The Impact of Risk and Resistance Factors on Quality of Life in Caregivers of Individuals with Dementia.

OBJECTIVES: The present study investigates the effect of caregiver and care recipient risk and resistance factors on caregiver quality of life (QOL). Risk factors are those characteristics that contribute to psychosocial maladjustment of the caregiver and reduce QOL, while resistance factors promote caregiver adjustment and improve QOL. METHODS: One-hundred and three caregiver/care recipient dyads were recruited from a memory assessment clinic in Midwestern United States. Caregivers completed questionnaires estimating perceived social support, spirituality, social problem-solving, and care recipient functional dependence. Care recipients' results from the Mini-Mental State Examination and Animal Naming task were also collected. RESULTS: In the final model, caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence each accounted for a significant portion of variance in caregiver QOL. The final model accounted for 46.1% of the variance in caregiver QOL. CONCLUSION: Caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence are important contributors to caregiver QOL. Further research is needed to specify which caregiver and care recipient characteristics are most important to caregiver QOL. CLINICAL IMPLICATIONS: Health professionals should assess caregiver problem-solving skills, social support, and care recipient functional dependence, as these may provide important information about caregiver QOL. Study results also suggest that caregiving has more of a negative impact on caregiver QOL for midlife adult caregivers compared to older adult caregivers, and appears to have a greater negative effect on spouses than on children.

Psychometric validation of the Clubhouse climate questionnaire as an autonomy support measure for people with severe mental illness.

BACKGROUND: Self-determination represents a paradigm shift from "shoulds" to "decisions and behaviors" as the best options for helping people with mental illness achieving recovery goals. Autonomy support plays an important role in self-determination. AIMS: The purpose of this study was to validate the Clubhouse climate questionnaire (CCQ) as an autonomy support measure. METHOD: One hundred and twenty-four participants were recruited from eight Clubhouse programs in Hawaii. Measurement structure of the CCQ was evaluated using exploratory and confirmatory factor analysis. FINDINGS: CCQ is a unidimensional scale with good reliability and acceptable levels of divergent and convergent validity. CONCLUSIONS: CCQ is a brief, reliable and valid instrument for assessing autonomy support and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Consumer perspectives on physical activity interventions within assertive community treatment programs.

OBJECTIVE: The purpose of this study was to identify strategies for encouraging greater levels of physical activity among community-dwelling individuals living with serious mental illness participating in assertive community treatment (ACT). METHOD: Eighteen individuals living with serious mental illness participated in focus group interviews. Participants were recruited from an ACT provider located in the Midwestern United States. A semistructured interview protocol was developed specifically for this study. Participants responded to a series of questions on ACT physical activity programming, providing (a) information about their personal experiences with physical activity-related interventions and (b) suggestions for intervention strategies that may enhance physical activity participation in this population. Consensual qualitative research conventions, a qualitative methodology used in social sciences, were followed for organizing, coding, quantifying, and interpreting participant responses. RESULTS: Several unique themes emerged from the data. Participants identified a variety of strategies used by their ACT provider to encourage physical activity, such as group physical activities and incentive programs. A number of recommendations related to skills training, intervention characteristics, and motivational strategies were identified by the participants as well. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Physical activity is an important part of successful treatment for individuals with serious mental illness. In this study, participants identified a variety of strategies that may be useful for incorporating within the ACT treatment paradigm. Participant responses were frequently consistent with the tenets of popular health behavior theory (e.g., self-determination theory). Future research should focus on the efficacy of the recommended intervention strategies and their implementation within ACT treatment settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain.

OBJECTIVE: To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. METHOD: Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. RESULTS: Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation. (PsycINFO Database Record

Towards an integration of the health promotion models of self-determination theory and theory of planned behavior among people with chronic pain.

PURPOSE: People with chronic pain and related disability often report motivational difficulties with engaging in health-promoting behaviors. Although health promotion models of self-determination theory (SDT) and theory of planned behavior (TPB) have been shown to explain the motivational processes behind health behaviors in the general population, there is limited theoretical research among persons with chronic pain. This study examined the integration of such theories relevant to physical activity and exercise behavior among pain populations. RESEARCH METHOD: Secondary data analyses were conducted using cross-sectional surveys from 198 participants with chronic musculoskeletal pain recruited from U.S. clinics and community networks. The primary outcome was self-reported physical activity and exercise participation. Predictor variables included pain intensity, functional disability, and SDT and TPB measures. Hierarchical regression analysis was conducted to examine the associations between these variables. RESULTS: Findings demonstrated that in the first step, functional disability was associated with physical activity and exercise; and in the second step, all SDT factors were associated with physical activity and exercise. In the final step of the model, only certain SDT and TPB factors were associated with physical activity and exercise. CONCLUSIONS: Despite preexisting pain and functional disability, the findings suggest that health behavior factors from both SDT and TPB are associated with physical activity and exercise participation. This line of research should encourage rehabilitation professionals to recommend regular physical activity and exercise, while simultaneously addressing and monitoring the SDT and TPB factors that are well-timed and appropriate for persons with chronic pain through motivation-oriented rehabilitation approaches. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Work-related social skills: Definitions and interventions in public vocational rehabilitation.

OBJECTIVE: Social skills play an important role in employment. This study provides a qualitative analysis of salient work related social skills and interventions for addressing social skills in public vocational rehabilitation (VR). RESEARCH DESIGN: A modified consensual qualitative research (CQR) approach was taken to understand the elements and influence of work related social skills in public VR. Thirty-five counselors, supervisors, and administrators participated in semistructured interviews to provide their perspectives of work related social skills and the interventions they use for addressing these skills. RESULTS: Multiple aspects of work-related social skills were described as being important for VR consumer success. The most common work related social skills across all participants were nonverbal communication and the ability to connect with others. Primary social interventions included informal social skills training (SST), systems collaboration, and creating an appropriate job match. CONCLUSIONS: Public rehabilitation agency staff, constantly faced with addressing work related social skills, possess many insights about salient skills and interventions that can benefit future research and practice. Agencies currently address social skills deficits by providing interventions to both person and environment. The research provides directions for future research related to identification of social skills and interventions to address related deficits.