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Background: Depressive symptoms in Arab women with breast cancer (AWBC) in Saudi Arabia can be influenced by spirituality, religiosity, social support, and breast cancer's stigma. Understanding the role of these factors can raise awareness and help create policies to improve care for breast cancer patients. Yet, there is limited research addressing the impact of these factors on depressive symptoms in AWBC., Objective: The aim of this study was to investigate factors influencing depressive symptoms in AWBC in Saudi Arabia., Methods: A cross-sectional design and convenience sampling were used to recruit 59 AWBC from oncology departments in Jeddah, Saudi Arabia, who were receiving active treatment to participate in this study. Participants completed an online survey or paper-based survey including questions on sociodemographics, social support, spirituality, religiosity, depressive symptoms, and breast cancer's stigma. Pearson correlation and multiple regression analysis were used to examine the influence of numerous factors on depressive symptoms in AWBC; Student t test statistic was used to distinguish the depressive symptom scores between online and paper-based survey., Results: The average age of participants was 49 years (SD = 8.31). The mean (SD) of depressive symptoms was 20.52 (12.36). Pearson correlation analyses indicated that cancer patients with high levels of depressive symptoms were associated with low levels of spiritualty and religiosity, and high levels of breast cancer stigma., Conclusions: Religiosity and spirituality work as protective factors against depressive symptoms in AWBC., Implications for Practice: Including religiosity and spirituality in the intervention plan should be considered when caring for AWBC., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Purpose: Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads., Methods: We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling., Results: A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older ( M =70.8, SD=11.9) than their caregivers ( M =52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological ( B =0.56, P <0.01) and environmental ( B =0.58, P <0.01) QOL at baseline and social QOL over time ( B =0.24, P <0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical ( B =0.25, P <0.01) and environmental ( B =0.18, P <0.05) QOL over time., Conclusions: Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.

Background: Little is known about the protective effect of spirituality on the association between known risk factors such as depression and quality of life (QOL) in stroke survivor-care partner dyads. Therefore, the aim of this study was to evaluate the moderating role of spirituality on the association between depressive symptomatology and QOL in stroke survivor-care partner dyads., Methods and Results: Longitudinal design with 223 stroke survivor-care partner dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivors' and care partners' depression, quality of life, and spirituality. Examining the moderating role of spirituality on the association between depressive symptoms and QOL within survivor-care partner dyads, we used a traditional Actor-Partner-Interdependence Model and a basic Actor-Partner-Interdependence Model moderation model for a mixed variable. Survivors (51% male) and care partners (66% female) were 70.7 and 52.3 years old, respectively. The survivor's spirituality significantly moderated the association between care partner depressive symptomatology and survivor psychological QOL (B=0.03, P <0.05) and moderated the association between care partner depressive symptoms and care partner physical (B=0.05, P <0.001) and psychological (B=0.04, P <0.001) QOL. The care partner's own level of spirituality was significantly positively associated with their physical QOL (B=0.28, P <0.001)., Conclusions: The findings from this study have broad implications for the role of spirituality in relation to QOL in medical-health contexts and the importance of examining such concepts within a dyadic framework. Greater awareness of the importance of spirituality among clinicians and nurses may improve cultural competence in healthcare services.

Objectives: The life-threatening context of heart failure (HF), high variability of the illness and complexity of care place considerable demands on both the adult patient and his/her spouse. The current study examines the role of congruent engagement in HF management behaviors on the depressive symptoms of the couple living with HF., Method: A cross-sectional design was used to examine 60 couples living with HF. Multilevel modeling was used to examine partner and within-dyad effects of engagement in HF behaviors on depressive symptoms., Results: Just over one quarter (27%) of couples had both members experiencing at least mild depressive symptoms. Controlling for stage of HF and one's own level of engagement, one's partner's level of engagement was significantly associated with one's level of depressive symptoms; higher levels of engagement by one's partner were associated with lower levels of depressive symptoms. Additionally, spouses had lower levels of depressive symptoms when they had similar levels of engagement to their partner with HF; spouses had higher levels of depressive symptoms when they had higher levels of engagement than their partner with HF., Conclusion: Findings confirm the importance of screening both members of the couple for depression and fostering collaboration within the couple.

