Factors associated with family caregiver stress related to behavioral and psychological symptoms of dementia: A stress process model-based path analysis

PURPOSE: Family caregivers of people living with dementia (PLWD) may experience mental and physical health issues. The purpose of this study was to examine factors associated with family caregiver outcomes and to describe their interrelationships. METHODS: Grounded in the stress process model, path analysis was conducted using secondary data from 178 dyads of community-dwelling PLWD and family caregivers in Korea. Caregiver outcome was assessed through caregivers' health status and stress due to behavioral and psychological symptoms of dementia (BPSD). Agitation and depression were specified as primary stressors, and PLWD factors were included as background factors associated with BPSD, with separate symptom models. RESULTS: Agitation and depression showed the strongest associations with family caregiver stress related to BPSD. Agitation explained 45.1% of caregiver stress related to BPSD variance (β=.66, p<.001), while depression explained 41.5% (β=.63, p<.001). Agitation and depression were related to caregiver health status (β=.17, p=.006; β=.18, p=.017). In both agitation and depression models, female caregivers (β=.19, p=.008, in both models), older age (β=.21, p=.007, in both models), and lower economic status (β=.32, p<.001, in both models) were associated with poorer caregiver health status. Dementia severity and patient age showed indirect associations with caregiver stress related to BPSD through agitation and depression. CONCLUSION: Agitation and depression were associated with caregiver stress related to BPSD, while caregiver characteristics were associated with health status. These findings highlight the need for tailored interventions to address BPSD and support caregivers. Family-centered and system-level approaches are essential for improving outcomes for PLWD and their families.