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Background and purpose: Bipolar disorder (BD) is a severe illness that has serious impacts on the lives of such patients and their families. Today families of individuals with BD are actively involved in providing care to their loved ones. Therefore, successful management of these patients relies significantly on the health of caregivers. The aim of this study was to explore the meaning of health according to family members who care for adult patients with BD. Materials and methods: A phenomenological qualitative research was carried out in the family members caregiving to BD patients in Farshian Psychiatric Hospital, Hamedan, 2010. The subjects were selected using purposive sampling. By reaching data saturation the number of participants was 12. In order to collect the data in-depth interviews were conducted and then analyzed by Van Manen method. Results: Six main themes with 14 subthemes were identified in this study including ‘living in hell’, ‘mental-emotional exhaustion’, ‘self-neglect’, ‘the need to receive support’, ‘condemned to isolation’ and ‘feelings of shame’. Conclusion: This study underlines the necessity for comprehensive support among family caregivers of BD patients. Hence, support and interventions regarding such families’ health have to be considered by all mental health treatment providers.

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Background and purpose: Informal caregiver are untrained people who are not paid for providing care services, while in the care system they are considered as the main option. This study was conducted to determine the status of caregiving of informal caregivers and some related factors. Materials and methods: This cross-sectional study was performed in 360 people older than 65 years of age who suffered from at least one chronic disease and 194 of their caregivers. The samples were selected through multi-stage random sampling method. The data was collected using questionnaires completed through face to face interviews and then analyzed using X2, T-test, Mannwitney, Gamma, Kruskal-wallis tests and Spearman's rank correlation test. Results: Among the population 53.9% of seniors had the advantage of having a caregiver. These caregivers were 65.5% female. The caregivers in some families bared the burden of responsibilities (5.2%). The mean number of assistance provided to the elderly in daily activities and using tools were 2.17±2 and 8.23± 2.5, respectively. We found a significant correlation between burden of responsibilities of caregivers with assistance provided for daily activities and using tools (P<0.05). Conclusion: The results showed burden of responsibility as an important variable influencing the process of informal care. In other words, factors reducing the burden of caregiver responsibility could play an important role in the quality of services provided.

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Background and purpose: Increasing spread of dementia is one the consequences of aging. Due to the nature of the disease and dependence of involved patients, their caregivers might face mental health problems. Hence, evaluating family functioning can be a suitable tool for predicting family’s mental health. This research aimed at investigating the level of depression in caregivers and their relationship with family function.
Materials and methods: In this correlational study, 150 family caregivers of the elderly suffering from dementia were recruited. They were selected from those attending the Iran Alzheimer's Association who met the study inclusion criteria, by sampling in 2015-2016. Depression in caregivers and their family function was measured through the Beck Depression Inventory II and family functioning McMaster. Data was analyzed using Pearson Correlation Coefficient, Analysis of Variance and Stepwise Multiple Linear Regression.
Results: In current study about 22%, 21.3%, and 14.7% of the family caregivers had mild, moderate, and severe depression, respectively. Family function was poor in all aspects except for problem solving. Also, there was a significant negative relationship between all subscales of family functioning and depression (P< 0.001). Results showed that Rools, behavior control, emotional support, and economic and health situation can predict depression variance of these family caregivers.
Conclusion: According to the prevalence of depression syndrome in caregivers of patients with dementia and their relation to family functioning with depression, evaluating the dimensions of family functioning as one of the important indicators of Family Therapy and Education can improve such caregivers’ health.

