Attitudes toward mental health and mental health care among custodial grandparents.

Objective: Two-hundred thirty-nine grandparents who were raising their grandchildren were surveyed regarding their attitudes toward mental health and mental health care as well as their use of mental health services, each twice over a one-year time frame.Methods: Mental health attitudes were assessed utilizing self-report scales assessing openness to seeking help, biases regarding mental health and mental health professionals, and breadth regarding beliefs about the origins of mental/emotional distress.Results: Findings suggested that grandparent caregivers were generally positive regarding their willingness to seek mental health care, biases regarding mental health professionals, and beliefs about the origins of emotional distress. Factors that predicted mental health attitudes reflected grandparent personal characteristics, aspects of caregiving, and sample demographics. There was a relationship between attitudes toward mental health and the use of mental health-related services, and having sought help was associated with mental health attitudes and emotional distress at both occasions of measurement and over the one-year timeframe. Some modest evidence was found for the role of openness to seeking help in partially mediating relationships between emotional/caregiving-related distress and mental health care use.Conclusion: These findings are important in understanding not only grandparent caregivers' attitudes toward mental health, but also can serve as a basis for enhancing their use of mental health care services.

Social and Emotional Loneliness: Their Relationship to Multiple Domains of Cognition in Later Life.

Despite the fact that the literature suggests loneliness to undermine cognitive functioning in later life, no work has simultaneously examined the relationships between these constructs taking a multidimensional approach to the assessment of each. The present study explored relationships among social and emotional loneliness and both general crystallized (Gc) and general fluid (Gf) ability, as well as to several indices of everyday intellectual functioning in later life. Sequential regression analyses suggested that neither social nor emotional loneliness predicted Gc. However, only when eliminating health as a covariate was more social loneliness associated with lower scores for Gf. Surprisingly, more emotional loneliness was associated with higher scores for Gf. More social loneliness also predicted more everyday cognitive failures and with less positive lifestyle attitudes. These findings support a view of loneliness-cognition relationships in later life that reflects the multidimensional nature of each construct.

Grandmother and Grandchild Reports of Psychological Difficulties Among Custodial Grandchildren: Whose View Matters and Why is It Important?

We conducted this first ever study comparing reports of custodial grandchildren's (CG) psychological difficulties obtained jointly from 163 custodial grandmothers (CGM) and their CG between ages 6-12. Internalizing and externalizing difficulties were indicated by whether any of the corresponding scales on the Strengths and Difficulties Questionnaire (SDQ, reported by CGM) or Dominic Interactive (DI, reported by CG) reached the 90th percentile. Internalizing and externalizing difficulties were reported by informant types at rates higher than those typically observed in the general population, with externalizing difficulties being more prevalent among male CG. At the dichotomous level of (dis)agreement, nearly two-thirds of informant pairs showed concordance regarding whether or not they reported the CG at the 90th percentile on either externalizing and internalizing difficulties. When (dis)agreement was further broken into four specific categories (i.e., "neither report", "both report", "CGM only", and "CG only", CGM's use of mental health services, race, depressive and anxiety symptoms, harsh/punitive discipline, and warmth impacted such concordance as did CG's gender, age, and use of mental health services. The overall findings were remarkably similar regardless of which specific SDQ and DI scales were used in the analyses. The present study unearths new ground regarding the extent to which grandchildren's distress is similarly perceived by CG themselves versus their CGMs. Such findings are important to the extent that accurate estimates exist regarding the emotional difficulties CG face and lay the groundwork for timely and efficacious interventions designed to alleviate their distress.

Predictors and moderators of treatment efficacy in reducing custodial grandmothers' psychological distress.

