Daily stressful experiences, depressive symptoms, and behavioral responses of ADRD family caregivers

Abstract

AbstractBackgroundFamily caregivers of individuals living with Alzheimer’s disease or related dementias (ADRDs) are at a higher risk for serious mental illness, specifically depression. Caring for individuals living with ADRDs can be stressful due to the behavioral symptoms of dementia (BSD). Over time, stressors, such as BSDs, can contribute to the onset of depressive symptoms. Few studies have examined BSDs as contextual triggers contributing to variations in daily mental health symptom experiences of caregivers. Further, it is unclear how behavioral adaptations to caregiving‐specific stressors, such as engaging in elder abuse and neglect (EAN), impact caregiver mental health. In this study, we identified specific individual vulnerabilities, daily environmental stressors, and caregiver behaviors that increase the daily odds of experiencing depressive symptoms.MethodUsing a micro‐longitudinal design and ecological momentary assessment methods, we examined daily environmental stressors (BSDs), caregiver behaviors (i.e., EAN events), and individual vulnerabilities (i.e., demographics, early life adversity, social isolation, social support, and coping strategies) that impact daily odds of experiencing depressive symptoms. Data were collected from a national sample of family caregivers (N=50) who completed daily diaries over a 21‐day period (n=841). Multi‐level modeling was used to test a series of hypotheses on the relationship between daily environmental stressors, caregiver behaviors, individual vulnerabilities, and depression symptom experiences.ResultFamily caregivers were more likely to report depressive symptoms on a given day when a BSD was present and perceived as bothersome (OR = 1.22, 95% CI: 1.09‐1.43, p = 0.002). Additionally, when an EAN event occurred on a given day, caregivers were more likely to report depressive symptoms (OR = 1.27, 95% CI: 1.02‐1.58, p = 0.034) . Individual‐level factors also interacted with BSD, EAN events, and daily depressive symptoms.ConclusionThe results from this study help elucidate factors that contribute to variations in the daily mental health symptom experiences of ADRD caregivers. The interactions between BSDs, EAN events, and depression identified in this study will inform interventions to better support family caregivers and improve mental health outcomes for an at‐risk population.