Original Article  Open Access
J Korean Acad Nurs. 2015 Feb;45(1):97-106. Korean.
Published online Feb 27, 2015.  https://doi.org/10.4040/jkan.2015.45.1.97
© 2015 Korean Society of Nursing Science
Structural Equation Model for Caregiving Experience of Families Providing Care for Family Members with Mental Disorders
In Ohg Oh,1 and Sunah Kim2
1National Health Insurance Service Ilsan Hospital, Goyang, Korea.
2College of Nursing, Yonsei University · Nursing Policy Research Institute, College of Nursing, Yonsei University, Seoul, Korea.

Address reprint requests to: Kim, Sunah. College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-3275, Fax: +82-2-392-5440, Email: PSY0962@yuhs.ac
Received July 22, 2014; Revised August 10, 2014; Accepted December 31, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.


 This article has been cited by 5 articles in  
 This article has been cited by Google Scholar.
 This article has been cited by 2 articles in PubMed Central.
 This article has been cited by 2 articles in  Scopus.
 This article has been cited by 1 article in  Web of Science.


Abstract

Purpose

This study was done to develop and test a structural model for caregiving experience including caregiving satisfaction and caregiving strain in families providing care for family members with a mental disorder.

Methods

The Stress-appraisal-coping model was used as the conceptual framework and the structural equation model to confirm the path that explains what and how variables affect caregiving experience in these families. In this hypothesis model, exogenous variables were optimism, severity of illness and uncertainty. The endogenous variables were self efficacy, social support, caregiving satisfaction and caregiving strain. Data were collected using structured questionnaires.

Results

Optimism and caregiving self-efficacy had significant direct and indirect effects on caregiving satisfaction. Optimism, severity of illness and uncertainty had significant direct and indirect effects on caregiving strain. The modified path model explained effects of optimism on caregiving self-efficacy with social support in the path structure as a mediator. Also, there were direct and indirect effects of optimism and uncertainty on caregiving satisfaction with social support and caregiving self-efficacy in the path structure as a mediators.

Conclusion

Results suggest the need to improve caregiving self-efficacy of these families, establish support systems such as a mental health professional support programs for caregiving self-efficacy. Optimism, severity of illness and uncertainty perceived by families need to be considered in the development of support programs in order to increase their effectiveness.
Keywords:
Structural model; Family caregivers; Mental disorders

Figures


 Figure 1
Conceptual framework.
Click for larger image


Figure 2
Path of modified model.
Click for larger image

Tables


 Table 1
Demographic Characteristics of Subjects (N=200)
Click for larger image


Table 2
Comparison of Model Fit of Modified Model to Hypothetical Model
Click for larger image


Table 3
Standardized Estimate of Modified Model
Click for larger image

Notes

This article is a condensed form of the first author's doctoral thesis from Yonsei University.

