Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ).

BACKGROUND: The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI, a generic tool, and of the IEQ, a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. METHODS: Secondary analyses of a 16-week, randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency, convergent and discriminative validity, and sensitivity to change) were evaluated for both ZBI and IEQ. RESULTS: Internal consistency was good and similar for both scales (ZBI: 0.91, 95% CI: 0.89, 0.94; IEQ: 0.86, 95% CI: 0.83, 0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69, 95% CI: 0.61, 0.75) and at least moderate for the rest of domains (ZBI total score, personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77, 95% CI: 0.71, 0.83; and 0.69, 95% CI: 0.63, 0.78 - for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72, 95% CI: 0.65, 0.78; and 0.69, 95% CI: 0.62, 0.77 - for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention, both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36, 95% CI: -0.58, -0.15 - for ZBI; -0.39, 95% CI: -0.60, -0.18 - for IEQ). CONCLUSIONS: Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. TRIAL REGISTRATION: ( ISRCTN32545295 ).

Sobrecarga y salud mental del cuidador informal del paciente psicogeriátrico institucionalizado (Estudio Resicare) / No disponible

Introducción: El cuidado de personas mayores con enfermedad mental en el domicilio puede generar un importante desgaste psicológico en el cuidador. Este fenómeno se conoce como "sobrecarga". Muchas veces es necesario ingresar al paciente en un recurso residencial psicogeriatrico. El proceso de institucionalización genera nuevas fuentes de estrés, pudiendo generar un nuevo fenómeno de sobrecarga. El objetivo de este estudio es describir y analizar el estado de sobrecarga, depresión, ansiedad, salud psíquica y conflictividad con el centro de los familiares tras el ingreso del paciente. Material y métodos: estudio observacional multicéntrico transversal realizado en 10 centros residenciales psicogeriátricos de España. Se evaluó a los familiares (n=66) con escalas autoadministradas: Escala de sobrecarga de Zarit (ZBI), Escala de sobrecarga para familiares con parientes ingresados en residencias (CBS-FNH), la Escala Hospitalaria de Ansiedad y Depresión (HADS), el Cuestionario de Salud General (GHQ-28) y la Escala de aspectos de mejora en la atención en centros residenciales (NHHS). Resultados: la muestra presentaba sobrecarga leve (ZBI-22 = 48.58;17.85 y CBS-FNH = 14.27; 7.12), distrés psicológico (GHQ-28 = 28.68; 14.74). Los cuidadores cuyos familiares llevaban más tiempo ingresados y recibian más atención del centro presentaron menor clínica. La gravedad psicopatológica del paciente y la conflictividad en la toma de decisión del ingreso se correlacionaron con mayores niveles de malestar en el cuidador. Conclusiones: A pesar del ingreso del paciente, los cuidadores mantienen niveles de sobrecarga y de distrés psicológico. Es necesaria una mayor atención por parte de los servicios residenciales en los momentos iniciales del ingreso

Introduction: The care of elderly people with mental illness at home can produce psychological distress to the informal caregiver. This phenomena has been defined as "caregiver burden". Institutionalize the patient in a psychogeriatric nursing-home becomes necessary. This process can generate new fonts of distress, and burden. The aim of this study is to describe and analyze the estate of burden, depression, anxiety, mental health and hassles with the care center. Material and methods: transversal multicenter observational study performed in 10 psycho-geriatric nursing homes in Spain. Caregivers (n= 66) were assessed with autoadministrated scales: Zarit burden interview (ZBI-22), Caregiver burden scale for family caregivers with relatives in nursing homes (CBS-FNH), Hospitalary anxiety and depression scale (HADS), General Health Questionnaire (GHQ-28) and Caregiving hassles scale (NHHS). Results: the sample showed moderate burden (ZBI-22 = 48.58;17.85 y CBS-FNH = 14.27; 7.12), psychological distress (GHQ-28 = 28.68; 14.74). Caregivers whose family members had more time hospitalized and received more attention had lower clinical scores. Pathological severity of the patient and conflict in decision making correlated directly with higher levels of caregiver distress. Conclusions: Despite the admission of the patient, caregivers maintain levels of burden and psychological distress. Greater attention from residential services in the initial moments of admission is required

A retrospective study of nursing diagnoses, outcomes, and interventions for patients with mental disorders.

