Caregiving can be stressful, and older adults’ health and well-being may be impacted by the roles and responsibilities they assume as caregivers for persons with serious mental illness (SMI). This study is the first to apply the Stress Process Model of Caregiving (SPM) in an attempt to understand how mental illness stigma influences caregiver outcomes, specifically their desire to relinquish care. The intent of this study was to call attention to care relinquishment as an under-studied stress process outcome and to explore stress factors, with a focus on mental illness stigma, that contribute to SMI caregivers’ desire to relinquish care. Using convenience sampling, members of the National Alliance on Mental Illness in the eastern U.S. were invited to participate in an online survey, resulting in a sample of n = 285. Regression analysis findings suggest that caregivers’ partnership status, exposure to problematic behaviors, and perceptions of courtesy stigma predicted desire to relinquish care. Neither age nor caregiver sense of mastery moderated the relationship between perceived courtesy stigma and relinquishment desire. Perceptions of stigma were negatively associated with caregiver health, sense of mastery, and social support levels, indicating stigma’s role in the erosion of caregiver resources. This study provides information that can inform the development of educational and supportive services that may help caregivers better cope with the stressors associated with SMI caregiving. With caregiving stressors diminished, older caregivers will be able to better apply their resources toward self-care and maintaining their quality of life.

As the baby boomer generation ages, and as advanced medical techniques keep people alive longer, the need for family caregivers will grow. Researchers have determined that the health of family caregivers is generally poorer that noncaregivers. Also, the type of family relationship has been determined to influence health outcomes. This study examined how caregiving parents and caregiving adult children compared with regard to caregiving variables and health outcomes. Social support was then assessed to determine if a mediating effect existed between the predictors and health outcomes. Using data from the MIDUS II survey, the health outcomes of self-identified caregiving parents and caregiving adult children was studied in light of the predictor variables of type of relationship, provision of activities of daily living, length of time caregiving, and family demands. Multiple regression analysis was used to determine the relation between the predictors and health outcomes. Mediation tests were administered to assess if social support mediated between the significant predictors and health outcomes. The type of family relationship influenced health outcomes with caregiving parents demonstrating poorer health than caregiving adult children. Caregiving parents had lower self-rated health and higher numbers of chronic conditions than caregiving adult children. Perceived family demands were associated with increased number of chronic conditions for both caregiving adult children and caregiving parents. No significant influence was found between provision of activities of daily living or length of time caregiving with health outcomes. Similarly, no mediation effect of social support was found between the significant predictor variables and health outcomes. Using the stress process model, this study examined caregiving predictor variables and health outcomes for caregiving parents and caregiving adult children. Caregiving parents were found to demonstrate poorer self-rated health and more chronic health conditions that caregiving adult children. Unlike many previous studies, perceived family demands was found to have a strong association with the number of chronic health conditions for both groups of caregivers. / Graduation date: 2012

The death of a parent represents a potential traumatic life event that has been linked to depression in both Japan and the United States. Yet experiences surrounding death and ways of grieving are framed differently across cultures. At the individual level, the majority of the bereaved people in both Japan and the United States attempt to maintain bonds with the deceased family members. Being complementary to the individual-level desire, Japanese death-related beliefs and practices seem to provide a tool to maintain bonds. In contrast, American death-related beliefs and practices may be at odds with the individual desires by encouraging the bereaved individuals to detach themselves from the deceased parents. Japanese culture may work as a macro level support to bereaved individuals, while American culture is not supportive of the individual desires. Using two national data sets from Japan and the United States, this study tested whether: (1) bereaved individuals report worse mental health than non-bereaved individuals, (2) the mental health consequences of losing a parent is greater in the United States than in Japan, and (3) in this vein, persons in Japan report greater emotional support than those in the United States, and emotional support explains cultural differences in the link between being bereaved and depression. Supporting Hypothesis 1, bereaved respondents were more depressed than non-bereaved respondents. The statistical test rejected Hypothesis 2, and Hypothesis 3 was not testable. This research considers the role of culture as a macro-level support and cross-national research methods.

abstract: Over 25% of children in the United States suffer from a chronic illness, and close to 70% of all childhood deaths are due to chronic illness. Prevalence of childhood chronic illness continues to increase, and as a result, the pervasiveness of parents faced with stress associated with caregiving for their child with a chronic illness is also rising. The Stress Process Model (SPM) conceptualizes the caregiving experience as a multidimensional process influenced by the caregiving context, primary and secondary stressors, resources, and caregiver outcomes. Utilizing the SPM, the goals of this study were to examine the relations between caregiving stress (role overload and role strain) and resources (instrumental support, social support, and positive attitudes) and psychological outcomes (depression and anxiety) to determine whether resources moderated the associations between caregiving stress and psychological outcomes. Participants included 200 parent caregivers of a child with a chronic illness. Participants responded to an online survey that measured demographics, role overload (Role Overload scale), role strain (The Revised Caregiver Burden Measure), instrumental support and social support (Medical Outcomes Survey), positive attitudes about caregiving (Brief Assessment Scale for Caregivers), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder scale-7). Pearson correlations and six hierarchical regression models were tested to examine caregiving stress, resources, and psychological outcomes. Consistent with the study hypotheses, positive correlations between caregiving stress (role overload and role strain) and depression and anxiety were found. Negative correlations were found between resources (instrumental support, social support, positive attitudes) and depression and anxiety. Both instrumental support and social support had negative moderating effects on the relations between role overload and psychological outcomes (depression and anxiety). Positive attitudes also negatively moderated the relations between role strain and psychological outcomes. Thus, when participants reported high instrumental and social support, they also reported low depression and anxiety, even when role overload was high. Participants also reported low anxiety and depression when they reported high positive attitudes, even when role strain was high. Implications of these findings are discussed. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2020

Thesis (DPhil (Environmental Health))--Cape Peninsula University of Technology, 2016. / Informal caregivers play an important role in the well-being of dependent members in a household. The burdens of these caregivers are multiple and pervasive and may contribute to mental health epidemiology as a result of worry, grief, anxiety and stress. The literature review revealed that studies in caregiving and its various facets began from a pragmatically applied interest rather than from theoretical and intellectual curiosity. The majority of the research on caregiver burden involves meta-analysis of qualitative studies with little quantitative research. Also, many of these studies are concentrated on caregivers of chronically ill patients, such as those suffering from dementia, Alzheimer’s disease, and heart disease, without much attention to care burden resulting from caring for those who are not necessarily ill. Similar studies by other researchers did not consider the impact of the physical health of the care recipients or the environmental factors that are critical in the study of female caregiver burden in low-income settings. In addition, existing studies did not adequately evaluate the many potential factors that may vary and influence the lives of the caregivers, especially in a single, comprehensive model. This study attempted to provide a more complete picture of these relationships in low-income and culturally diverse settings. The study population consisted of black/African and coloured populations living in subsidised or low-cost housing settlements. In each of the two different cultural communities, 100 black/African and 100 coloured female caregivers were selected through a systematic random sampling procedure. In addition, data were also collected from caregivers in Tamale, Ghana to assess differences between the socio-demographic profiles of the caregivers in Cape Town, South Africa and Tamale, Ghana. The theoretical paradigm used in this study is the Stress Process Model by Pearlin et al., (1990). The study instrument assessed caregiver burden with both objective and subjective measures through the use of a fully structured questionnaire. The information that was collected according to the constructs of the Stress Process Model included personal and role strains and incorporated the physical health of the care recipients and environmental factors such as kitchen and toilet hygiene. Inclusion criteria for the respondents in both Cape Town and Tamale were the principal female caregivers who were present, willing, and able to give informed consent. The Statistical Package for Social Sciences (SPSS Version 22) was used for the analyses. The Chi-square test was used to assess the relationships between environmental health, the socio-demographics of the female caregivers and the health status of the care recipients. The hierarchical regression analysis in the form of a General Linear Model was used to model caregiving burden. iv The results showed that the majority of the female caregivers were in the age group 40 – 49 years and in both Cape Town and Tamale, a large proportion was in the low-income group. Also, the majority of the informal caregivers in the two samples were in care tasks as a full-time job, providing more than 40 hours of care per week. Regarding the length of time in caregiving, a large proportion of the caregivers in both Cape Town and Tamale had been in the care role for more than three years preceding the survey, and almost all the caregivers in the Cape Town sample (98.4%) did not use any form of caregiving programme to ameliorate the negative effects of caregiving. Further, the results showed statistically significant relationships between the socio-demographic characteristics of female caregivers (age, education, population group and income status) and the diarrhoea status of the care recipients. Also, a significant relationship was shown between environmental health variables of the home (kitchen hygiene and toilet hygiene) and the physical health of the care recipients. The major predictors of female caregiver burden in the samples were the physical health of the care recipients and access to social grants. On the basis of the analyses, it was recommended that the government should recognise the importance of the physical health of the care recipients and increase the amounts of social grants to the caregivers since this could improve the circumstances of both the caregivers and the care recipients. In addition, this could aid in improving the standard of living of caregivers in these households. Future research in similar settings should disaggregate the data to compare the burden of caring for caregivers of physically strong care recipients with physically ill care recipients.

