A descriptive, cross-sectional, predictive correlation design was used to identify and test a causal relationship between behavior disturbances, coping, family conflict, self-esteem and social support to caregiver burden among dementia caregivers. A total of 450 caregivers of dementia aged over 18 years were recruited from 4 hospitals in northern Thailand based on selected criteria.  Demographic Questionnaire, Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD, The Family Conflict Scale, The Zarit Burden Interview Scale, The Perceived Social Support Questionnaire, The Brief COPE and The Rosenberg Self-Esteem with acceptable reliability coefficients were used to collect data.  Data were analyzed using descriptive statistics, Pearson’s Product-Moment Correlation and path analysis by structural equation modeling.

Results showed that the modified model fitted with the data and explained 58% of the variance in caregiving burden among dementia caregivers. Coping and family conflict had a positive direct effect on caregiving burden (p < 0.001), whereas self-esteem and social support had a direct negative effect on caregiving burden (p < 0.001).  Behavior disturbance had a positive indirect effect caregiving burden (p < 0.001) via family conflict. Coping had a positive indirect effect on caregiving burden (p < 0.001) via behavior disturbance and family conflict. Social support had a negative indirect effect on caregiving burden (p < 0.001) via family conflict and self-esteem. The results of this study could be used as a guideline for psychiatric nurses in planning an appropriate intervention program to reduce burden of caregivers of dementia patients in Thailand.


caregiving burden; dementia caregivers; causal model


Alzheimer's Association. Alzheimer's disease facts and figures. Alzheimers Dement. 2013; 9(2), 208-45.

A Wimo and M Prince. World Alzheimer Report 2010; The Global Economic Impact of Dementia. Alzheimer’s Disease International. 2010.

Department of Health. Living well with dementia. A National Dementia Strategy. 2009. London, UK, Department of Health.

M Prince, AGM Wimo, GC Ali, YT Wu and M Prina. World Alzheimer Report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends. Alzheimer’s Disease International. 2015.

V Senanarong, P Jamjumrus, K Harnphadungkit, S Vannasaeng, S Udompunthurak, N Prayoonwiwat and Poungvarin N. Risk factors for dementia and impaired cognitive status in Thai elderly.

J Med Assoc Thai. 2001; 84, 468-474.

D Lasuka, Dementia in Thailand Current Situation in Global Collaboration Center. Osaka University Booklet. 2014;15, 43

Alzheimer’s Association. Alzheimer’s disease facts and figures. Alzheimer’s And Dementia. Alzheimer & Dementia. 2016; 12, 459-509.

GR Oliveira, JF Neto, SM Camargo, AL Lucchetti, DC Espinha. and G Lucchetti. Caregiving across the lifespan. Psychogeriatrics 2015; 15: 123-132. doi:10.1111/psyg.12087

National Health Examination Survey Office. The 4 th National Health Examination Survey2008-2009. [cited 2014 March 30]. Available from http://www.nheso. or.th/download_file.php?


E Papastavrou, A Kalokerinou, SS Papacostas, H Tsangari and P Sourtzi. Caring for a relative with dementia : family caregiver burden. J Adv Nurs. 2007; 446-457.

K Chwalisz and V Kisler. “Perceive Stress: A Better Measure of Carer Burden,”Measurement and Evaluation in Counseling and Development. 1995; 28, 88-98.

SM Robertson, SH Zarit, LG Duncan, M Rovine and EE Femia. Family caregivers’ patterns of positive and negative affect. Family Relations. 2007; 56, 12-23.

L Barclay, A Zemcou, J Blass and J Sansone. Survival in Alzheimer's disease and vascular dementias. Neurology. 1985; 35, 834-840.

JL Conde-Sala, J Garre-Olmo, O Turro-Garriga, J Vilalta-Franch and S Lopez-Pousa. Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer’s disease: an exploratory comparative design. Int J Nurs Stud. 2010; 47, 1262–1273.

S Andren and S Elmstahl. The relationship between caregiver burden, caregivers’ perceived health and their, sense of coherence in caring for elders with dementia. J Clin Nurs. 2008b; 17: 790–799.

LI Pearlin, JT Mullan, Semple and MM Akaff. Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist. 1990; 30, 583-594.

SI Finkel, J S Costa, G Cohen, S Miller and N Sartorius. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr. 1996; 3:497-500.

SL Sample. Conflict in Alzheimer’s caregiving families: Its dimensions and consequences. The Gerontologist 1992; 32, 648-655.

M Rosenberg. Society and the adolescent self-image. Princeton, NJ: Princeton University Press, 1965.

DG Dyck, R Short and P P Vitaliano. Predictor of burden and infectious illness in schizophrenia caregivers. Psychosom Med. 1999; 61, 411-419.

CY Hsiao. Family demands, social support and caregiver burden inTaiwanese family caregivers living with mental illness: the role of family caregiver gender. J Clin Nurs. 2010;19, 3494–3503.

SH Zarit, KE Reever and J Bach-Peterson. Relatives of the impaired elderly: Correlates of feelings of burden. The Geronotologist. 1980; 20, 649-655.

