title: The role of family functioning in the stress process of dementia caregivers: a structural family framework.
abstract: OBJECTIVE
  The purpose of the study was to evaluate the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework. The stress-process model of caregiver distress included family functioning as an intervening variable in the relationship between objective burden and distress. We theorized family functioning to partially mediate the relationship between objective burden and distress and to significantly account for the prediction of distress beyond well-recognized predictors.
  
  
  METHODS
  One hundred eighty-one family caregivers from the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health project participated in this study. We assessed sociodemographics, burden, depression, anxiety, and perceived health for each caregiver. We measured family functioning by using a multidimensional and observational instrument. We used structural equation modeling to assess the fit of the model for the overall sample and for different caregiver subgroups and to examine whether demographic variables affected the relationships in the model.
  
  
  RESULTS
  The results of the study indicated that family functioning significantly contributed to distress in the overall sample and partially mediated the relationship between objective burden and distress. We also found that the stress-process model was adequately fit by the hypothesized relationships between objective burden, family functioning, and distress for the overall sample and all of the subsamples, except for wives.
  
  
  CONCLUSIONS
  This study provides support for the structural family approach as an explanatory model for the influence of family functioning on dementia caregivers. Family structural functioning is one contributor to the caregiver stress process. This suggests that interventions targeting structural family problems may reduce caregiver distress.
authors.affiliation: Center for Family Studies, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, 1425 NW 10th Avenue, Miami, FL 33136, USA. vmitrani@med.miami.edu
authors.forename: Victoria B
authors.initials: VB
authors.lastname: Mitrani
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feaster
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Czaja
authors.forename: Carl
authors.initials: C
authors.lastname: Eisdorfer
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.forename: Jose
authors.initials: J
authors.lastname: Szapocznik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003704:Dementia; D005190:Family / Q000523:psychology*; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological