Avoidant coping partially mediates the relationship between patient problem behaviors and depressive symptoms in spousal Alzheimer caregivers.
OBJECTIVE
Caring for a loved one with Alzheimer disease is a highly stressful experience that is associated with significant depressive symptoms. Previous studies indicate a positive association between problem behaviors in patients with Alzheimer disease (e.g., repeating questions, restlessness, and agitation) and depressive symptoms in their caregivers. Moreover, the extant literature indicates a robust negative relationship between escape-avoidance coping (i.e., avoiding people, wishing the situation would go away) and psychiatric well-being. The purpose of this study was to test a mediational model of the associations between patient problem behaviors, escape-avoidance coping, and depressive symptoms in Alzheimer caregivers.


METHODS
Ninety-five spousal caregivers (mean age: 72 years) completed measures assessing their loved ones' frequency of problem behaviors, escape-avoidance coping, and depressive symptoms. A mediational model was tested to determine if escape-avoidant coping partially mediated the relationship between patient problem behaviors and caregiver depressive symptoms.


RESULTS
Patient problem behaviors were positively associated with escape-avoidance coping (beta = 0.38, p < 0.01) and depressive symptoms (beta = 0.26, p < 0.05). Escape-avoidance coping was positively associated with depressive symptoms (beta = 0.33, p < 0.01). In a final regression analysis, the impact of problem behaviors on depressive symptoms was less after controlling for escape-avoidance coping. Sobel's test confirmed that escape-avoidance coping significantly mediated the relationship between problem behaviors and depressive symptoms (z = 2.07, p < 0.05).


CONCLUSIONS
Escape-avoidance coping partially mediates the association between patient problem behaviors and depressive symptoms among elderly caregivers of spouses with dementia. This finding provides a specific target for psychosocial interventions for caregivers.
Department of Psychiatry, University of California at San Diego, San Diego, California 92093-0680, USA. bmausbach@ucsd.edu
Brent T
BT
Mausbach
Kirstin
K
Aschbacher
Thomas L
TL
Patterson
Sonia
S
Ancoli-Israel
Roland
R
von Känel
Paul J
PJ
Mills
Joel E
JE
Dimsdale
Igor
I
Grant
D000223:Adaptation, Psychological; D000368:Aged; D000544:Alzheimer Disease / Q000150:complications*; D017028:Caregivers / Q000523:psychology*; D003710:Demography; D003863:Depression / Q000523:psychology*; D004924:Escape Reaction; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D018454:Spouses / Q000523:psychology*