美国农村地区痴呆患者家庭/朋友照护者心理困扰的预测因素：COVID-19 大流行的后果。
Predictors of Psychological Distress Among Rural Family/Friend Caregivers of People Living With Dementia in the United States: Consequences of the COVID-19 Pandemic.
机构信息
Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA.
Division of Geriatrics, University of California San Francisco, San Francisco, California, USA.
出版信息
J Gerontol B Psychol Sci Soc Sci. 2024 Feb 1;79(2). doi: 10.1093/geronb/gbad164.
OBJECTIVES
Caregivers of persons living with dementia in rural United States are a vulnerable population. During the coronavirus disease 2019 (COVID-19) pandemic, rural communities experienced heightened disparities in social services, healthcare, suicides, and mortality. Guided by the Caregiving Stress Process Model, this study examines the relationship between the stressors and resources of rural caregivers of persons living with dementia and their experience of depression, stress, and COVID-19.
METHODS
One hundred and fifty-two rural caregivers of persons living with dementia completed an online survey, March 1, 2021-April 30, 2022. Analyses used baseline responses to validated scales and an open-ended question, "How has COVID impacted your life as a caregiver?" Dependent variables were depressive symptoms and stress. Bivariate and hierarchical linear regression analyses examined associations of stressors and resources with depressive symptoms and stress. Thematic analysis examined open-ended question responses.
RESULTS
Among examined stressors, high care burden (b = 1.94, p < .05) and loneliness (b = 0.76, p < .0001) were positively associated with depressive symptoms. Loneliness (b = 0.24, p < .05) and ≥41 hr spent caregiving per week (reference 10-20 hr; b = 0.99, p < .05) were associated with stress. Among examined resources, self-efficacy for caregiving (b = -0.21, p < .05) was inversely associated with stress. Qualitative results confirmed quantitative results and identified additional pandemic-related themes in stressors and resources.
DISCUSSION
We found that caregiver burden, loneliness, and caregiving hours were associated with greater psychological distress among rural caregivers of persons living with dementia during the pandemic, whereas self-efficacy for caregiving was protective. Rural caregivers need increased support to address care burdens and enhance psychological resources for caregiving.
CLINICAL TRIAL REGISTRATION NUMBER
NCT04428112.
目的
居住在美国农村地区的痴呆症患者的护理人员是一个弱势群体。在 2019 年冠状病毒病（COVID-19）大流行期间，农村社区在社会服务、医疗保健、自杀和死亡率方面存在明显差异。本研究以照顾压力过程模型为指导，探讨了农村地区痴呆症患者护理人员的压力源和资源与其抑郁、压力和 COVID-19 经历之间的关系。
方法
2021 年 3 月 1 日至 2022 年 4 月 30 日，152 名农村地区的痴呆症患者护理人员完成了一项在线调查。分析使用基线对验证量表和一个开放式问题的回答，“COVID 如何影响你作为护理人员的生活？”因变量为抑郁症状和压力。单变量和分层线性回归分析检查了压力源和资源与抑郁症状和压力的关联。主题分析检查了开放式问题的回答。
结果
在所检查的压力源中，高护理负担（b=1.94，p<0.05）和孤独感（b=0.76，p<0.0001）与抑郁症状呈正相关。孤独感（b=0.24，p<0.05）和每周护理时间超过 41 小时（参考 10-20 小时；b=0.99，p<0.05）与压力有关。在所检查的资源中，照顾自我效能感（b=-0.21，p<0.05）与压力呈负相关。定性结果证实了定量结果，并确定了压力源和资源中与大流行相关的其他主题。
讨论
我们发现，在大流行期间，护理人员的负担、孤独感和护理时间与居住在农村地区的痴呆症患者的护理人员的心理困扰程度增加有关，而照顾自我效能感则具有保护作用。农村地区的护理人员需要更多的支持来减轻照顾负担，并增强照顾的心理资源。
临床试验注册号
NCT04428112。
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