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Background and purpose: Satisfaction of caregivers of hospitalized patients is one of the pillars of good quality in patient care. Providing appropriate trainings on this issue could lead to improvements in patient recovery. The present study was conducted to investigate the effects of a training program on satisfaction of caregivers of patients who had Coronary Artery Bypass Grafting.
Materials and methods: An interventional study was done in 69 caregivers of hospitalized patients in intensive care unit in Sari Fatemeh Zahra Hospital. The samples were randomly allocated into intervention and control groups. In the intervention group, the caregivers of the hospitalized patients alongside routine information received training starting one day before their patient’s surgery until 24 hr before discharge. The Family Satisfaction in the Intensive Care Unit (FSICU) was administered to measure the satisfaction of caregivers in both groups, 24 hr before discharge. Data were analyzed using Mann-Whitney, Independent t-test, and Chi-square.
Results: Compared to the control group, a significant difference was found between the mean score for satisfaction in intervention group after the training program (58.3±11.56 vs. 81.28±6.08), (P<0.001). Caregivers reported highest level of satisfaction with medical personnel performance and the lowest with making decisions about patients.
Conclusion: According to the findings, nurses can increase caregivers’ satisfaction from nursing care by providing them with training programs and improve patient care after heart surgery.

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Background and purpose: Autistic children have many behavioral problems. This situation causes a lot of stress for their mothers. The purpose of this study was to investigate the effect of positive psychotherapy on perceived stress and reasons for living in mothers of autistic children.
Materials and methods: This quasi-experimental study with pre-test and post-test design was performed in 24 mothers of autistic children attending Sari Nikandishan Children's Autism Center, 2017. The samples were randomly assigned into two groups of intervention (n=12) and control (n=12). Positive clinical program was performed for the intervention group in eight sessions of 90 minutes twice a week. Demographic characteristics were recorded and Perceived Stress Scale and The Linehan Reasons for Living Inventory were administered to collect the data. Statistical analysis was done applying Covariance analysis.
Results: Before the intervention, the mean score for perceived stress was not significantly different between the experimental and control groups, but after the intervention the score deresaed singnificantly in intervention group (21.00±7.6 vs. 27.83±7.5 in control group) (P< 0.0001). The mean scores of reasons for living were not significantly different between the two groups before the intervention. But after the intervention the score showed significant increase in experimental group (177.50 ± 15.0) compared to that of the control group (159.17± 17.9) (P <0.0001).
Conclusion: Positive psychotherapy seems to be effective in decreasing the mental health problems of mothers of children with autism, including high levels of perceived stress and improving their reasons for living. This intervention would also be beneficial in improving treatment results and reducing child maintenance.
 

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 Background and purpose: Population aging is increasing and aged people need supports and care from individuals who are resilient enough in providing all types of care. Measuring the resilience of caregivers requires a valid and reliable tool. This study aimed at designing, analyzing the psychometric properties, and using a questionnaire to investigate resilience among in-home caregivers of aged people.
Materials and methods: In first phase, a descriptive study was performed in 400 people aged 20 years and older in Isfahan, Tehran, Shiraz, and Hamedan provinces, Iran and the second phase was carried out in 216 individuals in 2021. Professors and experts in different fields, including psychology, psychiatry, gerontology, health of aged people, and geriatrics cooperated at different stages of designing the questionnaire. Face validity, content validity index, content validity ratio, convergent validity and divergent validity, exploratory factor analysis, and reliability (Cronbach's alpha) of the questionnaire were assessed. Descriptive statistics and Pearson correlation coefficient were used to report the data.
Results: At content validation stage, 31 items out of 70 were removed from the questionnaire. One other item was removed at internal consistency phase. In exploratory factor analysis, based on the acceptability of the factor load, 38 items were defined in 4 factors. These factors were named self-efficacy and acceptance, tolerance and controllability, responsibility and commitment, and behavioral emotion regulation, which explained 48.70% of the dispersion. Convergent validity and divergent validity were confirmed due to strong correlation between the scores of each item and its corresponding scale score (P<0.0001). The Cronbach alpha reliability coefficient for the whole questionnaire was 0.92 and for the scales ranged between 0.668 and 0.912.
Conclusion: Considering the validity and reliability of the questionnaire designed for investigating the resilience of in-home care givers of aged people, current findings could be used in education, research, and prevention. Families, aged people, researchers and the health researchers are among its beneficiaries.

