Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-27T17:40:17.908Z Has data issue: false hasContentIssue false
  • English
  • Français

PEAR model and sleep outcomes in dementia caregivers: influence of activity restriction and pleasant events on sleep disturbances

Published online by Cambridge University Press:  24 March 2011

Raeanne C. Moore ,
Alexandrea L. Harmell ,
Elizabeth Chattillion ,
Sonia Ancoli-Israel ,
Igor Grant  and
Brent T. Mausbach
Raeanne C. Moore
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, USA California School of Professional Psychology, Alliant International University, San Diego, California, USA
Alexandrea L. Harmell
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, USA
Elizabeth Chattillion
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, USA Joint Doctoral Program in Clinical PsychologySan Diego State University/University of California, San Diego, USA
Sonia Ancoli-Israel
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, USA Joint Doctoral Program in Clinical PsychologySan Diego State University/University of California, San Diego, USA
Igor Grant
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, USA Joint Doctoral Program in Clinical PsychologySan Diego State University/University of California, San Diego, USA
Brent T. Mausbach*
Affiliation:
Department of Psychiatry, University of California, San Diego, La Jolla, USA Joint Doctoral Program in Clinical PsychologySan Diego State University/University of California, San Diego, USA
*
Correspondence should be addressed to: Brent T. Mausbach, PhD, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive; La Jolla, California, 92093-0680, USA. Phone: +1 (858) 822-5925; Fax: +1 (858) 534-7723. Email: [email protected].
Get access

Abstract

Background: Sleep disturbance is a common consequence of providing care to a loved one with Alzheimer's disease (AD). We explored the usefulness of the Pleasant Events and Activity Restriction (PEAR) model for predicting multiple domains of sleep disturbance.

Methods: Our sample consisted of 125 spousal AD caregivers. Participants completed the Pittsburg Sleep Quality Index (PSQI) and were questioned regarding the frequency with which they engaged in pleasant events and the extent to which they felt restricted in engaging in social and recreational activities in the past month. Participants were classified into one of three groups: HPLR = High Pleasant Events + Low Activity Restriction (= reference group; N = 38); HPHR/LPLR = either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 52); and LPHR: Low Pleasant Events + High Activity Restriction (N = 35). These three groups were compared on the seven subscales of the PSQI.

Results: Significant differences were found between the HPLR and LPHR groups on measures of subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, and daytime dysfunction. Additionally, significant differences were found between the HPLR and HPHR/LPLR groups on subjective sleep quality, sleep latency, and habitual sleep efficiency, and between the HPHR/LPLR and LPHR groups on sleep disturbance and daytime dysfunction.

Conclusions: This study provides broad support for the PEAR model and suggests that interventions focusing on behavioral activation may potentially provide benefits to non-affective domains including sleep.

