Family Strain Questionnaire - Short Form for nurses and general practitioners.

AIM: Our paper presents an instrument for recognising the psychological problems of caregivers: the short form of a previously validated questionnaire, the Family Strain Questionnaire. BACKGROUND: Individuals caring for chronic patients frequently suffer from psychological problems, which are underestimated by medical professionals and, consequently, are not adequately treated. Therefore, clinical nurses, general practitioners and the members of home care teams have to recognise the psychological problems of caregivers. To do so, they need to quickly measure the problem's severity quickly and track it over time, without a specific training in psychological diagnosis. DESIGN: Survey. METHOD: Principal caregivers (n = 811) completed the Family Strain Questionnaire in its original form (semi-structured interview plus 44 dichotomous items, administrable in about 20 minutes), aimed at investigating the subjective perception of emotional burden, problems in social involvement, the need for more information about the disease, satisfaction with family relationships and thoughts about death. Data were analysed using the Rasch model for the reduction of items. Thirty items were selected and reanalysed in a new sample of 40 caregivers. RESULTS: The thirty items selected showed very good fit statistics and maintained the diagnostic qualities of the original form. They thus compose the Family Strain Questionnaire - Short Form that caregivers can complete in about five minutes. This brief measure can indicate the severity of stress and allows categorisation of caregivers by psychological risk, which is also represented by a graphic tool. CONCLUSION: This study confirms that the Family Strain Questionnaire - Short Form offers an initial measure of caregivers' psychological status, regardless of the patient's disease and allows professionals to monitor it over time with a rapid and effective instrument. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses, general practitioners and homecare teams should find the Family Strain Questionnaire - Short Form useful for assessing caregiving strain. The instrument is quick and easy to use and does not require any sophisticated psychological training.

[Organizational well-being in public health. Climate survey in a Piedmont public health organization]. / Benessere organizzativo in sanità. La rilevazione di clima in un'Azienda Sanitaria Piemontese.

INTRODUCTION: More and more Italian and European directives refers to organizational health promotion in work placements. As a matter of fact, organization well-being implies important benefits for individuals and improves business efficiency/efficacy. Improving factors involve listening tools aimed to analyze critical situations and needs, focus on working teams and communication development. In this respect, in a public health organization in Piedmont a research was devised for planning interventions of organizational health promotion and improvement, relying on climate analysis. The research process was supported by General Direction and involved the head of physicians and the departments CPSE (Coordinatore Professionale Sanitario Esperto: Professional Health Coordinator). METHODS: The survey was carried out on the organizational population, focusing on teambuilding, which is the core of daily work life. Team Climate Inventory Questionnaire (TCI) was employed and administered on-line. Beyond the 5 original factorial scales, 6 item groups related to the individuals feeling in working team and consistent with the research interests were identified. 75.42% (n=1264) of employees answered the provided questionnaire. RESULTS: The data highlighted average scores--expressing organizational climate--over other public health organization data. The subjects also showed a good organizational climate perception. Elderly workers appeared more satisfied than the young ones. Furthermore, higher educated subjects took more advantage of technical and organizational supports.

Application of the General Perceived Self-Efficacy Scale in cardiovascular rehabilitation.

Psychosocial support, education and self-management are important complements of rehabilitation programs. A central concept in self-management is self-efficacy, which refers to oneself confidence in reaching a desired goal. The General Perceived Self-Efficacy scale (GSE), developed to measure self-efficacy at the broadest level, could be useful in the rehabilitation setting, in order to assess patients' self-management difficulties as well as to design specific interventions for specific diseases. Aim of this work is to verify the GSE Italian version psychometric properties applied to the rehabilitation setting. Data were analyzed from 395 in-patients attending cardiac (83.8%) and neurological (16.2%) rehabilitation. Cardiac patients suffered from post-MI, CABG or heart-failure; all of the neurological patients suffered from amiotrophic lateral sclerosis (ALS). They were mostly males (84.5%), and the mean age was 55.7 years. Principal component factor analysis confirmed that GSE has a monofactorial structure with internal consistency of .85. As in previous studies, a gender difference emerged. There was no difference in cardiac patients, on the basis of their specific disease, but they showed higher self-efficacy perception compared to ALS patients. The findings confirm that GSE is a valid measure of self-efficacy in settings characterised by different levels of functional abilities, as in cardiac and neurological rehabilitation.

