照顾压力与抑郁症状之间关系的多种中介因素。
Multiple mediators of the relations between caregiving stress and depressive symptoms.
机构信息
Department of Psychiatry, University of California, San Diego, CA, USA.
出版信息
Aging Ment Health. 2012;16(1):27-38. doi: 10.1080/13607863.2011.615738.
OBJECTIVE
This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimer's disease. It was hypothesized that more depressive symptoms would be significantly correlated with both 'primary' caregiver stressors (i.e., care recipient problem behaviors) and 'secondary' stress (i.e., role overload), but that this relationship would be significantly mediated by four variables: (1) personal mastery, (2) coping self-efficacy, (3) activity restriction, and (4) avoidance coping.
METHOD
We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway.
RESULTS
Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms.
DISCUSSION
These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.
目的
本研究通过对阿尔茨海默病患者配偶照顾者的样本进行测试，构建了一个解释压力与抑郁症状之间关系的模型。研究假设，更多的抑郁症状与“主要”照顾者压力（即，照顾对象的问题行为）和“次要”压力（即，角色过载）显著相关，但这种关系会被四个变量显著调节：（1）个人掌控力，（2）应对自我效能，（3）活动受限，以及（4）回避应对。
方法
我们使用渐近和重抽样策略，同时检验压力到抑郁症状路径的多个中介变量。
结果
更大的压力与更多的抑郁症状显著相关。压力增加也与个人掌控力和自我效能感降低，以及活动受限和回避应对增加有关。最后，这四个中介变量解释了压力和抑郁症状之间关系的很大一部分。
讨论
这些结果表明，主要和次要照顾者压力可能通过多种途径与抑郁症状的增加相关，这可能为照顾者干预的多个治疗目标提供了依据。
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