JB Schreiber, FK Stage, J King, A Nora and EA Barlow. Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research. 2006; 99, 323–337.

JF Hair, WC Black, BJ Babin, RE Anderson and RT Tatham. Multivariate Data Analysis (6th ed.). Pearson Prentice Hall, New Jersey, 2006

O Pankong. 2006, Effects of self-help group on perceived burden and well-being of caregivers of the elderly persons with dementia, Master of Nursing Science thesis. Department of Gerontological Nursing, Graduate School. Burapha University, Bangkok, Thailand.

CS Carver, MF Scheier, and JK Weintraub. Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol. 1989; 56, 267-283.

C Kritpracha. 2004, Influcences of cognitive representations of breast cancer on emotional responses and coping in Thai woman newly diagnosis with breast cancer. Unpublished doctoral dissertation. The University of Michigan.

P Srimoragot. 1993, Effect of supportive counseling on perceived illness, self- esteem, and morale in cervical cancer patients undergoing radiotherapy. Dessertration. Mahidol University, Bangkok, Thailand.

SJ Semple, TL Patterson, LR Temoshok, K Straits-Troster, JH Atkinson and W Koch et al. Family conflict and depressive symptoms: A study of HIV-seropositive men. AIDS and Behavior.1997; 1, 53–60.

C Schaefer, JC Coyne and R S Lazarus. The health related functions of social support. J Behav Med.1981; 4, 381-406.

P Pipatananond. 2001, Caregiver burden predictive model: an empirical test among caregivers for the schizophrenic, Doctoral dissertation. Mahidol University, Bangkok, Thailand.

B Reisberg, SH Ferris, MJ de Leon and T Crook. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982, 139,1136-1139.

N Thavicachart, K Phanthumchinda, S C h a n k r a c h a n g, R P r a d i t s u w a n, S Nidhinandana and V Senanarong et al. Efficacy study of galantamine in possible Alzheimer’s disease with or without cerebrovascular disease and vascular dementia in thai patients: a slow-titration regimen. Int J Clin Pract. 2006; 60, 533-40.

H Kim, M Chang, K Rose and S Kim. Predictors of caregiver burden in caregivers of individuals with dementia. J Adv Nurs. 2011; 68, 846–855.

Y Arai, K Kumamoto, M Washio, T Ueda, H Miura and K Kudo. Factors related to feelings of burden among caregivers looking after impaired elderly in Japan under the Long-Term Care insurance system. Psychiatry Clin Neurosci. 2004; 58, 396–402.

LD Clyburn, MJ Stones, T Hadjistavropoulos and H Tuokko. J Gerontol B Psychol Sci Soc Sci. 2000; 55, S2-13.

M Grafstrom, L Fratiglioni and B Winblad. Caring for an elderly person: Predictors of burden in dementia care. International Journal of Geriatric Psychiatry. 2004; 9, 373-379.

W Black, and O Almeida. A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. Int Psychogeriatr. 2004; 16, 295–315.

RM Van der Linde, T Dening, FE Matthews and C Brayne. Grouping of behavioural and psychological symptoms of dementia. International Journal of Geriatric Psychiatry. 2014; 29,562-568. doi:10.1002/gps.4037.

A. Feast et al. Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. Br J Psychiatry. 2016; 208, 429–434.

S Andren, and S Elmstahl. The relationship between caregiver burden, caregivers’ perceived health and there, sense of coherence in caring forelders with dementia. J Clin Nurs.. 2008; 17, 790–799.

LE Valente, A Truzzi, WF Souza, GS Alves, CE Alves, FK Sudo, ME Lanna, DM Moreira, E Engelhardt and J Laks. Health self-perception by dementia family caregivers: sociodemographic and clinical factors. Arq Neuropsiquiatr. 2011; 69, 739–744.

M S Heinz. 2010, Dementia caregiving characteristics, elder impairment, and caregiver strain and burden, Graduate Theses and Dissertations. Paper. http://lib.dr.iastate.edu/etd/11283

M Beyebach and M Herrero de la Vega. 200 tareas en terapia breve. Herder, Barcelona, 2010.

NL Chappell and RC Reid. Burden and well-being among caregivers: examining the distinction. The Gerontologist. 2002; 42, 772- 780.

SH Zarit and JM Zarit. Mental disorders in older adults: Fundamentals of assessment and treatment (2nd ed.). The Guilford Press, New York, 2007.

LK George and L Gwyther. Caregiver well-being: a multidimensional examination of family caregivers of demented adults. Gerontologist. 1986; 26 (3).

PP Vitaliano, J Russo, HM Young, L Teri and RD Maiuro. Predictors of burden in spouse caregivers of individuals with Alzheimer’s disease. Psychol Aging. 1991; 6, 392–402.

GR Shurgot and BG Knight. Influence of neuroticism, ethnicity, familism and social support on perceived burden in dementia caregivers: Pilot test of the transactional stress and social support model.

J Gerontol B Psychol Sci Soc Sci. 2005; 60, P331–P334.


  • There are currently no refbacks.


Online ISSN: 2228-835X


Last updated: 29 December 2018