Caregiver mental health and potentially harmful caregiving behavior: the central role of caregiver anger.

PURPOSE Caregivers feeling stress and experiencing mental health problems can be at risk for engaging in abusive acts against elderly care recipients. Potentially harmful behavior (PHB) was used as a measure of caregivers' engagement in, or fear of engagement in, behavior that places dependent care recipients at risk of physical and/or psychological maltreatment and may be seen as an antecedent of, or a proxy for, identifiably abusive behavior. The study examined the ability of anger to mediate and moderate the relations of depression, resentment, and anxiety with PBH. DESIGN AND METHODS Data are from the first wave of the second Family Relationships in Late Life study of caregivers of community-dwelling elderly care recipients with whom they coreside. Caregivers (N = 417) completed face-to-face interviews. RESULTS Anger was found to mediate the relation between anxiety and PHB. Anger both mediates and moderates the relations of both depression and resentment with PHB in a dynamic way such that the mediating effect of anger increases substantially with increased scores on both depression and resentment. IMPLICATIONS Identifying anger levels among caregivers who report symptoms of depression is warranted. Reducing depression in caregivers who report high levels of anger may result in reductions of PHB. Screening for resentment is warranted, as the relation between resentment and anger is similar to that between depression and anger.

[1]  G. Livingston,et al.  Abuse of people with dementia by family carers: representative cross sectional survey , 2009, BMJ : British Medical Journal.

[2]  C. Holman,et al.  Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study , 2009, BMJ : British Medical Journal.

[3]  E. Laumann,et al.  Elder mistreatment in the United States: prevalence estimates from a nationally representative study. , 2008, The journals of gerontology. Series B, Psychological sciences and social sciences.

[4]  D. R. Shaffer,et al.  Endorsement of proactively aggressive caregiving strategies moderates the relation between caregiver mental health and potentially harmful caregiving behavior. , 2007, Psychology and aging.

[5]  Kristopher J Preacher,et al.  Addressing Moderated Mediation Hypotheses: Theory, Methods, and Prescriptions , 2007, Multivariate behavioral research.

[6]  C. Lance,et al.  Informal Care Can Be Better Than Adequate: Development and Evaluation of the Exemplary Care Scale , 2007 .

[7]  G. Livingston,et al.  A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia , 2006, International Psychogeriatrics.

[8]  C. Lance,et al.  Caregiver cognitive status and potentially harmful caregiver behavior , 2006, Aging & mental health.

[9]  Gill Livingston,et al.  Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. , 2005, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[10]  R. Schulz,et al.  Caregiver Resentment: Explaining Why Care Recipients Exhibit Problem Behavior. , 2005 .

[11]  C. Lance,et al.  Risk Factors for Potentially Harmful Informal Caregiver Behavior , 2005, Journal of the American Geriatrics Society.

[12]  M. Weiner,et al.  Caregiver attribution and resentment in dementia care , 2003, American journal of Alzheimer's disease and other dementias.

[13]  L. Martire,et al.  Emotional congruence in older couples coping with wives' osteoarthritis: exacerbating effects of pain behavior. , 2003, Psychology and aging.

[14]  S. Rubin,et al.  Prevalence and Correlates of Anxiety Symptoms in Well‐Functioning Older Adults: Findings from the Health Aging and Body Composition Study , 2003, Journal of the American Geriatrics Society.

[15]  Martin Pinquart,et al.  Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. , 2003, Psychology and aging.

[16]  Richard Schulz,et al.  Dementia caregiver intervention research: in search of clinical significance. , 2002, The Gerontologist.

[17]  R. Schulz,et al.  Caregiving and Detrimental Mental and Physical Health Outcomes , 2002 .

[18]  D. R. Shaffer,et al.  Relationship quality and potentially harmful behaviors by spousal caregivers: how we were then, how we are now. The Family Relationships in Late Life Project. , 2001, Psychology and aging.

