Patient-caregiver differences and dyad concordance towards psychosocial impacts of stroke

in Psychology and Health (2012), 27(suppl 1), 14

Are patient-caregiver dyads concordant when applying to stroke psychosocial impacts ? Methods: Two questionnaires administered two years poststroke in Luxemburg to 62 patients and their 62 natural ... [more ▼]

Are patient-caregiver dyads concordant when applying to stroke psychosocial impacts ? Methods: Two questionnaires administered two years poststroke in Luxemburg to 62 patients and their 62 natural caregivers include 15 common items assessing psychosocial impacts of stroke on both patients and caregivers. We (1) compare these impacts of stroke on patients and caregivers, and (2) use paired analysis of the concordance in responses within dyads. Findings: Patients feel ashamed, more often than caregivers imagine (11.3% vs. 3.2%*). Patients perceive less often than caregivers an upheaval in their couple (19.4% vs. 38.7%*), and preponderance of psychological difficulties (41.9% vs. 69.4%**). Loss of friends (90.7% convergent vs. 9.3% divergent*), social life (75% vs. 25%*) and family upheavals (76.8% vs. 23.2%*) are concordant subjects within dyads, contrary to feeling undervalued (62.8% vs. 37.2%; ns) and bonds’ strengthening (81.5% vs. 18.5%; ns). Discussion: Improving communication about feelings within patient-caregiver dyads may enhance their social capital as a health capability. [less ▲]

Failure of school project: the role of social, material, behavioural, physical and mental resources among multi-cultural students.

in Psychosociological Work in Transcultural Contexts (2012)

Youth context require social-material-behavioral-mental resources to realize school achievement and their community participation, but they are lacking or altered for many adolescents. In an early ... [more ▼]

Youth context require social-material-behavioral-mental resources to realize school achievement and their community participation, but they are lacking or altered for many adolescents. In an early adolescence context, this study assessed the associations of these factors with repeating a school year, low school-performance, and quitting-school thinking at 16 years. Methods: Questionnaires were completed by 1559 middle-school adolescents from north-eastern France including: sex, age, family structure, parental education, income, and occupation, WHOQoL (quality of life for 4 domains physical, psychological, social relationship, and environment; <25th percentile value), last-30-day consumption of tobacco/alcohol/ cannabis/hard drug, regular sports/physical activities, victim of violence, sexual abuse, implication in violence, suicidal ideation, social supports, repeating a school year, low summer-term school-performance (<10/20), and quitting-school-thinking. Data were analyzed using logistic models which yield adjusted odds ratios (OR). Results: Repeating a school-year affected 14.7%, low school performance 8.2%, and quitting-school-thinking 3.9%. Repeating a school-year was significantly related to increasing age (OR 2.18), father being a manual worker (2.79 vs. manager/professional), clerk (2.36), craftsman/tradesman/firm-head (1.68), or unemployed (4.65), low WHOQoL-environment (2.29), tobacco use (1.70), and hard drug use (2.35). Low school-performance was linked with increasing age (OR 1.25), father being a manual worker (4.81 vs. manager/professional), clerk (3.30), craftsman/tradesman/firm-head (2.36), or unemployed (5.41), tobacco use (3.95), low WHOQoL-physical (2.27), and low WHOQoL-psychological (1.56). Quitting-school-thinking was associated with being male (OR 4.03), divorced/separated-parents (2.92 vs. intact family), not living with parent(s) (3.45), implication in violence (5.19), sexual abuse (4.11), and suicidal ideation (2.47). Conclusion: Socioeconomic living conditions and physical/mental difficulties have impressive impacts on failure of school project in youth. Public policy aiming at improving school achievement should focus on improvement of environment and living conditions, well-being, and monitoring physical/behavioral/mental difficulties as well as services appropriate to reduce school difficulties. This should promote community participation at adolescence and also at adulthood. [less ▲]

Life satisfaction of two-year post-stroke survivors: effects of socioeconomic factors, motor impairment, Newcastle Stroke-specific Quality of Life leasure and World health Organization quality of Life-bref of informal caregivers in Luxembourg and a rural area in Portugal.

in Cerebrovascular Diseases (2012), 33

Background: Life satisfaction of stroke survivors is known to be associated with socio-economic factors and the survivor’s and his/her caregiver’s quality of life, but their respective influence remains ... [more ▼]

