Using a Stress Process Model to Examine Longitudinal Racial Differences in Well-Being and Health: Results from a Population-Based Study of Caregiving

As the older adult population of the United States increases over the next decade, many family caregivers will be needed to provide care for aging loved ones. The growing diversity of the population may also mean that more racial/ethnic minority caregivers will be providing care to older family members. Most of the studies examining race and caregiving have focused on racial differences in stress, coping, well-being and health among White and Black family caregivers. However, previous research examining racial differences in caregiving has often been limited to smaller convenience samples of caregivers, which limit generalizability of study findings. In this dissertation, a stress process model was used to investigate underlying mechanisms that may explain potential racial differences in family caregiving in a large, population-based sample of White and Black caregivers. The different components of the stress process model included caregiving stressors, appraisals, internal and external resources, and outcomes of well-being and health. In the first study, we used factorial ANOVAs to examine main effects of relationship type (caregiving for a parent, a spouse, or other relationship) and race (White or Black) and any potential interactions on measures of caregiving stressors and outcomes of well-being and health before and after covariate adjustment. Results of the first study found that Black caregivers reported better levels of Positive Well-being and lower levels of Depression/Anxiety compared to White caregivers despite performing more assistance with care activities and hours of care. There were no significant two-way interactions of relationship x race and there was no significant association of relationship type on outcomes of well-being and health after accounting for covariates. For the second study, we used a stress process model as a theoretical framework to examine racial differences in stressors, appraisals, internal and external resources, and their relationship to well-being. Initial ANOVA analyses examining the association of race on stress process measures found that White caregivers were more likely to experience emotional difficulty, reported lower internal and external resources, and reported worse levels of well-being compared to Black caregivers. We also conducted two multiple hierarchical regression analyses to examine significant predictors of well-being outcomes of positive well-being, and depression and anxiety. The stress process model variables used in the regression analyses helped explain individual differences in caregiver well-being. The internal resource measures of positive relationship and caregiving mastery were associated with better levels of Positive Well-being and lower levels of Depression/Anxiety. The purpose of the regression analyses was also to identify potential mediators on the association between race and well-being. After identifying potential mediators, we conducted mediation analyses using Hayes’ PROCESS macros to determine significant mediation pathways on the association between race and outcomes of Positive Well-being and Depression/Anxiety. The regression analyses identified the constructs of Appraisals and Internal Resources as potential mediators. Results of the mediation analyses found that only the Internal Resources construct was a significant mediator on the association between race and both well-being outcomes. Finally, in the third study we examined longitudinal changes in stress process model measures for White and Black caregivers from baseline to a follow-up interview conducted about four years later. We also examined potential main effects of relationship type, race, and time and any potential interactions of these three independent factors using both covariate adjusted and unadjusted factorial ANOVAs and repeated-measures logistic regression analyses. Results of the analyses showed that caregivers who were still providing care at the follow-up interview faced greater caregiving stressors and were at a greater likelihood of experiencing physical difficulty compared to baseline caregivers; however, there were no changes in outcomes of well-being or health. Black caregivers reported more caregiving stressors and better internal resources compared to White caregivers. Reports of well-being and health remained relatively stable despite an increase in caregiving stressors over time. Findings from this dissertation show the complex mechanisms that may explain racial differences among White and Black caregivers using stress process model measures. Potential racial differences in caregiving that have been previously reported mainly in small, convenience samples were generally replicated with this larger, population-based sample. Future research may use similar theoretical models to examine patterns of caregiving among diverse samples of family caregivers