Caregiver Stress Research Articles

Dyadic effects of perceived stress, relationship satisfaction and distress disclosure on emotional distress in colorectal cancer patients and their family caregivers: An actor-partner interdependence mediation model

ObjectiveThis study adopted a dyadic analysis method to examine the effect of perceived stress on emotional distress and determine whether relationship satisfaction and distress disclosure act as mediators in colorectal cancer (CRC) enterostomy patient-caregiver dyads. MethodsA total of 312 patient-caregiver dyads completed measures assessing perceived stress, relationship satisfaction, distress disclosure, and emotional distress. The data were analyzed using the actor-partner interdependence mediation model. ResultsThis study found that the perceived stress of patients and caregivers both had direct and indirect actor effects on emotional distress (through relationship satisfaction). Another important finding is that perceived stress had indirect actor-partner effects (through distress disclosure) on emotional distress. ConclusionsThis study highlights that perceived stress, relationship satisfaction, and distress disclosure of patients and their caregivers are key factors that can be considered for improving emotional distress. It also partially confirmed the interdependence of patients with CRC and their caregivers.

Effect of parenting centers on caregiver mental health ——Evidence from a large scale randomized controlled trial in rural China

In the context of economic development, the escalating prevalence of depression, anxiety and stress poses substantial challenges, not only impacting individuals' physical and mental well-being but also exerting a profound influence on future human capital. This study conducts an exploratory analysis of the effects of a center-based early childhood development intervention on the mental health of the caregivers, utilizing data from a cluster randomized controlled trial involving 1652 caregivers in rural China. Over the course of two years, caregivers and children in 50 villages received individualized parenting training, one-on-one parenting classes, and access to open play spaces in village parenting centers. Our findings reveal sustained and significant intervention effects on caregivers' anxiety and stress symptoms. The primary mechanisms driving these effects include increased parenting time investment, alterations in parenting styles, and changes in the level of trust in others. Furthermore, our research demonstrates that the positive treatment effects on mental health outcomes are more pronounced among caregivers of children who initially lower development skills. The intervention exhibits a stronger impact on caregivers with lower educational attainment, particularly when the caregivers are grandmothers. These results underscore the importance of governmental attention to mental health issues in rural China, suggesting avenues for intervention through the provision of parenting knowledge and spaces facilitating caregiver-child interactions. This research contributes valuable insights into addressing mental health challenges in rural settings, promoting effective strategies for future policy implementation.

A systematic review and meta-analysis of randomized controlled trials to reduce burden, stress, and strain in informal stroke caregivers

Objectives To understand the nature and effectiveness of interventions aimed at improving informal stroke caregiver burden, stress, and strain. Data sources In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of CENTRAL, CINAHL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted in May 2022. Review methods Studies were eligible if they included an intervention designed for informal stroke caregivers, reported on caregiver burden, strain, or stress, were published in English, and used a randomized controlled trial design. An updated search was conducted in June 2024. The methodological quality of studies was appraised using the Cochrane risk-of-bias tool for randomized trials. The data were pooled, and a meta-analysis was completed for caregiver burden and strain outcomes. Results Nineteen studies met inclusion criteria and were meta-analyzed. Interventions ranged from 4 days to 12 months. Most studies incorporated educational and/or support components. Meta-analyses revealed nonsignificant effects on caregiver burden or strain. Significant between-group differences for caregiver strain and burden were, however, found in seven studies. Conclusion Limited studies, small sample sizes, and conflicting results made definitive conclusions on the most effective intervention characteristics for improving caregiver outcomes difficult. Of the 19 studies, seven found significant between-group differences for caregiver outcomes postintervention, and these tended to incorporate educational components and comprised between seven and nine sessions. Further high-quality research is required to identify optimal format, duration, and frequency for improving caregiver outcomes.

Emotional competences as predictors of psychological wellbeing and quality of life of supplementary grandparents caregivers.

