la técnica de grupos conocidos. Resultados: La consistencia interna de la escala fue de 0,809. El CCI para la fiabilidad test-retest fue de 0,91. El análisis factorial exploratorio reveló tres factores que explicaron el 50,13% de la varianza. El análisis factorial confirmatorio mostró índices de ajuste aceptables para el modelo propuesto (CFI = 0,965; RMSA = 0,041; GFI = 0,963; SRMR = 0,041). Se encontraron diferencias estadísticamente significativas de sentido de coherencia entre los subgrupos de estudiantes con estilos de vida saludables y no saludables (p<0,001). Conclusiones: El estudio confirma la multidimensionalidad de la escala OLQ-13, en la que se identifican tres factores: significación, comprensión y manejabilidad externa, y comprensión y manejabilidad interna. El OLQ-13 puede ser una escala válida y fiable para su uso en población universitaria española

Objective: To analyze the factor structure of the OLQ-13 scale and to study the direct relationship between sense of coherence and lifestyles in university students of nursing. Method: Cross-sectional study.Location: University of Jaén. Andalusia, Spain.Participants: 384 students from the first three years of the nursing degree in the University of Jaén.Main measurement: Internal consistency was studied by Cronbach's alpha, reliability test-retest was measured by intraclass coefficient correlation (ICC) and construct validity was analysed by exploratory factor analysis, confirmatory factor analysis and known-groups technique. Results: The internal consistency of the scale was adequate (Cronbach alfa = 0.809). The ICC for the reliability test-retest was 0.91. The exploratory factor analysis showed 3 factors explaining 50.13% of the variance. The confirmatory factor analysis showed f goodness-of-fit indexes for the proposed model CFI=0.965; RMSA=0.041; GFI=0.963; SRMR=0.041. Statistically significant differences in sense of coherence were found among the subgroups of students with healthy and unhealthy lifestyles (p <0.001). Conclusions: The study confirms the multidimensionality of the OLQ-13 scale, in which 3 factors were identified: external meaningful, comprehensibility and manageability, and internal comprehensibility and manageability. The OLQ-13 may be a valid and reliable scale for use in the Spanish university population

Sentido de coherencia y sobrecarga subjetiva, ansiedad y depresión en personas cuidadoras de familiares mayores / Sense of coherence and subjective overload, anxiety and depression in caregivers of elderly relatives

Objetivo: Analizar la relación entre el sentido de coherencia y la sobrecarga subjetiva, la ansiedad y la depresión en personas cuidadoras de familiares mayores dependientes. Método: Estudio transversal en una región de la provincia de Jaén (Andalucía, España). Muestra probabilística de 132 personas cuidadoras familiares de mayores dependientes. Mediciones principales: sentido de coherencia (Cuestionario de Orientación a la Vida), sobrecarga subjetiva (Índice Esfuerzo del Cuidador), ansiedad y depresión (Escala de Goldberg), carga objetiva (Escala de Dedicación al Cuidado), sexo y parentesco. Análisis principales: análisis bivariado mediante el coeficiente de correlación de Pearson y análisis multivariado mediante regresión lineal múltiple. Resultados: La mayoría de las personas cuidadoras estudiadas eran mujeres (86,4%), hija o hijo de la persona cuidada (74,2%), y compartían domicilio con esta (69,7%). Al ajustar por carga objetiva, sexo y parentesco, se encontró que el sentido de coherencia estaba relacionado de forma inversa con la sobrecarga subjetiva (ß = −0,46; p <0,001), la ansiedad (ß = −0,57; p = 0,001) y la depresión (ß = −0,66; p <0,001). Conclusiones: El sentido de coherencia podría ser un importante factor protector de la sobrecarga subjetiva, la ansiedad y la depresión en personas cuidadoras de familiares mayores dependientes

Objective: To analyze the relationship between the sense of coherence and subjective overload, anxiety and depression in caregivers of dependent elderly relatives. Method: Cross-sectional study in an area of the province of Jaén (Andalusia, Spain) with a probabilistic sample of 132 caregivers of dependent elderly. Main measures: sense of coherence (Life Orientation Questionnaire), subjective burden (Caregiver Strain Index), anxiety and depression (Goldberg Scale), objective burden (Dedication to Care Scale), sex and kinship. Main analyses: bivariate analysis using the Pearson correlation coefficient and multivariate analysis using multiple linear regression. Results: Most of the caregivers studied were women (86.4%), daughter or son of the care recipient (74.2%) and shared home with the latter (69.7%). When controlling for objective burden, sex and kinship, we found that the sense of coherence was inversely related to subjective burden (ß = −0.46; p <0.001), anxiety (ß = −0.57; p = 0.001) and depression (ß = −0.66; p <0.001). Conclusions: The sense of coherence might be an important protective factor of subjective burden, anxiety and depression in caregivers of dependent elderly relatives

Perceived Needs of The Family Caregivers of People with Dementia in a Mediterranean Setting: A Qualitative Study.