It is increasingly recommended that hypothesis-generating studies be conducted after initial RCTs in order to identify moderators of differential treatment efficacy on individual outcomes. Such analyses are important because they help clarify the best inclusion and exclusion criteria or choice of stratification for maximizing power in subsequent RCTs, reduce the chances of discarding interventions that may appear to lack efficacy when only average treatment effects are taken into consideration, and facilitate the matching of individual clients to treatment alternatives. We identified predictors and moderators of treatment-related change in psychological distress among custodial grandmothers (n = 343) assigned within a prior RCT to behavior parent training (BPT), cognitive behavior therapy (CBT), or information only control (IOC) conditions. Latent change scores in psychological distress were estimated for each grandmother across pre-test to post-test and pre-test to six months, as indicated by self-reported and clinical ratings of depression and anxiety symptoms. These estimates served as outcomes in classification and regression tree analyses conducted separately within the CBT and BPT conditions to identify predictors of treatment efficacy. Matched groups based upon identified predictors were then formed across all RCT conditions, and Predictor × RCT Condition interactions were computed to test for moderation of differential treatment efficacy. Grandmother age was the only predictor and moderator of BPT efficacy at both measurement points, whereas multifaceted predictors and moderators emerged for CBT which varied by time since treatment.

Process-Outcome Relationships and Solution-Based Goal-Setting Interventions With Grandparent Caregivers.

The present study examines the impact of change processes on outcomes in a solution-based thinking and goal-setting intervention for grandparents raising their grandchildren. We found that across the 6 program sessions there was stability and/or increases in the salience of hypothesized change processes, i.e., hopefulness about the future, solution-based thinking, positive thoughts about one's grandchild, multiple indicators of decisional personal goal-setting regarding one's own well-being and grandchild relationship quality. Indicators of change processes were for the most part, related to both post-program outcomes as well as to pre-post program outcome difference scores. Regression analyses suggested that change processes in many cases partially mediated pre-post primary program outcome scores. These data suggest that how grandmother caregivers think about themselves and their grandchildren and their approach to setting personal goals are key change processes explaining the impact of a solution-based, goal-setting intervention on them.

Selective Optimization and Compensation, Skilled Golf Performance, and Age.

The present study tests predictions regarding skilled golf performance and age-based upon Selection, Optimization, and Compensation (SOC) theory. Participants were 1,324 adults (17-85 years old) who competed in a three-day major amateur golf tournament. Findings indicated that older golfers were most likely to identify difficulties in their games worthy of remediation, relied on performance-enhancing equipment to the greatest degree, and scored higher on SOC selection. For such players, SOC selection and remaining competitive predicted better tournament performance. Older players were also less likely to rate a variety of game improvement techniques as effective, less likely to engage in preround preparation, and were less likely than younger players to engage in SOC optimization and compensation strategies. This pattern of findings to a large extent also characterized middle-aged players. Despite a mixed picture of support for SOC theory, these findings provide valuable insights into its application to aging and the competitive sport domain.

The Role of Social Services in Reunified Custodial Grandfamilies.

Social services, including the child welfare system, are often heavily involved in situations where children are returned to the care of their parents, after being raised in kinship care by their grandparents. While previous research has highlighted custodial grandparents' service needs and the challenges they experience when accessing services and working with social service professionals, few studies have examined social services in the context of reunifying grandfamilies. Informed by bioecological theory, the aim of this qualitative study was to examine custodial grandmothers' perceptions of the role of social services in the process of their grandchildren being reunified with a biological parent. Semi-structured, in-depth interviews were conducted with a purposeful sample of 16 custodial grandmothers whose grandchildren had experienced reunification. Findings from a grounded theory analysis revealed grandmothers' perceptions that having a strong connection with a responsive caseworker facilitated successful reunification, as did ongoing efforts to address the parental issues that had resulted in the grandmother assuming a custodial role. Unfortunately, grandmothers also perceived barriers to successful reunification. These included having their perspectives dismissed by caseworkers and judges as well as the child welfare system prioritizing reunification, often to the perceived detriment of their grandchildren. Implications for policy and practice with reunifying grandfamilies are addressed.

Predicting Attrition Among Hospice Volunteers.

To explore those factors predicting continued involvement among hospice volunteers, this study collected data from questionnaires distributed among 53 individuals who were hospice volunteers, to include personal demographics and measures of locus of control, burnout, hospice self-efficacy, spirituality, and death anxiety. Participants were then contacted between 6 and 8 months later to assess whether they were still actively volunteering for hospice. Those who remained in hospice reported less burnout when adjusting for previous volunteer experience, age, education, and duration of volunteering and a combination of burnout, spirituality, and hospice self-efficacy accurately predicted group membership (completers vs. dropouts) in 82% of the cases. The implications of these exploratory findings for the retention of hospice volunteers are discussed in the context to carefully screening persons before they enter the hospice volunteer role and providing hospice volunteer training for them.