AIM: The aim of this study is to describe the most frequent NANDA-I nursing diagnoses, NOC outcomes, and NIC interventions used in nursing care plans in relation to psychiatric diagnosis. BACKGROUND: Although numerous studies have described the most prevalent NANDA-I, NIC and NOC labels in association with medical diagnosis in different specialties, only few connect these with psychiatric diagnoses. METHODS: This multicentric cross-sectional study was developed in Spain. Data were collected retrospectively from the electronic records of 690 psychiatric or psychogeriatric patients in long and medium-term units and, psychogeriatric day-care centres. RESULTS: The most common nursing diagnoses, interventions and outcomes were identified for patients with schizophrenia, organic mental disorders, mental retardation, affective disorders, disorders of adult personality and behavior, mental and behavioural disorders due to psychoactive substance use and neurotic, stress-related and somatoform disorders. CONCLUSION: Results suggest that NANDA-I, NIC and NOC labels combined with psychiatric diagnosis offer a complete description of the patients' actual condition.

Intervenciones en el cuidador del enfermo con demencia / Interventions for caregivers of patients with dementia

Introducción. El envejecimiento de la población trae aparejado un aumento del número de personas afectadas de demencia. La mayoría de estas personas son atendidas en el domicilio. Sus cuidadores se ven expuestos a toda una serie de factores estresantes, de los que se deriva la aparición de sobrecarga, depresión y ansiedad. Se han desarrollado diversos programas o intervenciones estructuradas destinadas a prevenir o reducir estas consecuencias negativas. La eficacia de estas intervenciones es objeto de discusión, debido principalmente a las diferencias metodológicas entre estudios. Los trabajos de revisión realizados hasta ahora también presentan importantes diferencias entre sí, lo que contribuye a perpetuar la falta de claridad en este importante problema asistencial geriátrico. Se revisan de manera precisa y rigurosa la eficacia de las intervenciones destinadas a prevenir o reducir la sobrecarga del cuidador, y/o la sintomatología ansiosa y depresiva del cuidador informal. Metodología. Revisión sistemática de estudios controlados y aleatorizados que valoran la eficacia de las intervenciones en cuidadores informales de pacientes con demencia en las variables de sobrecarga, depresión y ansiedad. Resultados. La búsqueda bibliográfica obtuvo 997 trabajos, de los que 35 cumplían con los criterios de selección. El 51,4% de los trabajos presentaron resultados estadísticamente favorables a la intervención. Existe una gran variabilidad en la metodología empleada. Conclusiones. En conjunto, la evidencia disponible favorece la aplicación de programas estructurados de intervención,si bien existe una amplia heterogeneidad de resultados. Las intervenciones psicoeducativas ofrecen mejores resultados, y se adaptan mejor a las necesidades de los cuidadores

Introduction. With the aging of the population, an increasing number of people have dementia, most of whom are receiving home care. Caregivers are exposed to a variety of stressors, which may lead to feeling burdened, or to depression and anxiety. Various programs or structured interventions have been developed to prevent or lessen these negative consequences. The efficacy of these interventions is debated, mainly due to methodological differences between studies. Review studies so far have presented important discrepancies, thus perpetuating a lack of clarity regarding this important geriatric care problem. The effectiveness of interventions designed to prevent or reduce the burden and/ or symptoms of anxiety and depression in informal caregivers are reviewed precisely and rigorously.Methods. A systematic review of randomized controlled studies assessing the efficacy of structured interventions on the variables of burden, depression and anxiety in informal caregivers of patients with dementia. Results. The literature search yielded 997 references, of which 35 met the screening criteria. Of these studies, 51.4% had results that were statistically favorable to intervention. The methodology used varied widely between studies. Conclusions. Overall, the available evidence favors the implementation of structured intervention programs, although the results are heterogeneous. Psychoeducational interventions yield better results and can be better adapted to the needs of caregivers

Interventions for caregivers of patients with dementia.

