Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
School of Social Sciences, Singapore Management University, Singapore, Singapore.
Sci Rep. 2024 Oct 26;14(1):25507. doi: 10.1038/s41598-024-76339-4.
Informal caregivers are crucial to the care of persons with dementia (PWD), but their role is often reported as challenging. This study aims to examine caregiver stress and depressive symptoms among informal caregivers of PWD using a modified transactional stress and coping model. Path analysis was conducted among a sample of informal caregivers of PWD in Singapore (n = 281) using information on functional dependence and memory and behavioral problems of PWD, and self-reported measurements on caregivers' knowledge of dementia, perceived positive aspects of caregiving, social support, coping patterns, caregiving self-efficacy, caregiving burden and depressive symptoms. The initial model reflecting our assumptions for the transactional stress and coping model showed a poor fit (model 1 - CFI = 0.858, TLI = 0.665, RMSEA = 0.118). Logical modifications were made until sufficient model fit was achieved (model 2 - CFI = 0.987, TLI = 0.955, RMSEA = 0.043). We then removed the insignificant paths in model 2 and obtained our final model (model 3 - CFI = 0.990, TLI = 0.974, RMSEA = 0.033). The final model supported our hypotheses, with some adjustments. This study advances our understanding of caregiver distress by modifying the transactional stress and coping model, including (1) the key role of caregiver self-efficacy in the primary appraisal process, (2) the dynamic assessment of coping resources across all stages of the model, and (3) the importance of coping patterns. Future studies could explore the generalizability of these findings.
非正式照护者对于痴呆症患者（PWD）的照护至关重要，但他们的角色往往被认为具有挑战性。本研究旨在使用修改后的交易性应激和应对模型来检验 PWD 的非正式照护者的照护者压力和抑郁症状。使用 PWD 的功能依赖和记忆及行为问题的信息，以及照护者对痴呆症的知识、感知到的积极照护方面、社会支持、应对模式、照护自我效能、照护负担和抑郁症状的自我报告测量值，对新加坡的 PWD 的非正式照护者样本（n=281）进行了路径分析。反映我们对交易性应激和应对模型的假设的初始模型显示拟合度较差（模型 1 - CFI=0.858，TLI=0.665，RMSEA=0.118）。进行了合理的修改，直到达到足够的模型拟合度（模型 2 - CFI=0.987，TLI=0.955，RMSEA=0.043）。然后我们在模型 2 中删除了不显著的路径，并得到了我们的最终模型（模型 3 - CFI=0.990，TLI=0.974，RMSEA=0.033）。最终模型支持了我们的假设，但进行了一些调整。通过修改交易性应激和应对模型，包括（1）照护自我效能在初步评估过程中的关键作用，（2）在模型的所有阶段动态评估应对资源，以及（3）应对模式的重要性，本研究推进了我们对照护者痛苦的理解。未来的研究可以探索这些发现的普遍性。