Keywords

behavioral activationsleep qualitydementiastress
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 9 , November 2011 , pp. 1462 - 1469
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Benca, R. M., Obermeyer, W. H., Thisted, R. A. and Gillin, J. C. (1992). Sleep and psychiatric disorders: a meta-analysis. Archives of General Psychiatry, 49, 651–668.CrossRefGoogle ScholarPubMed
Bower, B., Bylsma, L. M., Morris, B. H. and Rottenberg, J. (2010). Poor reported sleep quality predicts low positive affect in daily life among healthy and mood-disordered persons. Journal of Sleep Research, 19, 323–332.CrossRefGoogle ScholarPubMed
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R. and Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefGoogle ScholarPubMed
Buysse, D. J. et al. (1994). Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep, 17, 630–637.CrossRefGoogle ScholarPubMed
Carter, P. A. (2006). A brief behavioral sleep intervention for family caregivers of persons with cancer. Cancer Nursing, 29, 95–103.CrossRefGoogle ScholarPubMed
Cole, M. G. and Dendukuri, N. (2003). Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147–1156.CrossRefGoogle ScholarPubMed
Coon, D. W., Thompson, L., Steffen, A., Sorocco, K. and Gallagher-Thompson, D. (2003). Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. The Gerontologist, 43, 678–689.CrossRefGoogle ScholarPubMed
Creese, J., Bedard, M., Brazil, K. and Chambers, L. (2008). Sleep disturbances in spousal caregivers of individuals with Alzheimer's disease. International Psychogeriatrics, 20, 149–161.CrossRefGoogle ScholarPubMed
Faubel, R., et al. . (2009). Sleep duration and health-related quality of life among older adults: a population-based cohort in Spain. Sleep, 32, 1059–1068.Google ScholarPubMed
Gallagher-Thompson, D. and Coon, D. W. (2007). Evidence-based psychological treatments for distress in family caregivers of older adults. Psychology and Aging, 22, 37–51.CrossRefGoogle ScholarPubMed
Hawkley, L. C., Preacher, K. J. and Cacioppo, J. T. (2010). Loneliness impairs daytime functioning but not sleep duration. Health Psychology, 29, 124–129.CrossRefGoogle Scholar
Hayashino, Y., Yamazaki, S., Takegami, M., Nakayama, T., Sokejima, S. and Fukuhara, S. (2010). Association between number of comorbid conditions, depression, and sleep quality using the Pittsburgh Sleep Quality Index: results from a population-based survey. Sleep Medicine, 11, 366–371.CrossRefGoogle ScholarPubMed
Hope, T., Keene, J., Gedling, K., Fairburn, C. G. and Jacoby, R. (1998). Predictors of institutionalization for people with dementia living at home with a carer. International Journal of Geriatric Psychiatry, 13, 682–690.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Jacobson, D. L., Martell, C. R. and Dimidjian, S. (2001). Behavioral activation treatment for depression: returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255–270.Google Scholar
Jacobson, N. S. et al. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64, 295–304.CrossRefGoogle ScholarPubMed
Katz, S., Ford, A. B., Moscowitz, R. W., Jackson, B. A. and Jaffee, M. W. (1963). Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914–919.CrossRefGoogle Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.CrossRefGoogle ScholarPubMed
Lewinsohn, P. M. (1974). A behavioral approach to depression. InFriedman, R. J. and Katz, M. M. (eds.), The Psychology of Depression: Contemporary Theory and Research (pp. 157–178). New York: John Wiley & Sons.Google Scholar
Lewinsohn, P. M. (1975). Engagement in pleasant activities and depression level. Journal of Abnormal Psychology, 84, 729–731.CrossRefGoogle ScholarPubMed
Lewinsohn, P. M. and Amenson, C. S. (1978). Some relations between pleasant and unpleasant mood-related events and depression. Journal of Abnormal Psychology, 87, 644–654.CrossRefGoogle ScholarPubMed
Logsdon, R. G. and Teri, L. (1997). The Pleasant Events Schedule-AD: psychometric properties and relationship to depression and cognition in Alzheimer's disease patients. The Gerontologist, 37, 40–45.CrossRefGoogle ScholarPubMed
Mausbach, B. T., Patterson, T. L. and Grant, I. (2008). Is depression in Alzheimer's caregivers really due to activity restriction? A preliminary mediational test of the activity restriction. Journal of Behavior Therapy and Experimental Psychiatry, 39, 459–466.CrossRefGoogle ScholarPubMed
Mausbach, B. T., Roepke, S. K., Depp, C. A., Moore, R., Patterson, T. L. and Grant, I. (2011). Integration of the Pleasant Events (PE) and Activity Restriction (AR) models: development and validation of a “PEAR” model of negative outcomes in Alzheimer's caregivers. Behavior Therapy, 42, 78–88.CrossRefGoogle Scholar
Mazzucchelli, T., Kane, R. and Rees, C. (2009). Behavioral activation treatments for depression in adults: a meta-analysis and review. Clinical Psychology: Science and Practice, 16, 383–411.Google Scholar
McCurry, S. M., Logsdon, R. G., Teri, L. and Vitiello, M. V. (2007). Sleep disturbances in caregivers of persons with dementia: contributing factors and treatment implications. Sleep Medicine Review, 11, 143–153.CrossRefGoogle ScholarPubMed
McKibbin, C. L. et al. (2005). Sleep in spousal caregivers of people with Alzheimer's disease. Sleep, 28, 1245–1250.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Neikrug, A. B. and Ancoli-Israel, S. (2010). Sleep disorders in the older adult: a mini-review. Gerontology, 56, 181–189.CrossRefGoogle ScholarPubMed
Ohayon, M. M. and Roth, T. (2001). What are the contributing factors for insomnia in the general population? Journal of Psychosomatic Research, 51, 745–755.CrossRefGoogle ScholarPubMed
Ory, M. G., Hoffman, R. R. 3rd, Yee, J. L., Tennstedt, S. and Schulz, R. (1999). Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. The Gerontologist, 39, 177–185.CrossRefGoogle ScholarPubMed
Perlis, M. L. et al. (2006). Insomnia as a risk factor for onset of depression in the elderly. Behavioral Sleep Medicine, 4, 104–113.CrossRefGoogle ScholarPubMed
Schulz, R., O'Brien, A. T., Bookwala, J. and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. The Gerontologist, 35, 771–791.CrossRefGoogle ScholarPubMed
von Kanel, R. et al. (2010). Sleep and biomarkers of atherosclerosis in elderly Alzheimer caregivers and controls. Gerontology, 56, 41–50.CrossRefGoogle ScholarPubMed
Williamson, G. M. and Schulz, R. (1992). Physical illness and symptoms of depression among elderly outpatients. Psychology and Aging, 7, 343–351.CrossRefGoogle ScholarPubMed
Williamson, G. M. and Shaffer, D. R. (2000). The Activity Restriction Model of Depressed Affect: antecedents and consequences of restricted normal activities. In Williamson, G. M., Schafer, D. R. and Parmelee, P. A. (eds.), Physical Illness and Depression in Older Adults: A Handbook of Theory, Research, and Practice (pp. 173–200). Dordrecht, Netherlands: Kluwer Academic Publishers.CrossRefGoogle Scholar