Metric qualities of the cognitive behavioral assessment for outcome evaluation to estimate psychological treatment effects.

BACKGROUND: Cognitive behavioral assessment for outcome evaluation was developed to evaluate psychological treatment interventions, especially for counseling and psychotherapy. It is made up of 80 items and five scales: anxiety, well-being, perception of positive change, depression, and psychological distress. The aim of the study was to present the metric qualities and to show validity and reliability of the five constructs of the questionnaire both in nonclinical and clinical subjects. METHODS: Four steps were completed to assess reliability and factor structure: criterion-related and concurrent validity, responsiveness, and convergent-divergent validity. A nonclinical group of 269 subjects was enrolled, as was a clinical group comprising 168 adults undergoing psychotherapy and psychological counseling provided by the Italian public health service. RESULTS: Cronbach's alphas were between 0.80 and 0.91 for the clinical sample and between 0.74 and 0.91 in the nonclinical one. We observed an excellent structural validity for the five interrelated dimensions. The clinical group showed higher scores in the anxiety, depression, and psychological distress scales, as well as lower scores in well-being and perception of positive change scales than those observed in the nonclinical group. Responsiveness was large for the anxiety, well-being, and depression scales; the psychological distress and perception of positive change scales showed a moderate effect. CONCLUSION: The questionnaire showed excellent psychometric properties, thus demonstrating that the questionnaire is a good evaluative instrument, with which to assess pre- and post-treatment outcomes.

Emotional reactions and practical problems of the caregivers of hemodialysed patients.

BACKGROUND: The international literature consistently shows that the psychosocial outcomes of the informal carers (caregivers) of chronically ill patients are influenced by factors such as personality traits and perceived social support, but few studies have investigated these variables in the caregivers of hemodialysed patients, and the reciprocal experience of chronicity. METHODS: Fifty hemodialysed patients and their principal caregivers were recruited. They were administered specific questionnaires to evaluate their emotional stability and anxious/depressive reactions, the perceived burden related to the patients' condition, the quality of their family relationships and knowledge of the disease, and the degree of satisfaction with their lives. The study design was correlational and comparative. The data were analysed using Student's t test and Pearson's correlation. RESULTS: The patients were significantly more anxious and depressed than their caregivers, and had a more negative perception of their family relationships; they also had significantly higher neuroticism scores. Although the caregivers showed good emotional stability and a relatively low level of perceived burden, they stated that their daily lives were not very interesting and involved few social contacts. Twenty-five percent of them declared that they had financial problems; twelve percent also said they had to face problems of disease-related stigma and embarrassment. CONCLUSIONS: The results suggest that emotional stability is an important psychological determinant of perceived distress among the caregivers of hemodialysed patients. Assessing this personality trait and the reciprocal experience of chronicity in patients and caregivers may help nephrology teams identify subjects at major psychological risk, and to select the appropriate psychological support.

Caregiving-related needs analysis: a proposed model reflecting current research and socio-political developments.

The present authors have developed a model for assessing caregiving-related problems and needs, the Economic, Social, Psychological and Educational Requirements Table (ESPERT). The model was based on an analysis of the international literature concerning caregiving-related problems, and current specific European and Italian legislation, as well as the authors' own research results (which also permitted them to design a specific instrument for the general assessment of caregivers). This paper describes the socio-psychological and socio-political background prompting the development of the model, the general instrument for the assessment of caregivers and an example of its use in a sample of caregivers of cancer patients. In the example study, 80 caregivers of cancer patients were asked to complete questionnaires evaluating their state and trait anxiety, depressive symptoms, personality traits, and specifically, their neuroticism or emotional instability, caregiving strain and the degree of satisfaction with their lives. In addition to the specific information obtained about this group of caregivers, the present results show that the completion of the ESPERT makes it possible to identify the proportion of subjects at economic, social and emotional risk, and to decide rapidly what kind of resources/interventions can be implemented, bearing in mind the most balanced cost-benefit ratio.

