Role Overload and Psychological Health Among Caregivers of Older Adults with Dementia: The Mediating Role of Social Participation Restriction

Background and purpose:

Dementia caregiving is a public health concern. Research indicates that caregivers of older adults with dementia often experience a high level of role overload (i.e., feeling overwhelmed by caregiving demands that exceed available resources), which can take a toll on their psychological health. Moreover, dementia caregiving can restrict caregivers’ participation in valued social activities, leading to adverse mental health outcomes. Yet, there is limited knowledge about the relationships among role overload, social participation restriction, and psychological health in this caregiver population. This study aims to examine the mediating effect of social participation restriction on the relationship between role overload and psychological health in caregivers of older adults with dementia.

Methods:

This study used a cross-sectional research design. Data for this study were drawn from the 2017 National Study of Caregiving (NSOC), which included caregivers of Medicare enrollees aged 65 and older in the United States. The current analysis included a subsample of caregivers who provided care to an older adult with dementia (N = 866). Role overload was assessed using the Role Overload Scale. Social participation restriction was measured using an index of 4 activities that are somewhat or very important to the caregiver and were limited in the prior month because of caregiving. These activities included: visiting friends and family, attending religious services, attending club meetings or group activities, and going out for enjoyment. Psychological distress was measured using the Patient Health Questionnaire (PHQ)-4. Psychological well-being was measured using 3 items from the Ryff Scales of Psychological Well-Being. Caregiver socio-demographics (i.e., age, gender, race, education) and caregiving characteristics (i.e., caregiving hours per month) were included in the analysis as covariates.

Results:

Results from path analyses identified the mediating role of social participation restriction in the association between (1) caregiver role overload and psychological distress (indirect effect = .11, p < .001) and (2) caregiver role overload and psychological wellbeing (indirect effect = -.04, p < .05). Specifically, caregivers who experienced higher levels of role overload had more restrictions in participating social activities (B = .19, p < .001), which in turn, exacerbated their psychological distress (B = .60, p < .001). Also, caregivers who reported higher levels of role overload experienced higher levels of restriction in social participation (B = .19, p < .001), which in turn, decreased their psychological wellbeing (B = -.22, p < .05).

Conclusion:

The study suggests that social participation restriction can be the underlying mechanism that explains the relationship between role overload and psychological health in caregivers of older adults with dementia. Findings elucidate social participation restriction as a modifiable factor to mitigate psychological distress and improve psychological well-being and therefore, inform interventions tailored to increase social participation and advance psychological health. The study also informs policies that promote a dementia-friendly community. Such a community may help increase social support, encourage social participation, reduce social isolation due to caregiving, and improve the overall well-being of caregivers of older adults with dementia.