Biomedical subjects

D Gallagher-Thompson

Publications and source records attributed to D Gallagher-Thompson.

28 records · Page 2Linked to original sources

PubMed1993

Social support and caregiving burden in family caregivers of frail elders.

This study assessed the relationships between six different types of social support and five measures of caregiving burden. Two questions were addressed: Are all types of social support equally associated with burden, and do the same types of support correlate with different types of burden? Family caregivers (N = 217) to frail elders composed the sample. Multiple regression analyses demonstrated that all types of social support for caregivers of frail elders are not equal. Engaging in social interaction for fun and recreation appears to be the most important in diminishing the burden of caregiving. These findings are instructive both theoretically and clinically. The theoretical import of greater social participation under a condition of chronic stress is discussed. Further, interventions that focus on caregivers regularly experiencing pleasant activity with friends and other family would seem to go a long way toward managing the burden of caregiving.

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PubMed1992

Applying cognitive-behavioral psychotherapy to the chronically ill elderly: treatment issues and case illustration.

A large percentage of older adults must endure at least one chronic medical illness. Clinically significant depression and anxiety are common among these patients. Specific psychotherapy approaches as well as adaptations required to address the unique issues of this population have not been delineated in the literature. We outline a cognitive-behavioral therapy approach and discuss five treatment issues we have found to be important for this population. These issues include: (1) resolving practical barriers to participation; (2) accepting depression as a separate and reversible problem; (3) limiting excess disability; (4) counteracting the loss of important social roles and autonomy; and (5) challenging the perception of being a "burden." A case study of a chronic obstructive pulmonary disease (COPD) patient with depression is presented and recommendations for future research are suggested.

Activities of Daily Living↗

PubMed1992

Endogenous depression in the elderly: prevalence and agreement among measures.

This article describes agreement among diagnoses made according to five definitions of endogenous depression in a sample of 99 depressed elders and discusses the relationship among these systems and selected demographic and clinical characteristics. Poor to fair agreement was generally demonstrated, except for Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) and Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (American Psychiatric Association, 1987), which demonstrated excellent agreement. Mostly, demographic and clinical variables (e.g., severity of depression) were unrelated to endogeneity diagnoses. The conclusion was reached that these criteria are not all measuring the same construct in older adults and that the relationship between depression severity and endogeneity should be discussed in terms of specific definitions rather than general terms.

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PubMed1992

Changes in grief and mental health of bereaved spouses of older suicides.

Comparisons are made of the impact of a suicide death on the surviving spouse (55 years and older) with that of a natural death on spouse survivors and a married nonbereaved control group over a bereavement period of 2 1/2 years after death. Regardless of mode of death, the loss of a loved one is a difficult psychological trauma, accompanied by depression, confusion, and pervasive feelings of emptiness. Few differences in the impact of the deaths in the early months of bereavement were reported, but changes appeared over the course of the 2 1/2-year measurement period. Compared with natural death survivors, the process of bereavement was found to be more difficult for the survivors of a suicide death, whose severe depressive feelings do not seem to lessen significantly and whose feelings of mental health do not seem to improve until after the first year. Women, in general, report greater feelings than men of anxiety, tension, and apprehension, especially within the first 6 months. By the end of the observation period, most of the differences between the two bereaved groups have disappeared, and both report functioning adequately despite continuing feelings of sadness and loss.

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PubMed1992

The relations among caregiver stress, "sundowning" symptoms, and cognitive decline in Alzheimer's disease.

OBJECTIVE: To investigate the relations among the initial perceived stress of Alzheimer patients' caregivers, the rate of change of perceived stress, patients' sundowning behaviors, and patients' rate of cognitive decline. DESIGN: A longitudinal cohort study in which Alzheimer patients and their caregivers were assessed at 6-month intervals. SETTING: Hospital out-patient clinic. Patients and caregivers lived at home. SUBJECTS: Subjects were 35 patients (50-79 years) with Alzheimer's disease and their primary caregivers (24 males and 11 females); all caregivers were spouses. METHODS: At time of entry into the study, caregivers indicated which of seven behaviors indicative of sundowning were exhibited by the patient. Patients were evaluated successively using the Mini-Mental State Examination, whereas caregivers completed the Perceived Stress Scale, provided an index of social support utilization, and completed the Beck Depression Inventory. MAIN OUTCOME MEASURES: Caregivers' initial perceived stress and the rate of change of perceived stress, patients' sundowning behavior, and rate of cognitive decline. RESULTS: The pattern of correlations indicated that both rate of cognitive decline and initial sundowning behavior were significantly correlated with initial perceived caregiver stress. The average rate of increase of caregivers' perceived stress was positively correlated with the initial incidence of sundowning behaviors, even when controlling for the effects of caregiver depression and social support utilization. CONCLUSION: Sundowning behavior of Alzheimer patients is associated with an increased rate of change of caregivers' perceived stress. This association may be specific to sundowning behavior because there was no relation between the rate of change of perceived stress and morning agitation. The findings suggest that future caregiver intervention programs could profitably focus on sundowning behavior rather than general agitation.

Adult↗

PubMed1992

The role of social supports in the bereavement process of surviving spouses of suicide and natural deaths.

This report examines the changing role of social supports in the bereavement of spouses of elderly suicide and natural deaths, focusing on differences and similarities in relation to gender, time, and mode of death. Measurements were obtained 4 times after death (within 2 months, at 6 months, at 12 months, and at 2 to 2 1/2 years) on 79% of the 108 survivors of elderly suicide, 89% of the 199 natural death survivors, and 79% of the nonbereaved controls. The results indicated that the suicide survivors received significantly less emotional support for their feelings of depression and grief than the natural death survivors, and that they did not confide in the persons in their network any more than the nonbereaved controls did. Women report receiving more support overall than men. A low spot in social supports occurred at the 6-month point after loss for both bereaved groups, but primarily in practical help received by natural death survivors. By the end of the second year, both practical and emotional supports had increased to at least the same level as immediately after death.

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PubMed1991

Dimensions of perceived social support in clinically depressed and nondepressed female caregivers.

The relationship between social support and depression was studied in 165 women caring for frail family members. The Arizona Social Support Interview Schedule (Barrera, Sandler, & Ramsay, 1981), which includes 4 dimensions of availability and use of resources and satisfaction with and need for support, was used to examine 7 categories of supportive activity. Depression was assessed according to Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) with the Schedule of Affective Disorders and Schizophrenia (Endicott & Spitzer, 1978). There were no differences in overall satisfaction with received support in comparisons of depressed and nondepressed caregivers. However, depressed caregivers (n = 87) reported a higher incidence of negative interactions with others. Both groups appeared to have equal access to social support, with nondepressed caregivers (n = 78) reporting significantly greater use of those resources.

Activities of Daily Living↗

PubMed1991

The effects of late-life spousal bereavement over a 30-month interval.

Self-report measures of grief, depression, and general psychopathology were studied in widows and widowers over a 2.5-year period following death of their partner. A comparison sample of men and women was also followed for the same period. Differences in severity of depression and psychopathology previously reported at 2 months postloss (Gallagher, Breckenridge, Thompson, & Peterson, 1983) diminished to nonsignificant levels at 12 and 30 months. However, significant differences between bereaved and comparison subjects on measures of grief were still apparent 30 months after spousal loss. A main effect of gender for depression and psychopathology (but not for grief) was found at 2 and 12 months: Women reported more distress than men regardless of bereavement status. Results indicate that the experience of grief persists for at least 30 months in both older men and women who have lost their spouse.

Adaptation, Psychological↗

PubMed1991

Cognitive-behavioral interventions for treatment of depression in Alzheimer's patients.

This paper presents two strategies for treating depression in Alzheimer's patients. Cognitive therapy, used with mildly demented adults, challenges the patient's negative cognitions in order to reduce distortions and enable the patient to generate more adaptive ways of viewing specific situations and events. Behavioral intervention, used with more moderately or severely demented adults, attempts to modify person-environment interactions by increasing the level of positive activities and decreasing negative ones (Lewinsohn et al., 1984). Both theories have been used successfully in clinical settings.

Alzheimer Disease↗

PubMed1990

Maintenance of gains versus relapse following brief psychotherapy for depression.

Cross-sectional and longitudinal data are presented from a 2-year follow-up study of 91 older adults, initially diagnosed as in an episode of major depressive disorder (MDD), who were treated with brief cognitive, behavioral, or psychodynamic psychotherapy. Using research diagnostic criteria (RDC), 52%, 58%, and 70% of the sample did not meet criteria for any RDC depressive disorder at posttherapy, and 12- and 24-month follow-ups, respectively. There were no significant differences in response rate by therapy modality. Using Longitudinal Interval Follow-up Evaluation (LIFE; Shapiro & Keller, 1979; Keller et al., 1987) methodology, we noted that patients not depressed at posttreatment remained depression-free for longer time periods than those who were minor or MDD. These rates compare favorably with published reports on younger depressed patients.

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