Does gender moderate the associations of caregiving distress with engagement in healthy behaviors and self-management in rural caregivers?
Authors: Chung M.L , Miller J.L , Moser D.K 
Published: November 2020

Abstract

Introduction
Caregivers are globally vulnerable populations facing a high risk of cardiovascular disease (CVD) development and mortality. Caregiving distress, defined as caregiver burden, stress, depressive symptoms, and anxiety, may contribute to a lack of engagement in healthy behaviors and self-management. Although gender differences in caregiving distress have been reported, there is limited evidence about whether gender moderates the associations between caregiving distress and engagement in healthy behaviors or self-management in rural caregivers.

Purposes
To compare gender differences in caregiving distress (i.e., burden, stress, depressive symptoms, and anxiety), and engagement in healthy behaviors and self-management; and to determine whether gender moderates the associations of caregiving distress with engagement in healthy behaviors and self-management.

Methods
Rural informal caregivers caring for patients with chronic disease and having at least two or more CVD risk factors completed baseline assessment in an ongoing randomized controlled trial of a CVD risk reduction intervention. Caregiving distress was assessed using the Zarit Burden Interview, the Perceived Stress Scale, the Patient Health Questionnaire-9, and the Brief Symptom Inventory-Anxiety. Engagement in healthy behaviors and self-management were assessed using the MOS-Specific Adherence Scale and the Patient Activation Measure, respectively. Independent t-tests and multiple regression modeling with the PROCESS macro was used.

Results
Of the 262 rural caregivers (mean age= 53.7 years; 78% female; 96% white), 55% of the caregivers reported having at least one or more types of CVD. Female caregivers reported significantly higher levels of burden, perceived stress, depressive symptoms, and anxiety than male caregivers, but they experienced similar levels of engagement in healthy behaviors and self-management. High levels of burden (SB=−0.454, P&lt;0.001), stress (SB=−0.456, P&lt;0.001), depressive symptoms (SB=−0.363, P&lt;0.001) and anxiety (SB=−0.365, P&lt;0.001) were significantly associated with low levels of engagement in healthy behaviors, but there were no gender moderation effects on these associations. High levels of burden (SB=−0.334, P&lt;0.001) were significantly associated with poor engagement in self-care, but this association was strong and significantly only for female caregivers. High levels of stress (SB=−0.384, P&lt;0.001) were also significantly associated with poor engagement in self-care for only female caregivers. Although depressive symptoms (SB=−0.325, P&lt;0.001) and anxiety (SB=−0.349, P&lt;0.001) were associated with low levels of self-management, there were no gender effects on these associations.

Conclusions
Significant gender effects on associations of caregiving distress with self-management suggest the need for designing interventions targeting caregiving burden and stress to reduce caregiving distress for women rural caregivers.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): National Institutes of Health