Academic journal article Social Work Research

Appraisal and Coping: Moderators Mediators of Stress in Alzheimer's Disease Caregivers?

Academic journal article Social Work Research

Appraisal and Coping: Moderators Mediators of Stress in Alzheimer's Disease Caregivers?

Article excerpt

This study focused on one question: Do each of four caregiver responses--emotion-focused coping, problem-focused coping, appraisal of burden, and appraisal of satisfaction--mediate or moderate the effects of caregiving stress on caregiver psychological well-being? A series of regression equations was used to determine mediating and moderating effects for each of the responses in a convenience sample of 204 Hispanic and non-Hispanic caregivers. Appraisal of burden mediated the effects of caregiving stress on somatic complaints and depression; appraisal of satisfaction moderated the effects of stress on personal gain and life satisfaction; emotion-focused coping demonstrated moderating effects on depression and life satisfaction, although not in the predicted direction; problem-focused coping did not demonstrate any mediating or moderating effects. The findings indicate that development of interventions that focus on how caregivers appraise their situation, as well as their coping skills could help empower caregivers and improve their psychological well-being.

Key words: Alzheimer's disease; caregivers; mediating effects; moderating effects; stress


Alzheimer's disease (AD) has been estimated to affect more than 3.5 million people. By 2010, it is projected that more than 5.5 million people will be diagnosed with this disease (Alzheimer's Association, 1998). Numerous studies have found providing care to people with AD is associated with a number of negative consequences (Kramer, 1997; Schulz, O'Brien, Bookwala, & Fleissner, 1995). Increased levels of depression, anxiety, and somatic complaints are significantly higher than for caregivers than noncaregivers (Schulz et al.). The Alzheimer's Association (1998) estimated the cost of providing care to people diagnosed with AD to be $90 billion per year.

Although the majority of this financial burden falls directly on the caregivers, a financial burden of this magnitude has an indirect, if not direct, effect on the economy of the entire nation. The progression, duration, and demands of AD frequently result in caregivers no longer being able to provide care and having to resort to institutionalizing the individual with AD. Perhaps these facts are but two of the reasons we find such an abundance of AD caregiving studies in the gerontology literature.


Moderating versus Mediating Models

Kramer and Vitaliano (1994) in a review of the caregiving literature found that much of the research was based on the stress, appraisal, and coping model developed by Lazarus and Folkman (1984). Lazarus and Folkman stated that "in order to understand variations among individuals under comparable conditions, we must take into account the cognitive process that intervenes between the encounter and the reaction, and the factors that affect the nature of this mediation" (p. 23).

The majority of the caregiving literature has an a priori assumption that appraisal and coping are mediators of stress. The distinction between mediators and moderators is not discussed in most of the AD caregiving literature; however, the moderator-mediator discussion is found in the social psychology, child psychology, and industrial psychology literature.

Holmbeck (1997) posited that although Lazarus and Folkman (1984) used the term "mediation" in their conceptual model, [they] "appear to be describing a moderational process" (p. 606). Baron and Kenny (1986) stated that "there are conceptual implications of the failure to appreciate the moderator-mediator distinction" (p. 1173). They went on to say that in fact, many researchers have used the terms "moderator" and "mediator" interchangeably in the same study. "In other words, a moderator variable is one that affects the relationship between two variables, so that the nature of the impact of the predictor on the criterion varies according to the level or value of the moderator" (Holmbeck, 1997, p. …

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