Examinando por Autor "Del-Pino-Casado, Rafael"
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Ítem A systematic review and meta-analysis of the association between anxiety symptoms and coping in family carers of dependent people aged 18 and over(Wiley, 2023-08-02) Muñoz-Cruz, Juan Carlos; López-Martínez, Catalina; Orgeta, Vasiliki; Del-Pino-Casado, RafaelAnxiety symptoms are prevalent in family carers of dependent people. Despite accumulating evidence in the area, there are still inconsistent findings on the association between carer anxiety symptoms and coping strategies. The aim of our study was to systematically analyse the relationship between anxiety symptoms and coping strategies in carers of dependent adults aged 18 years and older, and examine possible sources of heterogeneity in the results. The study design was a systematic review and meta-analysis. We searched several international databases (Pubmed, CINAHL, PsycINFO and LILACS) from June 2022 up to February 2023. We followed the preferred reporting items for systematic reviews and meta-analyses statement and performed several subgroup analyses to examine whether study design, cause of dependency and whether or not controlling for various biases influenced results. Forty-one studies were included in the review. We found significant associations between greater use of dysfunctional coping and higher anxiety symptoms. Greater use of problem-focused coping was associated with lower anxiety symptoms in carers of frail older people, but higher anxiety in carers of people surviving cancer. Emotion-focused coping and some of its individual strategies, such as acceptance and positive reappraisal, in probabilistic samples, were associated with lower anxiety symptoms across all groups. Most of the studies included in this review were cross-sectional. Evidence overall indicates that only specific dimensions and strategies of coping are significantly associated with anxiety symptoms in family carers. These findings should be considered when developing future interventions supporting carers.Ítem Burden and anxiety in family caregivers in the hospital that debut in caregiving(MDPI, 2019-10-18) Pérez-Cruz, Margarita; Parra-Anguita, Laura; López-Martínez, Catalina; Moreno-Cámara, Sara; Del-Pino-Casado, RafaelThis cross-sectional study aims to determine the level of subjective burden and anxiety of caregivers of dependent older relatives that start providing care in the hospital and to analyse the relationship between objective burden, subjective burden and anxiety in these caregivers. Seventy-two caregivers of dependent older relatives were recruited in a medium–long stay hospital. Sociodemographic variables, number of basic activities of daily living (ADLs) attended, hours of surveillance, burden, and anxiety were collected from caregivers. A trajectory analysis was used to analyse the relationship between variables. Of the caregivers, 36.1% had subjective burden and 14.9% had anxiety. Subjective burden was positively associated with the number of basic ADLs attended, the hours of surveillance, and the cognitive impairment of the care recipient. Anxiety was also positively associated with subjective burden. Subjective burden mediated the effects of the number of basic ADLs attended, hours of surveillance and the cognitive impairment of the care recipient on anxiety. The levels of subjective burden and anxiety in caregivers debuting in hospital care are elevated, showing the need for these caregivers to be cared for. Subjective burden is a possible risk factor for anxiety, independent of the objective burden; it may buffer the effects of objective burden on anxiety.Ítem Coping and anxiety in caregivers of dependent older adult relatives(MDPI, 2019-05-12) Pérez-Cruz, Margarita; Parra-Anguita, Laura; López-Martínez, Catalina; Moreno-Cámara, Sara; Del-Pino-Casado, RafaelThe aim of this study was to analyze the relationship between coping and anxiety in caregivers of dependent older adult relatives. A cross-sectional study was carried out in the province of Jaén (Andalusia, Spain). The convenience sample consisted of 198 family caregivers of dependent older adults. The main measurements were anxiety (Hamilton scale), coping (Brief COPE), subjective burden (Caregiver Strain Index), objective burden and sex of the caregiver. The main analyses were bivariate analysis using the Pearson correlation coefficient, and multivariate analysis using multiple linear regression. An independent regression model was developed for anxiety and each type of coping, adjusting for sex, subjective burden and objective burden. Our results demonstrate that anxiety was negatively associated with planning (partial r = −0.18), acceptance (partial r = −0.22) and humor (partial r = −0.20), and it was positively associated with self-distraction (partial r = 0.19), venting (partial r = 0.22), denial (partial r = 0.27) and self-blame (partial r = 0.25). Planning, acceptance and humor coping strategies may be protective factors of anxiety. Strategies such self-management, relief, denial and self-blame may be risk factors for anxiety.