Restricted accessResearch articleFirst published online 2024-8
Cross-National Analysis of the Associations Between Familism and Self-Efficacy in Family Caregivers of People With Dementia: Effects on Burden and Depression
Objectives: To examine the cross-national associations between familism and self-efficacy dimensions, and levels of burden and depression. Methods: Sociodemographic, familism, self-efficacy, depressive symptoms, and burden variables were measured in 349 dementia family caregivers from the US and Spain. Results: US sample: greater support from family was positively related to self-efficacy for obtaining respite and self-efficacy for controlling upsetting thoughts and behaviors. Both self-efficacy constructs were negatively related to depression. Similar findings were obtained for burden. Spanish sample: higher scores on family as referents were associated with lower scores on self-efficacy for obtaining respite; lower scores on self-efficacy for obtaining respite were associated with higher depressive symptomatology. Discussion: Study findings suggest that a significant interplay exists between the various facets of familism and self-efficacy, leading to differential caregiving outcomes. Unique cultural contexts and values derived from each country may exert distinct influences on how the caregiving role is perceived and appraised.
Alzheimer’s Association. (2021). 2021 Alzheimer’s disease facts and figures. Alzheimer’s and Dementia, 17(3), 327–406. https://doi.org/10.1002/alz.12328
2.
ArandaM. P.KnightB. G. (1997). The influence of ethnicity and culture on the caregiver stress and coping process: A sociocultural review and analysis. The Gerontologist, 37(3), 342–354. https://doi.org/10.1093/geront/37.3.342
3.
BenoitJ. S.ChanW.PillerL.DoodyR. (2020). Longitudinal sensitivity of Alzheimer’s disease severity staging. American Journal of Alzheimer’s Disease & Other Dementiasr, 35, 153331752091871–153331752091878. https://doi.org/10.1177/1533317520918719
4.
CahillK. M.UpdegraffK. A.CausadiasJ. M.KorousK. M. (2021). Familism values and adjustment among Hispanic/Latino individuals: A systematic review and meta-analysis. Psychological Bulletin, 147(9), 947–985. https://doi.org/10.1037/bul0000336
5.
CamposB.RoeschS. C.GonzalezP.HookerE. D.CastañedaS. F.GiachelloA. L.PerreiraK. M.GalloL. C.GalloL. C. (2019). Measurement properties of Sabogal’s familism scale: Findings from the Hispanic community health study/study of Latinos (HCHS/SOL) sociocultural ancillary study. Journal of Latina/o psychology, 7(4), 257–272. https://doi.org/10.1037/lat0000126
6.
ChengS. T.AuA.LosadaA.ThompsonL. W.Gallagher-ThompsonD. (2019). Psychological interventions for dementia caregivers: What we have achieved, what we have learned. Current Psychiatry Reports, 21(7), 59. https://doi.org/10.1007/s11920-019-1045-9
7.
CollinsR. N.KishitaN. (2020). Prevalence of depression and burden among informal care-givers of people with dementia: A meta-analysis. Ageing and Society, 40(11), 2355–2392. https://doi.org/10.1017/S0144686X19000527
8.
CoronaK.CamposB.ChenC. (2017). Familism is associated with psychological well-being and physical health: Main effects and stress-buffering effects. Hispanic Journal of Behavioral Sciences, 39(1), 46–65. https://doi.org/10.1177/0739986316671297
9.
CrellinN. E.OrrellM.McDermottO.CharlesworthG. (2014). Self-efficacy and health-related quality of life in family carers of people with dementia: A systematic review. Aging & Mental Health, 18(8), 954–969. https://doi.org/10.1080/13607863.2014.915921
10.
Dilworth-AndersonP.GoodwinP. Y.WilliamsS. W. (2004). Can culture help explain the physical health effects of caregiving over time among African American caregivers?The Journals of Gerontology, Series B: Psychological Sciences and Social, 59(3), S138–S145. https://doi.org/10.1093/geronb/59.3.s138
11.
FalzaranoF.MoxleyJ.PillemerK.CzajaS. J. (2021). Family matters: Cross-cultural differences in familism and caregiving outcomes. The Journals of Gerontology: Series B, 59(3), 138–145. https://doi.org/10.1093/geronb/gbab160
12.
FeinbergL. F.SpillmanB. C. (2019). Shifts in family caregiving – and a growing care gap. Generations, 43(1), 71–75.
13.
Frías-OsunaA.Moreno-CámaraS.Moral-FernándezL.Palomino-MoralP. Á.López-MartínezC.del-Pino-CasadoR. (2019). Motivos y percepciones del cuidado familiar de mayores dependientes. Atención Primaria, 51(10), 637–644. https://doi.org/10.1016/j.aprim.2018.06.010
14.