Grandparents are increasingly becoming key figures in the supplementary care of grandchildren. Based on the Resilience Model of Family Stress, Adjustment and Adaptation, the present study aims to analyze the emotional competences that canpl predict higher levels of psychological wellbeing and quality of life in supplementary grandparents caregivers. A sample of 270 supplementary grandparents caregivers living in Spain participated. Most participants were women (71.1%), and the mean age was 67.83 years (SD = 6.26). Most participants were occasional caregivers, that is, they care for less than 10 h per week (76.3%). We conducted hierarchical multiple regression analysis, one for psychological wellbeing and the other for quality of life. The regression model for psychological wellbeing identified that age, management of caregiving stress, self-confidence in the caregiving role, management of work-life balance difficulties and emotional self-regulation explained 32.8% of its variance. The regression model for quality of life showed that age, type of grandparent caregiver, management of caregiving stress, management of work-life balance difficulties and emotional self-regulation explained 31.2% of its variance. This study focuses on supplementary grandparents caregivers, whereas literature has tended to look at primary grandparents caregivers. The results highlight the role of emotional competences as predictors of supplementary grandparents caregivers' psychological wellbeing and quality of life, overcoming the usual tendency in the literature to focus on the negative consequences of grandparents caregiving for grandchildren, and emphasizing the competences that grandparents have to cope with this care in a satisfactory way, which, moreover, can be trained.

The Relationship Between Social Support and Stress in Family Caregivers of Stroke Patients.

BACKGROUND: Stroke is a significant cause of disability. Family Informal caregivers face numerous stressors. This study examines whether social support during hospitalization would mediate the relationship between care time per day and stress in family caregivers of stroke patients. METHODS: A cross-sectional study design in Taiwan recruited 137 family caregivers. Descriptive information forms, the Caregiver Strain Index, and the Social Support Scale were used to collect data. RESULTS: Social support was negatively correlated with stress (r = -0.23, P = .006). By contrast, caregiving hours and physical support were significantly associated with psychological stress. Physical support mediated the association between caregiving hours and psychological stress (95% CI = 0.000-0.005), accounting for 22.02% of the total effect. CONCLUSION: Social support decreased family caregiver stress, notably psychological stress, due to prolonged care of 18 hours per day in the hospital. Physical support resources to alleviate caregiver stress.

A multi-constituent qualitative examination of facilitators and barriers to caregiver coaching for autistic children in publicly funded early intervention.

Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers' attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.

Young Children’s Social and Emotional Adjustment and Caregiver Stress During the COVID-19 Pandemic

Young Children’s Social and Emotional Adjustment and Caregiver Stress During the COVID-19 Pandemic

Support Group dalam Menurunkan Tingkat Stres pada Caregiver Skizofrenia

One of the cases experienced by schizophrenia caregivers is stress. One intervention to reduce stress levels in schizophrenia caregivers is a support group. Support groups are carried out with peer groups who have relatively similar problems by sharing information about the problems experienced by schizophrenia caregivers. This research aims to reduce the level of stress felt by caregivers of schizophrenia, using a quasi-experiment and using 6 research subjects consisting of 5 female subjects and 1 male subject who have moderate to severe stress level scores. The data collection method was carried out using the Kingston Caregiver Stress Scale (KCSS) and analysis used the Repeated Measured Anova Test. The results of the support group intervention showed that caregivers experienced significant changes (p<0.05) in terms of reducing stress levels before and after providing support group therapy. This study has important implications for the implementation of support groups in reducing stress levels among caregivers of individuals with schizophrenia. It can be concluded that support groups are effective in lowering stress levels in schizophrenia caregivers.

Exploring Stress and Coping in Caregivers of Children with Pulmonary Vein Stenosis: A Mixed-Method Study.

