A Causal Model of Caregiving Burden among Dementia Caregivers


  • Chalinee SUVANAYOS Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
  • Darawan THAPINTA Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
  • Wichit SRISUPHAN Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
  • Hunsa SETHABOUPPHA Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
  • Sirirat PANUTHAI Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand




Caregiving burden, Dementia caregivers, Causal model


In this study, a 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.


Download data is not yet available.


Metrics Loading ...


Alzheimer’s Association. Alzheimer’s disease facts and figures. Alzheimers Dement. 2013; 9, 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, Department of Health, London, UK, 2009.

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, 468-74.

D Lasuka. Dementia in Thailand Current Situation in Global Collaboration Center. Osaka University Booklet, 2014, p. 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, 123-32.

National Health Examination Survey Office. The 4th National Health Examination Survey2008 -2009. Available from http://www.nheso.or.th/download_file.php?content_id=14&down_id=8, accessed March 2014.

E Papastavrou, A Kalokerinou, SS Papacostas, H Tsangari and P Sourtzi. Caring for a relative with dementia: Family caregiver burden. J. Adv. Nurs. 2007; 58, 446-457.

K Chwalisz and V Kisler. Perceive stress: A better measure of carer burden. Meas. Eval. Counsel. Dev. 1995; 28, 88-98.

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

L Barclay, A Zemcou, J Blass and J Sansone. Survival in Alzheimer's disease and vascular dementias. Neurology 1985; 35, 834-40.

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, 1262-73.

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. 2008; 17, 790-9.

LI Pearlin, JT Mullan, Semple and MM Akaff. Caregiving and the stress process: An overview of concepts and their measures. Gerontologist 1990; 30, 583-94.

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. Gerontologist 1992; 32, 648-55.

M Rosenberg. Society and the Adolescent Self-image. Princeton University Press, Princeton, NJ, 1965.

DG Dyck, R Short and PP Vitaliano. Predictor of burden and infectious illness in schizophrenia caregivers. Psychosom. Med. 1999; 61, 411-9.

CY Hsiao. Family demands, social support and caregiver burden in Taiwanese family caregivers living with mental illness: The role of family caregiver gender. J. Clin. Nurs. 2010; 19, 3494-503.

SH Zarit, KE Reever and J Bach-Peterson. Relatives of the impaired elderly: Correlates of feelings of burden. Geronotologist 1980; 20, 649-55.

JB Schreiber, FK Stage, J King, A Nora and EA Barlow. Reporting structural equation modeling and confirmatory factor analysis results: A review. J. Educ. Res. 2006; 99, 323-37.

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, Burapha University, Bangkok, Thailand.

CS Carver, MF Scheier and JK Weintraub. Assessing coping strategies: A theoretically based approach. J. Pers. Soc. Psychol. 1989; 56, 267-83.

C Kritpracha. 2004, Influcences of Cognitive Representations of Breast Cancer on Emotional Responses and Coping in Thai Woman Newly Diagnosis with Breast Cancer. 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. Dissertation, Mahidol University, Bangkok, Thailand.

SJ Semple, TL Patterson, LR Temoshok, K Straits-Troster, JH Atkinson and W Koch and I Grant. Family conflict and depressive symptoms: A study of HIV-seropositive men. AIDS Behav. 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. Psychiat. 1982, 139, 1136-9.

N Thavicachart, K Phanthumchinda, S Chankrachang, R Praditsuwan, S Nidhinandana, V Senanarong and N Poungvarin. 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, 846-55.

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. Psychiat. Clin. Neurosci. 2004; 58, 396-402.

LD Clyburn, MJ Stones, T Hadjistavropoulos and H Tuokko. Predicting caregiver burden and depression in Alzheimer’s disease. J. Gerontol. B Psychol. Sci. Soc. Sci. 2000; 55, S2-S13

M Grafstrom, L Fratiglioni and B Winblad. Caring for an elderly person: Predictors of burden in dementia care. Int. J. Geriatr. Psychiatr. 2004; 9, 373-9.

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. Int. J. Geriatr. Psychiatr. 2014; 29, 562-8.

A Feast, M Orrell, G Charlesworth, N Melunsky, F Poland and E Moniz-Cook. Behavioural and psychological symptoms in dementia and the challenges for family carers: Systematic review. Br. J. Psychiatr. 2016; 208, 429-34.

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, 790-9.

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, 739-44.

MS Heinz. 2010, Dementia Caregiving Characteristics, Elder Impairment, and Caregiver Strain and Burden. Graduate Theses and Dissertations, Iowa State University, Ames, Iowa.

M Beyebach and MH Vega. 200 Tareas en Terapia Breve. Herder, Barcelona, 2010.

NL Chappell and RC Reid. Burden and well-being among caregivers: Examining the distinction. Gerontologist 2002; 42, 772-80.

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, 253-9.

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.




How to Cite

SUVANAYOS, C., THAPINTA, D., SRISUPHAN, W., SETHABOUPPHA, H., & PANUTHAI, S. (2018). A Causal Model of Caregiving Burden among Dementia Caregivers. Walailak Journal of Science and Technology (WJST), 17(5), 476–488. https://doi.org/10.48048/wjst.2020.4686