Background: Dementia, which affects an estimated 35 million individuals worldwide, is now recognised as a growing health and economic problem. With insufficient levels of health and welfare services in many nations, there exists a reliance on family caregivers to provide care for individuals with dementia (IWDs). However, the potential negative psychological and physical consequences of the caregiving role cannot be ignored. A growing literature base has improved the theoretical understanding of mental health difficulties (e.g. depression, burden) in caregivers. However, significant gaps in the research remain. These include understanding outcomes such as caregiver anxiety and examining the role of potentially crucial variables, such as levels of suffering and empathy. Objectives: An empirical study was conducted in order to add to the literature regarding depression and anxiety in spousal caregivers of IWDs. This research conducted exploratory analyses of the relationships between the suffering of IWDs, IWDs' depression and anxiety, caregivers' levels of empathy, caregiver satisfaction and caregiver anxiety and depression. Caregivers' anxiety and depression is considered in the context of research on co-morbidity. In addition, the levels of discrepancy between ratings of suffering, whereby caregivers frequently report IWDs to be suffering more than IWDs self-report, were also examined. A systematic review was conducted in order to evaluate the effectiveness of psychosocial interventions for anxiety in informal caregivers of IWDs. Method: For the empirical study, a cross-sectional survey methodology was employed where dyads of caregivers and IWDs completed questionnaires during face-to-face interviews. Primary variables examined were the suffering of IWDs, IWDs' levels of depression and anxiety, and caregivers' levels of empathy, satisfaction, depression and anxiety. The suffering of IWDs was rated both by the IWDs (self-reported suffering) and the caregivers (perceived suffering). Descriptive statistics and exploratory correlational analyses were used to address a number of exploratory research questions regarding the relationships between the investigated variables. For the systematic review, five scientific databases were searched for relevant randomised controlled trials (RCT). Study quality was assessed according to standardised, recommended criteria and a qualitative synthesis of the evidence, including effect sizes, is described. Results Results from the empirical study suggest high levels of clinical anxiety in the caregiver population. In the current sample, there was a high prevalence rate of anxiety (52.5%) and a lower rate of depression (15.0%). However, there were no statistically significant correlates for caregiver anxiety and depression found. Findings are discussed in the context of previous research, the demographics of the current sample and difficulties with recruitment. For the systematic review, twenty studies with substantially different methodological quality were included. Anxiety was rarely identified as the primary outcome measure. However, the evidence suggests that Cognitive Behavioural skills training and psycho-educational interventions can be effective in treating caregiver anxiety. Some preliminary evidence for interventions underpinned by Mindfulness-based strategies was also found. Conclusions: The empirical study found that a large proportion of Scottish spousal caregivers experience clinical levels of anxiety. This suggests that caregiver anxiety must be a key priority for both clinicians and researchers alike. In addition, further research examining these understudied variables and using dyadic methods remains crucial to increasing understanding into caregivers' outcomes. The systematic review demonstrated that research regarding interventions for anxiety in caregivers is growing and there is now a greater emphasis on the underlying theoretical models of delivered interventions. There is also growing evidence that interventions with clear theoretical basis may be more likely to be effective. However, both the empirical study and the systematic review highlight further questions that remain to be addressed in the literature. Further research continues to be necessary in this area to ensure that services are appropriately meeting the needs of both caregivers and IWDs.

We investigated the association of coping with quality of life (QoL) among parents of children with chronic illnesses, particularly inherited metabolic diseases (IMD); and whether coping may modify the association between caregiving complexity and parental QoL. In project 1, we systematically reviewed studies of parents of children with chronic illness. Among 10 eligible studies, we identified some evidence that adaptive coping strategies were positively associated with parental psychological QoL. In project 2, we analyzed data from a crosssectional mailed Canadian survey of parents of children <12 years of age with IMD. Among 113 respondents, greater emotion-focused coping was associated with lower mental QoL (all parents) and higher depressive symptoms (parents of children >=5 years). Analysis of significant interactions between coping and caregiving complexity did not reveal clear trends. Understanding the association of parental coping with QoL may help to inform interventions to promote parental health as part of family-centred care.

The purpose of this study is to explore the barriers Latino family caregivers of persons with Alzheimer’s may experience, and evaluate methods to increase the utilization of these services among the population. The researcher conducted face-face interviews with staff members that have observed the underutilization and provide feedback on method on reaching this particular population. The results of the interviews were transcribed to written form, and then analyzed to identify and label themes. The following four major themes emerged. These themes were: 1) culture 2) language barriers 3) fear 4) lack of knowledge of diagnosis. The potential impact of this study is to find ways to reach out to the Latino population, and provide accurate viable information and services to this particular population. This will continue to further the outreach in social work practice for the Latino population.