Background: Life satisfaction of stroke survivors is known to be associated with socio-economic factors and the survivor’s and his/her caregiver’s quality of life, but their respective influence remains to be fully elucidated. Purpose: To analyse the stroke survivors’ life satisfaction 2 years after the event and its relationships with quality of life, socio-economic and stroke-related characteristics, and with informal caregivers’ life satisfaction and quality of life . Methods: Over 18 months, all stroke patients from Luxembourg and northeastern Portugal who lived at home were identified from the Inspection Générale de la Sécurité Sociale and hospital records, respectively. The clinical diagnosis of cerebrovascular disease was confirmed. We excluded all patients who declared that stroke did not result in neurological impairmentsat the time of stroke from the statistical analysis. The samples comprised 79 patients in Luxembourg and 48 in Portugal. Patients and the people they identified as their main caregivers were interviewed using validated questionnaires measuring life satisfaction, i.e. the Newcastle Stroke-Specific Quality of Life (Newsqol – 11 subscales), which identifies the areas affected by stroke among patients, and the World Health Organization Quality of Life – bref (Whoqol-bref – 4 subscales) of informal caregivers. Survivors without neurological impairment at the time of stroke were excluded. Data were analysed via multiple-regression models. Results: Life satisfaction was higher among women and lower among subjects with impaired motor functions. It was lower among Portuguese respondents with low-level education ( <12th grade) and higher among those at work (37.6/100). In Luxembourg, retired people had more life satisfaction than did working people (–7.9/100). Controlling for socio-economic factors, life satisfaction was associated with feelings- Newsqol (slope 0.25) among Luxembourg residents, and with feelings-, mobility- and self-care-Newsqol (slopes 0.24, 0.27 and 0.33, respectively) among Portuguese respondents. Life satisfaction of patients was strongly related to that offamily caregivers among the Portuguese respondents (slope 0.66) but the relationship was moderate in Luxembourg (slope 0.28). The survivors’ life satisfaction was not correlated with any Whoqol-bref domain in the Luxembourg group, but was correlated with the Whoqol-bref psychological, social relationships and environment domains among the Portuguese respondents (slopes 0.55, 0.59 and 0.51, respectively). Conclusions: The life satisfaction scale and the Newsqol stroke instrument, which identify areas of quality of life affected by stroke, are reliable patient-centred markers of intervention outcome. They can be used within the framework of medical follow-up (such as telephone assistance, clinical practice and prevention). Depending on the stroke survivor’s and the family caregiver’s habitual lifestyle and material circumstances, enhancement of a caregiver’s quality of life can help maintain the patient’s life satisfaction, particularly in a rural setting. [less ▲]

Prendre soin des personnes après AVC : réactions émotionnelles des aidants informels hommes et femmes.

in Santé Publique: Revue Multidisciplinaire pour la Recherche et l'Action (2012), 24(2), 143-156

The objective of this study was to assess the emotional response to caregiving among stroke caregivers living in Luxembourg, and to assess the social and psychological impact of strokes on households, two ... [more ▼]

The objective of this study was to assess the emotional response to caregiving among stroke caregivers living in Luxembourg, and to assess the social and psychological impact of strokes on households, two years after the event. Questionnaires were administered to 62 patient (64.4 years old)/caregiver (59.3 years old) dyads. The survey focused on: 1) residual impairments, based on the American Heart Association Stroke Outcome Classification; 2) the Caregiver Reaction Assessment (CRA – 24 items – 5 dimensions); and 3) changes in the division of household tasks (seven items). Although male and female caregivers care for patients with similar residual impairments, the study found that female caregivers were more likely to be affected by the impact of caregiving on their health and schedule and by lack of family support. Women were more likely to feel “tired all the time” (50% vs. 12.5%), to struggle to “find time to relax” (35.7% vs. 6.3%) and to feel that “others dumped caring onto them” (35.7% vs. 11.8%). Since the onset of stroke, women had also taken on more responsibilities in the household (37.5% vs. 5.9%), while men were more likely to “enjoy caring” for patients (93.8% vs. 67.9%) and to have become more involved in organizing holidays (29% vs. 5.6%) and seeing friends (20.6% vs. 10.5%). Because of the high level of exhaustion, particularly among women, caregivers are a high-risk population for the healthcare system. Interventions such as trialogue and counseling are required to meet the needs of male and female caregivers. [less ▲]

