title: Domestic helpers as moderators of spousal caregiver distress.
abstract: OBJECTIVE
  Although domestic helpers increasingly play a role in elder care in many societies, there is a lack of research on their influence on caregiver distress. This study aimed to examine the influence of domestic helpers on the relationship between stressors (the care needs of frail elders and spousal provision of care) and spousal caregivers' psychological distress.
  
  
  METHODS
  This study was a secondary analysis of cross-sectional data collected between 2007 and 2009 from 6,442 Hong Kong adults aged 60 or older who were applying for government-subsidized long-term care services and whose spouses were their primary caregivers. Among the spousal caregivers, 73.04% were women, 44.16% felt distressed, and 5.73% were assisted by domestic helpers.
  
  
  RESULTS
  According to logistic regression analysis, spousal caregivers who provided personal care related to activities of daily living were more likely to be distressed if they were not assisted by domestic helpers.
  
  
  CONCLUSIONS
  The findings suggest that domestic help may moderate the effect of stressors on spousal caregivers. Domestic helpers provide support not just to frail older adults but also to spousal caregivers. Further studies are recommended to explore the precise effect of domestic help on family caregivers, care receivers, and the caregiving process.
authors.affiliation: Department of Applied Social Sciences, City University of Hong Kong, Hong Kong. alice.chong@cityu.edu.hk.
authors.forename: Alice M L
authors.initials: AM
authors.lastname: Chong
authors.affiliation: Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong.
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Kwan
authors.affiliation: School of Social Work, University of Southern California, Los Angeles.
authors.forename: Iris
authors.initials: I
authors.lastname: Chi
authors.affiliation: Department of Social Work and Social Administration. Sau Po Centre on Ageing, and.
authors.forename: Vivian W Q
authors.initials: VW
authors.lastname: Lou
authors.affiliation: Sau Po Centre on Ageing, and School of Nursing, University of Hong Kong, Hong Kong.
authors.forename: Angela Y M
authors.initials: AY
authors.lastname: Leung
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D006723:Hong Kong / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*
keywords: Caregiver distress; Chinese elders; Domestic helper; Spousal caregiving; Stress process model.