(1) Background: This mixed-method study aims to identify and describe factors associated with acute and long-term parenting stressors and coping strategies in caregivers of children with intraluminal pulmonary vein stenosis (PVS). (2) Methods: Parents of children with severe PVS were recruited from a large quaternary hospital to complete a survey that included demographics, the Pediatric Inventory for Parents (PIP), and the Coping Health Inventory for Parents (CHIP). We determined the Social Vulnerability Index (SVI) based on self-reported home address. A subset of caregivers completed a 60 min semi-structured interview via Zoom exploring the impact their child's diagnosis had on their family; experience managing stress in the hospital and at home; current resources and processes for coping; and potential recommendations for hospitals to build resilience and coping. We used multivariable linear regression to examine the association between SVI and parental stress and coping while adjusting for possible confounders. Thematic analysis identified themes related to stress and coping. Finally, we assessed instances of convergence and difference between the qualitative and quantitative results. (3) Results: Participants included 32 caregivers who were 91% female with a mean age of 39 years. The children of participants were 66% female, with a mean age of five years. The parents reported a high amount of stress with an average PIP score of 120, nearly 46 points higher than similar studies in the congenital heart community. We observed no significant associations between SVI and either parental stress or coping in adjusted models. We identified 13 themes, including medical care, hospital, family, support systems, and home medical routine or support. (4) Conclusions: Our study found high levels of illness-related parental stress among caregivers of children with PVS. Stress evolved over time from what caregivers described as 'survival mode' to a future-oriented outlook. Currently, caregivers rely heavily on support networks that are not available to all caregivers or may experience strain over time. Caregivers indicated that communication and parental role functioning were coping strategies that could be better supported by providers and health systems.

A Comparison of Parent-Reported Severe Autism With Mild/Moderate Autism Among US Children.

An expert commission has proposed the term "profound" autism for children on the spectrum who are minimally verbal or nonverbal and have intellectual disability (ID), behavioral challenges, and co-occurring conditions. It is unknown whether parents' rating of "severe" autism aligns with the definition of "profound" autism. Using the National Survey of Children's Health, we sought to (1) estimate the prevalence of parent-reported severe autism, (2) identify child characteristics that are associated with severe autism, (3) compare health care utilization, and (4) compare caregiver stress and resilience between families of children with severe versus mild/moderate autism. Parent responses on the 2018 to 2019 NSCH were used to compare school-age children with parent-reported severe autism and those with mild/moderate autism. Descriptive statistics, χ 2 tests, and logistic regression were used for statistical analysis. Among parents of 1,368 US children with autism, 10.1% characterized their child's autism as severe, a prevalence of 1 in 333. Parents of children with severe autism were more likely to report ID (45% vs 12.1%, p < 0.001), language delay (88% vs 58.7%, p < 0.001), and difficulties in dressing and bathing (67% vs 19.2%, p < 0.001). Children with severe autism had more behavioral problems and co-occurring conditions but were no more likely to see specialists or receive autism-specific behavioral therapy. Their caregivers reported more stress and less resilience. The characteristics of "profound" autism and parent-reported "severe" autism significantly overlap, allowing the use of the NSCH for studies of this vulnerable population. Children with profound/severe autism could benefit from more behavioral therapy, specialty care, and family support.

The Predictive Power of Religious Coping on Care Burden, Depression, Stress, and Anxiety of Parents of Pediatric Oncology Patients in Turkey.

This study aimed to determine the predictive power of religious coping of parents of children with canceron caregiver burden, depression, anxiety, and stress in Turkey. It was designed as a descriptive and cross-sectional study, utilizing correlational analysis and regression models to explore associations between variables. Data were collected from 164 parents in the pediatric hematology-oncology clinics of a university hospital between November 2023 and March 2024. There was a negative correlation between caregiver burden score and negative and positive religious coping scores. Caregiver burden scores werepositively correlated with depression, anxiety, and stress scores. Results indicated that caregiver burden, education level, employment status, family structure, family income, and age at diagnosis significantly predicted positive religious coping. For negative religious coping, caregiver burden, education level, family structure, and family income were significant predictors. This suggests that religious coping may help reduce caregiver burden, underscoring the importance of promoting constructive coping strategies to support caregivers' well-being.

Compassion, stress and coping strategies in family caregivers of patients with heart failure

The requirements of caring for individuals with diseases with excess care burden like heart failure (HF) comprise a source of stress for the caregiver. This situation affects the health of caregivers and may cause a reduction in their level of compassion. However, compassion is associated with psychological benefits and coping strategies like positive mood in caregivers.The aim of this study was to investigate the correlations between compassion, coping strategies and stress levels of family members caring for individuals with HF. We found that the dysfunctional coping strategies were determined to play a partial mediating role in the relationship between caregiver compassion levels and stress levels. Caregivers with higher compassion levels reported lower stress levels. This situation may be linked to their use of relatively fewer dysfunctional coping strategies. Findings help to examine the correlations between compassion, coping strategies and stress levels of family members caring for individuals with HF.