Survivors, two years post-event, the influence of an unequality of life

in Social Relations in Turbulent Times (2011)

Two' years' post)event,' we' described' the' survivors’' life' satisfaction' (LS)' and'Quality'of' Life' (QoL),' the' LS' and'QoL'of' their' caregivers,'and'their'socio)demographic'and'health ... [more ▼]

Two' years' post)event,' we' described' the' survivors’' life' satisfaction' (LS)' and'Quality'of' Life' (QoL),' the' LS' and'QoL'of' their' caregivers,'and'their'socio)demographic'and'health'characteristics.' We'analysed'survivors’'LS'and'its'associations'with'these'determi) nants,'from'a'national'(mainly'urban'society)'survey'in'Luxembourg' (LU)'and'a'Bragança'district'(mainly'rural)' survey' in'the'Northeast' Portugal'(PT).' Over' 18' months' stroke' survivors' (≥18' years)' living' at' home' and' having'given'their'informed'consent'were'contacted.'The'Inspection/ Générale/de/la/Sécurité/Sociale'(LU)'and'the'District'Health'Centre' (PT)'had'previously'listed'all'confirmed'diagnosis'population.'Survi) vors' and' their' main' caregivers' were' interviewed' at' home' with' questionnaires'measuring'LS'(scale'1)10)'and'validated'QoL’'scales:' survivors’' Newcastle' Quality' of' Life' (Newsqol);' Whoqol)Bref' for' caregivers.' Participation'rate'was'26.5%'LU,'38%'PT:'94'LU'(65.5'years)'and'50' PT' (70.1)' survivors;' 62' LU' (59.3)' and' 46' PT' (60.7)' caregivers.' LU' survivors'and'caregivers'had'higher'QoL'scores'than'PT'samples.'PT' survivors' were' more' affected' by' stroke' impacts,' with' significant' differences' in'Newsqol'mobility,' ‘self)care’' (preparing' food,' shop) ping,' transport,' getting' washed,' dressed' and' showed),' feelings' (dependence,' about' oneself,' change' acceptance,' depressive,' of' useless,'loss'of'control'over'life),'and'emotional/status'(more'emo) tional,' sometimes' crying,' short)tempered,' less' tolerant' and' nerv) ous).' Only' PT' survivors' LS'was' linked' to' the' current' neurological' impairments.' Difference' estimates' were' obtained' between' survi) vors’'LS'and'Newsqol'self=care'(regression'coefficient'(rc)')0.28'PT),' caregivers’'LS'(rc')0.63'PT)'and'Whoqol)bref'psychological'(rc')0.67' PT),' environmental' (rc' )0.73' PT),' and' social/ relationship' (rc' )0.91' PT).' LU' survivors’' LS'was' associated'with' all'Newsqol'dimensions;' stronger'links'in'feelings'and'sleep;'none'with'caregivers’'Whoqol) bref.' Survivors''multi)dimensional'QoL'was' predictive' of' their' LS.' LU)PT' differences' recalled' the' idea' of' the' cumulative' effect' throughout' life'of' social' inequalities' in'health' and' highlighted' the' distinct' im) pact' of' living' in' an' urban' society' turned' towards' community' sup) ports'or'a'rural'society'based'on'domestic'care.'In'home'care'set) tings,' survivors’' LS' and' Newsqol' are' patient)centred' markers' for' individual'and'community'interventions.' [less ▲]

Day-to-day home caring for a stroke survivor, two-year post-stroke perceived psychosocial impacts for woman caregivers in Luxembourg

in Women’s Mental Health (2011)

In the Grand-Duchy of Luxembourg (GDL) informal caregivers are increasingly requested to provide daily home care to stroke survivors to avoid institutionalization (Kjellstrom et al. 20071). As this major ... [more ▼]