References
1.
Perlick DA, Hohenstein JM, Clarkin JF, Kaczynski R, Rosenheck RA. Use of mental health and primary care services by caregivers of patients with bipolar disorder: A preliminary study. Bipolar Disord 2005;7(2):126–135. [doi: 10.1111/j.1399-5618.2004.00172.x]
2.
Park S, Park KS. Family stigma: A concept analysis. Asian Nurs Res 2014;8(3):165–171.
3.
Perlick DA, Rosenheck RA, Miklowitz DJ, Kaczynski R, Link B, Ketter T, et al. Caregiver burden and health in bipolar disorder: A cluster analytic approach. J Nerv Ment Dis 2008;196(6):484–484. [doi: 10.1097/NMD.0b013e3181773927]
4.
Lazarus RS, Folkman S. In: Kim JHStress, appraisal, and coping. Seoul: Dae-gwang Publishing Company; 1991.
5.
Baronet AM. The impact of family relations on caregivers' positive and negative appraisal of their caretaking activities. Fam Relat 2004;52(2):137–142. [doi: 10.1111/j.1741-3729.2003.00137.x]
6.
Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol 2000;55(6):647–654.
7.
Hilgeman MM, Allen RS, DeCoster J, Burgio LD. Positive aspects of caregiving as a moderator of treatment outcome over 12 months. Psychol Aging 2007;22(2):361–371.
8.
Kim YS. In: A study on caregiving appraisal and psychological well-being of family caregivers of a person with mental disorder [dissertation]. Seoul: Ewha Womans University; 2005.
9.
Gottlieb BH, Rooney JA. Validation of the RIS Eldercare Self-Efficacy scale. Can J Aging 2003;22(1):95–107. [doi: 10.1017/S0714980800003767]
10.
Löckenhoff CE, Duberstein PR, Friedman B, Costa PT Jr. Five-factor personality traits and subjective health among caregivers: The role of caregiver strain and self-efficacy. Psychol Aging 2011;26(3):592–604. [doi: 10.1037/a0022209]
11.
Post RM. The impact of bipolar depression. J Clin Psychiatry 2005;66 Suppl 5:5–10.
12.
Rose LE, Mallinson RK, Gerson LD. Mastery, burden, and areas of concern among family caregivers of mentally ill persons. Arch Psychiatr Nurs 2006;20(1):41–51. [doi: 10.1016/j.apnu.2005.08.009]
13.
Bauer R, Gottfriedsen GU, Binder H, Dobmeier M, Cording C, Hajak G, et al. Burden of caregivers of patients with bipolar affective disorders. Am J Orthopsychiatry 2011;81(1):139–148. [doi: 10.1111/j.1939-0025.2010.01081.x]
14.
Mishel MH, Padilla G, Grant M, Sorenson DS. Uncertainty in illness theory: A replication of the mediating effects of mastery and coping. Nurs Res 1991;40(4):236–240.
15.
Chien WT, Chan SW, Morrissey J. The perceived burden among Chinese family caregivers of people with schizophrenia. J Clin Nurs 2007;16(6):1151–1161. [doi: 10.1111/j.1365-2702.2007.01501.x]
16.
Reinhard SC. Living with mental illness: Effects of professional support and personal control on caregiver burden. Res Nurs Health 1994;17(2):79–88.
17.
Chen FP, Greenberg JS. A positive aspect of caregiving: The influence of social support on caregiving gains for family members of relatives with schizophrenia. Community Ment Health J 2004;40(5):423–435.
18.
Steffen AM, McKibbin C, Zeiss AM, Gallagher-Thompson D, Bandura A. The revised scale for caregiving self-efficacy: Reliability and validity studies. J Gerontol B Psychol Sci Soc Sci 2002;57(1):P74–P86.
19.
Cheng ST, Lam LC, Kwok T, Ng NS, Fung AW. Self-efficacy is associated with less burden and more gains from behavioral problems of Alzheimer's disease in Hong Kong Chinese caregivers. Gerontologist 2013;53(1):71–80. [doi: 10.1093/geront/gns062]
20.
Romero-Moreno R, Losada A, Mausbach BT, Márquez-Gonzalez M, Patterson TL, López J. Analysis of the moderating effect of self-efficacy domains in different points of the dementia caregiving process. Aging Ment Health 2011;15(2):221–231. [doi: 10.1080/13607863.2010.505231]
21.
Semiatin AM, O'Connor MK. The relationship between self-efficacy and positive aspects of caregiving in Alzheimer's disease caregivers. Aging Ment Health 2012;16(6):683–688.
22.
Majer JM, Jason LA, Olson BD. Optimism, abstinence self-efficacy, and self-mastery: A comparative analysis of cognitive resources. Assessment 2004;11(1):57–63.
23.
Bandura A. In: Kim UC, Park YS, Yang KMSelf-efficacy: The exercise of control. Paju: Kyoyookbook; 1999.
24.
Oh HS. Health promoting behaviors and quality of life of Korean women with arthritis. J Nurs Acad Soc 1993;23(4):617–630.
25.
Lee DS. In: Social support need and perceived social support of patients having gastric cancer [master's thesis]. Seoul: Seoul National University; 1996.
26.
Kim I, Suh MJ. The prediction model of adaptation in patients with rheumatoid arthritis: Propositional synthesis of Roy's and Lazarus & Folkman's theory. J Muscle Joint Health 1997;4(2):197–220.
27.
Orbell S, Hopkins N, Gillies B. Measuring the impact of informal caring. J Community Appl Soc Psychol 2006;3(2):149–163.
28.
Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test. J Pers Soc Psychol 1994;67(6):1063–1078.
29.
Kim SH. In: Psychological characteristics of realistic and unrealistic optimists [master's thesis]. Seoul: The Catholic University of Korea; 2003.
30.
Au A, Lai MK, Lau KM, Pan PC, Lam L, Thompson L, et al. Social support and well-being in dementia family caregivers: The mediating role of self-efficacy. Aging Ment Health 2009;13(5):761–768. [doi: 10.1080/13607860902918223]