Ítem Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden(Wiley, 2024-01-28) López-Martínez, Catalina; Orgeta, Vasiliki; Frías-Osuna, Antonio; Del-Pino-Casado, RafaelINTRODUCTION: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time. DESIGN: Prospective longitudinal study. METHODS: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time. RESULTS: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning (B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame (B = 0.90), and negatively associated with positive reframing (B = -0.83) and acceptance (B = -0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping. CONCLUSIONS: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers. CLINICAL RELEVANCE: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.Ítem Coping and anxiety symptoms in family carers of dependent older people: Mediation and moderation effects of subjective caregiver burden(Wiley, 2024-01-05) López-Martínez, Catalina; Orgeta, Vasiliki; Frías-Osuna, Antonio; Del-Pino-Casado, RafaelIntroduction: Coping responses influence anxiety symptoms experienced by informal carers. However, only a few studies have investigated the longitudinal association between coping responses and anxiety symptoms in family carers. We also currently have limited knowledge on the mediating or moderating influence of subjective caregiver burden on this relationship over time. The aim of the present study was to investigate the longitudinal relationship between coping and anxiety symptoms in family carers of dependent older people, and examine the mediating or moderating role of subjective caregiver burden over time.Design: Prospective longitudinal study.Methods: We recruited and enrolled participants from a probability sample of 132 family carers of older dependent relatives. We measured coping strategies, anxiety symptoms, subjective caregiver burden, and several covariates (sex and intensity of care) at baseline and at 1-year follow-up. We used generalized estimating equations with multiple imputations to examine associations over time.Results: Considering both direct and indirect effects through subjective burden, anxiety symptoms were positively associated with proactive coping (B = 0.13), planning(B = 0.15), self-distraction (B = 0.24), denial (B = 1.15), venting (B = 0.94) and self-blame(B = 0.90), and negatively associated with positive reframing (B = −0.83) and acceptance (B = −0.75). Subjective caregiver burden moderated the relationship between anxiety symptoms and planning, and the use of denial as a form of coping.Conclusions: Our results show that subjective caregiver burden is an important moderator and mediator of the longitudinal association between coping responses and anxiety symptoms in carers.Clinical Relevance: Proactive coping and planning when subjective burden is low, self-distraction, denial, venting, and self-blame significantly increase levels of anxiety and caregiver burden in carers over time. Acceptance and positive reframing however as coping responses are associated with lower levels of anxiety and caregiver burden long-term. Our findings highlight the need for a multi-dimensional approach in future caregiving interventions.Ítem Coping and depressive symptoms in family carers of dependent adults aged 18 and over: A systematic review and meta-analysis(Wiley, 2023-01-12) Muñoz-Cruz, Juan Carlos; López-Martínez, Catalina; Orgeta, Vasiliki; Del-Pino-Casado, RafaelBeing a family carer is associated with increased risk of experiencing depressive symptoms. Despite many decades of research investigating the association between coping strategies and depressive symptoms in carers results across studies remain contradictory. The objective of this study was to systematically review evidence on the association between depressive symptoms and coping strategies in carers of dependent people aged 18 and over and investigate potential sources of heterogeneity of findings. The study design was a systematic review and meta-analysis. We searched Pubmed, CINAHL, PsycINFO and LILACS up to April 2021. We performed meta-analyses following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and several subgroup analyses to investigate whether cause of caring dependency, study design, and controlling for several biases influenced results. Fifty-nine studies met our inclusion criteria. We found a robust and statistically significant association between greater use of dysfunctional coping and higher depressive symptoms. Greater use of emotion-focussed coping was associated with fewer depressive symptoms only in studies controlling for confounding bias. Use of problem-focussed coping was related to fewer depressive symptoms in carers of frail older people. The combined use of both problem-focussed and emotion-focussed coping was associated with lower symptoms of depression. Our review concludes that the broad domain of dysfunctional coping is consistently associated with higher levels of depressive symptoms in carers. After controlling for confounders, emotion-focussed coping and several of its individual strategies were consistently associated with fewer depressive symptoms. Whilst problem-focussed coping and some of its individual strategies are also associated with lower depressive symptoms, these strategies may not be as helpful in all caregiving groups.Ítem Coping strategies and psychological distress in family carers of frail older people: A longitudinal study(Elsevier, 2019) Del-Pino-Casado, Rafael; Serrano-Ortega, Natalia; López-Martínez, Catalina; Orgeta, VasilikiBackground. Carers of dependent older people experience high levels of psychological distress. However, little is known about the effects of coping on carer distress over time. In this one year longitudinal study we investigated the relationship between distress, and coping strategies in a representative sample of family carers living in Spain. Methods. Primary carers of older people were recruited (N = 200). We used probability sampling and collected data via individual interviews from 2013 to 2015. Variables investigated included psychological distress, coping, and levels of objective and subjective burden. Panel data analysis was used to test a model of association of psychological distress, and coping strategies controlling for key confounders. Results. Acceptance and emotional support were the most frequently used strategies, whereas behavioural disengagement and humour were the least used. In the panel data regressions, positive reframing (B = -0.79, p < 0.001), self-distraction (B = -0.46, p = 0.034), substance use (B = 0.57, p < 0.001) and denial (B = 0.57, p = 0,049) were significantly related to psychological distress at one year follow-up. Limitations. Limitations include participant drop out and assessing substance use coping via a brief measure. Conclusions. Positive reframing and self-distraction were longitudinally associated with lower levels of carer psychological distress. Using denial and substance use coping increased distress long-term. Our results suggest that interventions that focus on positive reframing and assisting carers in decreasing dysfunctional coping may be useful therapeutic targets mitigating carer psychological morbidity.Ítem Correlates of Burden in Primary Caregivers of Older Relatives: A Cross-sectional Study(Wiley, 2014) Del-Pino-Casado, Rafael; Millan-Cobo, Martín D.; Palomino-Moral, Pedro A.; Frias-Osuna, AntonioPURPOSE: To analyze the effect of cultural factors on the subjective burden of primary home caregivers of older relatives. DESIGN: Cross-sectional study. Primary home caregivers (N = 208) of older relatives were recruited in Spain using systematic random sampling. METHODS: The data were collected in 2010 through interviews. The measures included sociodemographic characteristics, stressors (the intensity of care provided and the care-recipient's needs; the latter were assessed using the Barthel Index, the Pfeiffer Short Portable Mental Status Questionnaire and the Cummings Neuropsychiatric Inventory), cultural factors (kinship ties, common residence, perceived social support, and cultural motives for caregiving), and caregiver subjective burden (Caregiver Strain Index). The data were analyzed using bivariate procedures and multiple linear regression. FINDINGS: After controlling for caregiver age, caregiver gender, stressors, and duration of caregiving, subjective burden was negatively associated with perceived social support and reciprocity, and in the subgroup of adult children, it was positively associated with common residence. Cultural factors explained 29% of the variance in burden. CONCLUSIONS: Our findings add to the existing evidence regarding the influence of cultural factors in the perception of burden in caregiving situations. CLINICAL RELEVANCE: A risk profile could be proposed for subjective burden in primary family caregivers. Individuals who are at risk are characterized as young, offspring who live with the care recipient, care for a care recipient with behavioral problems, are unsatisfied with the social support received, and have a low balanced reciprocity.