title: Stressors and anxiety in dementia caregiving: multiple mediation analysis of rumination, experiential avoidance, and leisure.
abstract: Despite the robust associations between stressors and anxiety in dementia caregiving, there is a lack of research examining which factors contribute to explain this relationship. This study was designed to test a multiple mediation model of behavioral and psychological symptoms of dementia (BPSD) and anxiety that proposes higher levels of rumination and experiential avoidance and lower levels of leisure satisfaction as potential mediating variables.
  
  
  
  The sample consisted of 256 family caregivers. In order to test a simultaneously parallel multiple mediation model of the BPSD to anxiety pathway, a PROCESS method was used and bias-corrected and accelerated bootstrapping method was used to test confidence intervals.
  
  
  
  Higher levels of stressors significantly predicted anxiety. Greater stressors significantly predicted higher levels of rumination and experiential avoidance, and lower levels of leisure satisfaction. These three coping variables significantly predicted anxiety. Finally, rumination, experiential avoidance, and leisure satisfaction significantly mediated the link between stressors and anxiety. The explained variance for the final model was 47.09%. Significant contrasts were found between rumination and leisure satisfaction, with rumination being a significantly higher mediator.
  
  
  
  The results suggest that caregivers' experiential avoidance, rumination, and leisure satisfaction may function as mechanisms through which BPSD influence on caregivers' anxiety. Training caregivers in reducing their levels of experiential avoidance and rumination by techniques that foster their ability of acceptance of their negative internal experiences, and increase their level of leisure satisfaction, may be helpful to reduce their anxiety symptoms developed by stressors.
authors.affiliation: Psychology Department,Universidad Rey Juan Carlos de Madrid,Alcorcón,Madrid,Spain.
authors.forename: R
authors.initials: R
authors.lastname: Romero-Moreno
authors.affiliation: Psychology Department,Universidad Rey Juan Carlos de Madrid,Alcorcón,Madrid,Spain.
authors.forename: A
authors.initials: A
authors.lastname: Losada
authors.affiliation: Biological and Health Psychology Department,Universidad Autónoma de Madrid,Campus de Cantoblanco,Madrid,Spain.
authors.forename: M
authors.initials: M
authors.lastname: Márquez-González
authors.affiliation: Department of Psychiatry,University of California San Diego,Gilman Drive,La Jolla,CA,USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Mausbach
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D001362:Avoidance Learning; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000523:psychology*; D005260:Female; D006801:Humans; D007899:Leisure Activities / Q000523:psychology*; D008297:Male; D008960:Models, Psychological; D010549:Personal Satisfaction; D000074222:Rumination, Cognitive; D013315:Stress, Psychological
keywords: anxiety; caregivers; dementia; experiential avoidance; family; mediation analysis; rumination; stressors