A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress.

Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety and depression as a result. We theorized that stress management adapted for allo-HSCT caregivers would reduce distress compared with treatment as usual (TAU). Of 267 consecutive caregivers of allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (i=74) or TAU (n=74). Eight one-on-one stress management sessions delivered across the 100-day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post transplant (mean=20.0, 95% confidence interval (95% CI)=17.9-22.0) compared with TAU (mean=23.0, 95% CI=21.0-25.0) with an effect size (ES) of 0.39 (P=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66, respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in allo-HSCT caregivers.

Challenges to bonnet monkey (Macaca radiata) social groups: Mother-infant dyad and infant social interactions.

The mother-infant dyad is crucial to early development in a variety of species. The complexity of social groupings in nonhuman primates makes this relationship resilient as well as susceptible to early challenges associated with environmental chaos. Quantitative behavior observations of bonnet monkey mother-infant interactions were collected from 28 mother-infant dyads between one and twelve months of age. Social groups were subjected to several prenatal and/or postnatal housing relocations within a single year resulting in two study groups. One group experienced relocations (ATYPICAL, n = 14) and the second group (TYPICAL, n = 14) was conceived and reared in the same location. Behaviors in the ethogram included mother-infant interactions and infant social interactions with other members of the group. Observations between ages of two to four months were analyzed by a mixed model analysis of variance including fixed effects of per and postnatal history (TYPICAL, ATYPICAL), age, and history by age interaction and random effects of mother and infant nested within mother. A significant effect of relocation history was noted on a number of infant behaviors. ATYPICAL infants were out of direct contact with their mother at an earlier age but remained in her proximity. Control of proximity shifted to offsrping in the ATYPICAL group compared to the TYPICAL group. Furthermore, greater social interactions between two and four months of age with other members of the social group as well as the ir mother were observed in the ATYPICAL group. It is suggested that continuous challenge associated with relocation may affect the infant at later developmental ages due to these early differences in ways that are yet unclear.