Psychological Difficulties among Custodial Grandchildren.

Although custodial grandchildren (CG) are likely to have more emotional and behavioral problems than children in general, only a handful of studies involving nationally representative data have investigated this important public health issue. The present study is unique in examining informant reports of psychological difficulties and prosocial behavior, obtained via the Strengths and Difficulties Questionnaire (SDQ) parent version, regarding two samples (n = 509 and n = 323) of CG between ages 4-12 and three samples of age peers from the 2004 National Health Interview Survey (NHIS) residing in homes with either no birth parent (n=184), one parent (n = 1,618), or both parents (n = 3,752). A MANCOVA encompassing the main effects of sample type, child gender, and informant's race across six SDQ subscales (with informant age and education, as well as child age controlled) showed all three main effects to be statistically significant (p < .001). Between subjects effects for sample type were significant for all six subscales (p <.001), with a general pattern found whereby the two CG samples had higher difficulty and lower prosocial scores than all three NHIS samples, with corresponding effect sizes falling in the moderate to very large range. Tests of between subjects effects for child gender showed, that regardless of sample type, males typically had higher difficulty scores and lower prosocial scores than those for females. Tests of between subjects effects by informant's race showed only sporadic differences that were independent of sample type. Comparisons of the SDQ banded scores suggested that CG have considerably different cutoff points than do children in other family structures to indicate a likely diagnosis of a serious psychological disorder. We conclude that primary school aged CG are at an especially high risk for both internalizing and externalizing difficulties regardless of children's gender or informant's race.

Depressive Symptomatology and Priming Effects Among Younger and Older Adults.

Background/Study Context: This study examined the potential impact of self-reported depressive symptoms on the age-related capacity for inhibition and suppression, utilizing a negative priming paradigm. METHODS: One hundred eighty-five community-residing adults varying in age (98 younger adults, Mage = 22; 87 older adults, Mage = 69) completed a nonconscious priming task, the Geriatric Depression Scale (GDS), the White Bear Suppression Inventory (WBSI), the Depression Sensitivity Scale (DSS), a free thought suppression task, as well as several measures indexing overall cognitive ability and psychomotor speed. Hierarchical regressions investigated the interaction of depressive symptoms with age and its effect on both positive and negative priming performance, indexing both facilitation and inhibition effects, respectively. RESULTS: Results support the hypothesis that noncognitive factors affect effortful performance among older adults, although this influence varied with the specific component of the GDS, i.e., Dysphoria, Social Withdrawal, and Cognitive Control, and with the measure of depressive symptoms, i.e., GDS versus DSS. CONCLUSION: These data suggest that aging's impact on both facilitation and inhibition, e.g., positive and negative priming, are to an extent, a function of individual differences in depressive symptoms that interact with age in influencing the necessity to reallocate one's cognitive resources to deal with depressive thoughts and feelings.

The impact of elder abuse education on young adults.

The present study examined the effectiveness of educational interventions in altering tolerance for and behavioral intentions of elder abuse among college student young adults. Participants were 225 undergraduates who were assigned to one of four educational groups: Elder Abuse Education, Aging Education, Family Education, and a Pre- and Posttest only condition. While the Elder Abuse Education group reported less tolerance and intentions for elder abuse compared to the other groups at the immediate posttest, a decrement in such positive changes at 1-month follow-up was observed in such persons. These mixed findings suggest that while specific interventions may reduce elder abuse tolerance, supplemental educational efforts over time may be necessary to maintain intervention-specific gains in intentions and behaviors particular to elder abuse.

Verbal expressive personality testing with older adults: 25+ years later.