Learn about the effect of stress related to care giving on psychological well-being

Psychological well-being may be significantly impacted by caregiver stress. Numerous researches have looked at how stress related to caring affects different facets of mental health, shedding light on the difficulties carers may experience and possible repercussions for their well-being. The stress theory of caring holds that providing care negatively affects the mental health of informal carers, whereas the rewards theory holds that doing so has positive effects on mental health. This study investigates whether or not these two points of view apply to care giving circumstances, and whether or not they do so in various ways depending on the major place of caring (i.e., at home, in another dwelling, or an institution) and the caregiver's gender. Using information from the representative national Indian Longitudinal Study on Aging, we compared non-caregivers to a mixed caregiver group before stratifying caregivers by the primary site of care to investigate the link between depression and life satisfaction. Carers performed low on happiness and despair questionnaires. When the care setting was broken down, only home caregivers reported more unhappiness and worse life satisfaction. Non-residential caregivers reported more life satisfaction and less unhappiness. Despite having higher rates of sadness, institutional carers remained satisfied. These tendencies were stronger in women. In-home carers may benefit more from the stress viewpoint, whereas non-residential caregivers may gain more from the rewards perspective when thinking about the caring experience. Caregiver gender and the care giving setting are highlighted as potential topics for concentrated practice. Interventions should concentrate on identifying and enhancing the benefits that non-residential carers get from providing care.

Demographic characteristics, diagnostic challenges, treatment patterns, and caregiver burden of mitochondrial diseases: a retrospective cross-sectional study

BackgroundThis study aimed to explore the demographic characteristics, diagnostic challenges, treatment patterns, and caregiver burden of mitochondrial diseases.MethodsThis retrospective cross-sectional study enrolled patients diagnosed with mitochondrial diseases from the Department of Neurology at Peking University First Hospital between January 2010 and December 2021. A questionnaire covering demographic characteristics, diagnostic dilemma, treatment, economic aspects, and caregiver stress was administered, and disability was assessed using the modified Rankin Scale (mRS).ResultsA total of 183 patients (mean age: 16 (IQR: 12–25), 49.72% males) were enrolled, including 124 pediatric patients and 59 adult patients. MELAS (106. 57.92%) and Leigh syndrome (37, 20.22%) were predominant among the mitochondrial disease subtypes. Among them, 132 (72.13%) patients were initially misdiagnosed with other diseases, 58 (31.69%) patients visited 2 hospitals before confirmed as mitochondrial disease, and 39 (21.31%) patients visited 3 hospitals before confirmed as mitochondrial disease. Metabolic modifiers were the most common type of drugs used, including several dietary supplements such as L-carnitine (117, 63.93%), Coenzyme Q10 (102, 55.74%), idebenone (82, 44.81%), and vitamins (99, 54.10%) for proper mitochondrial function. Mothers are the primary caregivers for both children (36.29%) and adults (38.98%). The mRS score ranged from 0 to 5, 92.35% of the patients had different degrees of disability due to mitochondrial disease. The average monthly treatment cost was 3000 RMB for children and 3100 RMB for adults.ConclusionsThis study provided valuable insights into the characteristics and challenges of mitochondrial diseases, which underscores the need for improved awareness, diagnostic efficiency, and comprehensive support for patients and caregivers.

Are Art-Based Interventions Effective in Improving Psychological Well-Being Among Informal Caregivers of Cancer Patients? A Systematic Review.

Objectives: To systematically synthesize the current evidence on the effects of art-based interventions on improving anxiety, depression, stress, sleep, and well-being of cancer caregivers. Design: A systematic review. Methods: We searched PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases from their inception up to April 2024. Studies exploring the effects of art-based interventions on the psychological symptoms of cancer caregivers were included. We did not restrict the publication to the particular study designs, including randomized controlled trials, quasiexperimental studies, and qualitative studies. Results: Fifteen studies of 607 participants were identified in this systematic review. Overall, the existing studies provided preliminary evidence to suggest that art-based interventions may benefit cancer caregivers in improving anxiety, depression, stress, caregiver burden, and quality of life. However, the relatively low quality of the current evidence limits the efficacy of these findings. Conclusions: According to the existing evidence, the therapeutic benefits of using art-based interventions for improving the psychological well-being of cancer caregivers are uncertain. More high-quality and well-designed studies are still required to confirm the psychological effectiveness of art-based interventions for cancer caregivers in the future.

The Coronavirus Pandemic and Mental Health Presentations of Young Children.

Children under the age of four are emotionally vulnerable to global disasters, such as the COVID-19 pandemic given the lack of socialization opportunities and coping mechanisms, and susceptibility to heightened caregiver stress. Currently, the extent to which the pandemic impacted the mental health of clinically referred young children is unknown. To evaluate how children's mental health outcomes were impacted during the pandemic, interRAI Early Years assessments (N = 1343) were obtained from 11 agencies across the Province of Ontario, during pre-pandemic and pandemic timepoints. Findings demonstrated that the number of completed assessments declined during the pandemic. Further, children's emotional concerns differed before and during the pandemic, whereby children exhibited greater emotional dysregulation during the pandemic. However, there were no significant differences when examining caregiver distress, parenting strengths, child distractibility/inattention or behavioural issues. Implications for young children and their families, clinicians, and policy makers are discussed.

Caregiving Experiences as Mediators Between Caregiving Stressors and Anticipatory Grief in Severe Dementia: Findings From Longitudinal Path Analysis

ObjectivesFamily caregivers of older adults with severe dementia often experience anticipatory grief. We aimed to investigate the temporal association of caregiving stressors (older adults’ behavioral symptoms, and caregiver-older adult co-residence and emotional closeness) and caregivers’ anticipatory grief, and its mediation by positive and negative caregiving experiences. DesignProspective cohort. SettingSingapore. ParticipantsAbout 169 family caregivers of older adults with severe dementia were surveyed every 4 months for 4 years (up to 13 surveys). MeasurementsWe measured anticipatory grief using the Marwit Meuser Caregiver Grief Inventory-Short Form, negative caregiving experiences using the Caregiver Reaction Assessment scale, positive caregiving experiences using Gain in Alzheimer Care Instrument and behavioral symptoms using the Cohen-Mansfield Agitation Inventory. We implemented a cross-lagged panel model to test mediation, a form of longitudinal path analysis. ResultsAbout 35% of the caregivers reported high anticipatory grief at least once during the study period. Older adults’ behavioral symptoms had a significant direct effect (Standardized coefficient [95% confidence interval]: 0.12 [0.04, 0.21]) on caregivers’ anticipatory grief. Negative experiences mediated the significant indirect effect of older adults’ behavioral symptoms (0.16 [0.06, 0.25]) and coresidence (0.16 [0.07, 0.25]) on caregivers’ anticipatory grief. Positive caregiving experiences did not mediate any path. ConclusionsFindings indicate a temporal association between caregiving stressors and anticipatory grief, mediated by negative caregiving experiences. Routine screening for anticipatory grief, and interventions to address caregiver stressors and negative caregiving experiences may alleviate caregivers’ grief.

Characteristics and correlates of aggressive behavior in autistic youths.