[19]  K. Browne,et al.  Risk factor characteristics in carers who physically abuse or neglect their elderly dependants , 2001, Aging & mental health.

[20]  John H. Harvey,et al.  Loss and trauma : general and close relationship perspectives , 2000 .

[21]  Patricia A. Parmelee,et al.  Physical illness and depression in older adults : a handbook of theory, research, and practice , 2000 .

[22]  M. A. Stephens,et al.  Stress reduction for family caregivers: effects of adult day care use. , 1998, The journals of gerontology. Series B, Psychological sciences and social sciences.

[23]  D. R. Shaffer,et al.  Activity restriction and prior relationship history as contributors to mental health outcomes among middle-aged and older spousal caregivers. , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[24]  B. Murphy,et al.  Family caregiving: measurement of emotional well-being and various aspects of the caregiving role , 1997, Psychological Medicine.

[25]  R. Schulz,et al.  Spousal similarity in subjective well-being: the Cardiovascular Health Study. , 1996, Psychology and aging.

[26]  J. Tangney,et al.  Relation of shame and guilt to constructive versus destructive responses to anger across the lifespan. , 1996, Journal of personality and social psychology.

[27]  M. Takigawa,et al.  Anxiety and quality of life in residents of a special nursing home , 1995 .

[28]  S. Thompson,et al.  Caregiving in the close relationships of cardiac patients: Exchange, power, and attributional perspectives on caregiver resentment , 1995 .

[29]  Charles S. Carver,et al.  Situational coping and coping dispositions in a stressful transaction. , 1994, Journal of personality and social psychology.

[30]  B. Kramer Marital History and the Prior Relationship as Predictors of Positive and Negative Outcomes among Wife Caregivers , 1993 .

[31]  H. Young,et al.  Does expressed emotion in spouses predict subsequent problems among care recipients with Alzheimer's disease? , 1993, Journal of gerontology.

[32]  C. Camp,et al.  Maintenance and Generalization of Object Naming Training in Anomia Associated with Degenerative Dementia , 1993 .

[33]  L. Teri,et al.  Interpersonal Family Stress in Alzheimer's Disease , 1993 .

[34]  S. Hobfoll,et al.  How loss affects anger and alienates potential supporters. , 1992, Journal of consulting and clinical psychology.

[35]  K. Pillemer,et al.  Violence and violent feelings: what causes them among family caregivers? , 1992, Journal of gerontology.

[36]  K. Kühl,et al.  Testing for limits of cognitive reserve capacity: a promising strategy for early diagnosis of dementia? , 1992, Journal of gerontology.

[37]  J. Tangney,et al.  Shamed into anger? The relation of shame and guilt to anger and self-reported aggression. , 1992, Journal of personality and social psychology.

[38]  W. A. Myers New techniques in the psychotherapy of older patients , 1991 .

[39]  R. Pruchno,et al.  Mental health of caregiving spouses: coping as mediator, moderator, or main effect? , 1989, Psychology and aging.

[40]  L. Thompson,et al.  Prevalence of depression in family caregivers. , 1989, The Gerontologist.

[41]  S. Steinmetz Elder abuse by family caregivers: Processes and intervention strategies , 1988 .

[42]  S. Folkman,et al.  The relationship between coping and emotion: implications for theory and research. , 1988, Social science & medicine.

[43]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[44]  S. Folkman,et al.  Stress, Appraisal, and Coping. New York, NY: Springer; , 1984 .

[45]  Ronald G. Stansfield,et al.  Sociological Methodology 1982 , 1983 .

[46]  J. Averill Anger and Aggression: An Essay on Emotion , 1982 .

[47]  C. Spielberger,et al.  Advances in personality assessment , 1982 .

[48]  S. Zarit,et al.  Relatives of the impaired elderly: correlates of feelings of burden. , 1980, The Gerontologist.

[49]  Murray A. Straus,et al.  Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scales. , 1979 .

[50]  L. Radloff The CES-D Scale , 1977 .

[51]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .