Early caregiving and adult depression: good news for young caregivers.

PURPOSE: Limited information is available on the effects of caregiving experiences on the adult development of caregivers under 21 years old in the United States. The current study provided an examination of the effects of youthful caregiving on the mental health of these persons when adults. DESIGN AND METHODS: Twelve individuals, 23 to 58 years old, were given brief phone interviews with semistructured questions, and then they completed questionnaires on their early caregiving experiences and current mental health. To be included, respondents must have provided primary caregiving assistance (i.e., bathing, dressing, feeding, etc.) for at least one parent when the caregiver was under 21 years old. RESULTS: The findings showed that individuals were young caregivers for parents with a number of problems, ranging from dementia to drug abuse. Individuals reported more positive mental health than negative mental health, and only two individuals had scores indicative of clinical depressive symptoms. IMPLICATIONS: It appears that early caregiving experiences may not result in universally negative consequences in the adulthood of young caregivers.

Does type of disease matter? Gender differences among Alzheimer's and Parkinson's disease spouse caregivers.

PURPOSE OF STUDY: Mental health outcomes are widely reported among spouse caregivers, with wives generally faring worse than husbands. We hypothesized that gender differences would not be as strong in a cognitively intact group because caring for cognitively intact spouses may involve less severe reciprocity losses. We also examined gender differences in coping strategies within each group. DESIGN AND METHOD: 175 spouse caregivers for patients with Alzheimer's disease (AD; n = 88) and Parkinson's disease (PD; n = 87) were interviewed. Participants completed perceived stress (PSS), depression (CES-D), state anxiety (STAI, Form Y), and coping strategies (WCCL-R) measures. RESULTS: Wives in the AD group reported significantly worse mental health outcomes than husbands, while wives and husbands in the PD group showed no differences. AD caregiving wives were less likely than husbands to use problem-focused coping strategies. There were no significant gender differences in either group for social support or emotion-focused coping. IMPLICATIONS: Loss of reciprocity in marital relationships may affect women more negatively than men. Future studies that address underlying mechanisms of gender differences and focus on similar caregiving situations and contexts deserve attention.

Judgments about estrogen replacement therapy: the role of age, cognitive abilities, and beliefs.

This study investigated age, cognitive abilities, health beliefs, and other factors in women's judgments about effective treatments for menopause. Women (N = 102) ranging in age from 20 to 79 read a vignette about a woman facing a decision about Estrogen Replacement Therapy (ERT) and then made judgments about what should be done. Participants also completed a battery of questions pertaining to ERT and cognitive abilities. Path-analytic techniques were used to determine the role of specific cognitive abilities and the representation of menopause and its treatment in making judgments about ERT treatments. Cognitive abilities had direct effects on treatment decisions. Education affected the number of perceived options for treatment. Age and education indirectly affected treatment decisions, operating through cognitive abilities. Factors related to the mental representation of menopause had no direct effects and few indirect effects on treatment decisions. Potential mechanisms that can help older adults compensate for declines in cognitive abilities in medical decisions are discussed.

Do cognitive processes predict mental health in individuals with rheumatoid arthritis?

The purpose of the present study was to assess the hypothesis that intellectual functioning affects the mental health of individuals with rheumatoid arthritis. Structural equation modeling techniques were used to assess the relative contributions of age, education, intellectual functioning, self-efficacy, and pain to mental health. It was hypothesized that individuals with rheumatoid arthritis who had higher intellectual functioning and higher self-efficacy would report better mental health than those with lower intellectual functioning and self-efficacy. One hundred twenty-one adults aged 34 to 84 with rheumatoid arthritis completed a battery of cognitive tasks, and multiple measures of self-efficacy, pain, and mental health, twice in 1 month. The data provided a good fit to the hypothesized model. Intellectual functioning was directly related to mental health and, also, indirectly related to mental health through self-efficacy and pain. Older individuals who performed poorly on cognitive tasks reported less self-efficacy, more pain, and poorer mental health than those individuals who performed well on cognitive tasks.

Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups.

The purpose of this study were to examine the influence of personality on mental and physical health of spouse caregivers and to determine whether there were differences in such influences depending on disease context. The disease contexts compared were Alzheimer's disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both chronic, degenerative diseases of later life. It was predicted that personality would be related to mental and physical health, directly and indirectly, and that AD caregivers would have higher levels of perceived stress and worse mental and physical health outcomes. Participants in the study were 175 caregivers (88 AD; 87 PD) living at home with their ill spouses. The data provided an excellent fit to the hypothesized model of the relationships between personality, disease group, social support, perceived stress, and mental and physical health. Seventy-eight percent of the variance in mental health was accounted for and 35% of the variance in physical health was explained. Personality had significant direct and indirect effects on mental health and significant indirect effects on physical health. As predicted, AD caregivers had significantly worse mental health than PD caregivers; however, AD caregivers had better physical health than PD caregivers, controlling for other variables in the model. These results are discussed in relation to the existing caregiving and behavioral medicine literature. Future research should include different domains of personality--states and longer term self-regulatory processes in addition to traits--to advance models of caregiving processes further.

Structure and variation of mood in individuals with Parkinson's disease: a dynamic factor analysis.

Mood structure was examined among individuals diagnosed with Parkinson's disease. Twelve individuals completed a measure of positive and negative affect for 70 consecutive days. Mood structure was determined by using dynamic factor analysis (DFA) models that account for both concurrent and lagged relationships in repeated measurements. Five individuals had sufficient variability in positive and negative affect to conduct DFA on both sets of variables. Results showed the presence of 2 2-factor 1-lag models, 2 1-factor 1-lag models, and a P-technique model. There was sufficient variability in positive affect to conduct DFA on positive affect for the entire sample. Two individuals displayed 2-factor 1-lag models, 6 individuals had 1-factor 1-lag models, and 4 individuals showed P-technique models. Implications of lagged relationships are discussed from substantive and methodological perspectives.

Individual differences in the perception of optimism and disease severity: a study among individuals with Parkinson's disease.

The extent to which individuals with Parkinson's disease (PD) show lability in optimism was explored in the present study. The relationship between optimism and perceived disease severity was examined as well. Twelve individuals diagnosed with PD completed self-report measures for 70 consecutive days. All individuals in this study showed lability in optimism over short time periods; however, 67% of the sample showed no pervasive negative changes in optimism over time. Increased levels of optimism on one day were predictive of decreased perceived disease severity the next day for one-fourth of the sample, after controlling for negative affect. Individual differences in the relationship between optimism and disease severity provided support for the idea that living with chronic illness has no monolithic meaning. More optimistic individuals reported less need for assistance with basic functional abilities than less optimistic individuals. The usefulness of lability in optimism among individuals with PD is discussed.

Stability and change in optimism: a study among spouse caregivers.

The extent to which caregivers (N = 30) for spouses with probable Alzheimer's disease show lability in optimism was explored. The relationship between caregivers' level of state optimism and level of affect was examined as well. The caregivers completed a measure of optimism and affect every day for 30 consecutive days. They showed variability in optimism over time, and their state optimism could be differentiated from their affect. In addition, we found individual differences in lead-lag relationships between optimism and affect over time. The results section clearly shows that most individuals did not show lead-lag relationships. These findings are integrated into the literature on caregiving.

Mental and physical health of spouse caregivers: the role of personality.

Although personal resources of caregivers, such as coping skills and social support, have been shown to be important in understanding caregiver stress and health outcomes, personality traits have not previously been considered. The purpose of this study was to examine the association between the personality traits of neuroticism and dispositional optimism and mental and physical health outcomes. It was predicted that personality would have direct effects, and indirect effects through perceived stress, on health outcomes. Participants were spouse caregivers of patients diagnosed with Alzheimer's disease. Results showed that neuroticism and optimism were significantly related to mental and physical health. Furthermore, neuroticism had significant direct effects on all of the health outcomes, and substantial indirect effects, through perceived stress, on mental health outcomes. Optimism showed stronger indirect than direct effects on all health outcomes. These findings demonstrate the importance of including personality of the caregiver in theoretical and empirical models of the caregiving process.