This study aimed to characterize aggressive behaviors in autistic youths and to identify the social environment variables most strongly linked with aggression in this clinical population. Participants were 2142 caregivers of autistic youths (ages 6.0-17.9) recruited from autism research centers across the United States. Caregivers completed self-report and behavior rating inventories that assessed both verbal and physical aggression as well as characteristics of the individual youths (sleep quality, gastrointestinal [GI] symptoms, and autism characteristics) and their families (caregiver stress, global family functioning, and sibling relations), peers (emotional bonding, number of friends), schools (academic functioning), and neighborhoods (perceived community safety). We used descriptive analyses to identify which aggressive acts were most common among autistic youths, and we performed bivariate correlations and multiple linear regression analyses to determine which characteristics of the youths and their social environments were most strongly linked with youth aggression. Verbally aggressive youth behaviors were endorsed by caregivers most frequently. Youth age and sex were not associated with verbal or physical aggression. A combination of youth and social environment characteristics accounted for 42.6% of the variance in verbal aggression and 26.0% of the variance in physical aggression. Thus, those characteristics most strongly linked with verbal and physical aggression were strained sibling relations, caregiver stress, youth sleep problems, and youth repetitive and restrictive behaviors. Viewed together, the results suggest that aggressive behaviors in autistic youths are associated with multiple characteristics pertaining to the individual youths and their immediate social environments. Implications for treatment and research are discussed.

Facilitators of and Barriers to Caregiver Adherence to Home Therapy Recommendations for Infants and Children With Neuromotor and Neuromuscular Diagnoses: A Scoping Review.

Caregiver-performed home therapy programs are essential to occupational therapy intervention for infants and children with neuromotor and neuromuscular diagnoses. Factors that facilitate or are barriers to caregiver adherence when making home therapy recommendations should be considered. To identify facilitators of and barriers to caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular disorders. The review followed the five-step methodological framework developed by Arksey and O'Malley (2005) and was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches with no language or date range limits were performed in MEDLINE, CINAHL Plus with Full Text, PsycINFO, and SocINDEX on the EBSCO platform, and Scopus on the Elsevier platform from database inception through January 24, 2023. Study inclusion criteria included caregiver adherence to home therapy recommendations for children with neuromotor and neuromuscular diagnoses. Eight hundred seventy-five articles underwent title and abstract screening; 64 articles met the criteria for full review. Twelve articles met the inclusion criteria. Four used qualitative measures, 7 used quantitative measures, and 1 used mixed methods. Qualitative thematic analysis revealed four facilitators: routine, efficacy of caregiver education, positive relationship with therapist, and perceived benefit of treatment. The analysis revealed three barriers: lack of time, lack of confidence, and caregiver stress. The facilitators and barriers identified are central to best-practice occupational therapy. Therapists can use expertise in analyzing routines and context to maximize the fit between family needs and home therapy recommendations. Plain-Language Summary: Home therapy for children with a neuromotor and neuromuscular diagnosis is common and uses some form of caregiver-performed movement activities or techniques. To support caregivers, occupational therapists need to understand what factors facilitate or serve as barriers to following home therapy recommendations. The review found three barriers: lack of time, lack of confidence, and caregiver stress. The review provides strategies to support home therapy based on core principles of occupational therapy practice. It also identifies the need for more research to support home therapy recommendations that fit within the child's and family's routine, that can be taught in a way that meets the child's and family's learning needs, that facilitate self-efficacy and confidence, and that reflect the values and motivators of all participants.

How do care-related beliefs contribute to depression and anxiety in family caregivers of people with dementia? Testing a cognitive vulnerability-stress model

Objectives Care-related beliefs are considered risk factors for decreased mental health in family caregivers of people with dementia. However, their exact role in the caregiver stress process remains unclear. Hence, we tested a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. Method A cross-sectional study was conducted using baseline data from a caregiver intervention trial (N = 322). Within Bayesian moderated mediation analysis, we examined mediation of effects of objective demands (severity of dementia, challenging behavior, caregiving intensity, caregiving duration) on depression and anxiety via subjective caregiver burden and moderation by care-related beliefs in four domains (dysfunctional caregiving standards, dysfunctional attitudes towards dementia, functional self-care-related beliefs, functional acceptance-related beliefs). Results The relation between objective demands and subjective burden was amplified by dysfunctional caregiving standards and dysfunctional attitudes towards dementia and mitigated by functional self-care-related beliefs. Further, functional acceptance-related beliefs attenuated the effect of subjective caregiver burden on depression. Conclusion The study provides preliminary evidence for a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. The results indicate that the four-domain model of care-related beliefs is a valuable framework for future research and may serve as a heuristic model for cognitive-behavioral therapy in this population.