[Life style and adherence to the recommended treatments after cardiac transplantation]. / Stile di vita e aderenza ai trattamenti raccomandati dopo trapianto cardiaco.

BACKGROUND: All the previous studies showed an increase in survival after cardiac transplantation. Nevertheless, a certain number of patients persist, in the short- and long-term period, in leading an incorrect lifestyle. Owing to this high-risk behavioral profile clinical, psychological and social problems could arise. METHODS: We have analyzed the quality of life and adherence to the recommended treatments in 107 patients at least 6 months (range 6-132 months) after they had been submitted to heart transplant and returned to their preoperative social and family environments. RESULTS: Data analysis has shown, in these patients, the return to their previous high-risk lifestyle habits: 18.4% of them did not adhere to the suggested diet, 13.2% did not perform physical activity, and 36.7% of the smokers took up the habit again after the transplant. Perceptions of emotional distress were still there: anxiety in 10.3% of cases and depression in 13.1%. An unsatisfactory sexuality was reported by 27.1% and only 27% returned to their previous job. Their outlook towards their self-efficacy seems to be predictive of the quality of life as perceived by the patient after the heart transplant: the better their outlook towards their self-efficacy, the better the quality of life. CONCLUSIONS: These data show that following heart transplant, before implementing postoperative preparation and rehabilitation programs one must carefully study those problem areas that unfortunately still exist.

Update on the family strain questionnaire: a tool for the general screening of caregiving-related problems.

BACKGROUND: The growing prevalence of chronic diseases and home-based treatments has led to the introduction of a large number of instruments for assessing the caregiving-related problems associated with specific diseases, but our Family Strain Questionnaire (FSQ) was designed to provide a basis for general screening and comparison regardless of the disease. We here describe the final validation of its psychometric characteristics. METHODS: The FSQ consists of a brief semi-structured interview and 44 dichotomic items, and has now been administered to 811 caregivers (285 were simultaneously administered other questionnaires assessing anxiety and depressive symptoms). After a factorial analysis confirmed the 5-factor structure identified in previous studies (emotional burden, problems in social involvement, need for knowledge about the disease, satisfaction with family relationships, and thoughts about death), we undertook correlation and reliability analyses, and a receiver operating characteristics curve analysis designed to determine the cut-off point for the emotional problems identified by the first factor. Finally, univariate ANOVA with Bonferroni's post-hoc test was used to compare the disease-specific scores. RESULTS: The validity and reliability of the FSQ is good, and its factorial structure refers to areas that are internationally considered as being of general importance. The semi-structured interview collects information concerning the socio-economic status of caregivers and their convictions/interpretations concerning the diseases of their patients. CONCLUSIONS: The FSQ can be used as a single instrument for the general assessment of caregiving-related problems regardless of the reference disease. This makes it possible to reduce administration and analysis times, and compare the problems experienced by the caregivers of patients with different diseases.

Agitation assessment in severe traumatic brain injury: methodological and clinical issues.

The aim of this single case study was to evaluate the applicability of a graphic and statistical time-series analyses in the observation of an agitation disturbance in a 16-year-old patient who had sustained a severe traumatic brain injury. The agitation was measured using the Agitated Behaviour Scale. The experimental model was of the A-B type: phase A corresponded to the period of vegetative state, and phase B to the period following the reawakening from coma. The data were submitted to visual and statistical analysis by the split-middle trend line method, function of autocorrelation, and C statistic. The results show the different nature and frequency of the agitated behaviour during the vegetative state and after reawakening from coma. The application of a statistical analysis to establish whether the behavioural disturbance is random or a response to the environment allows the adoption of specific and potentially more efficacious treatments.

