The mediating effect of social support and coping strategies on the relation between family stigma and caregiver burden among Israeli Arab family caregivers of people with Alzheimer’s disease (AD)

Abstract Objectives Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer’s disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support. Methods Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28). Results Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique – although modest – contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables. Conclusions Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.

[1]  N. Alquwez,et al.  Influence of Spiritual Coping and Social Support on the Mental Health and Quality of Life of the Saudi Informal Caregivers of Patients with Stroke , 2020, Journal of Religion and Health.

[2]  R. Gross,et al.  Mental Health, Social Influences, and HIV Pre-exposure Prophylaxis (PrEP) Utilization Among Men and Transgender Individuals Screening for HIV Prevention Trials , 2020, AIDS and Behavior.

[3]  P. Werner,et al.  Who internalizes courtesy stigma and how? A study among Israeli Arab family caregivers of persons with dementia , 2020, Aging & mental health.

[4]  Jian-An Su,et al.  Association Between Family Caregiver Burden and Affiliate Stigma in the Families of People with Dementia , 2020, International journal of environmental research and public health.

[5]  Jennifer D. Davis,et al.  Managing Shame: A Grounded Theory of How Stigma Manifests in Families Living With Dementia , 2020, Journal of the American Psychiatric Nurses Association.

[6]  I. Bigdeli,et al.  Stigma phenomenon to dementia in Iranian population: A phenomenological study , 2020, Dementia.

[7]  P. Werner,et al.  The Arabic and Hebrew versions of the caregiving ambivalence scale (CAS): examining its reliability, validity, and correlates among Israeli caregivers of individuals with Alzheimer’s disease , 2020, Aging & mental health.

[8]  Michael H. Connors,et al.  Dementia and caregiver burden: A three‐year longitudinal study , 2019, International journal of geriatric psychiatry.

[9]  R. Perneczky,et al.  Determinants of self‐ and carer‐rated quality of life and caregiver burden in Alzheimer disease , 2019, International journal of geriatric psychiatry.

[10]  V. Orgeta,et al.  The association between subjective caregiver burden and depressive symptoms in carers of older relatives: A systematic review and meta-analysis , 2019, PloS one.

[11]  Y. Lien,et al.  Public beliefs and attitudes toward schizophrenia and depression in Taiwan: A nationwide survey , 2019, Psychiatry Research.

[12]  M. Marczak,et al.  Self-Compassion, Coping Strategies, and Caregiver Burden in Caregivers of People with Dementia , 2019, Clinical gerontologist.

[13]  N. Devaraj,et al.  A REVIEW OF BURDEN OF CAREGIVERS OF PATIENTS WITH ALZHEIMER'S DISEASE , 2019, MNJ (Malang Neurology Journal).

[14]  M. İlnem,et al.  Behavioural and psychological symptoms of Alzheimer’s disease associated with caregiver burden and depression , 2018, Psychiatry and Clinical Psychopharmacology.

[15]  G. Bączyk,et al.  Burden of caregivers of patients with Alzheimer's disease. , 2018, Scandinavian journal of caring sciences.

[16]  P. Soysal,et al.  Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review , 2018, International journal of geriatric psychiatry.

[17]  R. Santos,et al.  Coping strategies among caregivers of people with Alzheimer disease: a systematic review. , 2018, Trends in psychiatry and psychotherapy.

[18]  Li-ye Zhou,et al.  Caregiver burden in Alzheimer's disease: Moderation effects of social support and mediation effects of positive aspects of caregiving , 2018, International journal of geriatric psychiatry.

[19]  L. Ayalon Family Relations and Elder Care Among Arabs in the North of Israel , 2018, Research on aging.

[20]  M. Macdonald,et al.  Experiences of unpaid family/friend caregivers of community-dwelling adults with dementia: a systematic review protocol. , 2017, JBI database of systematic reviews and implementation reports.

[21]  Benjamin K. P. Woo Family history and its relationship with dementia stigma beliefs among Chinese Americans , 2017, Geriatrics & gerontology international.

[22]  S. Chong,et al.  Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem , 2016, Psychiatry Research.

[23]  M. Ory,et al.  Socioecological factors and positive aspects of caregiving: findings from the REACH II intervention , 2016, Aging & mental health.

[24]  S. Grover,et al.  Stigma and its correlates among caregivers of schizophrenia: A study from North India , 2016, Psychiatry Research.

[25]  G. Kok,et al.  Stigma by association and family burden among family members of people with mental illness: the mediating role of coping , 2016, Social Psychiatry and Psychiatric Epidemiology.

[26]  S. Crutch,et al.  A meta-review of stress, coping and interventions in dementia and dementia caregiving , 2016, BMC Geriatrics.

[27]  H. Wishart,et al.  Caregiver Stigma and Burden in Memory Disorders: An Evaluation of the Effects of Caregiver Type and Gender , 2016, Current gerontology and geriatrics research.

[28]  Hui Chen,et al.  Coping Strategy and Caregiver Burden Among Caregivers of Patients With Dementia , 2015, American journal of Alzheimer's disease and other dementias.

[29]  F. Panza,et al.  Caregiver burden characterization in patients with Alzheimer's disease or vascular dementia , 2015, International journal of geriatric psychiatry.

[30]  Susanne Walitza,et al.  Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis , 2015, Schizophrenia Research.

[31]  Li-ye Zhou,et al.  Measuring the Caregiver Burden of Caring for Community-Residing People with Alzheimer’s Disease , 2015, PloS one.