Ítem Factores culturales y sobrecarga subjetiva en el cuidado familiar de mayores dependientes(Jaén : Universidad de Jaén, 2010/02/04) Del-Pino-Casado, Rafael; Frías-Osuna, Antonio; Universidad de Jaén. Departamento de Enfermería[ES]El objetivo de esta tesis es Analizar la relación entre los factores culturales y la sobrecarga subjetiva, en cuidadoras/es principales de familiares mayores dependientes (CPFMD). Metodología: Estudio descriptivo transversal mediante entrevistas a una muestra aleatoria de 208 CPFMD del Distrito Sanitario Jaén-Norte. Variables: factores culturales (edad, género, parentesco, residencia en común, apoyo social y motivos del cuidado familiar de mayores dependientes de carácter sociocultural) y carga objetiva (intensidad y necesidad de cuidados). Resultados y conclusiones: El perfil tipo de la CFFMD (59 años, 85,1% de mujeres, 60,1% de hijas/os) es similar al de la encuesta IMSERSO 2004. El porcentaje de sobrecarga subjetiva (46,2%) es superior al de otros estudios españoles con muestras similares, e inferior al de aquellos específicos en demencias. Este estudio apoya la idea de que el apoyo social percibido y la reciprocidad son factores protectores de la sobrecarga subjetiva (asociación estadística controlando por carga objetiva, p<0,05; r2 de ambas variables: 28,3%).Ítem Factors Influencing Nutritional Status in Hospitalized Individuals Aged 70 and above(MDPI, 2024-02-25) Ruiz-Rosso, Raquel; Moreno-Cámara, Sara; Gutiérrez-Sánchez, Belén; da-Silva-Domingues, Henrique; Del-Pino-Casado, Rafael; Palomino-Moral, Pedro Ángel: Background: Older adults are vulnerable to malnutrition due to physical, psychological, and social factors. Malnutrition, a prevalent and modifiable issue in this population, is associated with an elevated risk of adverse clinical outcomes. The purpose of the study is to assess the nutritional status of older adult individuals admitted to a general hospital and examine its correlation with socio-health and demographic variables. Methods: The study included 239 individuals aged 70 and above, employing a cross-sectional descriptive observational approach with a convenience sampling method. Sociodemographic information was gathered, and variables such as cognitive impairment, functional capacity, comorbidities, medication consumption, and nutritional status were evaluated. Statistical analysis involved descriptive calculations, bivariate analysis, and multivariate analysis, utilizing binary logistic regression. Results: Approximately half of the sample were at risk of malnutrition, with a more notable prevalence among women. Factors such as age (OR = 1.04), cognitive impairment (OR = 1.06), functional dependence (OR = 0.96), and comorbidities (OR = 1.08) were linked to an elevated risk of malnutrition. In our regression model, age, cognitive impairment, and drug consumption emerged as significant predictors of malnutrition risk. Conclusions: Individuals aged 70 and above have a notably high prevalence of malnutrition risk, particularly among those experiencing functional dependence and cognitive impairment. In our sample, cognitive impairment in older adults, coupled with above-median drug consumption, emerges as the primary predictor for malnutrition risk.Ítem Gender Differences Regarding Informal Caregivers of Older People(Wiley, 2012) Del-Pino-Casado, Rafael; Frias-Osuna, Antonio; Palomino-Moral, Pedro A.; Martinez-Riera, José RamónPurpose: The aim of this study was to examine differences related to gender among informal caregivers serving older disabled individuals. Design and Methods: A secondary analysis of the most recent national cross-sectional survey, which was conducted in Spain on informal caregivers who served older individuals (65 years of age or older), was conducted in 2011 (N= 1,272, probability sample). The relationships between gender and intensity of care (amount and type of care provided), duration of caregiving, subjective burden, and satisfaction with caregiving were analyzed by bivariate and multivariate procedures. Findings: No statistically significant gender differences were found with regard to the intensity of care, duration of caregiving, or satisfaction; however, subjective burden was found to differ between men and women, and this difference was statistically significant (odds ratio = 1.98; p= .012). Conclusions: Because this study was conducted in Spain, a country with strong patriarchal norms with regard to caregiving and familism, whereas gender differences in intensity of care have been reported in countries with low familism, we conclude that cultural diversity can influence the relationship between gender and intensity of care. On the other hand, our study increases the evidence in support of there being gender-based differences in subjective burden among family caregivers serving older people in Western industrial countries. Finally, the results of our study support the hypothesis that sources of satisfaction are more strongly related to the caregiver's personal context and characteristics than to his or her gender. Clinical Relevance: These findings support the following recommendations regarding nursing interventions: (a) nurses should take into account specific cultural patterns in caregiving to improve their understanding concerning the relationships between gender and intensity of care, and (b) gender should be taken into account in interventions that are tailored toward addressing subjective burden.Ítem Knowledge about the care of people with Alzheimer’s disease of the nursing staff of nursing homes in Spain(MDPI, 2019-12-05) Parra-Anguita, Laura; García-Fernández, Francisco P.; Del-Pino-Casado, Rafael; Pancorbo-Hidalgo, Pedro L.Abstract: People with Alzheimer’s disease often live in nursing homes. Updated knowledge among the nursing staff has led to better quality of care. The aim of this study was to measure the knowledge about the care of people with Alzheimer’s disease of the nursing staff of nursing homes in Spain. A cross-sectional study was conducted in 24 nursing homes in the province of Jaén (Spain) with a sample of 361 members of staff, i.e., registered nurses (RNs), assistant nurses (ANs), and eldercare workers (EWs). The University of Jaén UJA-Alzheimer’s Care Scale was used to measure the knowledge. The knowledge was higher among the RNs (83.3% of the maximum) than among the ANs and EWs (71.6%). Work experience and updated training were associated with the knowledge score in RNs, but only the updated training in ANs and EWs. Nursing homes with less experienced nursing staff and with a small proportion of staff receiving training on dementia have a low knowledge score. The nursing staff of nursing homes in Jaén have medium to high knowledge about Alzheimer’s care. There is a wide range of variation in the knowledge score among the nursing homes. Up-to-date staff training in dementia care is the factor with the strongest association with knowledge.Ítem Obligation and negative consequences in primary caregivers of dependent older relatives(2018-09-07) Del-Pino-Casado, Rafael; López-Martínez, Catalina; Serrano-Ortega, Natalia; Del Mar Pastor-Bravo, María; Parra-Anguita, LauraThe purpose of this study was to analyse the multidimensional nature of obligation and the relations between each dimension of obligation and both anxiety and depression. A secondary analysis of data from two cross-sectional studies of primary home caregivers (N = 400; probabilistic sample) of older adult relatives in Spain was conducted. Data regarding obligation (four categories basing on beliefs of obligation and social pressure: low pressure and low beliefs, low pressure and high beliefs, high pressure and low beliefs and high pressure and high beliefs), stressors, anxiety and depression were collected by interview in 2013. The combination of high pressure and low beliefs had the highest levels of anxiety and depression, and the combination of low pressure and high beliefs had the lowest levels of anxiety and depression. When the relation of behavioural problems with anxiety and depression stratified by the previous four categories of obligation was analysed, behavioural problems were associated with anxiety and depression in the subgroups with low beliefs of obligation, whereas this association disappeared in the subgroups with high beliefs of obligation.Ítem Psychological treatments for depression and anxiety in dementia and mild cognitive impairment (Review)(Cochrane Library, 2022-04-26) Orgeta, Vasiliki; Leung, Phuong; Del-Pino-Casado, Rafael; Qazi, Afifa; Orrell, Martin; Spector, Aimee E.; Methley, Abigail M.BACKGROUND: Experiencing anxiety and depression is very common in people living with dementia and mild cognitive impairment (MCI). There is uncertainty about the best treatment approach. Drug treatments may be ineffective and associated with adverse effects. Guidelines recommend psychological treatments. In this updated systematic review, we investigated the effectiveness of different psychological treatment approaches. OBJECTIVES: Primary objective To assess the clinical effectiveness of psychological interventions in reducing depression and anxiety in people with dementia or MCI. Secondary objectives To determine whether psychological interventions improve individuals' quality of life, cognition, activities of daily living (ADL), and reduce behavioural and psychological symptoms of dementia, and whether they improve caregiver quality of life or reduce caregiver burden. SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and three trials registers on 18 February 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared a psychological intervention for depression or anxiety with treatment as usual (TAU) or another control intervention in people with dementia or MCI. DATA COLLECTION AND ANALYSIS: A minimum of two authors worked independently to select trials, extract data, and assess studies for risk of bias. We classified the included psychological interventions as cognitive behavioural therapies (cognitive behavioural therapy (CBT), behavioural activation (BA), problem-solving therapy (PST)); 'third-wave' therapies (such as mindfulness-based cognitive therapy (MBCT)); supportive and counselling therapies; and interpersonal therapies. We compared each class of intervention with control. We expressed treatment effects as standardised mean differences or risk ratios. Where possible, we pooled data using a fixed-effects model. We used GRADE methods to assess the certainty of the evidence behind each result. MAIN RESULTS: We included 29 studies with 2599 participants. They were all published between 1997 and 2020. There were 15 trials of cognitive behavioural therapies (4 CBT, 8 BA, 3 PST), 11 trials of supportive and counselling therapies, three trials of MBCT, and one of interpersonal therapy. The comparison groups received either usual care, attention-control education, or enhanced usual care incorporating an active control condition that was not a specific psychological treatment. There were 24 trials of people with a diagnosis of dementia, and five trials of people with MCI. Most studies were conducted in community settings. We considered none of the studies to be at low risk of bias in all domains. Cognitive behavioural therapies (CBT, BA, PST) Cognitive behavioural therapies are probably slightly better than treatment as usual or active control conditions for reducing depressive symptoms (standardised mean difference (SMD) -0.23, 95% CI -0.37 to -0.10; 13 trials, 893 participants; moderate-certainty evidence). They may also increase rates of depression remission at the end of treatment (risk ratio (RR) 1.84, 95% CI 1.18 to 2.88; 2 studies, with one study contributing 2 independent comparisons, 146 participants; low-certainty evidence). We were very uncertain about the effect of cognitive behavioural therapies on anxiety at the end of treatment (SMD -0.03, 95% CI -0.36 to 0.30; 3 trials, 143 participants; very low-certainty evidence). Cognitive behavioural therapies probably improve patient quality of life (SMD 0.31, 95% CI 0.13 to 0.50; 7 trials, 459 participants; moderate-certainty evidence) and activities of daily living at end of treatment compared to treatment as usual or active control (SMD -0.25, 95% CI -0.40 to -0.09; 7 trials, 680 participants; moderate-certainty evidence). Supportive and counselling interventions Meta-analysis showed that supportive and counselling interventions may have little or no effect on depressive symptoms in people with dementia compared to usual care at end of treatment (SMD -0.05, 95% CI -0.18 to 0.07; 9 trials, 994 participants; low-certainty evidence). We were very uncertain about the effects of these treatments on anxiety, which was assessed only in one small pilot study. Other interventions There were very few data and very low-certainty evidence on MBCT and interpersonal therapy, so we were unable to draw any conclusions about the effectiveness of these interventions. AUTHORS' CONCLUSIONS: CBT-based treatments added to usual care probably slightly reduce symptoms of depression for people with dementia and MCI and may increase rates of remission of depression. There may be important effect modifiers (degree of baseline depression, cognitive diagnosis, or content of the intervention). CBT-based treatments probably also have a small positive effect on quality of life and activities of daily living. Supportive and counselling interventions may not improve symptoms of depression in people with dementia. Effects of both types of treatment on anxiety symptoms are very uncertain. We are also uncertain about the effects of other types of psychological treatments, and about persistence of effects over time. To inform clinical guidelines, future studies should assess detailed components of these interventions and their implementation in different patient populations and in different settings.Ítem Recreational physical activity reduces breast cancer recurrence in female survivors of breast cancer: A meta-analysis(Elsevier, 2022-08) Zagalaz-Anula, Noelia; Mora-Rubio, María José; Obrero-Gaitán, Esteban; Del-Pino-Casado, RafaelPurpose: The aim of this review was to systematically collect the published evidence to assess the effect of recreational physical activity (PA) in reducing breast cancer (BC) recurrence in female survivors. Methods: A bibliographic search was carried out in PubMed Medline, CINAHL Complete, Scopus and Lilacs until June 2021. We selected observational studies or clinical trials comprising women diagnosed with BC, in which the risk of recurrence of BC was measured before or after performing recreational PA. As a secondary outcome, we analyzed disease free survival for recurrence/disease-specific mortality. The methodological quality of observational studies was assessed with the Newcastle-Ottawa Scale and clinical trials with the PEDro scale. A random effects model was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) to infer the results for any female survivor of BC. We performed separate meta-analyses for prediagnosis and postdiagnosis recreational PA. Results: Eleven studies were included, providing data from 29,677 surviving women with BC with an age range of 18-79 years old. Postdiagnosis recreational PA reduced the risk of BC recurrence by 16% (RR, 0.84; 95% CI: 0.78 to 0.91) and the risk of recurrence/disease-specific mortality by 23% (RR, 0.77; 95% CI: 0.66 to 0.93). Prediagnosis PA reduced the risk of BC by 18% (RR, 0.82; 95% CI: 0.74 to 0.91). Conclusion: This systematic review with meta-analysis shows that recreational PA can be an interesting therapeutic tool to protect against recurrence of BC in female survivors.Ítem Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis(Public Library of Science, 2021-03-01) Del-Pino-Casado, Rafael; Priego-Cubero, Emilia; López-Martínez, Catalina; Orgeta, VasilikiThere is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.Ítem Subjective caregiver burden and coping in family carers of dependent adults and older people: A systematic review and meta‐analysis(Wiley, 2024-03-16) Muñoz-Cruz, Juan Carlos; López-Martínez, Catalina; Orgeta, Vasiliki; Del-Pino-Casado, RafaelSubjective caregiver burden is highly prevalent in family caregivers. Despite several studies investigating the relationship between subjective caregiver burden and coping strategies, results remain inconsistent. The aim of our study was to systematically review current literature on the relationship between subjective caregiver burden and coping in family carers of dependent adults and older people. A secondary objective was to analyse possible sources of heterogeneity in the estimated effect. The study design was a systematic review with meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement (PRISMA) guidelines. We searched several international databases (CINAHL, LILACS, PsycINFO and PubMed) up to February 2024. We performed several subgroup analyses to examine whether study design, methodological quality or care recipient dependency influenced results. Of the 1064 records identified in our search, a total of 80 studies met inclusion criteria. We found a significant association between greater use of dysfunctional coping and higher levels of subjective caregiver burden (r = 0.400; 95% CI = 0.315, 0.478); higher use of second‐order active coping was significantly associated with lower caregiver burden (r = −0.213; 95% CI = −0.316, −0.105). Problem‐focused coping showed no statistically significant association with levels of subjective burden; emotion‐focused coping was associated with caregiver burden only after controlling for confounding variables (r = −0.258; 95% CI = −0.441, −0.055); several individual strategies of this dimension such as acceptance (r = −0.135; 95% CI = −0.238, −0.028), positive reappraisal (r = −0.178; 95% CI = −0.255, −0.099) and religious coping (r = −0.083; 95% CI = −0.162, −0.002), were associated with lower burden. We found that several dimensions of coping strategies are significantly associated with levels of subjective caregiver burden experienced by carers. These results can inform future research evaluating the effectiveness of interventions aimed at improving carers' mental health.Ítem The association between subjective caregiver burden and depressive symptoms in carers of older relatives: A systematic review and meta-analysis(Public Library of Science, 2019-05-29) Del-Pino-Casado, Rafael; Rodriguez Cardosa, Marta; Lopez-Martinez, Catalina; Orgeta, VasilikiBACKGROUND: Family carers are an important source of care for older people. Although several studies have reported that subjective caregiver burden is related to depressive symptoms there are no systematic reviews quantifying this association. OBJECTIVE: To establish the extent to which subjective caregiver burden is associated with depressive symptoms and whether this association would vary by study or care characteristics. METHODS: We searched major databases such as PubMed, CINAHL, PsycINFO, Scopus and ISI Proceedings up to March 2018, and conducted a meta-analysis of included studies. Summary estimates of the association were obtained using a random-effects model to