title: Associations Between Secondary Caregivers' Supportive Behavior and Psychological Distress of Primary Spousal Caregivers of Cognitively Intact and Impaired Elders.
abstract: OBJECTIVE
  This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders.
  
  
  METHODS
  A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria.
  
  
  RESULTS
  More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms.
  
  
  CONCLUSIONS
  This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients.
authors.affiliation: Department of Social Work & Social Administration, Sau Po Centre on Ageing, University of Hong Kong. wlou@hku.hk.
authors.forename: Vivian W Q
authors.initials: VW
authors.lastname: Lou
authors.affiliation: Department of Statistics and Actuarial Science, University of Hong Kong.
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Kwan
authors.affiliation: Department of Applied Social Studies, City University of Hong Kong.
authors.forename: Ming Lin Alice
authors.initials: ML
authors.lastname: Chong
authors.affiliation: School of Social Work, University of Southern California.
authors.forename: Iris
authors.initials: I
authors.lastname: Chi
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D016022:Case-Control Studies; D060825:Cognitive Dysfunction / Q000451:nursing / Q000523:psychology*; D005260:Female; D006701:Home Nursing / Q000523:psychology* / Q000706:statistics & numerical data; D006723:Hong Kong; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Cognitively intact and impaired spouses; Psychological distress; Secondary caregivers’ supportive behavior; Spousal primary caregivers