GallagherD.Ni MhaolainA.CrosbyL.RyanD.LaceyL.CoenR. F.WalshC.CoakleyD.WalshJ. B.CunninghamC.LawlorB. A.LawlorB. A. (2011). Self-efficacy for managing dementia may protect against burden and depression in Alzheimer’s caregivers. Aging & Mental Health, 15(6), 663–670. https://doi.org/10.1080/13607863.2011.562179
15.
Gallagher-ThompsonD.Choryan BilbreyA.Apesoa-VaranoE. C.GhatakR.KimK. K.CothranF. (2020). Conceptual framework to guide intervention research across the trajectory of dementia caregiving. The Gerontologist, 60(Suppl 1), S29–S40. https://doi.org/10.1093/geront/gnz157
16.
Gallego-AlbertoL.LosadaA.CabreraI.Romero-MorenoR.Pérez-MiguelA.Pedroso-ChaparroM. d. S.Márquez-GonzálezM. (2022). I feel guilty”. Exploring guilt-related dynamics in family caregivers of people with dementia. Clinical Gerontologist, 45(5), 1294–1303. https://doi.org/10.1080/07317115.2020.1769244
17.
GelmanC. R. (2014). Familismo and its impact on the family caregiving of Latinos with Alzheimer’s disease: A complex narrative. Research on Aging, 36(1), 40–71. https://doi.org/10.1177/0164027512469213
18.
Huertas-DomingoC.Márquez-GonzálezM.CabreraI.Barrera-CaballeroS.Pedroso-ChaparroM. D. S.Romero-MorenoR.Losada-BaltarA. (2021). Sociocultural influences on the feeling of loneliness of family caregivers of people with dementia: The role of kinship. International Journal of Environmental Research and Public Health, 18(9), 4700. https://doi.org/10.3390/ijerph18094700
19.
JaldinM. A.BalbimG. M.ColinS. J.MarquesI. G.MejiaJ.MagallanesM.RochaJ. S.MarquezD. X. (2023). The influence of Latino cultural values on the perceived caregiver role of family members with Alzheimer’s disease and related dementias. Ethnicity and Health, 28(4), 619–633. https://doi.org/10.1080/13557858.2022.2115018
20.
JutkowitzE.GauglerJ. E.TrivediA. N.MitchellL. L.GozaloP. (2020). Family caregiving in the community up to 8-years after onset of dementia. BMC Geriatrics, 20, 216–219. https://doi.org/10.1186/s12877-020-01613-9
21.
KimJ.-H.KnightB. G.LongmireC. V. F. (2007). The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 26(5), 564–576. https://doi.org/10.1037/0278-6133.26.5.564
22.
KnightB. G.SayeghP. (2010). Cultural values and caregiving: The updated sociocultural stress and coping model. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65B(1), 5–13. https://doi.org/10.1093/geronb/gbp096
23.
LimY. M.AhnY. H.AhnJ. Y. (2016). Multidimensional caregiving burden of female family caregivers in Korea. Clinical Nursing Research, 25(6), 665–682. https://doi.org/10.1177/1054773815591472
24.
LosadaA.de los Ángeles VillarealM.NuevoR.Márquez-GonzálezM.SalazarB. C.Romero-MorenoR.CarrilloA. L.Fernáñdez-FernándezV.Fernández-FernándezV. (2012). Cross-cultural confirmatory factor analysis of the CES-D in Spanish and Mexican dementia caregivers. Spanish Journal of Psychology, 15(2), 783–792. https://doi.org/10.5209/rev_SJOP.2012.v15.n2.38890
25.
LosadaA.KnightB. G.MárquezM. (2003). Barreras cognitivas para el cuidado de personas mayores dependientes. Influencia de las variables socioculturales [Cognitive barriers against caregiving to elderly dependent individuals. The influence of sociocultural variables]. Revista Española de Geriatría y Gerontología, 38(2), 116–123. https://doi.org/10.1016/S0211-139X(03)74867-7
26.
LosadaA.KnightB. G.Márquez-GonzálezM.MontorioI.EtxeberríaI.PeñacobaC. (2008). Confirmatory factor analysis of the familism scale in a sample of dementia caregivers. Aging & Mental Health, 12(4), 504–508. https://doi.org/10.1080/13607860802224227
27.
LosadaA.Márquez-GonzálezM.KnightB. G.YanguasJ.SayeghP.Romero-MorenoR. (2010). Psychosocial factors and caregivers’ distress: Effects of familism and dysfunctional thoughts. Aging & Mental Health, 14(2), 193–202. https://doi.org/10.1080/13607860903167838
28.
LosadaA.Robinson ShurgotG.KnightB. G.MárquezM.MontorioI.IzalM.RuizM. A. (2006). Cross-cultural study comparing the association of familism with burden and depressive symptoms in two samples of Hispanic dementia caregivers. Aging & Mental Health, 10(1), 69–76. https://doi.org/10.1080/13607860500307647
29.
Losada-BaltarA.Vara-GarcíaC.Pedroso-ChaparroM. D. S.CabreraI.Jiménez-GonzaloL.Fernandes-PiresJ.Huertas-DomingoC.Barrera-CaballeroS.Gallego-AlbertoL.Romero-MorenoR.Márquez-GonzálezM.Márquez-GonzálezM. (2023). Family caregivers of people with dementia in the context of the sociocultural stress and coping model: An examination of gender differences. Journal of Women & Aging, 35(4), 354–368. https://doi.org/10.1080/08952841.2022.2052705
Márquez-GonzálezM.LosadaA.LópezJ.PeñacobaC. (2009). Reliability and validity of the Spanish version of the revised scale for caregiving self-efficacy. Clinical Gerontologist, 32(4), 347–357. https://doi.org/10.1080/07317110903110419
32.
Márquez-GonzálezM.Romero-MorenoR.LosadaA. (2010). Caregiving issues in a therapeutic context: New insights from the acceptance and commitment therapy approach. In PachanaN.LaidlawK.KnightB. (Eds.), Casebook of clinical geropsychology: International perspectives on practice (pp. 33–53). Oxford University Press. https://doi.org/10.1093/med/9780199583553.003.0003
33.
MartínM. (1996). Adaptación para nuestro medio de la Escala de Sobrecarga del Cuidador de Zarit. Revista Multidisciplinar de Gerontología, 6(4), 338.
34.
Mendez-LuckC. A.ApplewhiteS. R.LaraV. E.ToyokawaN. (2016). The concept of familism in the lived experiences of Mexican-origin caregivers. Journal of Marriage and Family, 78(3), 813–829. https://doi.org/10.1111/jomf.12300
35.
MuthénL. K.MuthénB. O. (2017). Mplus: Statistical Analysis with Latent Variables: User’s Guide (Version 8). Authors.
PattersonC. (2018). World Alzheimer Report 2018. Alzheimer’s Disease International.
38.
PearlinL. I.MullanJ. T.SempleS. J.SkaffM. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594. https://doi.org/10.1093/geront/30.5.583
39.
RadloffL. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
40.
RainerH.SiedlerT. (2012). Family location and caregiving patterns from an international perspective. Population and Development Review, 38(2), 337–351. https://doi.org/10.1111/j.1728-4457.2012.00495.x
41.
RothD. L.Dilworth-AndersonP.HuangJ.GrossA. L.GitlinL. N. (2015). Positive aspects of family caregiving for dementia: Differential item functioning by race. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(6), 813–819. https://doi.org/10.1093/geronb/gbv034
42.
RozarioP. A.DeRienzisD. (2008). Familism beliefs and psychological distress among African American women caregivers. The Gerontologist, 48(6), 772–780. https://doi.org/10.1093/geront/48.6.772
43.
SabogalF.MarínG.Otero-SabogalR.MarínB. V.Perez-StableE. J. (1987). Hispanic familism and acculturation: What changes and what doesn’t?Hispanic Journal of Behavioral Sciences, 9(4), 397–412. https://doi.org/10.1177/07399863870094003
44.
SayeghP.KnightB. G. (2011). The effects of familism and cultural justification on the mental and physical health of family caregivers. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66(1), 3–14. https://doi.org/10.1093/geronb/gbq061
SteffenA. M.Gallagher-ThompsonD.ArenellaK.AuA.ChengS. T.CrespoM.Cristancho-LacroixV.LópezJ.Losada-BaltarA.Márquez-GonzálezM.Nogales-GonzálezC.Romero-MorenoR. (2019). Validating the revised scale for caregiving self-efficacy: A cross-national review. The Gerontologist, 59(4), e325–e342. https://doi.org/10.1093/geront/gny004
47.
SteffenA. M.McKibbinC.ZeissA. M.Gallagher-ThompsonD.BanduraA. (2002). The revised scale for caregiving self-efficacy: Reliability and validity studies. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57(1), P74–P86. https://doi.org/10.1093/geronb/57.1.P74
48.
Valdivieso-MoraE.PeetC. L.Garnier-VillarrealM.Salazar-VillaneaM.JohnsonD. K. (2016). A systematic review of the relationship between familism and mental health outcomes in Latino population. Frontiers in Psychology, 7, 1632. https://doi.org/10.3389/fpsyg.2016.01632
49.
ZaritS. H.ReeverK. E.Bach-PetersonJ. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
