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      The impact of coping strategies of cancer caregivers on psychophysiological outcomes: an integrative review

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          Abstract

          Purpose

          A growing number of studies have explored the psychosocial burden experienced by cancer caregivers, but less attention has been given to the psychophysiological impact of caregiving and the impact of caregivers’ coping strategies on this association. This paper reviews existing research on the processes underlying distress experienced by cancer caregivers, with a specific focus on the role of coping strategies on psychophysiological correlates of burden.

          Methods

          A broad literature search was conducted in health-related databases namely MEDLINE, Science Citations Index Expanded, Scopus, and PsycINFO, using relevant search terms. All types of studies published in English were considered for inclusion.

          Results

          We found that cancer caregiving was related to increased blood pressure, dysregulation of autonomic nervous system, hypothalamic–pituitary–axis dysregulation, immune changes, and poor health-related behaviors. We also found that problem-focused coping was associated with decreased caregiver burden, decreased depression, and better adjustment, while emotion-focused coping was related to higher levels of posttraumatic growth and psychological distress. The way coping impacts psychophysiological correlates of burden, however, remains unexplored.

          Conclusion

          A better understanding of the psychophysiological elements of caregiver burden is needed. We propose a model that attends specifically to factors that may impact psychophysiological correlates of burden among cancer caregivers. Based on the proposed model, psychosocial interventions that specifically target caregivers’ coping and emotion regulation skills, family functioning, and self-care are endemic to the preservation of the health and well-being of this vulnerable population.

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          Most cited references69

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          Caregiving as a risk factor for mortality: the Caregiver Health Effects Study.

          There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality. To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline. Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up. Four US communities. A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses. Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported. After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls. Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.
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            How stress influences the immune response.

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              Health psychology: what is an unhealthy environment and how does it get under the skin?

              This review explores the role of environments in creating chronic and acute health disorders. A general framework for studying the nesting of social environments and the multiple pathways by which environmental factors may adversely affect health is offered. Treating socioeconomic status (SES) and race as contextual factors, we examine characteristics of the environments of community, work, family, and peer interaction for predictors of positive and adverse health outcomes across the lifespan. We consider chronic stress/allostatic load, mental distress, coping skills and resources, and health habits and behaviors as classes of mechanisms that address how unhealthy environments get "under the skin," to create health disorders. Across multiple environments, unhealthy environments are those that threaten safety, that undermine the creation of social ties, and that are conflictual, abusive, or violent. A healthy environment, in contrast, provides safety, opportunities for social integration, and the ability to predict and/or control aspects of that environment.
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                Author and article information

                Journal
                Psychol Res Behav Manag
                Psychol Res Behav Manag
                Psychology Research and Behavior Management
                Psychology Research and Behavior Management
                Dove Medical Press
                1179-1578
                2018
                24 May 2018
                : 11
                : 207-215
                Affiliations
                [1 ]Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
                [2 ]Clínica daOrdem, Porto, Portugal
                [3 ]CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, Gandra, Portugal
                [4 ]MamaHelp, Breast Cancer Support Center, Porto, Portugal
                [5 ]Memorial Sloan Kettering Cancer Center, New York, NY, USA
                [6 ]Department of Psychology, Gargi College, University of Delhi, New Delhi, India
                [7 ]Departamento de Psicologia, Centro de Investigação em Psicologia (CIP-UAL), Universidade Autónoma de Lisboa Luís de Camões, Lisboa, Portugal
                Author notes
                Correspondence: Ricardo João Teixeira, Department of Education and Psychology, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal, Tel +351 23 437 0353, Email ricardojft@ 123456gmail.com
                Article
                prbm-11-207
                10.2147/PRBM.S164946
                5973462
                29872357
                68a709cc-7717-4e34-b8b1-c452069ed7f4
                © 2018 Teixeira et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. 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
                Review

                Clinical Psychology & Psychiatry
                cancer,caregiver,burden,coping,psychophysiology
                Clinical Psychology & Psychiatry
                cancer, caregiver, burden, coping, psychophysiology

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