Mitrani Victoria B, Lewis John E, Feaster Daniel J, Czaja Sara J, Eisdorfer Carl, Schulz Richard, Szapocznik Jose
Center for Family Studies, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, 1425 NW 10th Avenue, Miami, FL 33136, USA.
Gerontologist. 2006 Feb;46(1):97-105. doi: 10.1093/geront/46.1.97.
The purpose of the study was to evaluate the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework. The stress-process model of caregiver distress included family functioning as an intervening variable in the relationship between objective burden and distress. We theorized family functioning to partially mediate the relationship between objective burden and distress and to significantly account for the prediction of distress beyond well-recognized predictors.
One hundred eighty-one family caregivers from the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health project participated in this study. We assessed sociodemographics, burden, depression, anxiety, and perceived health for each caregiver. We measured family functioning by using a multidimensional and observational instrument. We used structural equation modeling to assess the fit of the model for the overall sample and for different caregiver subgroups and to examine whether demographic variables affected the relationships in the model.
The results of the study indicated that family functioning significantly contributed to distress in the overall sample and partially mediated the relationship between objective burden and distress. We also found that the stress-process model was adequately fit by the hypothesized relationships between objective burden, family functioning, and distress for the overall sample and all of the subsamples, except for wives.
This study provides support for the structural family approach as an explanatory model for the influence of family functioning on dementia caregivers. Family structural functioning is one contributor to the caregiver stress process. This suggests that interventions targeting structural family problems may reduce caregiver distress.
本研究旨在通过运用结构性家庭框架，评估家庭功能在痴呆症患者照料者样本的压力过程中的作用。照料者痛苦的压力过程模型将家庭功能视为客观负担与痛苦之间关系的一个中介变量。我们推测家庭功能会部分介导客观负担与痛苦之间的关系，并能显著解释除公认预测因素之外的痛苦预测情况。
来自“增强老年痴呆症照料者健康资源”项目迈阿密站点的181名家庭照料者参与了本研究。我们评估了每位照料者的社会人口统计学特征、负担、抑郁、焦虑和自我感知健康状况。我们使用一种多维观察工具来衡量家庭功能。我们运用结构方程模型来评估该模型对总体样本和不同照料者亚组的拟合情况，并检验人口统计学变量是否会影响模型中的关系。
研究结果表明，家庭功能在总体样本中对痛苦有显著影响，并部分介导了客观负担与痛苦之间的关系。我们还发现，压力过程模型对于总体样本以及除妻子之外的所有子样本，在客观负担、家庭功能和痛苦之间的假设关系方面拟合良好。
本研究为结构性家庭方法作为家庭功能对痴呆症照料者影响的一种解释模型提供了支持。家庭结构功能是照料者压力过程的一个促成因素。这表明针对家庭结构问题的干预措施可能会减轻照料者的痛苦。
