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1.
J Psychosom Res ; 122: 13-23, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31126406

RESUMO

OBJECTIVES: We investigate the relationship between control in productive activities (paid work, housework, caregiving) and well-being in persons with a physical disability and their caregiving partners from a dyadic perspective, exploring not only the effect of own control on well-being, but also the effect of the partners' control on well-being. We further evaluated socioeconomic and caregiving characteristics as potential risk factors for low control in productive activities. METHODS: Longitudinal dyadic data from the pro-WELL survey (n = 246) including persons with spinal cord injury (SCI) and their caregiving partners were used and mixed-effects regression modelling was applied. Well-being was operationalized with a cognitive (Satisfaction with Life Scale, SWLS) and an affective component (Positive and Negative Affect Scale, PANAS). RESULTS: Control at work was positively related to well-being in persons with SCI, but less so in caregiving partners. Control in housework and caregiving was associated with higher well-being. The partners' control was linked to affective well-being. Poor socioeconomic conditions were negatively related to control at work and in caregiving, but not to control in housework. Caregiving characteristics seem unrelated to control at work or housework, but higher objective caregiver burden was linked to reduced control in caregiving. CONCLUSIONS: Our findings suggest that low control in productive activities are common in the disability setting and represent an instrumental factor for reduced well-being that is augmented by poor socioeconomic conditions and high objective burden of care. Interventions aiming to optimize well-being through the integration in productive activities should take into account opportunities of exerting control.

2.
Aging Ment Health ; : 1-8, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30789009

RESUMO

OBJECTIVES: To investigate type and load of productive activities as potential determinants of mental health and well-being in elderly persons with a physical disability. METHODS: We used data from a Swiss population-based sample of 314 adults at or past the legal retirement age (65 for men, 64 for women) who live with a chronic physical disability, spinal cord injury. Engagement in housework, volunteering, and paid work were dichotomized (no; some engagement) and three groups of engagement types were constructed (none; housework only; volunteering and/or paid work). Load of engagement was appraised using a sumscore on the overall frequency as well as the total number of performed activities. We used regression modelling to draw causal inference regarding the associations of type and load of engagement with general mental health (Mental Health Inventory, SF-36), self-reported depression (Self-Administered Comorbidity Questionnaire, SCQ), and well-being (WHOQoL-BREF items). RESULTS: Engagement in volunteering was positively related to well-being. Persons engaged only in housework reported better well-being and lower prevalence of depression than non-engaged persons, however, persons engaged in volunteering or paid work reported the highest well-being and the lowest prevalence of depression. The productivity sumscore tertiles and the number of performed activities were both positively linked to well-being and negatively linked to depression, while their association with general mental health was less pronounced. CONCLUSION: Strengthening the engagement in productive activities among the elderly with a chronic physical disability is suggested as a promising strategy to promote well-being and reduce the prevalence of depression.

3.
PLoS One ; 14(2): e0206069, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785880

RESUMO

OBJECTIVES: To evaluate socioeconomic inequalities in social relationships, and to assess whether socioeconomic conditions and social relationships are independently related to mental health problems in individuals with a physical disability due to spinal cord injury (SCI). METHODS: We analyzed cross-sectional data from 511 individuals with SCI aged over 16 years who participated in the community survey of the Swiss SCI Cohort Study (SwiSCI). Indicators for socioeconomic conditions included years of formal education, household income, and financial strain. Social relationships were operationalized by three structural (partner status; social contact frequency; number of supportive relationships) and four functional aspects (satisfaction with: overall social support; family relationships; contacts to friends; partner relationship). General mental health was assessed by the Mental Health Inventory (MHI-5) of SF-36 and depressive symptoms were measured by the Hospital Anxiety and Depression Scale (depression subscale, HADS-D). Established cut-offs for general mental health problems (MHI-5 ≤56) and depressive symptomatology (HADS-D ≥8) were used to dichotomize outcomes. Associations were assessed using logistic regressions. RESULTS: Lower household income was predominantly associated with poor structural social relationships, whereas financial strain was robustly linked to poor functional social relationships. Financial strain was associated with general mental health problems and depressive symptomatology, even after controlling for social relationships. Education and household income were not linked to mental health. Poor structural and functional social relationships were related to general mental health problems and depressive symptomatology. Notably, trends remained stable after accounting for socioeconomic conditions. CONCLUSION: This study provides evidence for socioeconomic inequalities in social relationships as well as for independent associations of financial strain and poor social relationships with mental health problems in individuals with SCI. Further research may develop strategies to improve mental health in SCI by strengthening social relationships. Such interventions may be especially beneficial for individuals with low income and financial strain.


Assuntos
Relações Interpessoais , Saúde Mental , Comportamento Social , Apoio Social , Traumatismos da Medula Espinal/psicologia , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Traumatismos da Medula Espinal/epidemiologia
4.
Psychol Health ; : 1-17, 2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-31888380

RESUMO

Objectives: Failed reciprocity at work and in partnerships was shown to adversely affect wellbeing in general populations, but evidence in disability settings is widely lacking. We explore the effects of failed reciprocity on wellbeing and the impact of the partners' perception of reciprocity on wellbeing in persons with a physical disability and their partners.Design: We use longitudinal dyadic data from the pro-WELL study, a Swiss survey of persons with spinal cord injury (SCI) and their partners (n = 246). Two-level mixed-models with random effects for persons and repeated measures were applied.Main outcome measures: Cognitive wellbeing was measured with the Satisfaction with Life Scale and affective wellbeing with the Positive and Negative Affect Scale short-form.Results: Failed reciprocity at work and in the partnership was associated with all indicators of wellbeing in persons with SCI and with cognitive wellbeing and negative affect in caregiving partners. Life satisfaction of caregiving partners and positive affect of persons with SCI was lower if the partner perceived the partnership as non-reciprocal.Conclusion: Negative associations of failed reciprocity with wellbeing are not restricted to general populations but equally apply to the disability setting and dyadic analyses reveal the importance of the partners' perception of partnership reciprocity for wellbeing.

5.
Int J Equity Health ; 19(1): 3, 2019 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-31892324

RESUMO

BACKGROUND: Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. However, the basic assumption that low SEP is associated with greater caregiver burden has so far lacked empirical support. The objective of this study was to investigate social inequalities in the caregiver burden among caregiving partners of persons with a physical disability, i.e., spinal cord injury (SCI), applying a dyadic approach. More specifically, we investigated 1) the association of the caregivers' SEP with caregiver burden ('actor effect'); 2) the association of the care-receivers' SEP with caregiver burden ('partner effect'), and 3) potential mediators of the association between SEP and caregiver burden. METHODS: Cross-sectional survey data from 118 couples of persons with SCI and their partners living in Switzerland was used. We firstly employed logistic regression to investigate the actor and partner effects of SEP on objective (hours of caregiving) and subjective caregiver burden (Zarit Burden Interview). We additionally used structural equation modelling to explore whether unfulfilled support needs, psychosocial resources and the care-receivers health status mediated the association between SEP and caregiver burden. SEP was operationalized by household income, education, subjective social position, financial strain and home ownership. RESULTS: We observed a consistent trend towards higher objective and subjective burden in lower SEP groups. Caregivers with higher subjective social positon and home ownership indicated lower subjective burden, and caregivers with higher education and absence of financial strain reported lower objective burden. Further evidence suggested a partner effect of SEP on caregiver burden, whereby objective caregiver burden was reduced in couples where the care-receiver had a higher educational level. The negative association between SEP and subjective burden was partially mediated by the unfulfilled support needs and deprived psychological resources of the caregiver, and the poor health status of the care-receiver. Similar mediation effects were not supported for objective burden. CONCLUSIONS: Our study, in the context of SCI, provides support for the contextual role of SEP in the Stress Process Model of caregiving. To reduce subjective caregiver burden, policy programs may target the strengthening of psychosocial resources, or the improvement of access to support services for caregivers with low SEP.

6.
J Psychosom Res ; 110: 61-67, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29764607

RESUMO

OBJECTIVE: Persons with physical disabilities and their caregiving partners are at an increased risk of experiencing reduced life satisfaction. One potential explanation for this trend may be the potentially harmful effects of loneliness and poor relationship quality which this population often experience. To date, little is known about how the perceptions of loneliness and relationship quality affect life satisfaction in the disability and caregiving setting, furthermore the directionality of effect is not well understood. In this study, we investigate the actor and partner effects, and the reciprocal effects of loneliness and relationship quality on life satisfaction. METHODS: The analyses are based on longitudinal dyadic data from a Swiss community survey of persons with spinal cord injury (SCI) and their partners (n = 246). We employed mixed effects modelling to explore standardized (ß) and unstandardized (B) actor and partner effects, and used cross-lagged path analysis to explore reciprocal effects. RESULTS: Loneliness was more prevalent in persons with SCI than in their caregiving partners. In caregiving partners, we found significant negative actor effects of loneliness (ß = -0.20 (-0.31, -0.10)) and positive actor effects of relationship quality (ß = 0.15 (0.04, 0.26)) on life satisfaction, and significant partner effects of relationship quality on wellbeing. In persons with SCI, only the negative actor effect of loneliness was significant (ß = -0.30 (-0.41, -0.18)). Over time, loneliness demonstrated reciprocal associations with life satisfaction. CONCLUSION: The findings of our study highlight the importance of reducing loneliness and strengthening relationship quality to improve life satisfaction in partnerships of persons coping with disability.