Background: Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device., Objective: The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation., Methods: This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes., Results: Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers., Conclusions: This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.

Objective: To investigate the association between health ambiguity and depressive symptoms among stroke survivors and whether survivor gender moderates this association., Design: Cross-sectional survey study., Setting: General community., Participants: Survivors of first stroke (N=36) recruited through provider referral, support groups, and print and Web-based sources., Interventions: Not applicable., Main Outcome Measures: Depressive symptoms as measured by the Patient Health Questionnaire-9., Results: Health ambiguity (β=.984, P<.001), gender (β=1.010, P<.01), and the interaction of the 2 variables (β=-1.269, P<.05) were significantly associated with depressive symptoms. Simple slopes tests indicated that the association between health ambiguity and depressive symptoms was stronger for male versus female survivors., Conclusions: Gender and health ambiguity impact survivor depressive symptoms, independently and in conjunction with one another. Results are promising, and further research with larger samples and more comprehensive statistical models is needed to confirm these findings., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Research on depression following stroke has traditionally been oriented toward understanding the experiences of individual survivors or their spousal caregivers outside of the context of their committed relationship. Moving toward a dyadic orientation to the problem of poststroke depression, in which the stroke survivor-spouse dyad is viewed as the primary unit of analysis, will open the door to new lines of inquiry and may eventually lead to more effective treatments for survivors and their spouses. The first half of this article discusses the rationale for moving poststroke depression research toward a more dyadic perspective and highlights current efforts in this area. The second half of this article discusses some methodological challenges associated with dyadic data and the practical benefits of one statistical methodology, multilevel modeling, for examining depression in survivor-stroke dyads.

Mutuality is a protective factor in family care situations, but little is known about changes in care-dyad mutuality. In this study, we examined mutuality in 103 care dyads over 20 months, and the enduring and contextual impact of older adult and family caregiver health on changes in mutuality. Care dyads consisted of frail older adults and their family caregiver. Older adults reported higher levels of mutuality than family caregivers, but their mutuality declined significantly faster over time. Although changes in physical health were more important than mean health for both older adults and family caregivers, mean depression was more important than changes in depression for older adults. This study shows the importance of examining time-varying covariates in the care dyad.

Aims To examine the moderating role of caregiver preparedness on the association between stroke survivors' depression and stroke-specific quality of life dimensions. Methods and results We used a multilevel modelling approach to analyse trajectories of change in the eight Stroke Impact Scale 3.0 subscales [i.e. strength, communication, mobility, activities of daily living (ADL)/instrumental activities of daily living (IADL), memory, emotion, hand function, participation] using Hierarchical Linear Modeling. Caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor communication (B = −0.95, P < 0.01), mobility (B = −0.60, P < 0.05), and ADL/IADL (B = −0.73, P < 0.01) at baseline; linear change for strength (B = 0.83, P < 0.05) and communication (B = 0.66, P < 0.05); and quadratic change for strength (B = −0.19, P < 0.01). Although caregiver preparedness did not significantly moderate the association between survivor depressive symptoms and strength at baseline, there was a significant moderating effect for change over time. Higher levels of caregiver preparedness were significantly associated with higher survivor scores of emotion, hand function, and participation at baseline. Conclusions Including immediate caregivers in the care process, through a psycho-educational training, would mean having better-prepared caregivers and consequently more-healthy stroke survivors. Given that preparedness includes coping with stress, responding and managing emergencies, assessing help and information may require tailored interventions aimed at improving the caregivers' skills and knowledge about stroke survivors' management. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine associations between level of depressive symptoms in older adult spouse/partner couples and their physical health and social factors (social activity and number of close friends). Methods: Using data from 116 community-dwelling couples (age 76.2 ± 8.5), we simultaneously analyzed associations between depressive symptoms (Geriatric Depression Scale, range 0-11) and dyadic physical health, engagement in social activities, and connectedness with close friends. Results: Greater engagement in social activities was associated with fewer depressive symptoms inmen, whereasmore close friendships were associated with fewer depressive symptoms in women, controlling for partner effects, age, education, and cognitive function, with goodmodel fit. Additionally, more disparate physical health within the couple (latent incongruence score) was associated with greater depressive symptoms in men. Discussion: Less social activity and fewer close friends were associated with depressive symptoms in older adult couples, but may be distinctly influential depending on gender and in the context of the older adult couple's physical health. [ABSTRACT FROM AUTHOR]

