Caregiver appraisal and psychological well-being associated with patient behavioral disturbances, functional status, and cognitive impairment in Alzheimer's disease

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)


Counseling Psychology

First Committee Member

Kent Burnett - Committee Chair


The primary purpose of this study was to test a model of stress, appraisal, and psychological adaptation among 114 (64 white non-Hispanic, 50 Hispanic) family caregivers of patients diagnosed with dementia of the Alzheimer's type. Specifically, this investigation examined the mediating role played by appraised caregiver burden between patient illness characteristics and caregiver depression. The study also identified the individual relations of patient cognitive dysfunction, limitations in functional status, and psychopathology to appraised caregiver burden. Consistent with the theory of stress and appraisal developed by Lazarus and Folkman (1984), the present study incorporated two caregiver coping resources (perceived physical health and perceived emotional support) in the proposed model. Additionally, the multi-ethnic makeup of the sample warranted an investigation of the relationship of ethnicity (Hispanic versus white non-Hispanic) to cognitive appraisal. A secondary objective was to determine the unique relationships between patent psychosis (delusions and hallucinations), patient depression, patient agitation, and appraised caregiver burden.Results of structural equation analysis showed that appraised caregiver burden played a central role in determining the psychological well-being of the caregivers. The findings indicated that this mediating variable, negative caregiver appraisal, was predicted by increased functional limitations and behavioral disturbances in the patient, poorer perceived physical health, and lower levels of perceived emotional support. Contrary to a priori hypotheses, patient cognitive impairment and caregiver ethnicity were not related to caregiver appraisal. Additionally, functional limitations in the patient exhibited a direct association with caregiver depression. Secondary analyses also showed that patient agitation and depression predicted caregiver burden, whereas patient psychosis no longer showed a relation to caregiver burden after controlling for covariation among these behavioral disturbances. The implications of these findings, limitations of the study, and future directions are discussed.


Health Sciences, Mental Health; Psychology, Clinical; Sociology, Individual and Family Studies; Sociology, Ethnic and Racial Studies

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