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 Background and purpose: Stigma and burden of care in caregivers of patients with schizophrenia have negative effects on the patient and their families. This research aimed to determine the effect of self-care training based on Acceptance and Commitment Therapy (ACT) on perceived stigma and caregiver burden of schizophrenic patients.
Materials and methods: This randomized clinical trial included 80 caregivers of schizophrenia patients in Sari Zare Hospital. Participants in intervention group received self-care training based on ACT in 8 sessions twice a week, while the control group received only routine care. The scores for stigma and care burden were measured in both groups before and after the intervention using Shamsaei stigma questionnaire and Zarit Burden Interview (ZBI, 22-item). T-test and paired t-test and descriptive statistical methods were used to analyze the data.
Results: The mean changes of the total score for perceived stigma before and after the intervention were found to be significantly different between the intervention group (65.45±6.79) and the control group (80.25±10.34)(P<0.05). Also, intergroup comparison showed a significant difference in mean changes of the total scores for burden of care before and after the intervention between the intervention group (44.35 ± 6.37) and the control group (55.05 ±10.29) (P <0.05).
Conclusion: According to current study, self-care training based on Acceptance and Commitment Therapy will improve perceived stigma and reduce burden of care in caregivers of patients with schizophrenia and such non-invasive interventions are recommended.

(Clinical Trials Registry Number: IRCT20171203037723N6)

 

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Background and purpose: Caring for patients with COVID-19 at home is mainly the responsibility of the family which leads to high burden of care. The burden of care refers to psychological pain, physical problems, financial and social pressures, disruption of family relationships, feelings of hopelessness, and other negative consequences of care tasks. The aim of this study was to determine the care burden in caregivers of patients with COVID-19 at home.
Materials and methods: This cross-sectional descriptive-analytical study was carried out in 390 family caregivers of patients with COVID-19 attending medical centers in Gorgan, Iran 2021, using convenience sampling. Caregiver Burden Inventory (CBI) was administered which consists of five domains and a score range of 24-120. Data were analyzed in SPSS V18 applying equivalent non-parametric tests.
Results: The mean total score for care burden was 52.70±17.03 and the mean scores for other subscales were as follows: 14.90±6.22 for time dependence=, 10.80±4.88 for developmental, 9.60±4.36 for physical burden, 7.80±2.91 for social burden, and 9.60±3.84 for emotional burden. As the age of the caregivers increase, the burden of time dependence increased. Women and caregivers with low educational backgrounds perceived a higher burden of care. There was a significant relationship between the burden of care and patient's economic status and the health status of the caregiver (P<0.05).
Conclusion: Family caregivers of patients with COVID-19 at home received a moderate burden of care that could negatively affect their health and wellbeing. Family caregivers need to be supported psychosocially and financially by formal community health systems.

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 Background and purpose: Heart failure influences patients and their family caregivers. This study was conducted to determine the effectiveness of the supportive-educational program based on the Creativity, Optimism, Planning, and Expert Information (COPE) care model on resilience in family caregivers of patients with heart failure.
Materials and methods: A clinical trial was conducted in 90 family caregivers of patients with heart failure in Isfahan Dr. Chamran Heart Hospital, 2021-22. The participants were randomly assigned into intervention group (n=45) and control group (n=45). The intervention group was then randomly divided into nine subgroups (n=5 per group). The intervention group received trainings based on COPE model in 6 sessions while the control group received only routine care. Demographic information checklist and Connor-Davidson Resilience Scale (CD-RISC) were completed before, immediately and three months after the intervention. Then, data analysis was performed. 
Results: Gender was found to be significantly different between the intervention group and the control group (P< 0.05), but this confounder showed no significant effect on resilience (P> 0.05). In the intervention group, the mean scores for resilience after the intervention and three months later were 80.71±9.56 and 85.96±6.96, respectively, compared to 64.80±16.09 before the intervention (P< 0.05). In the control group, the mean resilience scores were 70.04±15.29 and 66.29±13.71 after the intervention and three months later, respectively, compared to 71.69±16.95 before the intervention (P<0.05).
Conclusion: According to the positive effects of COPE model on resilience in caregivers, hospital managers and nursing professionals are suggested to consider this model in increasing awareness and knowledge of caregivers about self-care and patient care.

Clinical trial registry: IRCT20211128053202N1