title: Why does placement of persons with Alzheimer's disease into long-term care improve caregivers' well-being? Examination of psychological mediators.
abstract: Caregiving for individuals with Alzheimer's disease is associated with chronic stress and elevated symptoms of depression. Placement of the care receiver (CR) into a long-term care setting may be associated with improved caregiver well-being; however, the psychological mechanisms underlying this relationship are unclear. This study evaluated whether decreases in activity restriction and increases in personal mastery mediated placement-related reductions in caregiver depressive symptoms. In a 5-year longitudinal study of 126 spousal Alzheimer's disease caregivers, we used multilevel models to evaluate placement-related changes in depressive symptoms (short form of the Center for Epidemiologic Studies Depression scale), activity restriction (Activity Restriction Scale), and personal mastery (Pearlin Mastery Scale) in 44 caregivers who placed their spouses into long-term care relative to caregivers who never placed their CRs. The Monte Carlo method for assessing mediation was used to evaluate the significance of the indirect effect of activity restriction and personal mastery on postplacement changes in depressive symptoms. Placement of the CR was associated with significant reductions in depressive symptoms and activity restriction and was also associated with increased personal mastery. Lower activity restriction and higher personal mastery were associated with reduced depressive symptoms. Furthermore, both variables significantly mediated the effect of placement on depressive symptoms. Placement-related reductions in activity restriction and increases in personal mastery are important psychological factors that help explain postplacement reductions in depressive symptoms. The implications for clinical care provided to caregivers are discussed.
authors.affiliation: Department of Psychiatry.
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University/ University of California-San Diego.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chattillion
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University/ University of California-San Diego.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ho
authors.affiliation: Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii at Manoa.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Flynn
authors.affiliation: Department of Psychology, University of Missouri.
authors.forename: Denisse
authors.initials: D
authors.lastname: Tiznado
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital.
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.affiliation: Department of Psychiatry.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.affiliation: Department of Psychiatry.
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009010:Monte Carlo Method; D017008:Negotiating; D010549:Personal Satisfaction; D018454:Spouses / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology