Heterogeneity of emotion regulation strategies in patients with alcohol use disorder during the first year of abstinence: a clustering analysis.

AIMS: Studies examining the use of specific emotion regulation (ER) strategies in patients with severe alcohol use disorder (AUD) are mainly focused on intergroup comparisons to the detriment of intragroup variability. Yet, these patients are in fact characterized by emotional deficits of varying severity, and we seek to identify different patterns of ER strategies in people with AUD during their first year of abstinence. METHODS: Based on the ER strategies used by a large sample of patients with AUD, we applied cluster analysis to identify the existence of subgroups using distinct patterns of adaptive and nonadaptive strategies. To characterize these groups, we compared their clinical characteristics and then their emotional regulation strategies to those of control consumers. RESULTS: A first cluster, representing 61% of the sample, is constituted by individuals with high adaptive strategy scores and high nonadaptive strategy scores; a second cluster, representing 39% of the sample, corresponds to individuals with low adaptive strategy scores and high nonadaptive strategy scores. The individuals in these two clusters differed in terms of anxiety level and abstinence time. Compared with control consumers, the use of nonadaptive ER strategies remained lower for the two clusters, while the use of adaptative strategies differed. CONCLUSIONS: Our results support the idea of considering the heterogeneity of emotional capacities in individuals with AUD during the first year of abstinence. The identification of these profiles suggests either the existence of different adaptive ER capacities at baseline or a specific recovery of adaptive strategies over this period.

The use of psychological network analysis in informal dementia care: an empirical illustration.

Objective: Theoretical models in informal dementia care have been developed to understand how risk and protective factors interact to cause caregiver's distress. The development of psychological network analysis provides a rich complement to our current models, as explores how different variables (or nodes) are associated using graph theories. Methods: The present study explored the use of network analysis using data from 125 informal caregivers of their partner with dementia (PwD). The included variables were recipient's dependency, self-efficacy, conflict within the family, dyadic adjustment, and caregiver's distress. Results: The analysis suggests a complex network of interacting variables. The core variable was not the caregiver's distress but rather their dyadic adjustment with their PwD. Variables were associated with caregiver distress through a large array of direct and indirect pathways and were associated with each other in the form of an asymmetric spider's web.Conclusion: The results show the complex interplay of variables in a psychological network. The central role of distress suggests a complex and dynamic role, notably through a bidirectional influence with quality of interactions. In the same way, quality of interactions appeared as one of the strongest nodes, its connectivity suggesting a crucial role to consider in our models and interventions.

Considering management behaviours to identify vulnerable caregivers of persons with dementia.

BACKGROUND: Persons with dementia gradually disengage from daily activities, and therefore require increasing daily support. Caregivers face a dilemma as to whether they should encourage the persons with dementia in terms of initiative and autonomy, or supervise and take charge of tasks, which may cause distress for both parties. This study seeks to better understand how caregivers manage the disengagement of the persons with dementia and the repercussions on their caregiving experience. METHODS: A total of 217 caregivers participated. Their management behaviours and the characteristics of their caregiving experiences were assessed with questionnaires. A cluster analysis was first performed to identify possible profiles of management behaviours and comparison, which were then compared to identify the caregiving experience associated with each profile. RESULTS: The first cluster (25.8% of the sample) corresponds to caregivers with high negative control behaviour scores and high positive stimulation behaviour scores; the second cluster (43.8% of the sample) corresponds to caregivers with low positive stimulation behaviour scores and high negative control behaviour scores; and the third cluster (30.4% of the sample) corresponds to caregivers with low negative control behaviour scores and high positive stimulation behaviour scores. Caregivers in Clusters 2 and 3 differ in terms of anxiety, depression, burden, gratification, health and financial problems. Cluster 1 is an intermediate profile with similar characteristics to Cluster 3. CONCLUSIONS: Our results support the idea of considering management behaviours to identify vulnerable caregivers and highlight the deleterious role of negative control behaviours, especially when they are not offset by positive protective stimulation behaviours.

Development and Validation of a Scale to Assess Caregiver Management Behaviors in Response to the Decreased Engagement of People with Dementia in Daily Activities.

Objective: To explore types of caregivers' management approaches, to develop a scale to assess caregivers' management behaviors and their relationship implications and to examine the scale's psychometric qualities.Method: First, based on a qualitative study, developing the corpus of items to align as closely as possible to caregivers' experience using their own words; second, exploring the structure of the scale and reducing the number of items; and third, studying the validity of the scale.Results: After assessing the validity requirements of the original corpus of items, an exploratory factor analysis of the first version of the scale with 62 items permitted the identification of three dimensions of caregiver management: "Negative control", "Positive stimulation" and "Overwhelming feeling". Because of its redundancy with respect to existing scales, the last dimension was removed. In the last step, a confirmatory factor analysis showed that a 13-item two-order factor model was in an acceptable model.Conclusion: The 13-item scale can be used to identify caregivers facing difficulty adapting their support as a baseline for following caregivers over time or evaluating the effectiveness of an intervention.Clinical implications: This scale can rapidly evaluate caregivers' management behaviors and their relational consequences and monitor outcomes of support interventions.

Characterizing the determinants of sexual dissatisfaction among heterosexuals: The specific role of dyadic coping.

Sexual satisfaction is the most frequently studied sexual component of human sexuality related to its link with relationship satisfaction and stability (S. Sprecher & R. M. Cate, 2004. The handbook of sexuality in close relationships, pp. 235-256. Mahwah, NJ: Taylor & Francis). Previous studies have shown that sexual satisfaction is affected by personal, interpersonal, social and cultural variables, but few studies have considered the associations between these variables. The aim of this study was to evaluate a complex model of sexual satisfaction considering these various levels of variables and their associations. The study was conducted online and comprised 457 individuals in the final sample. The French version of the index of sexual satisfaction evaluated the level of sexual dissatisfaction. Personal, interpersonal, social and cultural variables were assessed with questionnaires and their associations were investigated with the partial least squares-path method. The association between dyadic coping (positive and negative) and sexual dissatisfaction was mediated by relationship satisfaction. The model also showed three sequential mediations through dyadic coping and relationship satisfaction: first between intra-individual vulnerability and sexual dissatisfaction, second between intra-individual resources and sexual dissatisfaction, and third between conjugal characteristics and sexual dissatisfaction. The simple and sequential mediations were stronger for positive dyadic coping. The relationship between intra-individual resources and positive dyadic coping was significantly stronger in women, while the relationship between conjugal characteristics and positive dyadic coping was stronger in men. Dyadic coping plays a key role in sexual dissatisfaction. Clinical interventions should reinforce positive self-image (particularly in women), support emotional and physical vulnerabilities, and promote more supportive dyadic coping (particularly in men in a long-term relationship).

Predictors of caregiver distress among spouses, adult children living with the person with dementia, and adult children not living with the person with dementia.

AIM: The caregiving situation differs according to the type of relationship between the patient caregiver, and among dementia caregivers, living with the person with dementia can contribute to caregiver distress. This study aimed to identify the predictors of caregiver distress based on caregiver profile: spouse, adult child living with the person with dementia, and adult child not living with the person with dementia. METHOD: In total, 213 caregivers participated in this study. Their responses to questionnaires helped identify the positive and negative implications of the caregiving situation and the level of caregiver distress. The analyses consisted of univariate and multiple linear regression models using a forward method. RESULTS: Based on the standardized beta scores, the variables that are the most significant in predicting spouse caregiver distress are the impact on health and impact on schedule. The variable that is the most significant in predicting the distress of adult child caregivers living with the person with dementia is the impact on health. The variables that are the most significant in predicting the distress of adult child caregivers not living with the person with dementia are the impact on health, impact on schedule, and impact on finances. CONCLUSION: The results make it possible to consider different approaches to providing support, including evaluating the health of all caregivers, giving guidance on accepting help and focusing caregivers' actions on their values for spouse caregivers, providing family mediation for adult child caregivers living with the person with dementia, and offering information and assistance on the available aids for adult child caregivers not living with the person with dementia.

Characteristics of the spouse caregiving experience: Comparison between early- and late-onset dementia.

OBJECTIVES: To investigate the characteristics of the caregiving experience according to age at onset of dementia to adapt support programs. METHOD: Fifty-seven spouse caregivers of persons with early-onset dementia (PEOD) and 93 spouse caregivers of persons with late-onset dementia (PLOD) participated. The characteristics of the caregiving experience were assessed using questionnaires. We compared the two groups according to age at onset of the disease using a multivariate test, Pillai's Trace test. RESULTS: The analysis showed that there were similarities and differences between the two groups of spouse caregivers. All spouse caregivers were confident in their caregiving role and fairly well prepared for future needs and reported mild depressive and anxious symptoms. However, they lacked informal support, had low confidence in requesting respite care and reported effects on their health. Compared to spouse caregivers of PLOD, spouse caregivers of PEOD had more severe perceptions of the cognitive disorders of persons with dementia (PWD) and had a better sense of preparedness and knowledge of services. Spouse caregivers of PLOD were more confident in their ability to control disturbing thoughts. CONCLUSION: The results suggest that programs should provide information on support networks to improve preparedness for spouse caregivers of PLOD as well as emphasizing positive coping strategies for caregivers of PEOD to maintain good-quality relationships with PWD, which influences the perception of the symptoms. For both groups, family relationships should be considered.

Do spouse caregivers of young and older persons with dementia have different needs? A comparative study.

AIM: The aim of this study was to explore the needs of spouse caregivers of persons with dementia (PWD) and then to compare them based on the PWD's age at disease onset. This data could be used to adapt support programmes to address differences between the two groups. METHOD: Thirty-eight spouse caregivers of persons with late-onset dementia and 40 spouse caregivers of persons with early-onset dementia (PEOD) agreed to participate in the study. The mean ± SD age of the PEOD was 57.6 ± 4.0 years, whereas it was 80.9 ± 5.3 years for the persons with late-onset dementia. Interviews were conducted in the spouse caregivers' homes with only the spouse caregiver. The semi-structured interviews were based on the French version of the Carers Outcome Agreement Tool. The interviews were analyzed in two steps. The first step was qualitative to identify needs. The data were thematically analyzed using QSR NVivo 10. The second step was quantitative to compare the needs depending on the PWD's age at onset. The comparison between the two groups was performed using the χ2 test. RESULTS: The results demonstrated that the majority of needs are the same for the two groups of spouse caregivers. All caregivers need to unwind, to stimulate and pay attention to the PWD, to break the isolation, and to be more prepared and confident. However, some differences emerge, with the spouse caregivers of PEOD expressing a greater number of needs. The caregivers of PEOD seem to have a greater need to interact and maintain contacts with other people (P = 0.001), have more general care-related needs (P = 0.005), require more appropriate care structures (P = 0.037), and need greater assistance with administrative procedures (P = 0.004). CONCLUSION: To improve spouse caregivers' well-being and sense of efficiency, it would be interesting to develop a support programme with a common framework and specific modules depending on the PWD's age at disease onset.

From 'needing to know' to 'needing not to know more': an interpretative phenomenological analysis of couples' experiences with early-onset Alzheimer's disease.

OBJECTIVES: To explore the experiences and adjustment modes of couples during the period between the initial signs of the Alzheimer's disease (AD) and the years following diagnosis, particularly in the case of early-onset AD. DESIGN: A dyadic interpretative phenomenological analysis was conducted with married couples in which one member of each couple received a diagnosis of probable early-onset AD (before 65 years of age). PARTICIPANTS: Sixteen young couples, followed by the National Reference Centre for Young Persons with AD, agreed to participate. For seven of the couples, the caregiver was a woman. The mean age was 57.4 (SD = 4.2) for the caregivers and 57.3 (SD = 4.1) for the persons with AD. METHODS: The semi-structured interviews were conducted in the couples' homes. Each interview was conducted with both spouses to capture their interactions in the context of individual and shared experiences. RESULTS: Two higher-order themes emerged from the analyses: the 'need to know' and, after the diagnosis, the 'need not to know more'. Indeed, the first signs mark the beginning of a period of doubt and a search for understanding. This pursuit of knowledge progresses to the recognition of more intense and severe signs that encourage couples to seek medical attention. Both reassuring and destabilising, the diagnosis is a breaking point that modifies how the changes and painful effects associated with disease are experienced. Couples employ strategies to minimise their suffering and consequently their knowledge about the disease. CONCLUSIONS: These results show that the couples oscillate between the need to know and the fear of knowing. To protect themselves, they use strategies to reduce their suffering and to distance the disease. The use of these avoidance strategies indicates that certain times in the course of disease management are less appropriate for couples to accept the assistance offered by formal caregivers.

The relationship at the heart of the experience of daughter caregivers of a parent with dementia: An interpretative phenomenological analysis.

BACKGROUND: Parents with dementia require emotional, physical, psychological and financial support from their child caregivers to continue living at home. Daughter caregivers have been shown to be more involved in self-care and household tasks and to experience higher levels of distress than son caregivers. OBJECTIVE: The aim of this study was to investigate the experience of daughter caregivers who provide informal care for a parent with dementia living in their own home. METHOD: Semi-structured interviews were conducted with 11 daughter caregivers of a parent with Alzheimer's disease. Interviews were analysed using Interpretative Phenomenological Analysis. RESULTS: Three axes emerged from the analyses: [1] the before conditions the after: the quality of the previous relationship with the parent with Alzheimer's disease is a determining factor and allows the identification of three profiles of daughter caregivers: 'the grateful', 'the resentful' and 'the ambivalent', [2] when the relationship protects against the sense of burden: the feeling of being invaded by the caregiving situation is influenced by the quality of the relationship with the parent with Alzheimer's disease, and [3] alone or almost: the support network is desired when it is absent but kept at arm's length when it is present. DISCUSSION: The results underline the importance of assessing the quality of attachment and supporting the relationship with the parent (especially when the relationship prior to the disease was difficult). Daughter caregivers should also be encouraged to delegate tasks and refocus their actions related to their values. Family mediation sessions may be planned to improve the organisation of care and set up an efficient collaboration.