The mediating role of sense of coherence on mental health outcomes in carers of older dependent relatives: A longitudinal study

Abstract

Background: Sense of coherence (SOC) is an important protective factor for carer well-being but research to date remains cross-sectional, focusing primarily on the direct effects of SOC on carers’ mental health. The study’s aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers’ psychological health, and its stability over time. Methods: Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at one-year follow-up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. Results: SOC was significantly negatively longitudinally associated with both anxiety (β= -0.38, p= 0.001) and depressive symptoms (β= -0.28, p= 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety and caregiver strain and depressive symptoms (Sobel test; p< 0.001 for anxiety and p< 0.001 for depressive symptoms). Differences between baseline and one-year follow-up SOC scores were not statistically significant (p= 0.617). Conclusions: SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non-experimental conditions over a period of one year in this sample. Findings suggest that interventions aimed at strengthening SOC may protect carer psychological well-being.