Adult Children's Education and Mothers' Psychological Well-Being: Do Adult Children's Problems Mediate This Relationship?

OBJECTIVES: A growing body of literature documents a positive association between adult children's education and older parents' health, and existing studies have identified social support, social influence, and material transfers as factors linking adult children's education and various dimensions of older parents' health. The present study joins this literature by assessing adult children's problems as mechanisms that may underlie disparities in psychological well-being between mothers whose adult children have completed higher and lower levels of education. METHODS: Using 2 waves of longitudinal data collected in 2001-2003 and 2008-2011 from 400 mothers aged 73-85 years at the second wave as part of the Within-Family Differences Study, we examine the role of adult children's problems in mediating the association between adult children's education and mothers' depressive symptoms. RESULTS: Mothers with children who completed post-high school education reported fewer depressive symptoms than mothers whose children all completed high school or less. We found evidence that this relationship was mediated by the proportion of adult children who have experienced physical and emotional problems in the last 5 years. DISCUSSION: This study underscores the importance of considering how resources and risks that affect well-being accumulate both across the life course and across generations. Providing education opportunities to younger generations and enhancing programs that address challenges that low-attaining children may face have the potential to help minimize socioeconomic disparities in psychological well-being among older adults.

How Do Own and Siblings' Genders Shape Caregivers' Risk of Perceiving Care-Related Criticism From Siblings?

OBJECTIVES: Caring for a parent takes a greater psychological toll on daughters than sons. To minimize the psychological burden of parent care, it is important to understand what contributes to this gender disparity. Inspired by the caregiver stress process model and gender-as-relational perspective, we investigate how caregivers' gender, and the genders of their siblings, shape their risk of perceiving care-related criticism from siblings, a secondary stressor of caregiving with negative implications for psychological well-being. METHODS: Using data from 408 adult child caregivers nested within 231 families collected as part of the Within-Family Differences Study, we employ multilevel modeling to examine how caregivers' gender, as well as the gender composition of their sibship, interact to shape caregivers' probability of perceiving criticism from siblings regarding the care that they provide their mother. Qualitative data from the same caregivers are then analyzed to illuminate processes underlying these statistical associations. RESULTS: Quantitative analyses reveal that daughters in predominantly-son sibships have a lower risk of perceiving care-related criticism than daughters in sibships with higher proportions of daughters. Qualitative analyses elucidate these findings. Daughters in predominantly-son sibships report that their siblings defer to them regarding their mother's care. Conversely, daughters in higher proportion-daughter sibships perceive care-related criticism because they and their sibling(s) hold conflicting views regarding care, and there is less consensus regarding who best understands their mother's care needs and preferences. DISCUSSION: Findings demonstrate how characteristics of caregivers and their sibships interact to affect caregivers' risk of perceiving criticism regarding their care to their mothers.

The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model.

BACKGROUND: Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. OBJECTIVES: The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. METHODS: Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. RESULTS: Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. CONCLUSIONS: Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.