Factors Affecting Depression Among Caregivers of Older Korean Americans With Dementia Symptoms: The Moderating Effects of Coping Resources

Background & Purpose: Asian older adults are the second fastest-growing older minority groups in the United States, projected to increase from 1 million in 2010 to 7.5 million by 2050. As Asian Americans have a longer life expectancy than any other racial groups, the needs of care for older Asian Americans affected by dementia are growing. Research has consistently shown elevated rates of depressive symptoms among dementia caregivers. Yet, few studies have examined the depression in dementia caregivers of older Asian Americans. Addressing this gap, this study examined factors affecting depressive symptoms among dementia caregivers of older Korean Americans (KAs). 

Methods: The data were drawn from a cross-sectional survey of KA caregivers who were identified as caregivers of an elderly KA with dementia symptoms (N = 122). Using a stress-appraisal model, we first examined the effects of background characteristics (caregiver gender, relationship to care recipient, and English proficiency), primary stressors (ADL and IADL caregiving hours), secondary stressors (financial hardship, family conflict), and caregiving appraisal (burden) on caregivers’ depression. In the second model, we added coping resources (health status of caregiver, dyadic relationship quality, family support network, and symptom management and service use self-efficacy) to examine the effects of these coping resources on depression. In the final model, we added interaction terms between burden and three coping resources shown direct effects on depression in the second model (health status, relationship quality, and symptom management self-efficacy) to examine moderating effects of these three resource factors. 

Results: The majority of caregivers were female (82%) with a mean age of 59.1 (SD = 12.0). About half of them were adult children and one-third spouses. Fifty-nine percent of the caregivers displayed depressive symptomatology as measured by the CES-D (cut-off score 16). In the first model, there was a direct effect of caregiver burden on depression (B=.309, p=.002). The second model showed direct effects of three coping resources: health status (B=.187, p=.026), relationship quality (B=-.189, p=.032), and symptom management self-efficacy (B=-.203, p=.045). In the third model, a significant interaction effect was detected between caregiver burden and relationship quality, indicating the quality of relationship moderated the effect of burden on caregivers’ depression: among caregivers with lower levels of dyadic relationship quality, higher levels of burden were associated with higher levels of depressive symptoms, but among caregivers with greater level of dyadic relationship quality, this relationship was attenuated.

Conclusions & Implications: The results suggest that quality of dyadic relationship, and caregivers’ health status and self-efficacy in managing symptoms function as protective coping resources against depression among KA dementia caregivers.  The moderating effect of relationship quality indicates that satisfactory relationship quality may also protect against the adverse effect of caregiver burden on their depressive symptoms. Depression interventions for KA dementia caregivers may benefit from including specific components designed to improve dyadic relationship quality. Such interventions may be more effective if they also include specific approaches aiming to address health needs of caregivers and increase caregivers’ self-efficacy to manage symptoms.