The impacts of objective and subjective caregiving stressors on caregiver mental health: a six-month prospective study of caregivers of older Chinese people with dementia

Abstract

Guided by Pearlin’s (1999) stress process model, this six-month prospective study investigated the impacts of objective and subjective caregiving stressors (patient problem behaviors and caregiver burden) on caregiver mental health in a sample of caregivers of older Chinese with dementia residing in Hong Kong. A consecutive sample of 122 family caregivers of dementia patients was recruited from local nongovernment organizations. Caregivers provided information on their demographic characteristics, patient behavior problems as measured by the Cohen Mansfield Agitation Inventory, and caregiver burden as measured by the Zarit Burden Interview. At six months following the initial contact, 108 caregivers were successfully contacted and responded to the Short Form General Health Questionnaire (GHQ-12). Family caregivers reported poor mental health, 81.5% of the respondents reported a GHQ-12 score above the cut-off point (greater than two). A series of regression analyses was conducted to determine the relationship between patient problem behavior, caregiver burden, and caregiver mental health. In the first two regression models, patient problem behavior was associated with caregiver mental health (B = .26, p < .05) and caregiver burden (B = .42, p < .01) respectively. In the final regression model, a full mediation was observed where the addition of caregiver burden to the regression for caregiver mental health reduced the relation of patient behavior problem to caregiver mental health (B = .03). This study found evidence that subjective appraisal of stress mediated the relationship between stressor and mental health. Specifically, the relationship between patient behavior problems and caregiver mental health was mediated by caregiver burden. For intervention programs for dementia patients and their caregivers to be effective, service providers should provide assistance that can reduce objective stress as well as assistance to help caregivers modify their subjective perception of the stressful situation.