In the Grand-Duchy of Luxembourg (GDL) informal caregivers are increasingly requested to provide daily home care to stroke survivors to avoid institutionalization (Kjellstrom et al. 20071). As this major life event brings upheavals to caregiver-survivor pairs, we aimed to identify and analyse the perceived psychosocial impacts for female caregivers. Method. Over 12 months, with the help of the Social Security, two-years post-stroke survivors were contacted, and 41 women (59,1 years) and 21 men (59,6 years) informal caregivers consented to participate in this cross national survey. Research assistants interviewed them at home, using face-to-face questionnaires, containing: 1) Life Satisfaction (LS) measure in accordance to the European Quality of Life Study (EQLS)2 (scale 0 - 10) ; 2) Caregiver Reaction Assessment 24 assertions (CRA) (Given et al., 19923); 3) 7 questions about the evolution of caregivers’ tasks and responsibilities in the household since the stroke onset. Means and percentages and, a comparison between sexes were estimated using t tests and chi². Results. The LS mean is lower in woman caregivers (6.84 vs. 8.00 male caregivers t = - 2.52). Women appear to be more affected in terms of physical health (33.0 ±22.1 vs. 19.1±20.1 t = 2.06), disrupted schedule (46.7 ±29.7 vs. 26.2 ±18.8 t = 2.54) and lack of family support (39.9 ±24.7 vs. 25.0 ±15.6 t = 2.18). More women responded to feel « tired all the time » (50.0% vs. 12.5% p=0.013) and found « difficult to find time for relaxation » (35.7% vs. 6.3% p=0.030). They admitted “others have dumped caring for their partner onto them” (35.7% vs. 11.8% p=0.078) and had difficulty “to get help from their family” (17.9% vs. 0.0% p = 0.073). Women considered to be more “in charge of the relationships with professionals” (52.0% vs. 6.3% p=0.003) and to “have more household responsibilities” than before the event (37.5% vs 5.9% p=0.020). Less women declared to « enjoy caring for their partner » (67.9% vs. 93.8% p= 0.049). Conclusions. Informal woman caregivers’ LS average (6.84) were one point lower than the indicator in 2007 for the GDL general population (7.85) who participated at the EQLS, near to the EU-27’ one (7.0). Our study showed their psychosocial repercussions them to require gender-based adaptation strategies to perform their caregiving role. Interventions reinforcing women’s health capability could improve their LS. Follow-up qualitative research would help to identify and understand women’s specific needs regarding these capabilities to develop. [less ▲]

The place oof health and the micro-prowers of health professionals in rtenetion centers for unauthorised migrants multi-situated ethnographic research (France-Spain).

in Social Relations in Turbulent Times (2011)

This research aimed to identify the place of health in Immigrants Retention Centres (IRC) and analyse the role of the health professionals regarding border control and immigration policies. The current ... [more ▼]

This research aimed to identify the place of health in Immigrants Retention Centres (IRC) and analyse the role of the health professionals regarding border control and immigration policies. The current structures to confine unauthorised migrants seem to address a two-fold issue: the repressive approach to controlling immigration and the increasing set-up of facilities participating in a mode of government centred on national security concern. Method. Ethnographical study was conducted in the Medical Units of a French (capacity: 35 pers.) and a Spanish (150 pers.) ICR for respectively, 9-months with a regularity of 30 half-days of presence every fortnight and 21 continuous days over a 3-weeks period. Qualitative data from observational notes and conversional interviews were triangulated and analysed under the Critical Categorical Content Discourse method, with Atlas.ti support. Findings. Illnesses that could halt deportation were infectious diseases involving treatment requiring a specialized infrastructure (tuberculosis); in France, those whose representation is bound to feelings of fear and disgust (mange) and mental illness that poses a threat to the individual and other persons; in Spain, pregnancy is a reason to allow a release from IRC. Squats are raid when expulsion quotas need to be filled; it accounted for the increased number of substance dependent persons in ICR at that time. Health professionals in IRC confront moral dilemmas. In France, they have a recognised micro-power able to overturn a deportation order: the medical certificate. Discussion. In ensuring healthcare access, they are drawn into the vigilance and control logics of the IRC security regime, despite themselves. Standardization of the medical practices is their main fall back and provides for risks management, which relies on the architecture and the neatness of the space, individual strategies of exception and social relationship that are shaped by a moral economy. The retreat into medical grounds allows keeping things “professional”and helps balance the tension resulting from providing medical care in a space that automatically appears to translate any act into one carried out in compliance with the repressive policy against undesired migration. Institutionalisation of European IRC medical units network is recommended to confront inequalities in care (access and quality). [less ▲]

Differences between Luxembourg and Portugal in the Life Satisfaction of Stroke Survivors, two years post-event: The influence of an unequal quality of life.

in Health inequalities across Europe (2011)

