Loneliness, Depression, and Anxiety Among Caregivers of Persons with Dementia: The Mediating Effect of Self-Efficacy

Background/Purpose: Since the advent of COVID-19, telehealth technology has been increasingly utilized in health care settings. When compared to traditional in-person clinic visits, literature shows that telehealth can be a more useful and less burdensome means for persons living with dementia (PWD) to access health services. The same usefulness applies to caregivers of PWD, many of whom report caregiving-related logistical constraints, including time and transportation, in obtaining health care for themselves. A federally-funded geriatrics workforce enhancement program located in the southern United States currently provides telehealth services to caregivers of PWD. An interdisciplinary health team composed of medical, nursing, and social work professionals routinely collects survey data via telehealth technology to better understand and improve the health of caregivers. Extant literature reports that social isolation, loneliness, anxiety, and depression are common among caregivers, especially among those with higher levels of caregiving burden. When caregivers struggle to manage their own health care needs, they may lose confidence in their abilities to improve their health. This confidence points directly to caregiver self-efficacy. Using loneliness as the independent variable, the current study tested the potential mediating effect of self-efficacy on symptoms of anxiety and depression.

Method: Using telehealth technology, a cross-sectional survey was administered by social workers employed by a large, regional hospital to 95 caregivers of persons with dementia (PWD) between September 2020 and March 2023 (age M=61.7[range 26–85]; white=66.3%; female=74.2%; relationship to patient, adult child=47.3%.). The independent variable was loneliness (UCLA Loneliness Scale; 3 items; α=.80). Dependent variables in the mediation models were depression (Patient Health Questionnaire-2; 2 items;α=.77) and anxiety (Generalized Anxiety Disorder-2; 2 items;α=.79). The mediator was self-efficacy (Family Caregiver Self-Efficacy for Managing Dementia scale; 10 items;α=.91). The control variables were age, gender, and relationship with the patient. PROCESS Macro version 4.2 was utilized with a bootstrapping approach to test the two hypothesized mediation models.

Results: The direct effects in the first mediation model were significant for (a) loneliness on self-efficacy (β=-.4.24, p<.01), (b) self-efficacy on depression (β=-.02, p<.05), and (c) loneliness on depression (β=.67, p<.001). The indirect mediation effect of loneliness on depression through self-efficacy was significant (β=.09, bootstrapping 95% CI[.01, 21]). The direct effects in the second mediation model were significant for (a) loneliness on self-efficacy (β=-.4.19, p<.01) and (b) self-efficacy on anxiety (β=-.02, p<.05); however, the direct effect of loneliness on anxiety was not significant (β=.04, p=.706). The indirect mediation effect of loneliness on anxiety was significant (β=.09, bootstrapping 95% CI[.02, 23]).

Conclusions/Implications: Model 1 results show that the positive relationship between loneliness and depression was mediated by self-efficacy among caregivers of PWD. Interventions should target depressive symptoms and address social isolation. No direct effect of loneliness on anxiety emerged in Model 2; however, self-efficacy mediated the relationship between loneliness and anxiety. Interventions for treating anxiety should primarily focus on increasing caregivers' social networks, which, in turn, will reduce symptoms of anxiety. Results underscore the importance of including self-efficacy as a mediator when assessing caregivers' depression and anxiety.