Objective: Cancer researchers have found midlife couples to have poorer outcomes compared to older couples due to the off-time nature of the illness for them. It is unknown if young couples (aged 18–39), who are under-represented in cancer studies and overlooked for supportive programs, are at further risk. This study explored the moderating roles of survivor age and sex on the associations between active engagement and protective buffering and depressive symptoms in couples surviving cancer. Methods: The exploratory study comprised 49 couples (aged 27–58) 1–3 years post-diagnosis. Multilevel modeling was used to explore the moderating roles of survivor age and sex, controlling for interdependent data. Results: Approximately, 37% of survivors and 27% of partners met clinical criteria for further assessment of depression, with 50% of couples having at least one member meeting the criteria. Survivors and their partners did not significantly differ on depressive symptoms, active engagement, or protective buffering. Male survivors reported significantly higher levels of active engagement by their partners than female survivors and female survivors reported significantly higher levels of protective buffering by their partners than male survivors. We found some evidence to suggest that survivor age and sex may play moderating roles between active engagement and protective buffering and depressive symptoms. Older partners and female survivors appeared to experience more positive effects from engaging in positive dyadic behaviors than younger partners and male survivors. Conclusion: Findings not only confirm the important role of dyadic behaviors for couples surviving cancer together, but also the important roles of survivor age and sex may play in whether such behaviors are associated with lower levels of depressive symptoms. Future research that examines these complex associations over time and across the adult life span in diverse populations is needed. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground and Purpose:The impact of dementia-related stressors and strains have been examined for their potential to threaten the well-being of either the person with dementia or the family care partner, but rarely have studies considered the dyadic nature of well-being in dementia. The purpose of this study was to examine the dyadic effects of multiple dimensions of strain on the well-being of dementia care dyads.Methods: Using multilevel modeling to account for the inter-relatedness of individual well-being within dementia care dyads, we examined cross-sectional responses collected from 42 dyads comprised of a hospitalized patient diagnosed with a primary progressive dementia (PWD) and their family care partner (CP). Both PWDs and CPs self-reported on their own well-being using measures of quality of life (QOL-Alzheimer's Disease scale) and depressive symptoms (Center for Epidemiological Studies Depression Scale).Results: In adjusted models, the PWD's well-being (higher QOL and lower depressive symptoms) was associated with significantly less strain in the dyad's relationship. The CP's well-being was associated with significantly less care-related strain and (for QOL scale) less relationship strain.Conclusions: Understanding the impact of dementia on the well-being of PWDs or CPs may require an assessment of both members of the dementia care dyad in order to gain a complete picture of how dementia-related stressors and strains impact individual well-being. These results underscore the need to assess and manage dementia-related strain as a multi-dimensional construct that may include strain related to the progression of the disease, strain from providing care, and strain on the dyad's relationship quality. [ABSTRACT FROM AUTHOR]

Background: Both heart failure symptoms and self-care are associated with patient outcomes. Although it is thought that symptoms drive self-care, there is limited evidence to support this assumption over time. Aims: To determine whether patterns of physical symptoms are significantly associated with heart failure self-care over time. Method: Latent mixture analysis was used to identify subgroups based on physical symptoms of dyspnea, sleepiness and edema (using the heart failure somatic perception and Epworth sleepiness scales). Growth modeling was used to determine if symptom subgroups were associated with self-care behaviors (using the self-care in heart failure index) over 6 months. Sociodemographic and clinical variables predicting the likelihood of subgroup membership were identified using logistic regression. Results: The sample (n=146) was on average 57 years old, 70% were men and 59% had class III/IV heart failure. Two symptom subgroups were identified (entropy 0.91): a high symptom group (n=24; 16%) with no significant change in symptoms over time (high sustained), and a low symptom group (n=122; 84%) with no significant change in symptoms over time (low sustained). The high sustained group was associated significantly with better self-care behaviors at baseline and over 6 months. Women (odds ratio (OR) 3.67, P=0.023) and patients with more depressive symptoms (OR 1.16, P=0.015) were more likely to be in the high sustained symptom group. Those treated with a renin–angiotensin–aldosterone system agent were less likely to be in the high symptom group (OR 0.17, P=0.015). Conclusion: Patients bothered more by symptoms are consistently more engaged in self-care behaviors over time. The results of this study support symptoms as an important driver of self-care behaviors. [ABSTRACT FROM AUTHOR]

Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms. Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling. The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child–Turcotte–Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P <.05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P <.001). Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population. [ABSTRACT FROM AUTHOR]

Objectives:This pilot study investigated stroke survivors’ and caregiving spouses’ individual perspectives on survivor cognitive and physical functioning and the extent to which incongruence between partners’ perceptions affects spouse depressive symptoms and overall mental health. Method:Mixed-methods, with quantitative survey data from 35 couples and qualitative interview data from a subsample of 13 couples being collected and analyzed using pairedt-tests, multiple regression with survivor–spouse discrepancy scores as predictors of spouse depressive symptoms, and interpretive-description techniques. Results:Quantitative data indicated that spouses rated survivor cognitive functioning as significantly worse than survivors rated their own and that survivor–spouse discrepancy scores for physical functioning were significantly associated with spouse depressive symptoms. Qualitative data enhanced understanding about the nuances of partner incongruence and the ramifications of partner incongruence for spouse mental health. Conclusion:Partner incongruence has an impact on spouse depressive symptoms and overall mental health. Interventions targeted at survivor–spouse dyads and focused on improving communication between partners about survivor abilities may be effective for improving the mental health of spousal caregivers. [ABSTRACT FROM PUBLISHER]

Depression is the most common psychological challenge faced by many individuals and families following stroke. Fortunately, poststroke depression is treatable, and even preventable, if social work and other rehabilitation practitioners understand the most common risk factors and become familiar with measures for assessing for depression among patients with medical comorbidities such as stroke. The purpose of this article is to raise awareness among readers about the strong potential for depression following stroke and to provide an overview of common assessment measures. On the basis of increasing numbers of patients being cared for by informal caregivers following discharge from inpatient care facilities, growing evidence of the interconnectedness of couples' emotional well-being and the significance of couples-level factors like relationship quality and coping in the well-being of couples experiencing stroke, and current needs for effective interventions for poststroke depression, a secondary purpose of this article is to describe the importance of assessing and treating survivors in the context of their committed relationships. [ABSTRACT FROM AUTHOR]

Abstract Objectives To identify the distinct quality of life (QOL) trajectories among stroke survivors, and to evaluate the associations with their caregivers' burden, anxiety, and depression. Design This was a longitudinal dyadic study. Settings Stroke survivors and their informal caregivers were enrolled upon discharge from several rehabilitation hospitals, and they were followed during this multisite longitudinal study. Participants The stroke survivors (N=405, mean age=70.7y) included older adult men (52.0%), most of whom (80.9%) had had ischemic strokes. The caregivers (n=244, mean age=52.7y) included mostly women (65.2%), most of whom were the survivors' children (50.0%) or spouses (36.1%). Interventions Not applicable. Main Outcome Measures Latent growth mixture modeling was used to identify the distinct QOL trajectories among the stroke survivors over the course of 12 months of recovery. The longitudinal associations between the stroke survivor QOL trajectories and the caregivers' burden, anxiety, and depression were evaluated. A multinomial regression was then used to identify the predictors of the various survivor QOL trajectories. Results Three distinct survivor QOL trajectories were identified: high and slightly improving QOL, moderate and slightly worsening QOL, and markedly improving QOL. The caregivers' burden, anxiety, and depression mirrored the survivors' QOL trajectories. In the multinomial models, an older survivor age, hemorrhagic stroke, lower education, and coexisting chronic obstructive pulmonary disease or thyroid disease were significantly associated with a moderate and slightly worsening QOL trajectory. Women and blindness were associated with a markedly improving QOL survivor trajectory. Conclusions A survivor's QOL trajectory after a stroke was associated with their caregiver's burden, anxiety, and depression. Those survivors belonging to the moderate and slightly worsening QOL trajectory and their caregivers, in particular, need special care, because they are at risk for the worst outcomes. [ABSTRACT FROM AUTHOR]