This review builds on those conducted over 25 years ago by Panek and Hayslip in examining the literature dealing with the use of verbal expressive techniques with older adults. Such findings based on the Rorschach Ink Blot Test, Holtzman Inkblot Technique, Hand Test, Sentence Completion methods, and the Thematic Apperception Test and kindred thematic apperceptive techniques are presented and evaluated regarding the evidence for age differences, differential diagnosis, extraneous individual differences in performance, and adequacy of normative data. Although available evidence appears to warrant the continued use of verbal expressive techniques with older adults, more adequately designed studies are necessary to fully support the potential of these assessment tools for decision making with this population: assisting in diagnosis, recommending the appropriateness of various living arrangements, facilitating supportive care choices, and aiding in treatment planning.

A self-administered, mild form of exposure therapy for older adults.

Despite the effectiveness of exposure therapy to alleviate trauma-related distress, many older adults are unable or unwilling to enter therapy. Mild forms of exposure therapy, such as completing memory questionnaires about a stressful event, have been shown to reduce distress in younger adults. This study attempted to examine the impact of a mild form of exposure therapy in an older adult population. A community-living sample of 263 older adults nominated a stressful event from their lives, and were randomly assigned to either complete questionnaires concerning their memory of the stressful event, or a control task. Results indicated that those who had completed the memory questionnaires about a nominated stressful event evidenced lower levels of distress two weeks later. This effect was stronger for events that were either more recent or had elevated initial levels of distress. These findings suggest an alternative treatment for older adults who have experienced a stressful or traumatic event.

The role of caregiver burden in understanding African American custodial grandmothers.

African American grandmothers who parent their grandchildren often experience burden and altered health related to these responsibilities. However, little is known about how such burden reliably predicts physical and mental health, needs for information about services, needs for service and service use. Recruited from churches and community centers, 93 African American grandmothers who provided care for their grandchildren participated in this study. Hierarchical multiple regression was used to ascertain relationships between variables. Findings suggested that burden predicted needs for information about services, needs for service, service use, and physical health, but not mental health. In order to better understand grandmother caregivers' well-being and orientation to services, the present study suggests that the role of burden be centralized as a predictor of many parameters pertinent to grandparents raising their grandchildren.

A Proactive Behavioral Activities Program (EWA) and the Influence of COVID-19 among Seniors in Congregate Living Communities.

Older adults in affordable housing are at risk for mental health problems, physical vulnerability, and isolation. We examine the role of an activities program in buffering the influence of life stressors on the mental health of seniors in congregate housing, using a non-experimental pretest-posttest study design. Results based upon repeated measures analyses (N = 29), found statistically significant (p < .05) program by time effects for depression, coping strategies, positive affect, isolation, and resident satisfaction. Analyses based upon independent samples of pretest and posttest measures (N = 60) were considerably less strong, but consistent in yielding similar patterns to those of the longitudinally gathered data. Our longitudinal findings substantiate the positive impact of the Engage with Age program in supporting older adults living in congregate housing. Researchers need to develop strategies to assess and support the mental health of older persons in low-income urban congregate living in the larger context of COVID-19.

Should I Do This? Factors Influencing the Decision to Raise Grandchildren Among Custodial Grandparents.

BACKGROUND AND OBJECTIVES: Grandparents often step in to raise grandchildren when the middle generation is unavailable or unwilling. Although the consequences of raising grandchildren are well researched, little is known about the factors influencing grandparents' decisions to raise grandchildren. The objectives of this study were to (a) explore the factors that influence decision-making processes among grandparent caregivers, and (b) investigate the extent to which these factors reflect a multifaceted, dualistic framework. RESEARCH DESIGN AND METHODS: Data were collected from 108 custodial grandparents who answered an open-ended question about their decision to raise grandchildren. RESULTS: Content analyses of participants' answers yielded 15 factorial dimensions defined in terms of their negative/push or positive/pull poles, as it related to their decision to raise grandchildren. Chi-squared tests were used to examine each dimension to the extent to which elicited frequencies were differentially represented for positive versus negative poles. For 12 dimensions, the negative decisional parameters outweighed those that were positive. DISCUSSION AND IMPLICATIONS: Grandparents report both positive and negative parameters when reflecting on their decision to raise grandchildren. These results call for further research to advance the understanding of the decision-making processes that caregiving grandparents make and the role that they may have on their experiences.