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This dissertation addresses the role of welfare state/family care regimes, intersecting social locations and stress process factors in influencing the mental health and subjective well-being of informal caregivers of care recipients with age-related needs or disabilities within a European international context. Empirical analyses were conducted with secondary data from the 2012 and 2016 European Quality of Life Surveys. The study sample included informal caregivers (n=6,007) residing in seven different welfare state/family care regimes, including Denmark, Sweden, France, Germany, Italy, Greece and the United Kingdom. Ordinary least squares and ordered logit regression models revealed that welfare state/family care regime, social location (including both additive and interactive associations among gender, age group, marital status, and income), and stress process factors were independently associated with the mental health and life satisfaction of informal caregivers. Furthermore, there was some evidence to suggest that social location and stress process factors mediate some of the relationships between regime type and self-reported health and well-being and that stress process factors mediate relationships between social location factors and mental health and well-being. Overall, the results provide support for integrating welfare state/family care regime type and intersectionality factors into the SPM. Thus, future research on informal caregivers‘ mental health and well-being ought to incorporate such factors into their empirical analyses. The results also have some policy and practice implications. Residence in social democratic formal (Denmark), semi-formal (Sweden) and conservative formal (France) care regimes was the most beneficial to informal caregivers self-reported mental health. This was also the case for life satisfaction, except that residence in the liberal semi-formal (UK) was more beneficial than in the conservative formal (France) care regime. Mediating social location and stress process factors suggest that UK policy makers should address the greater social location disparities, greater role overload, and lack of coping resources that advantage Danish and Swedish informal caregivers compared to those residing in the UK. Lastly, policy makers from all the European countries assessed in the study should address the poorer mental health status of women and rural informal caregivers, those who experience role overload, secondary stressors, and lack coping resources. They should also address the the lower levels of formal education, more secondary stressors, and lack of coping resources associated with poorer subjective well-being. / Graduate

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End of life (EOL) caregiving can be a daunting and challenging endeavor as caregivers adjust to the ever-changing care demands associated with dying. Increased personal care, assisting with symptom and medication management, and attending to the emotional and spiritual needs of the dying person require caregivers to learn new tasks and to assume new roles such as social worker, nurse, and chaplain. As families continue to play an essential role in meeting the health care needs of their dying loved ones, it is imperative for social workers to understand the complexities of the end of life caregiving experience in order to better serve this population. One way to better understand this experience is by examining it within the context of the stress process model of caregiving. This model provides a comprehensive way to examine the relationship among multiple risk and protective factors within the "caregiver-in-environment" context. Using a secondary dataset, the best fit predictive model of caregiver depression included a mix of sociodemographic characteristics, primary objective and subjective stressors, and mediating variables. Two protective factors, social support and the fulfillment of spiritual needs lessened the effects of caregiver depression among the most vulnerable caregivers. Findings from this study help to bridge the gap between theory and social work practice. The stress process model of caregiving is a well-tested theoretical model, which can be utilized to guide social workers in developing comprehensive assessment measures and interventions that target specific aspects and sources of stress within the EOL caregiving experience.