INTRODUCTION: With the aging of the population, an increasing number of people have dementia, most of whom are receiving home care. Caregivers are exposed to a variety of stressors, which may lead to feeling burdened, or to depression and anxiety. Various programs or structured interventions have been developed to prevent or lessen these negative consequences. The efficacy of these interventions is debated, mainly due to methodological differences between studies. Review studies so far have presented important discrepancies, thus perpetuating a lack of clarity regarding this important geriatric care problem. The effectiveness of interventions designed to prevent or reduce the burden and/or symptoms of anxiety and depression in informal caregivers are reviewed precisely and rigorously. METHODS: A systematic review of randomized controlled studies assessing the efficacy of structured interventions on the variables of burden, depression and anxiety in informal caregivers of patients with dementia. RESULTS: The literature search yielded 997 references, of which 35 met the screening criteria. Of these studies, 51.4% had results that were statistically favorable to intervention. The methodology used varied widely between studies. CONCLUSIONS: Overall, the available evidence favors the implementation of structured intervention programs, although the results are heterogeneous. Psychoeducational interventions yield better results and can be better adapted to the needs of caregivers.

Effectiveness of a psychoeducational intervention group program in the reduction of the burden experienced by caregivers of patients with dementia: the EDUCA-II randomized trial.

We conducted a multicenter, prospective, evaluator-blinded, 2-arm parallel randomized trial to compare the effectiveness of a group psychoeducational intervention (PIP) with that of standard care in dementia caregivers. The primary outcome was the burden experience evaluated by the Zarit Burden Interview. Secondary outcomes were psychological distress evaluated with the scaled General Health Questionnaire-28 items, and quality of life evaluated with the Short-Form Health Survey 12. Effectiveness endpoint was at 4 months since inception. Statistical analyses used complete case and intention-to-treat analysis (ITT). The trial recruited 238 caregivers from 22 research sites (115 randomized to PIP, 123 randomized to standard care). No differences were found in the Zarit Burden Interview scores (complete case analysis: mean difference=-1.02, 95% confidence interval=-4.41 to 2.37; ITT analysis: MD=-0.55, 95% confidence interval=-3.64 to 2.55), the Short-Form Health Survey 12 domain scores (all P>0.05), and total General Health Questionnaire-28 items scores and some of its subscales (all P>0.05) except the anxiety and insomnia subscale for the ITT analysis (P=0.03). In summary, PIP in modality of group intervention was not better than standard care to reduce caregiver burden and overall psychological distress or to improve quality-of-life domains. EDUCA-II trial registry: ISRCTN14411440.

Instrumentos para medir la sobrecarga en el cuidador informal del paciente con demencia / Assessment tools to measure burden in the informal caregiver of patients with dementia

La complejidad del concepto de sobrecarga del cuidador del paciente con demencia ha dado lugar a gran número de pruebas de evaluación, empleando diferentes enfoques. Por ello, puede resultar de utilidad para el clínico o el investigador disponer de una revisión de las mismas. Objetivo. Efectuar una revisión actualizada de los instrumentos disponibles, clasificándolos según el criterio de sobrecarga, estudiando sus características y propiedades psicométricas y presentando con más detalle aquellos más relevantes para su aplicación. Método. La metodología aplicada ha sido la búsqueda en bases de datos −Pubmed, PsycINFO, Embase y Psicodoc (1980-2012). Resultados. Se han seleccionado 31 instrumentos de evaluación, que han sido agrupados en función de 3 enfoques: sobrecarga objetiva/subjetiva, sobrecarga desde un enfoque multidimensional y sobrecarga como estrés asociado al deterioro del paciente. Conclusiones. Este trabajo proporciona una recopilación de instrumentos, clasificados de forma que facilite la selección y uso de los mismos. Se constata la necesidad de establecer consensos sobre el concepto de sobrecarga y los métodos de evaluación utilizados para desarrollar un marco de conocimiento uniforme y de aplicación a la práctica asistencial (AU)

The complexity of dementia caregiver burden concept has led to a significant number of assessment tests using various approaches. For this reason, a review of these measurementss could be useful for clinical or research purposes.ObjectiveThe objective of the study is to perform an updated review on the tools available, classifying them according to the burden criterion by studying their characteristics and psychometric properties, and providing those most relevant for application.MethodThe method applied consisted of a database search −Pubmed, PsycINFO, Embase and Psicodoc (1980-2012).ResultsA total of 31 assessment tools were selected, grouped on the basis of the burden concept evaluated: objective/subjective burden, burden from a multidimensional approach, and as distress associated with patient impairment.ConclusionsThis study provides a suitable tool for using caregiver burden assessment tools accurately. A marked conclusion is the need to establish agreements in the assessment methods, in order to develop standard knowledge and application to healthcare practice (AU)

[Assessment tools to measure burden in the informal caregiver of patients with dementia]. / Instrumentos para medir la sobrecarga en el cuidador informal del paciente con demencia.

