Dyadic Pathways in Caregiving Demands and Depression: The Mediating Role of Sleep Disturbances

Background and Purpose: Understanding caregiving as a shared experience is critical, as caregiving tasks significantly affect both caregivers (CGs) and care recipients (CRs), particularly in dementia contexts. Dementia caregiving is associated with increased stress, depression, and disrupted sleep for both members of the caregiving dyad. Cognitive decline and increasing dependency uniquely influence the caregiving relationship, underscoring the importance of examining CG and CR experiences simultaneously. Thus, guided by Stress Process Framework, this study investigates how caregiving tasks (daily care, health-related activities, and medical care) impact CG and CR depression through CG and CR sleep disturbances.

Methods: This study utilized data from Round 5 of the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC), consisting of 2,100 care dyads (caregivers and care recipients). Dyadic analyses using multilevel modeling examined relationships between caregiving tasks (daily care, health-related activities, medical care), caregiver and care recipient sleep disturbances (interrupted sleep, difficulty returning to sleep), and depression symptoms in both care dyads. Relevant background factors, including age and gender, were controlled. Multilevel mediation models tested indirect effects through sleep disturbances.

Results: Approximately 76% of caregivers were non-spousal, and 60% had less than or some college education. The mean caregiver age was 61 years, with 65% of care recipients under age 74. At the within- level, caregivers reported poorer sleep on days when they provided more assistance with daily tasks, health-related activities, and medical care. Poor caregiver sleep, in turn, was significantly associated with greater caregiver depression. Care recipient depression was predicted by their own sleep but not by caregiving behaviors or caregiver sleep. Significant indirect effects revealed that caregiving tasks influenced caregiver depression via caregiver sleep. At the between- level, greater overall assistance with medical care was associated with poorer caregiver sleep, while care recipient sleep was positively associated with medical help and negatively associated with health-related help. Caregiver depression was again predicted by poorer caregiver sleep. Care recipient depression was associated with poorer caregiver sleep, poorer recipient sleep, and greater health-related help. Mediation analyses showed that both caregiver and care recipient sleep significantly mediated the effects of caregiving demands on caregiver and care recipient depression outcomes.

Discussion: Our findings underscore sleep disturbances as critical mediators linking caregiving tasks with depression among caregiving dyads. These results highlight the necessity of employing a dyadic perspective to better understand caregiving stress's interdependent impacts. Targeted interventions to improve sleep quality may help mitigate depressive symptoms and mental health burdens associated with caregiving. Future study should investigate the role of the quality of caregiver and care recipient relationships which might also buffer negative caregiving stress impacts, improving overall mental health outcomes for both caregivers and care recipients. Future longitudinal research should explore these dyadic effects further and evaluate interventions specifically designed to alleviate caregiving-related stress, enhance sleep quality, and strengthen relationship dynamics in particular for dementia caregiving dyads.