The purpose of this study was to identify, classify and analyze the perceived needs of caregivers of elderly people with dementia during the care process. A descriptive phenomenological qualitative study using seven focus groups was conducted in different primary health care centers in the province of Jaén (Spain) between July 2012 and February 2013. Eighty-two family caregivers who were caring for people with dementia in different stages of the disease were selected by purposeful maximum variation sampling. Data were analyzed and organized thematically, considering the semantic and pragmatic content and field notes. Two main categories of the perceived needs of caregivers were identified. The first was related to the management of caring for a relative with dementia, and the second was related to the management of the caregivers' own care. Our findings support the provision of comprehensive interventions for the improvement of caregivers' emotional health that encompass more than one care need. This is where psycho-educational interventions aimed at managing the various aspects of dementia and self-care in caregivers can be accommodated. In addition, proactive interventions to develop important skills to care for a relative with dementia, which are not perceived as needs by the caregivers, are needed. These include skills in family negotiation, planning and searching for resources outside the family.

[Sense of coherence and subjective overload, anxiety and depression in caregivers of elderly relatives]. / Sentido de coherencia y sobrecarga subjetiva, ansiedad y depresión en personas cuidadoras de familiares mayores.

OBJECTIVE: To analyze the relationship between the sense of coherence and subjective overload, anxiety and depression in caregivers of dependent elderly relatives. METHOD: Cross-sectional study in an area of the province of Jaén (Andalusia, Spain) with a probabilistic sample of 132 caregivers of dependent elderly. MAIN MEASURES: sense of coherence (Life Orientation Questionnaire), subjective burden (Caregiver Strain Index), anxiety and depression (Goldberg Scale), objective burden (Dedication to Care Scale), sex and kinship. Main analyses: bivariate analysis using the Pearson correlation coefficient and multivariate analysis using multiple linear regression. RESULTS: Most of the caregivers studied were women (86.4%), daughter or son of the care recipient (74.2%) and shared home with the latter (69.7%). When controlling for objective burden, sex and kinship, we found that the sense of coherence was inversely related to subjective burden (ß = -0.46; p <0.001), anxiety (ß = -0.57; p = 0.001) and depression (ß = -0.66; p <0.001). CONCLUSIONS: The sense of coherence might be an important protective factor of subjective burden, anxiety and depression in caregivers of dependent elderly relatives.

[Motives and perceptions of family care for dependent elderly]. / Motivos y percepciones del cuidado familiar de mayores dependientes.

OBJECTIVE: To identify and analyze the motives that lead people to take care of a dependent relative and their perceptions of the care situation. DESIGN: Phenomenological qualitative study. LOCATION: The study was conducted in the Jaén-Norte Sanitary District, during 2013 and 2014. PARTICIPANTS: A total of 13 primary caregivers of dependent elderly relatives with a minimum experience of one year in care participated, selected by intentional sampling. METHOD: Discourse analysis of 13 in-depth interviews considering the semantic and pragmatic content and field notes. Triangulation was performed in the analysis to favor the credibility of the study. RESULTS: The motives for caring for a dependent relative are:'Familism','Material gains' and'Social pressure'. In turn, the'Familism' include 7 dimensions/motives:'Family obligation','Affection to the person taken care of','Return the received','Well-being of the person taken care of','Respect to the decision of the person taken care of','Agreement','Habit'. When the main motive to take care of is the'Family obligation', the'Material gains' or the'Social pressure' caregivers do not manifest positive perceptions for caring, and vice versa. CONCLUSION: This study has identified that'Familism','Material gains' and'Social pressure' are reasons why people care for a dependent relative in our sociocultural environment, as well as the relationship with the perception of the care situation. This will facilitate the identification of caregivers with greater predisposition to suffer negative consequences for caring and the development of interventions aimed at the prevention of such consequences.

