Global and caregiving mastery as moderators in the caregiving stress process

Abstract

Objectives: The study tests the circumstances under which global mastery and caregiving mastery moderate the impact of objective and subjective stressors on depressive and anxious symptoms among Alzheimer's caregivers.

Methods: Data from a sample of 200 spousal caregivers to people with Alzheimer's disease were examined. Sixteen separate models were tested with depression and anxiety regressed on two measures of objective demand (activities of daily living and problem behaviors) and two measures of subjective demand (role overload and role captivity) matched with each of the two mastery measures and their relevant interaction terms.

Results: Caregiving mastery functions as a moderator in the relationship between subjective demands and depression and anxiety, that is, at higher levels of caregiving mastery, the positive association between role overload and role captivity on depression and anxiety was weaker. Although there is a strong main effect of global mastery on mental health, it was not found to act as a moderator in this study.

Conclusion: The findings demonstrate the importance of evaluating role-specific measures, such as caregiving mastery, as well as assessing a variety of stressful demands, in order to explicate the pathways through which psychosocial resources exert their protective effects.

Keywords:

• Alzheimer's disease
• caregiving
• self-efficacy
• personal control
• subjective demands
• objective demands

Acknowledgments

The study was supported in part by a grant from the National Institute on Aging (AG no. 1746) to Leonard I. Pearlin. I would like to thank Len Pearlin, Melissa Milkie, Scott Schieman, Marybeth Stalp, Cyndi Dunn, and Gayle Rhineburger-Dunn, and the anonymous reviewers for their helpful comments in the preparation of this study.

Notes

1. A cross-sectional approach was taken to maintain adequate statistical power for the analyses. By the second wave of the AFS, only 123 of the original subjects continued to care for their spouses in the home.

2. Although role overload, role captivity, and both measures of mastery are moderately correlated (Table 2), these constructs are conceptually distinct. On its face, the language of the items used in these measures reflects this distinction, as does the internal consistency of the indices and scales.

3. The unstandardized regression coefficient for the mastery main effect represents the influence of this variable when all other non-interaction variables are equal to zero. This is a conditional relationship as opposed to the general relationship estimated in standard regression models. This interpretation holds for all main effect variables in product-term models (Jaccard et al., 1990, pp. 26–27). In simple regression models (not shown), the same pattern of significance for the direct relationships of the mastery variables with the mental health variables was found as reported in the interaction models here, although the coefficients differed.

4. Using guidelines suggested by Cohen and Cohen (1983), separate regression lines were created for values of the centered caregiving mastery variables at the mean, one standard deviation above and one standard deviation below the mean. These lines were then plotted to illustrate how the relationship of subjective demands (role overload and role captivity) to mental health (depression and anxiety) depends on the level of caregiving mastery.

5. Fortinsky et al. (2002) measured control over caregiving with a ‘self-efficacy for symptom management’ scale. All questions in the five-item scale began with ‘How certain are you right now that you can. ..’ followed by phrases such as ‘handle any problems your relative has, like memory loss, wandering, or behavior problems’ and ‘deal with the frustrations of caring for your relative.’ Steffen and colleagues (Gilliam & Steffen, 2006; Steffen et al., 2002) used the revised scale for caregiving self-efficacy, for which caregivers were asked to rate their level of confidence (from 0–100%) that they could perform each activity if they gave their best effort. The 5-item ‘responding to disruptive patient behaviors’ subscale most closely matches the caregiving mastery scale used in this study (e.g., ‘How confident are you that you can control worrying about future problems that may come up with your family member?’).