UNLABELLED: The complexity of dementia caregiver burden concept has led to a significant number of assessment tests using various approaches. For this reason, a review of these measurementss could be useful for clinical or research purposes. OBJECTIVE: The objective of the study is to perform an updated review on the tools available, classifying them according to the burden criterion by studying their characteristics and psychometric properties, and providing those most relevant for application. METHOD: The method applied consisted of a database search -Pubmed, PsycINFO, Embase and Psicodoc (1980-2012). RESULTS: A total of 31 assessment tools were selected, grouped on the basis of the burden concept evaluated: objective/subjective burden, burden from a multidimensional approach, and as distress associated with patient impairment. CONCLUSIONS: This study provides a suitable tool for using caregiver burden assessment tools accurately. A marked conclusion is the need to establish agreements in the assessment methods, in order to develop standard knowledge and application to healthcare practice.

[Nursing care for psychiatric patients defined by NANDA-NIC-NOC terminology: a literature review]. / Atención de enfermería a pacientes psiquiátricos. NANDA-NIC-NOC: una revisión de la literatura.

AIM: The purpose of this literature review is to provide a synthesis of the most relevant studies describing nursing work in mental health by means of NNN taxonomy. METHOD: Literature from 1990 to September 2011 was reviewed using the "scoping review" methodology. Three independent reviewers examined the articles which were found and selected those fulfilling the inclusion criteria for subsequent analysis. RESULTS: From the 220 articles obtained, 14 studies were finally included and divided into two groups. The aim of the first ten papers was examining the most frequent NANDA nursing diagnosis or/and NIC nursing interventions in different mental health care settings. The remaining four articles describe health care plans for psychiatric patients developed with NNN taxonomy. Combining results from both groups, the most prevalent diagnostic labels are: disturbed thought processes and impaired social interaction. CONCLUSIONS: This review has illustrated the lack of evidence in relation to NNN taxonomy in the field of mental health and the need of further research in this area.

Atención de enfermería a pacientes psiquiátricos / Nursing care for psychiatric patients defined by nanda-nic-noc terminology: a literature review

Objetivo: el propósito de esta revisión bibliográfica es ofrecer una síntesis de los principales estudios que describen la labor desarrollada por enfermería en salud mental a través de la taxonomía NANDA-NIC-NOC (NNN). Método: se realizó una revisión de la literatura (de 1990 a septiembre de 2011) utilizando la metodología para el desarrollo de scoping reviews. Tres jueces independientes examinaron los artículos encontrados y seleccionaron aquellos que cumplían los criterios de inclusión para su posterior análisis. Resultados: de los 220 artículos obtenidos, se incluyeron finalmente 14 estudios que se dividieron en dos subgrupos. Los diez primeros escritos tienen como objetivo examinar los diagnósticos de enfermería NANDA y/o las intervenciones de enfermería NIC más frecuentes en diferentes ámbitos asistenciales de salud mental. Los otros cuatro describen planes de cuidados para pacientes psiquiátricos elaborados a partir de la taxonomía NNN. Combinando los resultados de los estudios de ambos grupos, las etiquetas diagnósticas más prevalentes son trastorno de los procesos de pensamiento y deterioro de la interacción social. Conclusiones: esta revisión ha puesto de manifiesto la insuficiente evidencia disponible con relación a la taxonomía NNN en el campo de la salud mental y la necesidad de nuevas investigaciones en esta área(AU)

Aim: The purpose of this literature review is to provide a synthesis of the most relevant studies describing nursing work in mental health by means of NNN taxonomy. Method: Literature from 1990 to September 2011 was reviewed using the «scoping review» methodology. Three independent reviewers examined the articles which were found and selected those fulfilling the inclusion criteria for subsequent analysis. Results: From the 220 articles obtained, 14 studies were finally included and divided into two groups. The aim of the first ten papers was examining the most frequent NANDA nursing diagnosis or/and NIC nursing interventions in different mental health care settings. The remaining four articles describe health care plans for psychiatric patients developed with NNN taxonomy. Combining results from both groups, the most prevalent diagnostic labels are: disturbed thought processes and impaired social interaction. Conclusions: This review has illustrated the lack of evidence in relation to NNN taxonomy in the field of mental health and the need of further research in this area(AU)

Unidimensional 12-item Zarit Caregiver Burden Interview for the assessment of dementia caregivers' burden obtained by item response theory.

