Socio-Psychological Impacts of Terminal Illness on Patients and their Spousal Relationship

This phenomenological study was conducted to explore the im- pacts of terminal illness on patients and familial relationships of couples in Pakhtun society. 36 terminally ill patients selected purposively were interviewed separately (24 male & 12 female patients) by the way of open-ended questions. Numerous themes were extracted following verbatim transcripts. All the participants explained the impacts of terminal illness on their social lives and the positive and negative aspects of their spousal relationship. Depression, anger and desperation were apparent in the terminal patients. Similarly bitterness, guilt, persistent sadness and loss were common in the patients and alternatively in their partners as explained by the patients. This research highlights adistinct viewpoint on the damaging influences which terminal illness can have on the marital rela- tionship. However it also recommends how to deal the situation in apositive manner by making adjustments required by the concerned disease. The findings indicate that social scientists need to confess and reply to the incredible psycho-social im- pacts that serious illnesses and related medical procedures can have on the patients and their families even in this modern era of advance technology. Advance social and psychotherapeutic techniques and socio-psychological support of partners can as- sist such patients to live with apositive life style till the end.

Psychological Adjustment to Spousal Bereavement in Older Adults: A Systematic Review

Research articles examining psychological adjustment to spousal bereavement in older adults (65+) were identified through searches on five electronical databases alongside forward citation and reference list searches. A total of 15 articles involving 686 unique participants were identified. Five characteristics were discovered which can facilitate and inhibit psychological adjustment to spousal bereavement in older adults: the pre-loss spousal relationship, social support, finding meaning and spirituality in loss, the surviving spouse’s personality traits, and death characteristics. These findings support that concepts of ‘meaning making’ and social support should be incorporated into therapeutic work with bereaved spouses to help facilitate psychological adjustment.

Determinants of Caregiver Burden in Early-Onset Dementia

<b><i>Introduction:</i></b> Caregivers of patients with early-onset dementia (EOD) experience high levels of burden, which is known to be affected by caregivers’ psychological features as well as by patients’ and caregivers’ demographical and social variables. Although potential clinical, demographical, and social determinants have been separately examined, it is not known how they reciprocally interact. <b><i>Methods:</i></b> Ninety-two consecutive patient-caregiver dyads were recruited from the Cognitive Neurology Clinics of Modena, Northern Italy. Caregivers were asked to fill in questionnaires regarding their burden, psychological distress, and family economic status. Data were analyzed with multivariable regression models and then entered in a mediation model. <b><i>Results:</i></b> Caregiver burden was positively related to female caregiver sex, spousal relationship to the patient, severity of patient’s behavioral symptoms, diagnostic delay, and financial distress of the family. It was negatively related to disease duration, patient’s education, region of birth, caregiver age, number of caregiver’s days off work, number of offspring, and caregiver perception of patient’s quality of life. While the effect of caregiver age, diagnostic delay, and of proxies of family or social network directly impacted on caregiver’s burden, the effect of patient’s disease duration, being a wife caregiver, financial distress, and number of caregiver’s days off work was entirely mediated by the level of caregiver psychological distress. <b><i>Conclusions:</i></b> Both direct actions (such as increasing social networks and shortening diagnostic delay) and indirect actions aimed at reducing psychological distress (such as increasing the number of caregiver’s days off work and financial support) should be planned to reduce caregiver’s burden.

Couple relationship satisfaction: The role of recollection of parental acceptance, self-differentiation, and spousal caregiving

The actor–partner interdependence model (APIM) was employed in this study to investigate the mediating effect self-differentiation and spousal caregiving have on the relationship between recollection of parental care and acceptance and couple satisfaction. One hundred and forty-four non-clinical couples (N = 288) in enduring relationships were recruited. Results for actor effects revealed two mediating paths whereby, among both partners, recollection of maternal (but not paternal) acceptance was associated with their self-differentiation and responsive spousal caregiving, which, in turn, were linked to their spousal relationship satisfaction. Partner effects revealed three mediating paths: for both partners, recollection of childhood maternal acceptance was associated with responsive caregiving, which, in turn, was linked with their partner’s relationship satisfaction. Interestingly, the husbands’ recollection of maternal acceptance was associated with their partners’ responsive spousal caregiving, which was linked to both spouses’ relationship satisfaction. Our results may support the theoretical assumptions regarding intergenerational continuity from perceptions of childhood via self-differentiation effecting couple caregiving to couple relationship, but only on the mother’s part.

