Stress Process and Self-Rated Health Among Adult Children Caregivers to Older Adults In Shanghai, China

Background: Numerous studies have shown that family caregivers experience unpleasant tasks and concomitant stressors, and therefore encounter adverse outcomes physically and mentally. The research on stress process and health outcomes among caregivers to older adults in China is very limited, both in terms of theoretical reasoning and sampling method. On the other hand, the stress process model has been tested intensively in western contexts. Whether the knowledge developed in western countries could apply in the context of China is worth exploration. Objectives: By utilizing the stress process model, this paper aims to examine how primary and secondary stressors impact self-rated health among adult children caregivers to older adults in Shanghai, since previous studies indicate that spouse caregiver and adult children caregiver have different experiences. Methods: Data used in this study came from a comparison study entitled “Family Caregivers for the Frail and Very Elderly: Well-being and Needs in Hong Kong and Shanghai”, collected in 2010 by Dr. Lou at the University of Hong Kong and her colleagues. Multi-stage random sampling following the regiment developed by the Shanghai Research Center on Aging (SRCA) for the Shanghai longitudinal study was conducted. A subsample of adult children caregivers (N=445) from Shanghai was included in the analysis. Primary stressors included activities of daily living (ADLs), instrumental activities of daily living (IADLs), mental status, and behavioral problems of elderly care recipients. Established measurements from western countries were translated and tested in terms of reliability and validity in Chinese population by former studies. For example, ADLs were measured by the translated version of Barthel Index. IADLs were measured by the translated version of Lawton Instrumental Activities of Daily Living. Robust internal consistency was found for aforementioned measurements. Summated scores were calculated and used in the analysis. Secondary stressors was operationalized as caregiver burden and measured by the Chinese caregiver burden inventory (CCBI). CCBI was a Chinese version of the 24-item Caregiver Burden Inventory developed by Novak and Guest (1989) on a 5-point Likert scale. Summated score with a range from 0 to96 was calculated and higher score indicates higher levels of burden. The Cronbach's alpha for the scale in this study was 0.895. Self-rated health (SRH) was measured by a single question "how would you rate your overall health at the present time?" with a 5-point response set. SRH was recoded into a binary variable “poor” versus “good” based on the distribution. Path analysis with binary outcome variable using MPlus 5.1 was conducted. Results: The model fits the data well (χ2/df=6.063/5, p=0.300; CFI=0.982; RMSEA=0.022). Primary stressors including ADLs, IADLs, and behavioral problems of care recipients were found to be significantly related with caregiver burden. Caregiver burden was shown to be positively correlated with self-rated health of caregiver, whereas primary stressors were not associated with caregiver self-rated health. Conclusions and Implications: These findings suggest that application of stress process model in Chinese context would be beneficial to understand the caregiving process. Interventions should focus on reducing caregiver burden in order to improve health outcomes.