Two years post-event, we described the survivors’ life satisfaction (LS) and Quality of Life (QoL), the LS and QoL of their caregivers, and their socio-demographic and health characteristics. We analysed ... [more ▼]

Two years post-event, we described the survivors’ life satisfaction (LS) and Quality of Life (QoL), the LS and QoL of their caregivers, and their socio-demographic and health characteristics. We analysed the survivors’ LS and its associations with the above-mentioned determinants from a national (mainly urban society) survey in Luxembourg (LU) and a Bragança district (mainly rural) survey in the Northeast of Portugal (PT). Methods. Over 18 months, survivors (≥18 years) of a stroke, living at home and having given their informed consent were contacted. The Inspection Générale de la Sécurité Sociale of LU and the District Health Centre in PT had previously confirmed all diagnoses and listed the potential participants. Survivors identified their caregivers and both were interviewed, at home, using questionnaires measuring LS (scale 1-10) and two internationally validated QoL’ scales: the survivors’ Newcastle Quality of Life (Newsqol) and the Whoqol-Bref for the caregivers. Results. The participation rate was 26.5% LU and 38% PT: 94 LU (65.5 years) and 50 PT (70.1 years) survivors; 62 LU (59.3 years) and 46 PT (60.7 years) caregivers. The LU survivors and their caregivers had higher QoL scores than the PT samples. In contrast, the PT survivors were more affected by stroke-related impacts, with significant differences in Newsqol ‘mobility’ (i.e. walking, managing stairs, bending down, standing), ‘self-care’ (i.e. preparing food, shopping, using transport, getting washed, getting dressed, and showed), feelings regarding the current situation (i.e. less independence, feelings about oneself, life changes acceptance, depressive mood, feelings of useless, loss of control over their life), and their emotional status (i.e. more emotional, sometimes crying, short-tempered, less tolerant and nervous). Only the PT survivors’ LS was linked to the ‘current neurological impairment’ domains. The LU survivors’ LS was associated with all Newsqol dimensions; stronger links (p<0.001) were found in ‘feelings’ and ‘sleep’, but no relation existed with the caregivers’ Whoqol-bref domains. Difference estimates were obtained between the survivors’ LS and the Newsqol ‘self-care’ dimension (regression coefficient (rc) -0.28 for PT), their caregivers’ LS (rc -0.63 for PT) and Whoqol-bref psychological (rc -0.67 for PT), environmental (rc -0.73 for PT), and social relationship (rc -0.91 for PT) domains. Discussion. Two years post-event, the survivors' multi-dimensional QoL was a more relevant predictor of their LS, than that of their caregivers. LU-PT differences recalled the hypothesis of the cumulative effect throughout life of social inequalities in health and highlighted the distinct impact in survivors’ LS of living in an urban society, turned towards community supports or in a rural society based on a domestic care. In home-based care settings, the survivors’ LS and Newsqol are useful patient-centred markers for individual and community interventions. [less ▲]

Two years post-stroke, predictors of survivors’ life satisfaction: common associations between Luxembourg and Portugal.

in Psychology and Health (2011), 26(suppl 2), 90

Two years post-stroke, we analysed the survivors’ LS by looking at its associations with their QoL and their informal caregivers’ QoL and drawing from a national survey in Luxembourg (LU) and a Braganc¸a ... [more ▼]

Two years post-stroke, we analysed the survivors’ LS by looking at its associations with their QoL and their informal caregivers’ QoL and drawing from a national survey in Luxembourg (LU) and a Braganc¸a district survey in Portugal (PT). Method: Face-to-face structured interviews at home. Findings: For LU, the 94 stroke survivors’ LS was linked with all survivors’ Newsqol (Newscstle Stroke-Specific Quality of Life)* dimensions, with strong links for feelings and sleep. No association was observed with their 62 caregivers’ Whoqol-bref domains. For PT, the 50 survivors’ LS was correlated with all Newsqol’ dimensions (except vision) with strong relations for mobility, self-care, feelings and sleep, and with all 46 caregivers’ Whoqol-bref domains (physical, psychological, environmental and social relationships). Discussion: Common associations exist with stronger links for PT. Survivors’ QoL is a predictor of LS which is a useful patient-centred marker for the practice of the psychologists who develop family interventions and counselling programmes. [less ▲]

On the collaborative work between psychiatry and social work in developing transcultural capability in mental health care.

in Effets psychosociaux de la mondialisation sur la santé mentale. (2011)