The Effects of Caregiving, Self-Efficacy and Stigma on Wellness Among Asian-American Family Caregivers of People with Mental Illness

Background and Purpose: The family is an interconnected system, wherein each person affects and is affected by other family members. Thus, having a person with a serious mental illness (hereafter called consumers) impacts the family’s wellness, especially that of the primary family caregiver (FC), as affected individuals often rely on family members for temporary or permanent care. Primary FCs often experience intense anxiety and stress, putting them at higher risk of developing mental health problems (e.g., depression and anxiety) and impaired social functioning (e.g., restriction of normal social activities leading to social isolation). Caregivers who co-reside with consumers experience increased burden due to the stress of managing multiple issues involved in ensuring the consumers’ recovery and well-being. In addition to caregiving burden, general population studies note the debilitating impact of stigma and indicate the positive impact of self-efficacy and using mental health services (e.g., family therapy, psychoeducation) on FC's wellness. However, limited information is available on Asian-American caregivers in this regard. This is concerning because Asian-Americans represent the fastest growing population group in America. Moreover, Asian collectivist culture (e.g., family oriented and high concern about saving face) may increase cohabitation and affiliated stigma that can exacerbate caregiver stress. Further, little attention has been given to understanding Asian-American FCs’ mental health and social functioning, which are intertwined yet distinctive as mental health explains affective domains and subjective life quality while social functioning explains the capacity to engage in preferred activities. To address this gap, this study examines the roles of caregiver burden, cohabitation, service use, stigma and self-efficacy on mental health and social functioning among Asian-American FCs.

Methods: Using a cross-sectional design we surveyed a group of 116 Asian-American FCs (61 Chinese Americans and 55 Vietnamese Americans representing two of the largest Asian-American groups in the San Francisco Bay area). The mean age of the sample was 51.2 years (SD = 14.28), females comprised 58.6%, mostly first-generation immigrants (91.4%), a majority cohabited with consumers (75.9%), and had education beyond a high school diploma (77.6%). Standardized instruments were used: Caregiver Burden Scale; Affiliate Stigma Scale; Caregiver Self-Efficacy Scale; 36-item Short Form Medical Outcome Survey measuring mental health and social functioning; and a survey on service use.

Findings: Multiple regression analyses showed that, after controlling for FC’s demographic characteristics (age, gender, educational level) and other contextual variables (severity of consumers’ illness, consumer’s treatment engagement), caregiving burden and stigma played different roles while self-efficacy was a significant predictor of both mental health and social functioning. Specifically, lower affiliated stigma and higher self-efficacy (standardized β = -0.32 and 0.19, respectively) predicted better mental health; and lower caregiving burden and higher self-efficacy (standardized β = -0.34 and 0.19, respectively) predicted better social functioning.

Discussion and Implications: To promote wellness among Asian-American FCs, the findings suggest that mental health professionals continue to help reduce caregiver burden and stigma and develop culturally sensitive interventions to enhance Asian-American FCs’ self-efficacy which is fundamental to maintaining a balanced emotional state, navigating the mental health system, and engaging in health-promoting behaviors.