‘The care circle consists of me.’ Loneliness and social isolation for older male spousal care-givers. A qualitative study

Whilst loneliness and social isolation amongst older care-givers are becoming increasingly recognised, little is known about how these concepts impact on specific sub-groups of care-givers, such as older males. In the current study, we aimed to gain a better understanding of the experiences of loneliness and social isolation amongst older spousal male care-givers. Semi-structured interviews were undertaken with 24 participants, caring for a spouse/partner with a long-term chronic condition. After thematic analysis of the data, three themes were identified: dwindling social interactions, loneliness in the spousal relationship, and living with loneliness and social isolation. Study findings suggest that opportunities for social interactions gradually ‘dwindled’ due to a reluctance by older male care-givers to leave their spouse/partner at home alone, to accept offers of help or respite, or to attend social events without their spouse/partner. Consequently, social isolation increased. Feelings of physical and emotional loneliness were evident, and the loss of spousal companionship (such as loss of conversation and shared interests) increased loneliness. Individualised coping strategies were adopted including focusing on moments of positivity, talking to others and using prescribed medication. Findings provide insight into the experience of loneliness and social isolation for many older male spousal care-givers. This may facilitate a better understanding of older male care-givers’ support needs in addressing loneliness and social isolation, and should help to inform the development of targeted support services for this population.

Genetic Polymorphism of rs13306146 Affects α2AAR Expression and Associated With Postpartum Depressive Symptoms in Chinese Women Who Received Cesarean Section

Postpartum depressive symptom (PDS) is a common psychological and mental disorder after giving birth. Our previous studies showing the application of dexmedetomidine, an α2-AR agonist, can significantly improve maternal sleep, as well as relieve and reduce the incidence of PDS. This study investigated the association between α2AAR gene polymorphisms and PDS. A total of 568 cesarean section patients were enrolled; the incidence of PDS is 18.13% (103 with PDS, 465 with non-PDS). The Edinburgh Postpartum Depression Scale score ≥10 was used to diagnose PDS at 42 days after delivery. The single-nucleotide polymorphisms of α2AR were sequenced by pyrosequencing. The effect of rs13306146 A &gt; G polymorphism on α2AR transcription and the regulation of miR-646 on α2AR expression were assessed by dual luciferase reporter assays or gene transfection. Increased stress during pregnancy, poor relationship between mother-in-law and daughter-in-law, spousal relationship, domestic violence, antenatal depression, self-harm ideation, and stressful life events were all associated with increased PDS incidence (p &lt; 0.05). The logistic regression analysis found that the α2AAR rs13306146 polymorphism was associated with PDS after adjusting confounding variables. The transcriptional function of the α2AAR rs13306146 A allele was decreased compared with the G allele, and the α2AAR expression level was correspondingly decreased (p &lt; 0.05), as the strongest binding ability of miR-646 to the α2AAR rs13306146 AA genotype. The effect of α2AAR rs13306146 A &gt; G polymorphism may change the binding ability of miR-646 at the 3′UTR of the α2AAR gene, affecting the expression of α2AAR. This study supports the involvement of the norepinephrine system in the pathogenesis of PDS. Genotypes of α2AAR may be novel and useful biomarkers for PDS.