[Validity and reliability of the sense of coherence scale among nursing undergraduate students from a Spanish university]. / Validez y confiabilidad de la escala de sentido de coherencia en estudiantes de grado de enfermería de una universidad española.

OBJECTIVE: To analyze the factor structure of the OLQ-13 scale and to study the direct relationship between sense of coherence and lifestyles in university students of nursing. METHOD: Cross-sectional study. LOCATION: University of Jaén. Andalusia, Spain. PARTICIPANTS: 384 students from the first three years of the nursing degree in the University of Jaén. MAIN MEASUREMENT: Internal consistency was studied by Cronbach's alpha, reliability test-retest was measured by intraclass coefficient correlation (ICC) and construct validity was analysed by exploratory factor analysis, confirmatory factor analysis and known-groups technique. RESULTS: The internal consistency of the scale was adequate (Cronbach α = 0.809). The ICC for the reliability test-retest was 0.91. The exploratory factor analysis showed 3 factors explaining 50.13% of the variance. The confirmatory factor analysis showed f goodness-of-fit indexes for the proposed model CFI=0.965; RMSA=0.041; GFI=0.963; SRMR=0.041. Statistically significant differences in sense of coherence were found among the subgroups of students with healthy and unhealthy lifestyles (p <0.001). CONCLUSIONS: The study confirms the multidimensionality of the OLQ-13 scale, in which 3 factors were identified: external meaningful, comprehensibility and manageability, and internal comprehensibility and manageability. The OLQ-13 may be a valid and reliable scale for use in the Spanish university population.

The start of caring for an elderly dependent family member: a qualitative metasynthesis.

BACKGROUND: The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers' lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. METHODS: A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. RESULTS: Three categories were developed to explain the process of becoming a caregiver 'taking on the role' (life changes, uncertainty and confusion, and acceptance or resistance); 'beginning to realise' (new needs, impact, and appraisal); and 'implementing strategies' (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). CONCLUSIONS: The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.

Primeros momentos del cuidado: el proceso de convertirse en cuidador de un familiar mayor dependiente / The first moments of the carer: The process of becoming a caregiver of a dependent elderly relative

Objetivo: Describir el proceso inicial por el que pasan las personas que se convierten inminentemente en cuidadores de algún familiar mayor en situación de dependencia. Diseño: Estudio cualitativo cuyo análisis se ha regido por los principios de la teoría fundamentada. Emplazamiento: El estudio se ha realizado en los distritos sanitarios de Jaén, durante 2015 y 2016, a nivel comunitario. Participantes y/o contextos: La captación se realizó mediante los enfermeros gestores de casos de los Centros de Salud de cada distrito sanitario, los cuales localizaron participantes que cumpliesen los criterios de inclusión y los invitaban a participar en el estudio. Método: Se han llevado a cabo 11 entrevistas en profundidad a personas que llevan cuidando menos de un año a un familiar mayor con dependencia hasta la saturación de la información. Resultados: Tres fases han sido descritas durante este proceso. Una fase inicial de cambios, en los que la persona cuidadora asume nuevas actividades; una segunda fase atestada de emociones, en la que emergen necesidades y consecuencias en las personas cuidadoras; y una tercera fase donde destaca la aceptación como estrategia de afrontamiento y la incertidumbre como expectativa de futuro. Discusión: La descripción de este proceso proporciona una mejor comprensión de la experiencia de convertirse en persona cuidadora familiar, con el fin de ayudar a los profesionales de la salud a adaptar los planes de atención a esta situación inicial

Aim: Describe the initial process through which people who imminently become aregivers of a dependent elderly relative. Design: Qualitative study, for which its analysis has been directed by Grounded Theory principles. Location: This study was conducted in the Health Districts of Jaén, during 2015 and 2016 at the community level. Participants and/or contexts: The recruitment was carried out by managers of the Health Centres of each Health District, who located the participants who met the inclusion criteria and invited them to participate in the study. Method: Eleven in-depth interviews were carried out, until saturation of information, on individuals who had been caring for an older relative with dependency for less than one year. Results: Three phases have been described during this process. An initial phase of changes, in which the caregiver assumes new activities; a second phase full of emotions, in which the needs and consequences emerge in caregivers; and a third phase that emphasises acceptance as a coping strategy and uncertainty as an expectation of the future. Discussion: The description of this process provides a comprehensive understanding of the experience of becoming a family caregiver, in order to help health professionals to adapt to the plans of care for this initial situation

Social support and subjective burden in caregivers of adults and older adults: A meta-analysis.