In early 2014, 3 West African states of Guinea, Liberia, and Sierra Leone made news headlines when Ebola virus disease (EVD) ravaged the sub-region. The Liberian government was ill-equipped to efficiently contain EVD outbreak due to inadequate training for hospitals and healthcare workers. The government's mandatory cremation policies and the banning of public gatherings significantly contributed to the spread of EVD. EVD infected 10,666 and 4,808 died from the disease in the first 6 months of the epidemic. Using Bandura's Social Cognitive Theory (SCT) as the theoretical framework, the purpose of this case study research was to examine the social, economic, and policy factors that contributed to the spread of EVD in the city of Monrovia, Liberia. Utilizing snowball sampling to identify participants, data were collected through in-depth interviews with 30 participants that included 10 EVD survivors, 10 family caregivers, 2 government officials, 4 nongovernmental organization staff, 2 academicians, and 2 members of the media. All data were inductively coded and analyzed using Braun and Clarke's thematic analysis procedure. Two key themes were identified through data analysis. First, participants noted that a better understanding of cultural traditions may have created opportunities for intervention that prevented unnecessary exposure to the virus. Second, survivors and caregivers experienced a 'hope for the best, but expect the worst' mentality throughout the experience that guided faith. The positive social change implications stemming include recommendations to the government of Monrovia to implement culturally sensitive policies related to pandemic containment, including training of healthcare workers and the public in the event of disease outbreak.

Research has shown that child abuse is a serious public health issue that may warrant child welfare agency intervention and removal of children from their homes. Placement with kin caregivers is considered the least restrictive placement option by social workers. It has been recognized that kin caregivers require some type of formal parental training to prepare them to care for relative children. A large city implemented the Caring for Our Own training program as prelicensing training to prepare relatives for roles as kin caregivers. Prior to this study, no research had assessed whether this training program adequately addressed caregivers' ability to adopt effective discipline practices in response to perceived child misbehavior. The purpose of the study was to examine how the Caring for Our Own prelicense training impacted kin caregivers' use of ineffective discipline practices, as measured by change in scores on the 3 subscales of the Parenting Scale. The theoretical framework for this study was based on Ajzen's theory of planned behavior. One-way repeated measures ANOVA revealed no statistically significant difference in kin caregivers' (n = 27) use of ineffective discipline practices as measured by the 3 subscales of the Parenting Scale over time. In light of this finding, the child welfare agency may create an evidence-based curriculum to assist in the development of competent kin caregivers. Social change to improve training and thus foster more effective responses from kin caregivers may occur within educational departments of child welfare agencies, through assessing and developing prelicensing kin caregiver training that allows for effective child behavior discipline management.

In recent years, family support partners (FSPs) have been hired to work in the behavioral health care system for the state in which this study was conducted. FSPs are legacy caregivers, meaning they have raised a child with a mental health illness. At the time of this study, there was not a set criterion in the state to measure the effectiveness or benefits of FSPs working with families. The purpose of this quantitative, correlational study was to determine whether a caregiver's level of empowerment, as measured by the Family Empowerment Scale (FES), was increased through working with an FSP. Social learning theory provided the framework for the study. Survey data were collected from 93 caregivers using the FES. Simultaneous multiple regression analysis was conducted to examine the predictive relationship between the caregiver's gender, age, ethnicity, length of time as a caregiver of a child or youth with a mental health illness, and length of time the caregiver worked with an FSP, and the level of caregiver empowerment on the family, service system, and community/political levels. On the family level, caregiver age and length of time the caregiver worked with an FSP were statistically significant predictors. On the service system level, length of time the caregiver worked with an FSP was a statistically significant predictor. On the community/political level, caregiver age, ethnicity, and length of time the caregiver worked with an FSP were statistically significant predictors. Length of time the caregiver worked with an FSP was the only variable shown to be statistically significant on all 3 levels. Findings may be used to support peer specialists in the state this study was conducted and other states, not only in the mental health field, but in additional fields as well.

