Exciting advances in family caregiver research

I am honored to be given this opportunity to share my thoughts about three important papers that are included in this issue, each of which makes a unique contribution to new knowledge about family caregiving—and does so from an international perspective. The first, by van den Wijngaart et al. refines our current thinking about why some spousal caregivers become overburdened in their role while others do not. This is a very important issue to address in an era of shrinking resources and increased demand for services: by sharpening our current knowledge about what factors serve to mediate the well-known relationship between objective stressors of the caregiving situation and the caregivers’ perceived burden, we can better target specific interventions to those who need them the most. This research paper carefully studies key variables in the widely endorsed ‘stress/coping’ model of Lazarus and Folkman (1984) that highlights the roles of appraisal of stress and perceived effectiveness of one’s ability to cope and evaluates their mediating role on reported burden associated with caregiving. Unexpectedly, the authors found that some alterations of that popular conceptual model may well be warranted: for example, caregivers’ functional health may play an important (but until now, relatively untested) role in mediating the relationship between objective stress and subjective burden. Furthermore, this research team discusses the intricacies of conceptualizing and measuring the constructs of social support, self-efficacy and coping, thus encouraging us to think ‘outside the box’ about these variables and the role they play in either heightening or mitigating the burden that caregivers experience. At the same time, it may be somewhat problematic that some of the measures used in this study (although well-described) are likely to be unfamiliar to non-European readers—for example, only two single-item measures of appraisal were used. Many studies that include an index of appraisal use a more widely known scale by Lawton to measure this construct, thus facilitating the comparison of findings across different national groups. Nevertheless, that observation is not meant in any way to detract from a very important contribution of this work—namely, its recommendation that we consider employing novel intervention strategies that have not been the typical focus of intervention research designed to reduce caregivers’ burden. These include interventions to improve the functional health of the caregiver and others to increase the amount and quality of social interaction between spousal caregivers and their loved ones. These suggestions are based on their empirical findings: namely, that these particular variables were the ones that actually functioned as mediators in their test of the Lazarus and Folkman conceptual model. In contrast, the expected mediators (appraisal and coping) were not significant predictors in the path analyses conducted. These are important observations and point to fruitful areas for future research— particularly in light of the fact that most psychosocial intervention research with family caregivers has focused on teaching skills for emotional regulation (cf. Coon, Thompson, steffen, Sorocco, & Gallagher-thompson, 2003) or skills to improve one’s cognitive and behavioral coping skills (cf. review by Gallagher-Thompson & Coon, 2007) or has provided a combination of skill training and emotional support (cf. the work of Mittelman Roth, Haley & Zarit., 2004). To date, few if any studies have attempted to improve the functional health of the caregiver or to directly influence the amount and quality of social exchange between caregiver and care-recipient. These promise to be exciting areas for future clinical trials. The second study, by Marquez-Gonzalez and colleagues, focuses on providing caregivers in Madrid, Spain with an intervention program to assist them in the development of more adaptive cognitive and behavioral coping skills. This is one of the first attempts to take an intervention program