Stressors and anxiety in dementia caregiving: multiple mediation analysis of rumination, experiential avoidance, and leisure
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BACKGROUND: Despite the robust associations between stressors and anxiety in dementia caregiving, there is a lack of research examining which factors contribute to explain this relationship. This study was designed to test a multiple mediation model of behavioral and psychological symptoms of dementia (BPSD) and anxiety that proposes higher levels of rumination and experiential avoidance and lower levels of leisure satisfaction as potential mediating variables. METHODS: The sample consisted of 256 family caregivers. In order to test a simultaneously parallel multiple mediation model of the BPSD to anxiety pathway, a PROCESS method was used and bias-corrected and accelerated bootstrapping method was used to test confidence intervals. RESULTS: Higher levels of stressors significantly predicted anxiety. Greater stressors significantly predicted higher levels of rumination and experiential avoidance, and lower levels of leisure satisfaction. These three coping variables significantly predicted anxiety. Finally, rumination, experiential avoidance, and leisure satisfaction significantly mediated the link between stressors and anxiety. The explained variance for the final model was 47.09%. Significant contrasts were found between rumination and leisure satisfaction, with rumination being a significantly higher mediator. CONCLUSIONS: The results suggest that caregivers' experiential avoidance, rumination, and leisure satisfaction may function as mechanisms through which BPSD influence on caregivers' anxiety. Training caregivers in reducing their levels of experiential avoidance and rumination by techniques that foster their ability of acceptance of their negative internal experiences, and increase their level of leisure satisfaction, may be helpful to reduce their anxiety symptoms developed by stressors.
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Previous studies within dementia caregiving have investigated the mediating or moderating role of experiential avoidance or cognitive fusion separately in the association between caregiving stressors and mental health outcomes.
“previous studies within dementia caregiving have investigated mediating or moderating role of experiential avoidance or cognitive fusion separately in the association between caregiving stressors and mental health outcomes (Barrera-Caballero et al., 2021; Mausbach et al., 2012; Romero-Moreno et al., 2016).”
From The role of experiential avoidance and cognitive fusion in the development of anxiety symptoms among family carers of people with dementia (2024) · cites this paper as Romero-Moreno et al., 2016
Experiential avoidance has a significant association with depression and anxiety among dementia family caregivers.
“EA is also considered to have a significant association with depression and anxiety among dementia family caregivers (Kishita et al., 2020; Losada et al., 2014; Romero-Moreno et al., 2016; Spira et al., 2007).”
From Reliability and validity of the Japanese version of the experiential avoidance in caregiving questionnaire (EACQ) (2023) · cites this paper as Romero-Moreno et al., 2016
Psychological inflexibility (as assessed by the AAQ) moderated the relationship between neuropsychiatric symptoms of dementia and carer anxiety.
“Another more recent study conducted by Romero-Moreno, Losada, Márquez-González, and Mausbach (2016) demonstrated that psychological inflexibility (as assessed by the AAQ) moderated the relationship between neuropsychiatric symptoms of dementia and carer anxiety.”
From Exploring the impact of carer stressors and psychological inflexibility on depression and anxiety in family carers of people with dementia (2020) · cites this paper as Romero-Moreno, Losada, Márquez-González, and Mausbach (2016)
Prior work has documented associations between rumination and anxiety, depressive symptoms, and broader distress in dementia caregivers.
“Prior work has documented associations between rumination and anxiety, depressive symptoms, and broader distress in dementia caregivers (Keune et al., 2023; Romero-Moreno et al., 2016).”
From Mindfulness and rumination: stress pathways for caregivers of persons living with dementia. (2026) · cites this paper as Romero-Moreno et al., 2016
Emerging evidence indicates that psychological flexibility predicts both anxiety and depression in dementia carers.
“There is now emerging evidence that psychological flexibility predicts both anxiety 67 and depression 68 in carers of people with dementia.”
From Anxiety in Informal Dementia Carers: A Meta-Analysis of Prevalence (2020) · cites this paper as [67]
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“Prior work has documented associations between rumination and anxiety, depressive symptoms, and broader distress in dementia caregivers (Keune et al., 2023; Romero-Moreno et al., 2016).”
- Authors
- Romero-Moreno, R., Losada, A., Márquez-González, M., & Mausbach, B. T.
- Affiliations
- Universidad Rey Juan Carlos (ES)
- University of California San Diego (US)
- ORCID
- Mausbach, B.T.
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 28
- Issue
- 11
- Pages
- 1835-1844
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W2495078408
- Cited by
- 37
- References
- 41
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 1
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Ministerio de Ciencia e Innovación
- Ministerio de Economía y Competitividad (PSI2009-08132/PSIC, PSI2012-31293)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- dementia caregiving, caregiver anxiety, behavioral and psychological symptoms of dementia, rumination, experiential avoidance, leisure satisfaction, caregiver stressors, coping, mediation, family caregivers
- MeSH terms
- Rumination, Cognitive, Adaptation, Psychological, Adult, Aged, Anxiety, Avoidance Learning, Dementia, Female, Humans, Leisure Activities, Male, Models, Psychological, Personal Satisfaction, Stress, Psychological, Caregivers
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