improve generalisation of findings. RESULTS: After screening of 4,688 articles, 55 studies were included providing a total of 56 independent comparisons with a total of 9,847 carers from data across 20 countries. There was a large, positive association between subjective caregiver burden and depressive symptoms ([Formula: see text] = 0.514; 95% CI = 0.486, 0.541), with very low heterogeneity amongst individual studies (I2 = 8.6%). Sensitivity analyses showed no differences between cross-sectional or repeated measures ([Formula: see text] = 0.521; 95% CI = 0.491, 0.550; 51 samples) and longitudinal studies ([Formula: see text] = 0.454; 95% CI = 0.398, 0.508; 6 samples). We found a higher effect size for those caring for people living with dementia compared to those caring for frail older people, and stroke survivors. Carer sex, age and kinship did not change the estimate of the effect. CONCLUSIONS: Subjective caregiver burden is a significant risk factor for depressive symptoms in carers of older people and may precipitate clinical depression. Those caring for people with dementia experience greater burden. There is a need for longitudinal evaluations examining the effects of potential mediators of the association of subjective burden and depressive symptoms. Future interventions should test whether minimizing subjective burden may modify the risk of developing depression in carers of older relatives.Ítem The mediating role of sense of coherence on mental health outcomes in carers of older dependent relatives: A longitudinal study(Wiley, 2021) López-Martínez, Catalina; Orgeta, Vasiliki; Frías-Osuna, Antonio; Del-Pino-Casado, RafaelBackground: Sense of coherence (SOC) is an important protective factor for carer well-being but research to date remains cross-sectional, focusing primarily on the direct effects of SOC on carers’ mental health. The study’s aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers’ psychological health, and its stability over time. Methods: Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at one-year follow-up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. Results: SOC was significantly negatively longitudinally associated with both anxiety (β= -0.38, p= 0.001) and depressive symptoms (β= -0.28, p= 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety and caregiver strain and depressive symptoms (Sobel test; p< 0.001 for anxiety and p< 0.001 for depressive symptoms). Differences between baseline and one-year follow-up SOC scores were not statistically significant (p= 0.617). Conclusions: SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non-experimental conditions over a period of one year in this sample. Findings suggest that interventions aimed at strengthening SOC may protect carer psychological well-being.Ítem The relationship between perceived social support and psychological distress in carers of older relatives: A longitudinal cross-lagged analysis(Elsevier, 2022) Del-Pino-Casado, Rafael; López- Martínez, Catalina; Frías-Osuna, Antonio; Orgeta, VasilikiBackground and objectives: Although a large body of research has examined the relationship between social support and psychological health of family carers of frail older people, the exact nature and direction of this relationship is not well understood with most research to date being cross-sectional. This longitudinal study explored the relationship between perceived social support and psychological distress in carers of older relatives. Methods: We used data from two longitudinal cohorts which included a total of 332 family carers of frail older people. We used cross-lagged panel analysis to investigate the longitudinal association between perceived social support and carer psychological distress controlling for a number of covariates over time. Results: Fully-adjusted Generalised Estimating Equations (GEE) and cross-lagged models indicated that higher social support was significantly associated with lower carer psychological distress over time (regression coefficient [B] = -0.178, standard error [SE] = 0.028), with levels of perceived social support exerting an effect on psychological distress rather than vice versa (β = 0.03, p = 0.32). Limitations: All observations were based on self-report data, and there may be other variables that may explain the results that we did not account for. Discussion and implications: Our study finds that the directionality of the relationship appears to be from perceived social support to carer psychological distress suggesting that social support directly affects carer psychological health but not vice versa. This finding has important implications for the provision of social support interventions for carers of frail older people at risk of experiencing psychological distress.