Stress and depression among Alzheimer's family caregivers: Examining the role of religiosity among Latinos

Background and Purpose: According to Pearlin and associates' (1990) stress process model, religiosity moderates the relationship between caregiving stressors and caregiver depressive symptoms. While previous research has documented the protective role of religiosity among non-Hispanic White and African American family caregivers, little research has been conducted with Latino samples. In light of the growing size and cultural distinctiveness of the Latino population, this study extends previous research by examining the protective role of religiosity in the area of depression among a sample of Latino Alzheimer's family caregivers (N = 209).

Methods: The study was conducted using baseline Latino participants from the NIH-funded Resources for Enhancing Alzheimer's Caregiver Health (REACH) II dataset. The sample was 82.3% female and 34.6% Cuban American, 21.6% Mexican heritage, 21.2 % Puerto Rican, and 22.5% other Latino. The mean age was 58 (SD = 13.7). In keeping with Pearlin and associate's model, objective caregiving stressors (e.g., care recipient ADL/IADL difficulties) and subjective stressors (e.g., self-rated health) were assessed. Depression was measured using the Center for Epidemiological Studies' Depression Scale (CESD). Three measures of religiosity were used: frequency of church attendance, frequency of prayer, and a measure of religious coping. Covariates included caregiver demographics (e.g., national heritage) and informal support. Three-step hierarchical regression was used to test Pearlin and associates' (1990) stress process model—i.e., to determine if religiosity moderated the relationship between stress and depression among Latino caregivers.

Results: At bivariate level, all three indicators of religiosity were inversely associated with depression. The first step of the hierarchical regression model included objective stressors, subjective stressors, and covariates for depression. None of the objective stressors were significant. Three subjective stressors (i.e., greater perceived burden, higher levels of perceived daily care bother, and poorer self-rated health) predicted higher levels of depression (p <.05). Females, Cuban Americans, and individuals with lower levels of informal support reported higher levels of depression (p <.01). The second step—the addition of religiosity variables—indicated that church attendance predicted lower levels of depression (p <.05), while the three subjective stressors remained statistically significant. The third step added interaction terms (church attendance x subjective stressors) to test for moderation. Only one interaction term was significant (church attendance x self-rated health), indicating that church attendance moderates the relationship between self-rated health and depression. The last model had a R square of .50, and R square changes at each step were statistically significant (p <.01).

Conclusions and Implications:

Except for self-rated health, religiosity did not moderate the relationship between caregiving stressors and depressive symptoms as proposed in Pearlin and associate's conceptual model. In addition, direct effects between objective, and several subjective stressors and depression were also absent. Religiosity, however, appears to exhibit a direct protective influence on depression. Given the cultural differences that exist between white, black, and Latino cultures, a more culturally appropriate model may be needed to explain the caregiving processes and outcomes among Latino family caregivers. The results regarding Cuban Americans also suggest that future researchers should also consider variability within the larger Latino population.