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      Neuropsychiatric Disease and Treatment (submit here)

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      Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease

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          Abstract

          Background

          Alzheimer’s disease (AD) causes considerable distress in caregivers who are continuously required to deal with requests from patients. Coping strategies play a fundamental role in modulating the psychologic impact of the disease, although their role is still debated. The present study aims to evaluate the burden and anxiety experienced by caregivers, the effectiveness of adopted coping strategies, and their relationships with burden and anxiety.

          Methods

          Eighty-six caregivers received the Caregiver Burden Inventory (CBI) and the State-Trait Anxiety Inventory (STAI Y-1 and Y-2). The coping strategies were assessed by means of the Coping Inventory for Stressful Situations (CISS), according to the model proposed by Endler and Parker in 1990.

          Results

          The CBI scores (overall and single sections) were extremely high and correlated with dementia severity. Women, as well as older caregivers, showed higher scores. The trait anxiety (STAI-Y-2) correlated with the CBI overall score. The CISS showed that caregivers mainly adopted task-focused strategies. Women mainly adopted emotion-focused strategies and this style was related to a higher level of distress.

          Conclusion

          AD is associated with high distress among caregivers. The burden strongly correlates with dementia severity and is higher in women and in elderly subjects. Chronic anxiety affects caregivers who mainly rely on emotion-oriented coping strategies. The findings suggest providing support to families of patients with AD through tailored strategies aimed to reshape the dysfunctional coping styles.

          Most cited references37

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          Stress, Appraisal, and Coping

          <p><b>The reissue of a classic work, now with a foreword by Daniel Goleman!</b><p>Here is a monumental work that continues in the tradition pioneered by co-author Richard Lazarus in his classic book <i>Psychological Stress and the Coping Process</i>. Dr. Lazarus and his collaborator, Dr. Susan Folkman, present here a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping which have become major themes of theory and investigation.</p> <p>As an integrative theoretical analysis, this volume pulls together two decades of research and thought on issues in behavioral medicine, emotion, stress management, treatment, and life span development. A selective review of the most pertinent literature is included in each chapter. The total reference listing for the book extends to 60 pages.</p> <p>This work is necessarily multidisciplinary, reflecting the many dimensions of stress-related problems and their situation within a complex social context. While the emphasis is on psychological aspects of stress, the book is oriented towards professionals in various disciplines, as well as advanced students and educated laypersons. The intended audience ranges from psychiatrists, clinical psychologists, nurses, and social workers to sociologists, anthropologists, medical researchers, and physiologists.</p>
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            If it changes it must be a process: study of emotion and coping during three stages of a college examination.

            This natural experiment provides substantial evidence for the following major themes, which are based on a cognitively oriented, process-centered theory of stress and coping: First, a stressful encounter should be viewed as a dynamic, unfolding process, not as a static, unitary event. Emotion and coping (including the use of social support) were assessed at three stages of a midterm examination: the anticipation stage before the exam, the waiting stage after the exam and before grades were announced, and after grades were posted. For the group as a whole there were significant changes in emotions and coping (including the use of social support) across the three stages. Second, people experience seemingly contradictory emotions and states of mind during every stage of an encounter. In this study, for example, subjects experienced both threat emotions and challege emotions. The complexity of emotions and their cognitive appraisals reflects ambiguity regarding the multifaceted nature of the exam and its meanings, especially during the anticipation stage. Third, coping is a complex process. On the average, subjects used combinations of most of the available forms of problem-focused coping and emotion-focused coping at every stage of the exam. Different forms of coping were salient during the anticipation and waiting stages. Problem-focused coping and emphasizing the positive were more prominent during the former, and distancing more prominent during the latter. Finally, despite normatively shared emotional reactions at each stage, substantial individual differences remained. Using selected appraisal and coping variables, and taking grade point averages (GPA) into account, approximately 48% of the variances in threat and challenge emotions at the anticipation stage was explained. Controlling for variance due to the grade received, appraisal, and coping variables accounted for 28% of the variance in positive and negative emotions at the outcome stage. Including grade, 57% of the variance in positive emotions at outcome and 61% of the negative emotions at outcome were explained.
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              Positive aspects of caregiving: rounding out the caregiver experience.

              To identify positive aspects of caregiving and examine how they are associated with caregiver outcomes. This study used a national sample of caregivers derived from the Canadian Study of Health and Aging (part 2). Two hundred and eighty-nine caregivers caring for seniors living in the community were questioned about their experience of caregiving. Caregivers were asked whether they could identify any positive aspects related to their role, the type of positive aspects and to rate their feelings about caring. Using a conceptual model developed by Noonan and Tennstedt (1997), a staged stepwise multiple regression approach was used factoring the background/contextual variables, stressor variables (3 MS score, ADL limitations), mediator variables (positive aspects of caregiving, number of services used) and outcome variables (depression, burden and self-assessed health measures) into the model. Two hundred and eleven caregivers (73%) could identify at least one specific positive aspect of caregiving. An additional 20 (6.9%) could identify more than one positive aspect. Positive feelings about caring were associated with lower CES-D scores ( p<0.001), lower burden scores ( p<0.001) and better self assessed health ( p<0.001). Clinicians should inquire about the positive aspects of caregiving if they are to fully comprehend the caregiver experience and identify risk factors for negative caregiver outcomes. Copyright 2002 John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                1176-6328
                1178-2021
                2014
                29 July 2014
                : 10
                : 1407-1413
                Affiliations
                [1 ]Neurological and Stroke Unit, CTO Hospital, Naples, Italy
                [2 ]Italian Association on Alzheimer’s Disease (AIMA), Naples, Italy
                [3 ]Memory Clinic, Neurological Unit, AORN Cardarelli Hospital, Naples, Italy
                [4 ]Clinical Research, Telemedicine and Telepharmacy Centre, University of Camerino, Camerino, Italy
                [5 ]Department of Psychology, Second University of Naples, Caserta, Italy
                Author notes
                Correspondence: Antonio Rosario Ziello, Unità Valutativa Alzheimer e Malattie Involutive Cerebrali, Azienda Ospedaliera Rilievo Nazionale A Cardarelli, Via Antonio Cardarelli 9, 80131 Napoli, Italy, Tel +39 339 338 2280, Fax +39 081 747 2503, Email antonioziello@ 123456libero.it
                Article
                ndt-10-1407
                10.2147/NDT.S58063
                4122550
                25114532
                127297c4-eb1a-43cf-bec4-238964f6e28e
                © 2014 Iavarone et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Neurology
                alzheimer’s disease,distress,caregiver burden,stress,coping strategies
                Neurology
                alzheimer’s disease, distress, caregiver burden, stress, coping strategies

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