title: Mediating effects of sense of coherence on family caregivers' depressive distress while caring for terminally ill cancer patients.
abstract: BACKGROUND
  The stress and coping theory suggests that the impact of caregiving on caregivers' life depends more on personal psychological resources (ie, sense of coherence [SOC]) than on objective caregiving demands or social resources. However, SOC's mediation roles in helping caregivers cope with the challenges of end-of-life care have never been explored.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the mediation effects of SOC on caregivers' depressive distress while providing end-of-life care.
  
  
  METHODS
  The Center for Epidemiological Studies-Depression Scale scores from a convenience sample of 621 family caregivers were analyzed using structural equation modeling. We used the Sobel test to verify the significance of SOC's mediation effects on the relationships between identified stressors (objective caregiving demands, patient symptom distress), appraisals (confidence in caregiving, subjective caregiving burden), and caregivers' depressive distress.
  
  
  RESULTS
  Sense of coherence mediated effects on relationships between Center for Epidemiological Studies-Depression Scale scores and subjective caregiving burden (P = .000), confidence in caregiving (P = .014), and objective caregiving demands (P = .000). Although the strength of SOC did not attenuate the impact of caregivers' perceived patient symptom distress on caregiver depressive distress, SOC mediated this effect secondarily through appraisals of subjective caregiving burden and confidence in caregiving.
  
  
  CONCLUSIONS
  Personal psychological resources, as indicated by the strength of personal SOC, significantly mediated the effects of caregiving stressors, appraisals of caregiving confidence, and subjective caregiving burden on depressive distress of family caregivers while providing end-of-life care.
  
  
  CONCLUSIONS
  Nursing interventions to enhance caregivers' SOC may decrease their depressive distress through increasing their confidence in providing end-of-life care and lightening their perceived caregiving burden.
authors.affiliation: Author Affiliations: Graduate School of Nursing (Dr Tang), Chang Gung University, Tao-Yuan; Departments of Public Health (Dr Cheng) and Nursing (Dr Liu), Fu-Jen Catholic University, Taipei; School of Nursing (Dr Lee), China Medical University, Taichung; Department of Nursing, Kang-Ning Junior College of Medical Care and Management (Ms Chen), Taipei, Republic of China.
authors.forename: Siew T
authors.initials: ST
authors.lastname: Tang
authors.forename: Chi C J
authors.initials: CC
authors.lastname: Cheng
authors.forename: Kwo C
authors.initials: KC
authors.lastname: Lee
authors.forename: Chen H
authors.initials: CH
authors.lastname: Chen
authors.forename: Li N
authors.initials: LN
authors.lastname: Liu
mesh_terms: D000223:Adaptation, Psychological; D000465:Algorithms; D017028:Caregivers / Q000523:psychology; D003863:Depression / Q000209:etiology*; D006801:Humans; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D064887:Observational Studies as Topic; D012107:Research Design; D060685:Sense of Coherence; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D013624:Taiwan; D013727:Terminal Care / Q000523:psychology; D019452:Terminally Ill