Assuntos
Pessoas com Deficiência/psicologia , Solidão/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
7.
BMJ Open ; 7(12): e017369, 2017 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-29275339

RESUMO

OBJECTIVE: To investigate associations of objective caregiver burden, subjective caregiver burden and positive aspects of caregiving with self-reported health indicators in caregiving partners of persons with a severe physical disability (spinal cord injury). DESIGN: Cross-sectional, observational. SETTING: Community, Switzerland. PARTICIPANTS: Caregiving partners of persons with spinal cord injury (n=118, response rate 19.7%). OUTCOME MEASURES: General health, role limitations due to physical health, role limitations due to mental health, pain intensity, mental health and vitality were assessed using items from the 36-Item Short Form Health Survey (SF-36). Three items were used to assess the frequency of different types of sleep problems. RESULTS: Subjective caregiver burden was associated to all self-reported health indicators. A high subjective burden was linked to poorer general health (OR 6.5, 95% CI 2.0 to 21.5), more role limitations due to physical health (OR 4.2, 95% CI 1.4 to 12.8), more role limitations due to mental health (OR 3.6, 95 % CI 1.1 to 11.7), higher pain intensity (OR 4.0, 95% CI 1.4 to 11.5), poorer mental health (coefficient -17.9, 95% CI -24.5 to -11.2), lower vitality (coefficient -20.3, 95% CI -28.4 to -12.1), and more frequent sleep problems (OR 5.3, 95% CI 1.6 to 18.4). Partners who indicated positive aspects of caregiving further reported better mental health (coefficient 6.5, 95% CI 0.2 to 12.8). Objective burden was not related to any health indicator. CONCLUSIONS: Subjective burden and lack of positive aspects of caregiving were associated with poorer physical and mental health. Caregiver health may be promoted through the strengthening of psychological and psychosocial resources.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Pessoas com Deficiência , Qualidade de Vida , Traumatismos da Medula Espinal/enfermagem , Adaptação Psicológica , Adulto , Compreensão , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Autorrelato , Suíça
9.
BMC Public Health ; 17(1): 414, 2017 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-28482878

RESUMO

BACKGROUND: Research has consistently found that favourable exchange with one's proximal social environment has positive effects on both mental health and wellbeing. Adults with physical disabilities may have fewer opportunities of favourable exchange, and therefore the effects on mental health and wellbeing may be less advantageous. The aim of this study is to systematically review quantitative studies exploring associations of social relationships with mental health and wellbeing in persons with physical disabilities. METHODS: The databases PubMed, PsycINFO and Scopus were searched for relevant studies published between 1995 and 2016. Data was extracted on study and participants' characteristics, independent and dependent variables, used measures and effects sizes of associations between social relationships and mental health or wellbeing. A narrative review was performed to synthesize findings along the constructs social support, social networks, negative social interactions, family functioning and relationship quality. RESULTS: Of the 63 included studies, 47 were cross-sectional and 16 longitudinal. Most studies included a measure of social support (n = 58), while other concepts were less often studied (social networks n = 6; negative social interaction n = 3; family functioning n = 2; relationship quality n = 1). Over half of studies included depression as outcome (n = 33), followed by wellbeing (n = 14), composite mental health measures (n = 10), anxiety (n = 8), psychological distress (n = 7), posttraumatic stress disorder (n = 3), and hopelessness (n = 1). Although trends for associations of social support with mental health and wellbeing were consistent, around a quarter of studies failed to report significant associations. Social networks were related to depression, but not to other mental health or wellbeing measures. Family functioning, negative social interactions and relationship quality showed consistent associations with mental health and wellbeing, however, only few studies were available. CONCLUSIONS: This review indicates that social relationships play an important role in mental health and wellbeing in persons with disabilities, although findings are less consistent than in general populations and strength of associations vary between constructs. Integrating persons with disabilities into social networks seems not sufficient and rehabilitation professionals together with affected persons and their peers should ensure that high quality relationships and tailored support are available.


Assuntos
Pessoas com Deficiência/psicologia , Relações Interpessoais , Saúde Mental , Qualidade de Vida/psicologia , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Transtorno Depressivo , Humanos , Meio Social , Apoio Social
10.
Arch Phys Med Rehabil ; 98(10): 2042-2051, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28286200

RESUMO

OBJECTIVE: To explore the effect of relationship quality and reciprocity in partnerships on subjective caregiver burden and caregiver satisfaction in partners of persons with a severe physical disability (spinal cord injury). DESIGN: Cross-sectional, observational. SETTING: Community setting. PARTICIPANTS: Caregiving partners of persons with spinal cord injury (N=118). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjective caregiver burden measured by the Zarit Burden Interview (short form) and caregiver satisfaction measured by a single item on feelings of satisfaction resulting from the caregiver role. RESULTS: Caregiving partners who rated their relationship quality as high encountered less subjective caregiver burden (ß=-1.10; 95% confidence interval [CI], -1.47 to -0.72; P<.001) and more caregiver satisfaction (odds ratio [OR], 1.18; 95% CI, 1.01-1.45; P=.049). These associations persisted even after controlling for sociodemographic characteristics, lesion severity of the care receiver, and objective caregiver burden. Partners who indicated high reciprocity in their relationship to the care receiver indicated less subjective caregiver burden and more caregiver satisfaction when relationship quality was excluded from the final models; however, the effect of reciprocity on subjective burden (ß=-.38; 95% CI, -3.71 to 2.95; P=.82) and caregiver satisfaction (OR, 1.21; 95% CI, 0.28-5.22; P=.80) disappeared when including relationship quality. CONCLUSIONS: Results highlight the importance of relationship quality as a target for couple interventions aimed at reducing subjective caregiver burden and increasing satisfaction in the caregiving role.


Assuntos
Cuidadores/psicologia , Relações Interpessoais , Satisfação Pessoal , Estresse Psicológico/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/terapia
11.
BMJ Open ; 7(1): e011597, 2017 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-28122827

RESUMO

PURPOSE: Social participation is an important determinant of well-being. Among persons with disabilities, and with spinal cord injury (SCI) in particular, opportunities for social participation are restricted and may impact well-being. The longitudinal pro-WELL study aims to investigate associations of 2 major domains of social participation with well-being: (1) availability and quality of close social relationships and (2) acting in core social roles (eg, paid work). The joint inclusion of persons with SCI and their partners is a major innovative aspect of this study enabling an in-depth analysis of interpersonal dynamics in coping with disability. PARTICIPANTS: Pro-WELL is a nested project of the Swiss Spinal Cord Injury Cohort Study (SwiSCI) and involves community-dwelling persons aged 30-65 with SCI and their partners living in Switzerland. Baseline data were collected from mid-2015 to early 2016 by telephone interviews and questionnaires. The first and second follow-up assessments are scheduled with a 6 months interval. FINDINGS TO DATE: The baseline sample consists of 133 persons with SCI and their partners. We provide an overview of baseline characteristics and well-being and describe recruitment outcomes and participation rates. A comprehensive non-response analysis demonstrates adequate representation of the source population with negligible selection bias regarding sociodemographic and lesion characteristics. FUTURE PLANS: The prospective data collection and analysis of month 6 and 12 assessments are ongoing and tests of the main research hypotheses will be performed. Findings will be disseminated through peer-reviewed journals and scientific conferences. A workshop and a newsletter on study findings are proposed to feed back findings to participants and other stakeholders.


Assuntos
Saúde Mental , Papel (figurativo) , Participação Social , Traumatismos da Medula Espinal/psicologia , Cônjuges/psicologia , Adulto , Idoso , Feminino , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Autoimagem , Autoeficácia , Suíça
12.
Disabil Health J ; 10(2): 294-302, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28034572

RESUMO

BACKGROUND: Various social relationship constructs have been proposed to affect mental health. However, these constructs have rarely been studied in a comprehensive way in persons with chronic disabilities and their partners, inhibiting researchers from evaluating their relative importance. OBJECTIVE: To investigate 1) the variation in the quantity and quality of social relationships in persons with spinal cord injury (SCI) and their partners; 2) dyadic coherence within social relationship constructs; 3) the interrelationships between social relationship constructs; and 4) the associations of social relationship constructs with vitality and mental health. METHODS: Cross-sectional survey data from 133 couples of persons with SCI and their partners was used. Quantitative (social networks) and qualitative aspects (social support, relationship quality, loneliness, and reciprocity in partnerships) of social relationships were assessed. Correlations were performed to analyse dyadic coherence and interrelationships of social relationship constructs and multivariable regressions were applied to examine associations with vitality and mental health. RESULTS: Loneliness, larger social networks and higher relationship quality were more prevalent in SCI. All social relationship constructs, apart from loneliness, were more similar within couples than between couples and the interrelationships between different constructs were small. Qualitative aspects of relationships were more important than the quantitative aspects in their associations to vitality and mental health. These associations were most consistent for loneliness, reciprocity and relationship quality in both groups. CONCLUSIONS: In the long-term management of community functioning in persons with SCI and their partners, the fostering of high quality intimate relationships should take priority.


Assuntos
Pessoas com Deficiência , Relações Interpessoais , Solidão , Saúde Mental , Qualidade de Vida , Apoio Social , Traumatismos da Medula Espinal , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência
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