[32]  A. Larner,et al.  Zarit Burden Interview: pragmatic study in a dedicated cognitive function clinic , 2015 .

[33]  M. Goldfracht,et al.  Between modern and traditional values: Informal mental health help-seeking attitudes according to Israeli Arab women, primary care patients and their providers , 2015, The International journal of social psychiatry.

[34]  D. Roth,et al.  Positive Aspects of Family Caregiving for Dementia: Differential Item Functioning by Race. , 2015, The journals of gerontology. Series B, Psychological sciences and social sciences.

[35]  L. Xiao,et al.  Perceived Challenges in Dementia Care by Vietnamese Family Caregivers and Care Workers in South Australia , 2015, Journal of cross-cultural gerontology.

[36]  C-Y Hsiao,et al.  Caregiver burden for informal caregivers of patients with dementia: A systematic review. , 2015, International nursing review.

[37]  C. Spivey,et al.  Burden Among Male Alzheimer’s Caregivers , 2015, American journal of Alzheimer's disease and other dementias.

[38]  Hui Chen,et al.  Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia , 2015, Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society.

[39]  A. Iavarone,et al.  Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease , 2014, Neuropsychiatric disease and treatment.

[40]  H. Duivenvoorden,et al.  Multivariate models of subjective caregiver burden in dementia: A systematic review , 2014, Ageing Research Reviews.

[41]  Y. Bachner Preliminary assessment of the psychometric properties of the abridged Arabic version of the Zarit Burden Interview among caregivers of cancer patients. , 2013, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[42]  Julie Chronister,et al.  THE ROLE OF STIGMA COPING AND SOCIAL SUPPORT IN MEDIATING THE EFFECT OF SOCIETAL STIGMA ON INTERNALIZED STIGMA, MENTAL HEALTH RECOVERY, AND QUALITY OF LIFE AMONG PEOPLE WITH SERIOUS MENTAL ILLNESS , 2013 .

[43]  Trevor Hastie,et al.  An Introduction to Statistical Learning , 2013, Springer Texts in Statistics.

[44]  H. Peyrovi,et al.  Stigma among Iranian family caregivers of patients with Alzheimer's disease: A hermeneutic study. , 2013, Nursing & health sciences.

[45]  A. Hayes Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach , 2013 .

[46]  J. Heinik,et al.  Family stigma and caregiver burden in Alzheimer's disease. , 2012, The Gerontologist.

[47]  G. Zimet,et al.  Multidimensional Scale of Perceived Social Support , 2011 .

[48]  J. Leeper,et al.  Social Support, Caregiver Burden, and Life Satisfaction in a Sample of Rural African American and White Caregivers of Older Persons With Dementia , 2010, Journal of gerontological social work.

[49]  I. Lavi,et al.  Patients with multiple sclerosis in a war zone: coping strategies associated with reduced risk for relapse , 2010, Multiple sclerosis.

[50]  Dolores Gallagher-Thompson,et al.  Ethnic differences in beliefs regarding Alzheimer disease among dementia family caregivers. , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[51]  I. Kawachi,et al.  Ethnicity and nativity status as determinants of perceived social support: testing the concept of familism. , 2009, Social science & medicine.

[52]  Miri Cohen,et al.  Emotional reactions of Arab lay persons to a person with Alzheimer's disease , 2009, Aging & mental health.

[53]  W. Mak,et al.  Affiliate Stigma Among Caregivers of People with Intellectual Disability or Mental Illness , 2008 .

[54]  Kristopher J Preacher,et al.  Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models , 2008, Behavior research methods.

[55]  D. Hinton,et al.  Reexamining the Relationships Among Dementia, Stigma, and Aging in Immigrant Chinese and Vietnamese Family Caregivers , 2008, Journal of cross-cultural gerontology.

[56]  Scott E. Wilks,et al.  Perceived stress and resilience in Alzheimer's disease caregivers: Testing moderation and mediation models of social support , 2008, Aging & mental health.

[57]  David Tartakover Israel's Independence Day 2002 , 2007 .

[58]  L. Zhan Caring for family members with Alzheimer's disease: perspectives from Chinese American caregivers. , 2004, Journal of gerontological nursing.

[59]  D. Molloy,et al.  The Zarit Burden Interview: a new short version and screening version. , 2001, The Gerontologist.

[60]  M. Skaff,et al.  Caregiving and the stress process: an overview of concepts and their measures. , 1990, The Gerontologist.

[61]  S. Folkman,et al.  Stress: Appraisal and Coping , 2020, Encyclopedia of Behavioral Medicine.

[62]  Nesma S Sayed,et al.  Stigma and Quality Of Life among Caregivers of Mentally Ill Patients : Family and Nursing Staff , 2018 .

[63]  P. Krolak-Salmon,et al.  Risk factors of caregiver burden among patients with Alzheimer's disease or related disorders: a cross-sectional study. , 2015, Journal of Alzheimer's disease : JAD.

[64]  D. Selkoe Alzheimer's disease. , 2011, Cold Spring Harbor perspectives in biology.

[65]  B. Major,et al.  The social psychology of stigma. , 2005, Annual review of psychology.

[66]  S. Levkoff,et al.  Working with culture: A qualitative analysis of barriers to the recruitment of Chinese–American family caregivers for dementia research , 2000, Journal of cross-cultural gerontology.

[67]  M. Zeidner,et al.  Coping with a national crisis: The Israeli experience with the threat of missile attacks. , 1993 .