Gender Differences in the Longitudinal Association Between Husbands' and Wives' Depressive Symptoms Among Korean Older Adults: The Moderating Effects of the Spousal Relationship

Purpose: The mutual effects of depressive symptoms between couples have long been reported; however, it remains unknown whether the spousal concordance of depression differs depending on spousal relationships.Method: Data on 291 married couples from the Korean Social Life, Health, and Aging Project (KSHAP) were examined. The KSHAP collected global network data from the target population living in one Korean village over eight years and across five waves. A seemingly unrelated regression (SUR) model in the panel data was employed to address correlation and heterogeneity.Results: If one spouse (husband or wife) had depressive symptoms, the other spouse tended to have depressive symptoms. However, the effect of marital relations on spousal concordance for depression was different in husbands and wives. This study demonstrated both spousal support aspects and spousal network aspects of spousal relationships. Depression concordance was more substantial for couples with a more negative marital relationship. A supportive marital relationship mitigated the impact of a husband's depression on his wife's depression but did not work in the opposite case. Spousal network overlap decreased the effect of a wife's depression on her husband's depression, but rather directly increased a wife's depression and failed to mediate the impact of a husband's depression on his wife's depression. Conclusion: Our findings suggest that approaches to helping older adults deal with mental health disorders should proceed not only on an individual but on a couple-level. Also, gender-specific strategies need to be constructed to enhance the mental well-being of the older population.

Exploring Experiences and Needs of Spousal Carers of People with Behavioural variant Frontotemporal Dementia (bvFTD) including those with familial FTD (fFTD): A Qualitative Study

IntroductionCarers of people with frontotemporal dementia (FTD) experience greater challenges than carers of people with other dementias due to the younger age of onset and the challenging presentation of symptoms. The aim of the present study was to explore experiences of spousal carers of people with bvFTD, including those with the familial form of the disease (fFTD). MethodFourteen qualitative interviews were analysed using an inductive approach to Thematic Analysis to understand experiences of spousal carers of people with bvFTD including those with fFTD. ResultsFive main themes were identified including: a) The “Constant Battle” – A journey toward an FTD diagnosis, b) Shock, Relief and Fear – Challenges persist post diagnosis, c) The “Life Altering” impact – The loss of the spousal relationship and shifting roles, d) Adapting, Managing Symptoms and Receiving Carer Support, e) Lack of General Knowledge – Barriers to support. ConclusionsHealthcare professionals should be educated on the initial presentations of FTD, to enable carers and families receive timely diagnosis and appropriate support. Future research should investigate the impact of fFTD on carers and families, to explore positive or meaningful experiences in caring, as well as theory-driven research to identify helpful coping strategies for carers of people with FTD.

Sexual Dysfunction in Iranian Older Women and its Predictors: A Cross- Sectional Study

Background: The population of older women is rapidly increasing in every country in the world, including Iran. Given the effect of Sexual Function (SF) and sexual health on older women’s health, the present study was conducted to determine Sexual Dysfunction (SD) and the factors predicting it in Iranian older women in Karaj. Methods: The present cross-sectional study was conducted on 550 eligible older women selected by stratified cluster sampling from those visiting health centers in Karaj between October 2019 and February 2020. Data were collected using self-report questionnaires including demographic questionnaire, the hospital anxiety and depression scale (HADS), and the Female Sexual Function Index (FSFI). To take account of the effect of sampling design on the analyses, survey command in Stata-14 was used. Results: A total of 94.5% of the participating women had SD, 74.4% reported desire disorder, 79.8% arousal disorder, 57.6% lubrication disorder, 65.3% orgasm disorder, and 72.2% sexual dissatisfaction, and 52.4% had dyspareunia. The participating women’s SF had significant relationships with physical activity, hysterectomy, spouse’s SD, and the intimate and emotional closeness with the spouse (P<0.05). SF had significant inverse relationships with age, duration of marriage and menopause, anxiety, and depression (P<0.001). Nonetheless, SF had no significant relationship with occupation, education, smoking, and type and frequency of childbirth. The results of the linear regression test showed that the duration of menopause (B=-0.04, P=0.023), spouse’s SD (B=-0.95, P<0.001), intimacy (B=13.89, P<0.001), emotional closeness (B=6.49, P<0.001), anxiety (B=-0.08, P=0.033), and depression (B=-0.24, P<0.001) predicted the participating women’s SF significantly. Conclusion: The majority of the participating women had SD. Attention mental health, spousal relationship, and spouse’s sexual health may have significant positive effects on the sexual health of Iranian older women.