Alzheimer's disease: usefulness of the Family Strain Questionnaire and the Screen for Caregiver Burden in the study of caregiving-related problems.

OBJECTIVES: The economic and psychosocial impacts of Alzheimer's disease (AD) on caregivers are so well documented that they have stimulated socioeconomic regulations that are international in scope. In Italy caregivers have the right to receive economic and psychosocial aid. However, to distribute such aid the needs of caregivers, must be properly assessed. Here we have attempted to integrate two measures, the Family Strain Questionnaire (FSQ) and the Screen for Caregiver Burden (SCB), in order to evaluate caregiver needs that are both general and specific to AD. MATERIAL AND METHODS: The SCB and FSQ were administered to 91 primary caregivers of home-based patients with AD. Caregivers also were asked to rate the activities of daily living of their care recipients, the latter of which were administered the Mini-Mental State Examination. RESULTS: The SCB and FSQ provide different, but complementary assessments of the needs of AD caregivers. The SCB identifies situations that are potentially stressful to AD caregivers and the FSQ identifies the needs of specific caregivers (e.g. men vs women, spouses vs children, unemployed vs employed). CONCLUSION: Together these measures may help government agencies to assess caregiver needs beyond those assessed by each individual measure.

Advanced cancer at home: caregiving and bereavement.

BACKGROUND: The advanced and terminal phases of cancer are being increasingly treated at home with the aid of palliative care teams. It is well known that caregivers are overburdened emotionally, financially and physically, and some studies have demonstrated that this overload extends beyond the period of mourning. Identifying caregivers at risk of bereavement maladjustment is a useful means of ensuring prompt psychological and social assistance, and optimising the available resources. METHODS: One hundred and eleven caregivers of home-treated patients with advanced/terminal cancer were recruited by the palliative care unit operating in their place of residence. After giving their informed consent, all of the caregivers were asked to complete questionnaires designed to evaluate various emotional, financial and social aspects. Three, six and 12 months after the decease of their patients, the caregivers were contacted again and asked to complete other questionnaires aimed at assessing their emotional reactions and bereavement-related problems. RESULTS: The 12-month follow-up was completed by 93 caregivers. Their bereavement maladjustment problems correlated with their perception of emotional distress and the caregiving-related problems detected at the time of referral, particularly among females. Spouses, subjects aged over 61 years and those perceiving a substantial emotional burden proved to be at greater long-term risk. CONCLUSIONS: The identification of overburdened caregivers and those at risk of long-term bereavement maladjustment may facilitate the programming of ad hoc interventions that could reduce inherent health and social costs. Palliative care teams can usefully include someone to identify such caregivers by means of inexpensive and objectively predictive instruments.

Trends in smoking, diet, physical exercise, and attitudes toward health in European university students from 13 countries, 1990-2000.

BACKGROUND: Smoking, diet, and physical exercise are key determinants of health. This study assessed changes over 10 years and their relationship to changes in health beliefs and risk awareness. METHOD: A survey was carried out of university students from 13 European countries (Belgium, England, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, The Netherlands, Poland, Portugal, and Spain) in 1990 (4,701 men, 5,729 women) and repeated in 2000 (4,604 men, 5,732 women). We assessed smoking, exercise, fruit and fat intake, beliefs in the importance of behaviors for health, and awareness of the influence of behaviors on heart disease risk. RESULTS: Smoking prevalence increased and fruit consumption decreased between 1990 and 2000, while physical exercise and fat intake were more stable. There were large variations between country samples. Health beliefs weakened, with marked decreases in beliefs about smoking and diet. Across country samples, changes in beliefs correlated with changes in the prevalence of behaviors. Awareness of the effects of smoking and exercise was stable, but knowledge of the role of fat intake increased over the decade. CONCLUSIONS: The differences in health behaviors, beliefs, and risk awareness between the two surveys were disappointing in this educated sector of young adult Europeans. The association between changes in beliefs and prevalence of behavior emphasizes the importance of enhancing positive attitudes to healthier lifestyles.