The Moderating Influence of Demographic Characteristics, Social Support, and Religious Coping on the Effectiveness of a Multicomponent Psychosocial Caregiver Intervention in Three Racial Ethnic Groups
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Abstract
This article extends the findings from the Resources for Enhancing Alzheimer's Caregiver
Health (REACH II) program, a multisite randomized clinical trial of a multicomponent
psychosocial intervention, to improve the well-being of informal caregivers (CGs)
of persons with dementia. We used residual change scores and stepwise hierarchical
regression analyses to explore separately in 3 racial ethnic groups (Hispanic or Latino,
Black or African American, and White or Caucasian) how the effects of the intervention
were moderated by CG characteristics (sex, age, education, and relationship), CG resources
(social support), and religious coping. The results indicated that CG's age and religious
coping moderated the effects of the intervention for Hispanics and Blacks. The older
Hispanic and Black CGs who received the intervention reported a decrease in CG burden
from baseline to follow-up. Black CGs with less religious coping who received the
intervention also reported a decrease in depressive symptoms from baseline to follow-up.
We investigated ethnic differences in caregiver background variables, objective stressors, filial obligations beliefs, psychological and social resources, coping processes, and psychological and physical health. We used a meta-analysis to integrate the results of 116 empirical studies. Ethnic minority caregivers had a lower socioeconomic status, were younger, were less likely to be a spouse, and more likely to receive informal support. They provided more care than White caregivers and had stronger filial obligations beliefs than White caregivers. Asian-American caregivers, but not African-American and Hispanic caregivers, used less formal support than non-Hispanic White caregivers. Whereas African-American caregivers had lower levels of caregiver burden and depression than White caregivers, we found that Hispanic and Asian-American caregivers were more depressed than their White non-Hispanic peers. However, all groups of ethnic minority caregivers reported worse physical health than Whites. Observed ethnic differences in burden and depression were influenced by study characteristics, such as the type of illness of the care recipient and the representativeness of the sample. The results suggest that more specific theories are needed to explain differential effects of ethnic minority groups of caregivers. Intervention needs vary, in part, between ethnic groups of caregivers.
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