Religious coping among ethnically diverse caregivers of Alzheimer's disease

Background and Purpose: In recent years, religion has received attention as protective factors that may have positive impacts on caregiving outcomes. Since Alzheimer's disease is progressive and often lengthy, families caring for persons with dementia are often overwhelmed by the financial, emotional and physical burden of caregiving.

The purpose of the current study is to provide a better understanding of the role of religious coping and underlying structures in the relationships between religious coping, burden and depression in AD caregiving by analyzing baseline data from REACH II study. The three study aims are: 1) investigate the relationship between religious coping and depression 2) test the mediation of caregiver burden 3) explore the moderating effect of race in the relationship between religious coping and depression.

Methods: This study used data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II project. The data were collected through telephone interview with caregivers. In this study, only baseline assessment data (Time 1) were used for analysis. The respondents consist of total 642 caregivers, 211 African-Americans, 220 Caucasians, and 211 Hispanics. Religious coping was assed by the frequency of religious attendance, prayer/meditation and the Brief RCOPE (Pargament et al., 1998). Caregiver burden was measured by the 12-item brief version of the Zarit Caregiver Burden Interview (ZBI) (Zarit et al., 1985). Caregiver depressive symptoms were assessed by using the Center for Epidemiological Studies-Depression (CES-D) scale (Radloff, 1977). The hypothesized path model composed of study variables was evaluated using structural equation modeling (SEM). To test moderation of race, multi-sample SEM was conducted. Multi-sample SEM (MSEM) is to test for differences on the parameters of a model among samples. To identify significant group-specific differences, Lagrange multiplier (LM) tests of equality constraints across samples were examined.

Results: The fit of the specified model ÷2 (5, N = 642) = 11.68, CFI = .99, RMSEA = .05. suggested a good fit of the data to the model. Religious coping was a negative predictor of depression (â = -.19, z = -4.89, p<.001). This is a significant path, suggesting that as caregivers' level of religious coping increases, their level of depression decreases. Caregiver burden was found to partially mediate the prediction of depression by religious coping (â = -.09, z = -2.63, p<.001). The results also showed that religious coping had both a direct effect on depression and an indirect effect through caregiver burden. This suggests that family caregivers who use religious coping will have fewer burdens, which in turn, less depressive symptoms than those who do not. This study also found that African American caregivers reported the highest level of religiosity as well as the lowest level of burden among three race groups. However, the overall test of constraints from MSEM showed that there are no significant differences in the parameters among race groups.

Implications: The findings suggest that enhancing religious coping would help caregivers overcome burden and depression. Social workers should raise awareness and knowledge of issues of religion in Alzheimer's caregiving.