Reevaluation of the Coping Inventory for Task Stressors: Distinguishing Between African American and Caucasian, Alzheimer's Disease Caregivers

Background and Purpose:

Studies have shown Alzheimer’s disease (AD) caregivers are at risk for psychological, behavioral, and physiological health problems as a result of increased stress. AD caregivers may engage in various forms of coping to combat stress, including task-focused coping, emotion-focused coping, and avoidance. The Coping Inventory for Task Stressors (CITS) is used to measure the aforementioned coping strategies with individuals involved routinely with adversity, e.g., AD caregivers. The purpose of this study was to assess coping differences among Caucasian and African American caregivers and to conduct a psychometric reevaluation of the CITS, noting property differences between the ethnic groups.

Method:

This study used cross-sectional survey data from 691 AD caregivers. Measures included the CITS and theoretically-linked constructs of caregiver burden and resilience. T-tests were used to examine differences in coping, burden, and resilience between Caucasians (n = 424) and African Americans (n = 246). Randomly split subsamples were used to conduct the psychometric reevaluation. One subsample (n₁ = 346) was used for principal component analysis (PCA) and reliability tests via Cronbach’s alpha and Guttman split-half coefficients. The second subsample (n₂ = 345) was used to test convergent validity via zero-order correlations between the CITS and linked constructs. Differences on these psychometric properties also were examined between the two ethnic groups.

 

Results:

African American and Caucasian caregivers were equally likely to use both task- and emotion-focused coping, whereas African Americans were significantly more likely to use avoidance coping (t = 1.29, p < .05). No differences were observed between ethnic groups on levels of burden or resilience. Factor analysis results for the broader subsample revealed four underlying components accounting for 57% of the total variance, indicating a fourth coping strategy not previously found in psychometric examination. Factor analysis among the African American subsample yielded results similar to the analysis from the broader sample, with four components accounting for 64% of the variance. An additional component emerged in the Caucasian subsample, yielding five components accounting for 63% of the variance. Reliability of task- and emotion-focused CITS subscales, but not the avoidance subscale, was acceptable across all samples. Validity analyses revealed a significant positive relationship between task-focused coping and resilience, while emotion-focused and avoidance coping had negative relationships with resilience. Results were mixed across all samples for the CITS and the two burden measures.

Conclusions and Implications:

African American’s high use of avoidance coping may indicate that this population of caregivers poorly copes with stress; and, in turn, may impact their overall health. Psychometric reevaluation of the CITS indicated support for the reliability of subscales, but mixed results emerged in the factor structure and the convergent validity of subscales with caregiver burden. These results may indicate that the originally identified three-factor model of coping is not appropriate for assessing caregivers, and that burden varies in its relationship with coping. Overall, the CITS appears to be a psychometrically sound measure and can be utilized to appraise caregivers’ coping strategies.