Unmasking Verbal Defensiveness: The Role of Psychological Threat in Sentence Completion Tests.

Shedding light on the validity of sentence completion test (SCT) verbal defensiveness as an index of defensive behavior, the current two-part study examined the relationship between psychological threat and verbal defensiveness among military security and mission-critical team candidates using SCTs. Our study showed that as the threatening nature of SCT stems increased, defensive responses also increased, substantiating the link between psychological threat and defensive behavior. In addition, expert ratings of stem content revealed moderately strong relationships with defensive responses across two different SCTs, irrespective of their structural characteristics. In contrast to previous studies using total verbal defensiveness scores, we examined specific defensive response types and their associations with stem threat ratings, finding that omissions, denial, and comments about the test were linked to stem threat levels. Lastly, our study extends the application of the SCT verbal defensiveness index beyond specialized personnel selection, finding no significant differences in verbal defensiveness based on gender or military status. Overall, these findings contribute to a comprehensive understanding of defensive behavior and its contextual variations.

Recruitment and retention of ethnic minority elders into clinical research.

Despite an increasing awareness of the problem, clinical research continues to include lesser numbers of ethnic minority participants disproportionate to their population percentages. To rectify this problem, this article attempts to identify key barriers to minority recruitment and retention as well as specific strategies and methods successful in the past. We propose specific recommendations to address these barriers, and formulate a 3-prong approach to increasing minority recruitment and retention, with emphasis on elderly participants. The article discusses such concerns as building trust in the target community, using appropriate methods of outreach, and providing culturally sensitive written materials at appropriate health literacy levels. Through an awareness of and attention to cultural differences and sensitivities, researchers can and must address the chronic underrepresentation of ethnic minorities in clinical research.

Is religious coping associated with cumulative health risk? An examination of religious coping styles and health behavior patterns in Alzheimer's dementia caregivers.

The current study explored the relationship between religious coping and cumulative health risk associated with health behavior patterns in a sample of 256 Latina and Caucasian female caregivers of elderly relatives with dementia. Primary analyses examined the relationship between religious coping (both positive and negative) and an overall index of cumulative health risk. Secondary analyses were conducted on the individual health behaviors subsumed in the broader index. Findings revealed that negative religious coping was significantly associated with increased cumulative health risk. Positive religious coping was predictive of decreased cumulative health risk among Latina caregivers but not among Caucasians. Negative religious coping was significantly associated with both an increased likelihood for weight gain and increased dietary restriction. Positive religious coping was associated with decreased likelihood for weight gain in Latinas. Implications for both caregivers and clinicians are discussed.

Self-efficacy as a moderator of the relationship between care recipient memory and behavioral problems and caregiver depression in female dementia caregivers.

PURPOSE: The purpose of the current study was to explore the moderating effect of 3 domains of caregiver self-efficacy on the relationship between exogenous caregiving stressors (care recipient memory and behavioral problems) and depression. DESIGN AND METHODS: Moderator analyses were used to analyze data for 256 caregivers of elder relatives with dementia recruited at the Palo-Alto site of the National REACH (Resources for Enhancing Alzheimer's Caregiver Health) Project. Significant interactions between the stressor and self-efficacy indicated a potential moderating effect. Post hoc analyses were then conducted to determine the nature of the interaction(s). RESULTS: Self-efficacy for managing disruptive behaviors and self-efficacy for controlling upsetting thoughts had a direct effect on depression. Self-efficacy for responding to disruptive behaviors moderated the relationship between care recipient memory and behavioral problems and symptoms of depression. IMPLICATIONS: Self-efficacy may be an important clinical tool for identifying the caregivers who are most vulnerable to depression. Self-efficacy for responding to disruptive behaviors may be especially helpful in identifying caregivers at the greatest risk for depression when care recipient memory and behavior problems are high.

The relationship between religiosity and health behaviors in female caregivers of older adults with dementia.

The current study explored the relationship between three dimensions of religiosity: (a) organizational religiosity (e.g. attendance at religious events), (b) non-organizational religiosity (e.g. prayer), and (c) subjective religiosity (e.g. importance of religion) and caregiver health behavior patterns in a sample of Latina and Caucasian female caregivers of older adult relatives with dementia. It was hypothesized that religiosity would have a significant association with reduced cumulative health risk as determined by an index of health behaviors. It was also hypothesized that, when examining the individual health behaviors subsumed in the overarching index, religiosity would be positively associated with adaptive health behaviors like exercise and negatively associated with health risk behaviors like smoking. Amongst Caucasians, increased subjective religiosity was related to increased cumulative health risk. Conversely, in Latinas, non-organizational religiosity was positively correlated with improved dietary practices (reduced dietary restriction). Increased levels of subjective religiosity were significantly associated with decreased maintenance of a routine exercise regimen across ethnic groups. Recommendations for clinicians and religious leaders, and avenues of future research are discussed.

Managing aviator fatigue in a deployed environment: the relationship between fatigue and neurocognitive functioning.

The current military battlefield requires aviators to make split-second decisions that often have life-and-death consequences, making identifying predictors of diminished cognitive performance a vital aeromedical and safety concern. The current study explored the relationship between aviator effectiveness, as determined by sleep-wake patterns, and neurocognitive functioning in a brigade-size rotary wing aviation element deployed in Iraq. Actigraphy and the Fatigue Avoidance Scheduling Tool (FAST) were used to assess the ratio of sleep-wake patterns over a 24-hour time period, and a computerized multitasking measure, which mimics the task demands of flying, was utilized to evaluate neurocognitive functioning during preflight operations. Results showed a significant positive association between level of effectiveness and neurocognitive functioning before flight operations. The reported sleep habits and trends in types of sleep difficulties are noted. The results speak to the potential efficacy of using actigraphy and software to evaluate a pilot's effectiveness before flight operations, and suggest that flight surgeons and psychologists may be able to play a vital role in improving overall sleep patterns and enhancing the warfighting efforts of aviators in combat. They also suggest that mandated crew rest and evaluation of total reported sleep time may not be sufficient to ensure optimum performance levels.

Depression and distress predict time to cardiovascular disease in dementia caregivers.

OBJECTIVE: This study assessed the impact of depressive symptoms and distress from patient problem behaviors on time to developing a diagnosis of cardiovascular disease (CVD) in a sample of 643 dementia family caregivers. DESIGN: A longitudinal, prospective design was used. Over an 18-month period, caregivers free from a CVD diagnosis at baseline were assessed at 6, 12, and 18-month follow-ups for the onset of CVD. MAIN OUTCOME MEASURES: Days to the onset of CVD was the primary outcome. RESULTS: Over the length of the study, 32 participants (5%) reported a diagnosis of CVD. After adjusting for sociodemographic and health factors (e.g., high blood pressure, age, smoking history), greater depressive symptoms (p = .040) and distress from patient problem behaviors (p = .034) were significant predictors of time to CVD diagnosis. CONCLUSION: This study suggests that increased depressive symptoms and reaction to patient problem behaviors (i.e., distress) may increase caregivers' risk for experiencing negative health outcomes, specifically CVD.

The relationship between self-efficacy and cumulative health risk associated with health behavior patterns in female caregivers of elderly relatives with Alzheimer's dementia.

OBJECTIVE: To promote caregiver well-being and to help caregivers persevere in their invaluable roles, personal resources that predict increased self-care and reduced health risk behaviors need to be identified. METHOD: This study examined relationships between self-efficacy beliefs in three distinct domains of caregiving and cumulative health risk associated with health behavior patterns. RESULTS: Higher levels of self-efficacy for Obtaining Respite and self-efficacy for Controlling Upsetting Thoughts were found to be related to reduced health risk. DISCUSSION: These findings suggest that caregivers who believe that they can remove themselves from the stresses of caregiving and who can manage the distorted cognitions often associated with caregiving may experience tangible benefits in health behaviors and, ultimately, improved physical health.

Ethnicity and time to institutionalization of dementia patients: a comparison of Latina and Caucasian female family caregivers.

OBJECTIVES: To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care-recipient characteristics predicted institutionalization. DESIGN: Longitudinal. SETTING: San Francisco Bay area, California. PARTICIPANTS: Two hundred sixty-four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers. MEASUREMENTS: Number of days between baseline interview and institutionalization was recorded over an 18-month period. Kaplan-Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care-recipient or caregiver characteristics (e.g., care-recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization. RESULTS: Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care-recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more-positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less-acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more-acculturated Latinas. CONCLUSION: Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia.

Understanding caregiver health behaviors: depressive symptoms mediate caregiver self-efficacy and health behavior patterns.

Previous research on female caregivers of elderly relatives with dementia has demonstrated that caregiving self-efficacy (SE) is associated with reduced cumulative health risk. The overarching aim of the current study was to expand on that research by exploring whether depressive symptoms mediate the relationship between 3 domains of caregiving SE and cumulative health risk associated with health behavior patterns. Data from 256 female family caregivers of patients with dementia are presented. Path analysis revealed a significant mediated effect for depressive symptoms as both SE for obtaining respite and SE for controlling upsetting Thoughts had a significant, indirect effect on cumulative health risk. There were no direct effects between caregiver SE and cumulative health risk. The current study sheds light on the complex pathway between caregiver SE and health and speaks to the importance of skills-based interventions designed to enhance efficacy beliefs and minimize depression in dementia caregivers.

The moderating effect of self-efficacy on intervention response in women family caregivers of older adults with dementia.

This study performed moderator analyses to determine if self-efficacy predicted differential outcome in a randomized trial comparing a cognitive behavior psychoeducational intervention and an enhanced support group (ESG). The four key outcomes were depression, anxiety, social support, and coping. Low baseline self-efficacy scores were hypothesized to be more predictive of positive response in the psychoeducational intervention than in the support group. Change from pre- to posttreatment (baseline to three months) for 213 female caregivers of older adult relatives with dementia (122 Anglos and 91 Latinos) are presented. Caregivers were randomly assigned to either the coping with caregiving class (CWC), a skill-building, small group intervention designed to reduce caregiving stress, or to an enhanced support group (ESG), which used guided discussion and empathic listening to develop within-group reciprocal support. The findings showed that low baseline self-efficacy scores better predicted positive response to treatment in the CWC intervention than in the ESG intervention. This study supports the use of self-efficacy as a screening tool for appropriate caregiver intervention assignment.