Although findings from a pilot study indicate that caregivers of persons with dementia (PwD) report feeling stigmatized (Burgener, 2007; Burgener & Buckwalter, 2010), little research has been conducted on the effects of perceived stigma on fostering depressive symptoms among caregivers of PwD. The purpose of this study was to examine the relationship between perceived stigma and depressive symptoms among caregivers of PwD. The Modified Labeling Theory (MLT) developed by Link et. al. (1987; 1989) served as the organizing framework. The design of this study was a mixed methods approach including a descriptive longitudinal design with a qualitative interview. Caregivers of PwD (n=51) were interviewed regarding ethnic background, geographic location (rural and urban), knowledge of dementia, perceived stigma, depressive symptoms, and were asked to rate the extent of PwD's behavioral symptoms, while PwD (n=47) were assessed on their mental ability and disease stage. Caregivers were also asked to share their perceptions of stigma and mood change once their family members were diagnosed. Pearson product-moment correlations and a linear mixed model analysis determined the relationship between variables; for qualitative analysis, a directed approach to content analysis was applied. Findings indicated that caregivers' perceptions of stigma were significantly associated with depressive symptoms, both at baseline (r = 0.357, p = 0.0175) and over 18 months (p = 0.0045). Results also indicated that caregivers of PwD felt more depressed when they perceived additional stigma (p = 0.0019), regardless of caregiver ethnicity/race and caregivers' reactions in response to PwD memory and behavior problems. Moreover, perceived stigma minimally mediated the effect between caregivers' reactions toward the PwD's memory and behavior problems and depressive symptoms (14.4% decrease in the coefficient). Analysis of the qualitative data provided preliminary validation of the MLT and an in-depth understanding of caregivers' mood change since the diagnosis of their family member. Together our findings suggest that depressive symptoms among caregivers of PwD in response to the stresses of perceived stigma underscore the seriousness of this social problem. There is a need for effective interventions to combat caregivers' perceived stigma in order to enhance their psychological well-being.

Stroke is a major health problem in Taiwan often causing disability and dependence for elderly persons. Family caregivers shoulder major caregiving tasks while caring for their stroke survivors at home. Despite the availability of home healthcare service for family caregivers, the quality of care outcomes remain poor. According to role acquisition theory, sufficient preparation before discharge is positively related to quality of care. Caregiver education is proposed as the way to increase quality of care outcomes, yet current educational programs in Taiwan have not incorporated three fundamental learning determinants: readiness to learn, learning needs, and learning styles. The purpose of this descriptive qualitative study was to describe the experiences of Taiwanese family caregivers learning to caregiver for a stroke survivor during the first year after discharge. Participants included 16 stroke survivors cared for by 17 family caregivers and 11 foreign care attendants during at-home and in-hospital phases. Data collection included three formal interviews and one care activity observation. While still in the hospital, family caregivers took on the caregiver role. They sought out resources to learn caregiving. They learned some care skills and stated that they felt ready to go home prior to discharge. Yet, once at-home, they immediately described a sense of uncertainty -not knowing what to do in new care situations. Fifteen challenges were identified. The most common ones were diet preparation, elimination problems, transportation, breathing and sputum problems, and rehabilitation resources. Three time periods were identified as the time for readiness to learn: before discharge, the first month after discharge, and when facing new care situations. All of the family caregivers were unprepared for the new care situations before discharge because of problematic preparation and fragmented health care services. Recommendations include further studies on the three learning determinants, development of an organized and systemic discharge planning protocol, and increased in-home nursing and rehabilitation services.

Research in the area of caregiving has tended to focus on the impact of the caregiving experience itself without consideration of continued psychological distress for caregivers after institutionalisation or death. Seven caregivers of loved ones with Alzheimer's Dementia (mostly spousal) were interviewed about their experiences of caregiving and their emotional well-being after placement of their loved one into a residential care facility or death. The nature of the carers relationship with their loved one (e.g. highly dependent), lack of social supports, inactivity and a poor experience of transition into care seemed to be factors relating to poorer outcomes for these caregivers. Utilisation of social supports, involvement in pleasant events, adequate preparation and information relating to the disease and collaboratively planned transition into care played protective roles for the remaining carers who reported decreased levels of anxiety, guilt, depression and stress post-institutionalisation/death. The implications of the current research for practise, policy change and prevention are extensive and suggest that risk factors may be identifiable and thus poorer mental health outcomes in caregivers preventable. A need for greater support to be made available to caregivers is necessary.

Research has demonstrated that taking care of a patient with schizophrenia has serious mental health costs to caregivers including high levels of burden and poorer overall mental health. Research also indicates that caregivers from certain ethnic/racial groups may fare better in this process. Specifically, prior research indicates that African American and Hispanic caregivers often exhibit better mental health than their Caucasian counterparts. Using a sample of 176 caregivers of patients with schizophrenia, the present study was specifically aimed at examining whether three variables (caregiver burden, family cohesion and interdependence) may account for part of the formerly observed ethnic/racial differences in psychological outcomes. Study hypotheses pertaining to ethnicity/race and family cohesion were not supported. For the most part, minorities in this study did not demonstrate better mental health outcomes than Caucasians and family cohesion did not predict mental health outcomes. However, in line with study hypotheses, we did find that subjective burden mediated the relationship between objective burden and mental health. In other words, subjective appraisals of caregiving appear to partially underlie the association between concrete costs of caregiving and psychological outcomes in schizophrenia caregivers. Also as expected, we found that interdependence moderated the relationship between objective burden and subjective burden. This finding suggests that helping caregivers to value harmony and connection with others over individual self-interests may reduce the likelihood that objective stressors (which are often inevitable in schizophrenia) will result in subjective distress.