BACKGROUND: Despite the generally accepted belief that social support improves caregiver adjustment in general and subjective burden in particular, the literature shows mixed findings, and a recent review concluded that the predictive strength of caregiver social support in determining caregiver burden is less evident, due to the conceptual diversity of this determinant. OBJECTIVE: The purpose of this review is to analyse the relationship of perceived and received social support with subjective burden among informal caregivers of an adult or older adult. METHODS: A systematic search was carried out up to September 2017 in the following databases: MEDLINE (PubMed), CINAHL, EMBASE, PsycINFO), Scopus and ISI Proceedings, and a meta-analysis was performed with the results of the selected and included studies. RESULTS: Fifty-six studies were included in the meta-analysis, which provided 46 independent comparisons for perceived support and 16 for received support. Most of these studies were cross-sectional. There was a moderate, negative association of perceived social support on subjective burden (r = -0.36; CI 95% = -0.40, -0.32) and a very small, negative association of received support on subjective burden (r = -0.05; CI 95% = -0.095, -0.001). CONCLUSIONS: 1) perceived and received support are not redundant constructs, 2) the relationships between social support and subjective burden depend on whether the social support is measured as perceived or received, 3) the relationship of perceived social support with subjective burden has a bigger effect size than that of received social support, the relation between received support and subjective burden being clinically irrelevant, 4) perceived social support may be a good predictor of subjective burden. IMPLICATIONS OF KEY FINDINGS: Our findings broadly support interventions promoting social support in caregivers to prevent or alleviate subjective burden, and specifically, to intervene on the promotion of perceived social support more than on the promotion of received social support when preventing or alleviating burden.

[The first moments of the carer: The process of becoming a caregiver of a dependent elderly relative]. / Primeros momentos del cuidado: el proceso de convertirse en cuidador de un familiar mayor dependiente.

AIM: Describe the initial process through which people who imminently become caregivers of a dependent elderly relative. DESIGN: Qualitative study, for which its analysis has been directed by Grounded Theory principles. LOCATION: This study was conducted in the Health Districts of Jaén, during 2015 and 2016 at the community level. PARTICIPANTS AND/OR CONTEXTS: The recruitment was carried out by managers of the Health Centres of each Health District, who located the participants who met the inclusion criteria and invited them to participate in the study. METHOD: Eleven in-depth interviews were carried out, until saturation of information, on individuals who had been caring for an older relative with dependency for less than one year. RESULTS: Three phases have been described during this process. An initial phase of changes, in which the caregiver assumes new activities; a second phase full of emotions, in which the needs and consequences emerge in caregivers; and a third phase that emphasises acceptance as a coping strategy and uncertainty as an expectation of the future. DISCUSSION: The description of this process provides a comprehensive understanding of the experience of becoming a family caregiver, in order to help health professionals to adapt to the plans of care for this initial situation.

Determinants of depression in primary caregivers of disabled older relatives: a path analysis.

BACKGROUND: Despite the large literature analysing factors related to depression, several factors such as caregiving obligation and the interrelationships among the different variables relating to depression have been little studied. The current study aimed to analyse the effect of caregiving obligation (beliefs regarding obligation and social pressure) on depression, and the mediating effects of perceived burden on the relationship between stressors and depression, in primary caregivers of older relatives. METHODS: Cross-sectional study design. A probabilistic sample of caregivers from Spain (N = 200) was used. The data collection was conducted in 2013 through structured interviews in the caregivers' homes. The measures included sense of obligation for caregiving, perceived burden, stressors and depression. RESULTS: Depression had a direct and positive association with perceived burden, behavioural problems, and social pressure, and it was indirectly related through perceived burden to behavioural problems, independence for the activities of daily living and beliefs of obligation. CONCLUSIONS: Our results support the multidimensional concept of obligation, suggesting the existence of both an external obligation (social pressure) and an internal obligation (beliefs of obligation); (b) our findings support the hypothesis that external obligation is related to negative caregiving consequences, while internal obligation protects from these consequences; and (c) our findings support the partial mediation of stressors on depression by perceived burden. The relevance of the research to clinical practice includes the importance of understanding the perceived obligation of caregiving related to both internal and external sources of obligation.