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Avoidant Coping Partially Mediates the Relationship Between Patient Problem Behaviors and Depressive Symptoms in Spousal Alzheimer Caregivers

From the Department of Psychiatry, University of California at San Diego, San Diego, California (BTM, KA, TLP, SA-I, PJM, JED, IG), San Diego Veterans Affairs Healthcare System, San Diego, California (TLP, SA-I, IG), and the Department of General Internal Medicine, University Hospital, Bern, Switzerland (RvK).

Objective: Caring for a loved one with Alzheimer disease is a highly stressful experience that is associated with significant depressive symptoms. Previous studies indicate a positive association between problem behaviors in patients with Alzheimer disease (e.g., repeating questions, restlessness, and agitation) and depressive symptoms in their caregivers. Moreover, the extant literature indicates a robust negative relationship between escape–avoidance coping (i.e., avoiding people, wishing the situation would go away) and psychiatric well-being. The purpose of this study was to test a mediational model of the associations between patient problem behaviors, escape–avoidance coping, and depressive symptoms in Alzheimer caregivers.

Methods: Ninety-five spousal caregivers (mean age: 72 years) completed measures assessing their loved ones’ frequency of problem behaviors, escape–avoidance coping, and depressive symptoms. A mediational model was tested to determine if escape–avoidant coping partially mediated the relationship between patient problem behaviors and caregiver depressive symptoms.

Results: Patient problem behaviors were positively associated with escape–avoidance coping (ß = 0.38, p <0.01) and depressive symptoms (ß = 0.26, p <0.05). Escape–avoidance coping was positively associated with depressive symptoms (ß = 0.33, p <0.01). In a final regression analysis, the impact of problem behaviors on depressive symptoms was less after controlling for escape–avoidance coping. Sobel’s test confirmed that escape–avoidance coping significantly mediated the relationship between problem behaviors and depressive symptoms (z = 2.07, p <0.05).

Conclusion: Escape–avoidance coping partially mediates the association between patient problem behaviors and depressive symptoms among elderly caregivers of spouses with dementia. This finding provides a specific target for psychosocial interventions for caregivers.

Key Words: Coping • caregivers • Alzheimer disease • depression

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