Exploring the Effect of Caregiver Burden among Alzheimer's Caregivers: A Test of The Stress Process Model

The diagnosis of Alzheimer’s disease (AD) is stressful for both patients and their family caregivers (FCG). As the disease progresses, the patient’s memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. This research examines the impact of the subjective burden with the objective stressors on FCG’s depression and to determines which psychosocial resources can be used to either mediate or moderate this relationship. I examine the baseline data that was collected from 670 family caregivers of Alzheimer’s patients in the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) II clinical trial (REACH II), 2001–2004. The measurements used in the current study are caregivers’ background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Three research questions will be investigated in this study: (1) How do the caregivers’ background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs’ depressive symptoms? (3) How do psychosocial resources mediate and or moderate the relationship between the primary stressors and FCGs’ depression experiences? Exploring the Effect of Caregiver Burden among Alzheimer’s Caregivers: A Test of The Stress Process Model Yuxin Zhao GENERAL AUDIENCE ABSTRACT The diagnosis of Alzheimer’s disease (AD) is stressful for both patients and their family caregivers (FCG). In 2018, an estimated 5.7 million Americans have been diagnosed with Alzheimer’s disease (Alzheimer’s Association 2018). As the disease progresses, the patient’s memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. As Aneshensel, Carol S. , Leonard I. Pearlin, Joseph T. Mullan, Steven H. Zarit, and Carol J. Whitlatch (1995) noted in their book Profiles in Caregiving: The Unexpected Career, the role of caregiving is generally an ‘unexpected job’ for FCGs (Aneshensel et al. 1995). Based on Pearlin’s stress process model (SPM), the primary goal of my thesis is to compare the impact of the subjective burden of caregiving with that of objective stressors on FCG’s depression, and to determine whether psychosocial resources can either mediate or moderate this relationship. Objective stressors refer to the AD patient’s memory and behavior problems, his or her cognitive impairment, self-care activities, and functional status. Subjective burden is the FCG’s emotional response to objective stressors. Objective stressors and subjective burden are associated with each other, and they are primary stressors in the SPM. Psychosocial resources include FCG’s religious coping, their positive experiences of caregiving, their social networks and whether they were satisfied with social support that they received from others. The present study is important for two reasons. First, rather than focusing on subjective burden alone, the model examined how objective stressors (i.e. burden) influence mental health through their impact on subjective burden. Second, previous influential studies of the stressors of caregiving either did not include the moderating effects of psychosocial resources (Pearlin et al., 1999), or included a limited number of resources and found that they did not play a significant role in how caregiving stress influences caregivers mental health (Aneshensel et al. 1995). In my thesis, I will explore both of the mediating and moderating effects of four types of psychosocial resources. I examine the baseline data that was collected from 670 family caregivers of Alzheimer’s patients from the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) II clinical trial (REACH II), 2001–2004 (Schulz, Burgio, and Stevens 2006). The study participants target on FCGs who are vulnerable to the caregiving stressors. The purpose of the baseline data was to describe the AD patients’ cognitive impairment and behavior problems at the initial stage of the REACH II study, the demands caused by the impairments imposed upon FCGs, the psychosocial resources adopted by FCGs to relieve the caregiving stress, and the consequences of the primary stressors on FCGs’ daily lives. I will explore three research questions in the current study: (1) How do the caregivers’ background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs’ depressive symptoms? (3) How do psychosocial resources mediate or moderate the relationship between the primary stressors and FCGs’ depression experiences? The measurements used in the current study are caregivers’ background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Data analysis is primarily based on multiple linear regression. I will also use the post-hoc probing methods to specifically test the significance of the moderating test. There are four key findings in the present study. First, caregivers’ background and context factors have some significant associations with objective stressors and subjective burden, but overall, their impact is minimal. Second, subjective burden has a stronger impact on depressive symptoms than all of the objective stressors do. Third, subjective burden undermines all four psychosocial resources tested in the current study. Fourth, the mediating and moderating effects of psychosocial resources have a negligible impact in the caregiving stress process. Surprisingly, the effect of subjective burden on depressive symptoms among FCGs remained largely unchanged after all psychosocial resources were included in the model as mediators and moderators. In the mediational test, the effects of subjective burden on depression decreased by only 14 percent after all psychosocial resources were taken into account. Likewise, each of these psychosocial resources had only a negligible effect on moderating the impacts of stressors. The study suggests that unless there is a full understanding of the effects of these stressors on caregivers’ well-being, any interventions or preventive actions will be of limited utility. Future research should pay more attention to exploring the relationships between the subjective burden and objective stressors, and examining their different impacts on FCGs’ depression experience. Additionally, the fact that none of the psychosocial resources have a buffering effect in the caregiving process suggests that there is little in the lives of caregivers that mitigates the deleterious effects of caregiving stress on Alzheimer’s caregivers. Policy makers and mental health providers should consider the stress of caregiving, as reflected in both its objective and subjective aspects, as a major risk factor in the lives of those who care for family members with Alzheimer’s disease. Those factors may play a causal role in caregivers’ mental disorders and suicidal ideation.