OBJECTIVES: To develop a one-dimensional version of the 22-item Zarit Caregiver Burden Interview (ZBI) by applying item response theory approaches. METHODS: The answers to the 22-item ZBI of 241 caregivers participating in a clinical trial were analyzed 1) with a Mokken nonparametric item response theory analysis to ascertain the dimensional structure underlying the scale and obtain a one-dimensional reduced version, 2) with the Samejima's graded response model to assess the item characteristics of the reduced version, and 3) with confirmatory factor analysis to confirm the unidimensionality of the reduced ZBI version and assess the item loadings to the burden latent variable. RESULTS: Mokken analysis resulted in a major one-dimensional scale comprising 12 items directly related with burden. All items showed scalability indices over 0.30. The scalability for the overall scale was 0.44 defining a medium scale according to Mokken's criteria. An unconstrained Samejima's graded response model showed appropriate fit, and most items of the reduced 12-item ZBI presented pertinent difficulty and discrimination parameters. The results of the 12-item ZBI confirmatory factor analysis fitted to a one-dimensional latent structure for burden (comparative fit index=0.975; root-mean-square error of approximation=0.067; weighted root mean square residual=0.677). All factor lodgings were above 0.40 with items 9 (strained by the relative) and 22 (overall feeling of burden) presenting the highest loadings. CONCLUSIONS: The reduced 12-item ZBI fits a one-dimensional latent variable of burden. Further psychometric studies, focusing on its equivalence for different populations, sensitivity to change, and minimal important difference are warranted.

Esquizofrenia tardía. Terapéutica integral / No disponible

Los cambios demográficos van a traer consigo un aumento muy notable del número de personas mayores con esquizofrenia en las próximas décadas. Si bien en la mayoría de los casos (80 % o más) se trata de procesos de inicio temprano, hay un número no desdeñable de formas tardías. El tratamiento de la esquizofrenia en el anciano adolece de una falta muy notable de ensayos clínicos controlados, por lo que en la mayoría de las veces se utilizan inferencias realizadas a partir de los datos obtenidos en estudios con otro tipo de población. En conjunto, los datos disponibles avalan el tratamiento de la esquizofrenia en el anciano con antipsicóticos de segunda generación, por su mejor tolerancia y perfil de seguridad con respecto a los antipsicóticos típicos, aunque no existen diferencias en cuanto a eficacia global con ambos tipos de sustancias. El empleo de sustancias con propiedades anticolinérgicas está especialmente mal indicado en personas mayores. La eficacia global del tratamiento antipsicótico es similar a la que observamos en sujetos más jóvenes. Los datos acerca de otras formas de tratamiento, como técnicas de psicoterapia o intervenciones psicosociales, son todavía más escasos, aunque cada vez se reconoce más el papel de estas opciones terapéuticas en aras de una terapia integral (AU)

Demographic changes will cause an increasing prevalence of elderly people affected by schizophrenia in the next decades. Although most of the cases (80 % or more) have an early onset, the number of late onset is by no means despicable. Given that good quality data from randomized clinical trials are lacking as far as therapy of schizophrenia in the elderly is concerned, inferences from studies performed in other age segments are commonly used. Taking together the available data, the use of atypical antipsychotics is recommended in the elderly, because of better tolerance and safety profile, since there is no evidence of better efficacy compared with classic first generation antipsychotics. Drugs with anticholinergic properties are particularly inadvisable in elderly people. Antipsychotic therapy efficacy is broadly similar between age groups. Data about the clinical usefulness of non pharmacological treatments -such as psychotherapy or psychosocial interventions- are even sparser, while the role of these therapeutical options is increasingly recognized (AU)