Longitudinal support to the sociocultural stress and coping model. A 4-year follow-up of family caregivers of people with dementia

Abstract

Objectives: According to the sociocultural stress-and-coping model for family caregivers, caregiving stressors contribute directly to caregivers' distress. In addition, there is another path to explain this distress, as several cultural (e.g., familism) and cognitive variables (e.g., dysfunctional thoughts) have important intermediate roles in the pathway from stress to distress. In particular, coping variables appear to play important intermediary roles in this pathway. The aim of this study was to provide longitudinal support to this two-paths stress and coping model. Methods: Participants were 304 dementia family caregivers who were interviewed yearly during a 4-year period (5 assessment points). Sociodemographic variables, stressors, familism, dysfunctional thoughts about caregiving, cognitive fusion, leisure engagement, ambivalence, guilt and depressive symptoms were measured. The paths established by the sociocultural stress and coping model were tested. Results: Greater cognitive fusion, greater reaction to BPSD, increased ambivalence, increased guilt, and reduced engagement in leisure activities were associated with greater experience of depressive symptoms. However, cultural and cognitive variables (i.e., familism and dysfunctional thoughts) did not show a direct association with depressive symptoms but were associated with increased cognitive fusion and reduced engagement in leisure activities. Overall, the stress-and-coping model explained 52.45 % of the variance in depressive symptoms through the 4-year study period. Discussion: This study provides longitudinal support to the two-paths proposed by the sociocultural stress and coping model. Specifically, cultural and cognitive factors are more distally related to caregiver outcomes via their association with coping variables, which in turn appear proximally related to caregiver distress (i.e., depressive symptoms).