The role of religious coping in Alzheimer's Disease caregiving

Purpose: Alzheimer's Disease (AD) and other dementias are one of the most critical public health problems in elderly populations. Whereas the financial, emotional and physical costs of the disease for the caregiver are enormous, support for the caregiver becomes more and more important. One aspect of caregiver support, however, religious coping and well-being in caregivers of AD has been relatively unexplored. Thus, there is limited work that explores how religious coping affects well-being of caregivers in caregiving. The purpose of this study is to investigate the relationships between religious coping, positive aspects of caregiving (PAC), social support, burden and depression in Alzheimer's caregiving. The study examines how two different types of religious coping (negative and positive) impact well-being of caregivers by utilizing Structural Equation Modeling (SEM).

Methods: Data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II study were used for analysis in this study. Participants were screened for eligibility, given a baseline assessment, and subsequently randomized to treatment or control condition. Religious coping was assed by two measures. The first measure is from the Brief RCOPE (Pargament et al., 1998) and the second measure is two-item questions on behavioral religious practices. Caregiver burden was measured by the brief (12-item) version of the Zarit Caregiver Burden Interview (Zarit et al., 1985, Bedard et al, 2001). Caregiver depressive symptoms were assessed by using the Center for Epidemiological Studies-Depression (CES-D) scale (Radloff, 1977). The structural equation analysis (EQS) was run on all hypothesized paths.

Results: The fit of the specified model, ÷2 (7) = 62.33, CFI = .90, GFI = .95, RMSEA = .13 suggested a reasonable fit of the data to the model. Two paths (from negative coping to PAC and negative coping to social support) were not significant. Modification indices indicate a direct path from social support to burden. The non-significant paths were dropped and a path from social support to burden was added. Reestimation of these paths results in an better fitting model, ÷2 (8) = 28.86, CFI = .96, GFI = .98, RMSEA = .07.

The results provided some support for our hypothesized path model from religious coping to depression. Higher positive religious coping was associated with higher PAC and higher PAC was associated with fewer burdens. Fewer burdens were also associated with less depression. Higher positive religious coping was associated with higher social support and higher social support was related to fewer burdens and less depression. Yet, negative religious coping significantly predicted neither PAC nor social support.

Implications: The findings suggest developing and maintaining religiosity plays an important role in enhancing PAC, social support and thus in decreasing caregiving burden and depression. Greater understanding of religious coping and its role in the caregiving process will help researchers discover better ways to assist family members in dealing with AD caregiving. Future research into the most useful methods for accomplishing caregiver service programs will need to incorporate the important issues of religious coping that influence caregiving outcomes for families dealing with AD.