ORIGINAL PAPER
Traumatic stress as a mediator of quality of life and burden in informal caregivers of amputees due to diabetic foot: a longitudinal study
 
More details
Hide details
1
School of Psychology, University of Minho, Braga, Portugal
Submission date: 2020-06-26
Final revision date: 2020-09-15
Acceptance date: 2020-10-07
Online publication date: 2020-12-07
Publication date: 2020-12-07
 
Health Psychology Report 2021;9(4):338–348
 
KEYWORDS
TOPICS
ABSTRACT
Background:
Type 2 diabetes mellitus (DMT2) is frequently associated with complications that can lead to lower limb ampu-tation, being the second major cause of amputation. The amputee becomes dependent on caregivers, who are often unprepared for this new role and face many challenges. Caregiving influences several dimensions of the caregiver’s life. This study evaluates the mediating role of traumatic stress in the relationship between caregiv-er perceived stress and burden/quality of life (QoL) taking also into consideration the duration of caregiving and whether the caregiver receives help in caregiving tasks, in informal caregivers of amputees due to diabetic foot over a 10 month period.

Participants and procedure:
The sample consisted of 110 informal caregivers of amputees due to diabetic foot with type 2 diabetes. This longitudinal study evaluates, at three time points, the mediating role of traumatic stress in the relationship be-tween perceived stress and burden/quality of life considering the duration of caregiving and whether the care-giver received help and social support in caregiving tasks.

Results:
The results showed that the duration of caregiving, help in caregiving and caregiver stress (T1) predicted trau-matic stress seven months (T2) after patients’ amputation; and traumatic stress (T2) predicted mental QoL and burden, 10 months later (T3).

Conclusions:
This study emphasizes the importance of intervention in caregivers at the beginning of caregiving, to improve mental QoL and decrease the burden, ten months after amputation.

 
REFERENCES (57)
1.
Anaforoğlu, İ., Ramazanoğulları, İ., Algün, E., & Kutanis, R. (2012). Depression, anxiety and quality of life of family caregivers of patients with type 2 diabetes. Medical Principles and Practice, 21, 360–365. https://doi.org/10.1159/000334....
 
2.
Aravena, J. M., Albala, C., & Gitlin, L. N. (2018). Measuring change in perceived well‐being of family caregivers: Validation of the Spanish version of the Perceived Change Index (PCI‐S) in Chilean dementia caregivers. International Journal of Geriatric Psychiatry, 33, e120–e130. https://doi.org/10.1002/gps.47....
 
3.
Bandeira, M., & Barroso, S. M. (2005). Sobrecarga das famílias de pacientes psiquiátricos [Family burden of psychiatric patients]. Jornal Brasileiro de Psiquiatria, 54, 34–46.
 
4.
Barrios, P. G., González, R. P., Hanna, S. M., Lunde, A. M., Fields, J. A., Locke, D. E., & Smith, G. E. (2016). Priority of treatment outcomes for caregivers and patients with mild cognitive impair-ment: Preliminary analyses. Neurology and Therapy, 5, 183–192. https://doi.org/10.1007/s40120....
 
5.
Bevans, M., & Sternberg, E. M. (2012). Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA, 307, 398–403. https://doi.org/10.1001/jama.2....
 
6.
Boscarino, J. A. (2000). Postwar experiences of Vietnam veterans. In G. Fink (Ed.), Encyclopedia of stress (Vol. 3, pp. 656–662). Academic Press.
 
7.
Boscarino, J. A. (2004). Posttraumatic stress disorder and physical illness: Results from clinical and epidemiologic studies. Annals of the New York Academy of Sciences, 1032, 141–153. https://doi.org/10.1196/annals....
 
8.
Bremner, J. D., Staib, L. H., Kaloupek, D., Southwick, S. M., Soufer, R., & Charney, D. S. (1999). Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: a positron emission tomography study. Biological Psychia-try, 45, 806–816. https://doi.org/10.1016/s0006-....
 
9.
Burgio, L., Gaugler, J., & Hilgeman, M. (Eds.) (2016). The spectrum of family caregiving for adults and elders with chronic illness. Oxford University Press.
 
10.
Chang, H. Y., Chiou, C. J., & Chen, N. S. (2010). Impact of mental health and caregiver burden on family caregivers’ physical health. Archives of Gerontology and Geriatrics, 50, 267–271. https://doi.org/10.1016/j.arch....
 
11.
Costa, M. S. A., Machado, J. C., & Pereira, M. G. (2018). Burden changes in caregivers of patients with type 2 diabetes: a longitudinal study. Journal of Advanced Nursing, 74, 2322–2330. https://doi.org/10.1111/jan.13....
 
12.
Coutrim, H., Azeredo, Z., & Pereira, M. G. (2007). Impacto do cancro colorectal no doente e cuidadores/família: Implicações para o cuidar [Impact of colorectal cancer on patients and caregiv-ers/family: Implications for caring] (PhD thesis). University of Porto, Porto, Portugal.
 
13.
Da Silva, F. M., Batista, E. C., & Cerqueira, G. R. (2017). O uso de fármacos ansiolíticos e antidepressivos pelo cuidador de idoso acamado [The anxiolytics and antidepressants drug use of the elderly caregiver of bedridden]. Saúde em Foco, 3, 62–76.
 
14.
Day, M. C., Wadey, R., & Strike, S. (2019). Living with limb loss: Everyday experiences of “good” and “bad” days in people with lower limb amputation. Disability and Rehabilitation, 41, 2433–2442. https://doi.org/10.1080/096382....
 
15.
Epstein-Lubow, G., Gaudiano, B. A., Hinckley, M., Salloway, S., & Miller, I. W. (2010). Evidence for the validity of the American Medical Association’s caregiver self-assessment questionnaire as a screening measure for depression. Journal of the American Geriatrics Society, 58, 387–388. https://doi.org/10.1111/j.1532....
 
16.
Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171–180. https://doi.org/10.1111/j.1752....
 
17.
Ferreira, P. L. (2000). Criação da versão portuguesa do MOS SF-36. Parte I – Adaptação cultural e linguística [Development of the Portuguese version of MOS SF-36. Part I. Cultural and linguistic adaptation]. Acta Médica Portuguesa, 13, 55–66.
 
18.
Foss, M. H., Martins, M. R., Mazaro, L. M., Martins, M. I., & Godoy, J. M. (2009). Qualidade de vida dos cuidadores de amputados de membros inferiores [Quality of life of lower limb amputees’ caregivers]. Revista Neurociências, 17, 8–13. https://doi.org/10.34024/rnc.2....
 
19.
Franchini, M. G., & Savoia, M. G. (2018). Psicoterapia de grupo para pacientes diabéticos amputados e seus cuidadores [Group psychotherapy of diabetes patients with amputations and their caretak-ers]. Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, 58, 10–17.
 
20.
Ganjparvar, Z., Mousavi, B., Masumi, M., Soroush, M., & Montazeri, A. (2016). Determinants of quali-ty of life in the caregivers of Iranian war survivors with bilateral lower-limb amputation after more than two decades. Iranian Journal of Medical Sciences, 41, 257–264.
 
21.
Golden-Kreutz, D. M., Thornton, L. M., Gregorio, W. D., Frierson, G. M., Jim, H. S., Carpenter, K. M., Shelby, R. A., & Andersen, B. L. (2005). Traumatic stress perceived global stress, and life events: prospectively predicting quality of life in breast cancer patients. Health Psychology, 24, 288–296. https://doi.org/10.1037/0278-6....
 
22.
Götze, H., Brähler, E., Gansera, L., Schnabel, A., Gottschalk‐Fleischer, A., & Köhler, N. (2018). Anxi-ety, depression and quality of life in family caregivers of palliative cancer patients during home care and after the patient’s death. European Journal of Cancer Care, 27, e12606. https://doi.org/10.1111/ecc.12....
 
23.
Gray, N. A., Zuo, L., Hong, D., Smyth, B., Jun, M., De Zoysa, J., Vo, K., Howard, K., Wang, J., Lu, C., & Liu, Z. (2019). Quality of life in caregivers compared with dialysis recipients: The Co‐ACTIVE sub‐study of the ACTIVE dialysis trial. Nephrology, 24, 1056–1063. https://doi.org/10.1111/nep.13....
 
24.
Kang, A., Yu, Z., Foo, M., Chan, C. M., & Griva, K. (2019). Evaluating burden and quality of life among caregivers of patients receiving peritoneal dialysis. Peritoneal Dialysis International, 39, 176–180. https://doi.org/10.3747/pdi.20....
 
25.
Kaux, J. F., Delvaux, F., Schaus, J., Demoulin, C., Locquet, M., Buckinx, F., Beaudart, C., Dardenne, N., Van Beveren, J., Croisier, J. L., Forthomme, B., & Bruyère, O. (2016). Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral el-bow tendinopathy for French-speaking patients. Journal of Hand Therapy, 29, 496–504. https://doi.org/10.1016/j.jht.....
 
26.
Lage, M. I. (2005). Cuidados familiares a idosos [Family care for the elderly]. In C. Paul & A. M. Fon-seca (Eds.), Envelhecer em Portugal [Getting older in Portugal] (pp. 203–229). Climepsi Editores.
 
27.
Lee, Y. H., Liao, Y. C., Shun, S. C., Lin, K. C., Liao, W. Y., Chang, P. H., Jhang, S. Y., Yu, C. J., Yang, P. C., Hsieh, P. Y., & Lai, Y. H. (2018). Trajectories of caregiver burden and related factors in family caregivers of patients with lung cancer. Psycho-Oncology, 27, 1493–1500. https://doi.org/10.1002/pon.46....
 
28.
Mason, J. E., LeBouthillier, D. M., & Asmundson, G. J. (2019). Relationships between health behav-iors, posttraumatic stress disorder, and comorbid general anxiety and depression. Cognitive Be-haviour Therapy, 48, 184–199. https://doi.org/10.1080/165060....
 
29.
Nazarko, L. (2019). Diabetes and foot problems: The role of the practice nurse. Practice Nursing, 30, 9–15. https://doi.org/10.12968/pnur.....
 
30.
Oldenkamp, M. (2018). Caregiving experiences of informal caregivers: The importance of characteristics of the informal caregiver, care recipient, and care situation. Rijksuniversiteit Groningen.
 
31.
Pan, K. C., Hung, S. Y., Chen, C. I., Lu, C. Y., Shih, M. L., & Huang, C. Y. (2019). Social support as a mediator between sleep disturbances, depressive symptoms, and health-related quality of life in patients undergoing hemodialysis. PLoS One, 14, e0216045. https://doi.org/10.1371/journa....
 
32.
Pedras, S., Carvalho, R., & Pereira, M. G. (2018). Predictors of quality of life in patients with diabetic foot ulcer: The role of anxiety, depression, and functionality. Journal of Health Psychology, 23, 1488–1498. https://doi.org/10.1177/135910....
 
33.
Pedras, S., Carvalho, R., & Pereira, M. G. (2016). Quality of life in Portuguese patients with diabetic foot ulcer before and after an amputation surgery. International Journal of Behavioral Medicine, 23, 714–721. https://doi.org/10.1007/s12529....
 
34.
Pedras, S., Preto, I., Carvalho, R., & Pereira, M. G. (2019). Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study. Psychology & Health, 34, 535-549. https://doi.org/10.1080/088704....
 
35.
Pedras, S., Vilhena, E., Carvalho, R., & Pereira, M. G. (2018). Psychosocial adjustment to a lower limb amputation ten months after surgery. Rehabilitation Psychology, 63, 418–430. https://doi.org/10.1037/rep000....
 
36.
Pereira, M. G., & Costa, S. (2013a). Versão do Revised Impact of Events Scale para cuidadores de pacientes diabetticos mellitus tipo 2 amputados devido pé diabético [Version of the Revised Impact of Events Scale for caregivers of type 2 diabetic mellitus patients amputated due to diabetic foot]. Family Health & Disease Research Group, School of Psychology, University of Minho, Braga, Por-tugal.
 
37.
Pereira, M. G., & Costa, S. (2013b). Versão do Self-Assessment Caregiver Questionnaire para cuidadores de pacientes diabéticos mellitus tipo 2 amputados devido pé diabético [Version of the Self-Assessment Caregiver Questionnaire for caregivers of type 2 diabetic mellitus patients ampu-tated due to diabetic foot]. Family Health & Disease Research Group, School of Psychology, Uni-versity of Minho, Braga, Portugal.
 
38.
Piran, P., Khademi, Z., Tayari, N., & Mansouri, N. (2017). Caregiving burden of children with chronic diseases. Electronic Physician, 9, 5380. https://doi.org/10.19082/5380.
 
39.
Potier, F., Degryse, J. M., Bihin, B., Debacq-Chainiaux, F., Charlet-Renard, C., Martens, H., & de Saint-Hubert, M. (2018). Health and frailty among older spousal caregivers: an observational cohort study in Belgium. BMC Geriatrics, 18, 291. https://doi.org/10.1186/s12877....
 
40.
Pucciarelli, G., Ausili, D., Galbussera, A. A., Rebora, P., Savini, S., Simeone, S., Alvaro, R., & Vellone, E. (2018). Quality of life, anxiety, depression and burden among stroke caregivers: a longitudinal, observational multicentre study. Journal of Advanced Nursing, 74, 1875–1887. https://doi.org/10.1111/jan.13....
 
41.
Reinhard, S. C., Gubman, G. D., Horwitz, A. V., & Minsky, S. (1994). Burden assessment scale for families of the seriously mentally ill. Evaluation and Program Planning, 17, 261–269. https://doi.org/10.1016/0149-7....
 
42.
Ribé, J. M., Salamero, M., Pérez-Testor, C., Mercadal, J., Aguilera, C., & Cleris, M. (2018). Quality of life in family caregivers of schizophrenia patients in Spain: Caregiver characteristics, caregiving burden, family functioning, and social and professional support. International Journal of Psychiatry In Clinical Practice, 22, 25–33. https://doi.org/10.1080/136515....
 
43.
Ribeiro, J. L. P. (1999). Escala de Satisfação com o Suporte Social (ESSS) [Social Support Satisfac-tion Scale (SSSS)]. Análise Psicológica, 17, 547–558.
 
44.
Ryu, J. H., Kredentser, M. S., Bienvenu, O. J., Blouw, M., Sareen, J., & Olafson, K. (2016). Post-traumatic stress disorder in survivors of critical illness. In C. Martin, V. Preedy, & V. Patel (Eds.), Comprehensive guide to post-traumatic stress disorders (pp. 263–280). Springer.
 
45.
Settineri, S., Rizzo, A., Liotta, M., & Mento, C. (2014). Caregiver’s burden and quality of life: Caring for physical and mental illness. International Journal of Psychological Research, 7, 30–39. https://doi.org/10.21500/20112....
 
46.
Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. New England Journal of Medicine, 376, 2459–2469. https://doi.org/10.1056/NEJMra....
 
47.
Schnitzer, S., Oedekoven, M., Amin-Kotb, K., Gellert, P., Balke, K., & Kuhlmey, A. (2017). Caregivers’ burden and education level: Does subjective health mediate the association? Innovation in Aging, 1, 447. https://doi.org/10.1093/geroni....
 
48.
Solorzano, C. S., Steptoe, A., Leigh, E., Kidd, T., Jahangiri, M., & Poole, L. (2019). Pre-surgical care-giver burden and anxiety are associated with post-surgery cortisol over the day in caregivers of coronary artery bypass graft surgery patients. International Journal of Behavioral Medicine, 26, 316–322. https://doi.org/10.1007/s12529....
 
49.
Tochel, C., Smith, M., Baldwin, H., Gustavsson, A., Ly, A., Bexelius, C., Nelson, M., Bintener, C., Fan-toni, E., Garre-Olmo, J., Janssen, O., Jindra, C., Jørgensen, I. F., McKeown, A., Öztürk, B., Pon-joan, A., Potashman, M. H., Reed, C., Roncancio-Diaz, E., Vos, S., Sudlow, C., & ROADMAP consortium (2019). What outcomes are important to patients with mild cognitive impairment or Alz-heimer’s disease, their caregivers, and health-care professionals? A systematic review. Alzheimer’s & Dementia, 11, 231–247. https://doi.org/10.1016/j.dadm....
 
50.
Tough, H., Brinkhof, M. W., Siegrist, J., & Fekete, C. (2017). Subjective caregiver burden and care-giver satisfaction: the role of partner relationship quality and reciprocity. Archives of Physical Med-icine and Rehabilitation, 98, 2042–2051. https://doi.org/10.1016/j.apmr....
 
51.
Valeberg, B. T., & Grov, E. K. (2013). Symptoms in the cancer patient – Of importance for their care-givers’ quality of life and mental health? European Journal of Oncology Nursing, 17, 46–51. https://doi.org/10.1016/j.ejon....
 
52.
Vranceanu, A. M. (2019). Can we prevent chronic posttraumatic stress disorder in caregivers of critical care patients? Journal of Emergency and Critical Care Medicine, 3, 2. https://doi.org/10.21037/jeccm....
 
53.
Ware, J. E. Jr, Kosinski, M., Gandek, B., Aaronson, N. K., Apolone, G., Bech, P., Brazier, J., Bull-inger, M., Kaasa, S., Leplège, A., & Prieto, L. (1998). The factor structure of the SF-36 Health Sur-vey in 10 countries: Results from the IQOLA Project. Journal of Clinical Epidemiology, 51, 1159–1165. https://doi.org/10.1016/S0895-....
 
54.
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD: a practitioner’s handbook (pp. 399–411). Guilford Press.
 
55.
Wingrove, C., & Rickwood, D. (2019). Parents and carers of young people with mental ill-health: What factors mediate the effect of burden on stress? Counselling Psychology Quarterly, 32, 121–134. https://doi.org/10.1080/095150....
 
56.
Wintermann, G. B., Petrowski, K., Weidner, K., Strauß, B., & Rosendahl, J. (2019). Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: Age matters. Critical Care, 23, 39. https://doi.org/10.1186/s13054....
 
57.
Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M. (2016). Psy-chosocial care for people with diabetes: a position statement of the American Diabetes Associa-tion. Diabetes Care, 39, 2126–2140. https://doi.org/10.2337/dc16-2....
 
eISSN:2353-5571
ISSN:2353-4184