Too Much of a Good Thing?: Positive Religious Coping Predicts Worse Diurnal Salivary Cortisol Patterns for Overwhelmed African American Female Dementia Family Caregivers

Abstract

Objectives Religious coping arguably prevents negative health outcomes for stressed persons. This study examined the moderating role of religious coping (positive, negative, and combined) in the connection of care recipient functional status with diurnal salivary cortisol patterns among dementia family caregivers. Methods Thirty African-American (AA) female dementia caregivers and 48 AA noncaregivers completed the Religious Coping (RCOPE) scale, Activities of Daily Living (ADL) scale and Revised Memory and Behavior Problem checklist (RMBPC) and collected five saliva samples daily (at awakening, 9am, 12pm, 5pm, and 9pm) for two straight days. Results Hierarchical regression tests with mean diurnal cortisol slope as the outcome illustrated surprisingly that higher combined and positive (but not negative) RCOPE scores were associated with increasingly flatter or worse cortisol slope scores for caregivers (but not non-caregivers). Of note, the RCOPE by RMBPC interaction was significant. Among caregivers who reported higher RMBPC scores, higher combined and positive (but not negative) RCOPE scores were unexpectedly associated with increasingly flatter cortisol slopes. Conclusions These results extend current findings by showing that being AA, a caregiver, and high in positive religious coping may predict increased daily stress responses, mainly for those with higher patient behavioral problems. Since religious coping is a central coping strategy for AA caregivers, it is vital that epidemiological assessments of religious coping in health and aging as well as tailored interventions focus on the unique reasons for this disparity.

A Closer Look at Religiosity Among Family Caregivers

“…However, the stress associated with caregiving may also play a significant role in this finding since results supported the notion that African American family caregivers spend extensive hours per week caring for their loved ones (Guinta, Chow, Scharlach, & Dal Santo, 2004), with more than half caring for family members that need assistance with at least four out of six activities of daily living. Therefore, it could be that as caregiving becomes more stressful, these caregivers devoted more time in prayer to cope with the negative appraisal of the situation (Merritt & McCallum, 2013). While prayer and meditation may be effective coping (Haley et al, 2004), it may not result in a more positive evaluation of caregiving.…”

Coping strategies among caregivers of people with Alzheimer disease: a systematic review

“…32,33 Coping strategies Emotion-focused coping was the intervention strategy most frequently mentioned (n = 10). 1,7,15,[17][18][19][20]22,25,30 Seven studies mentioned problem-focused strategies 4,[26][27][28][29]31,33 and one 13 mentioned only dysfunctional coping. Eight studies 4,14,16,21,23,24,32 mentioned two or more strategies at the same time.…”

“…33 One study did not find a significant difference between usual care and the intervention in depressive symptoms in PwAD or their family caregivers. 17 The problem-focused strategies most frequently thinking hard about what steps to take). 23,32…”

“…4,[13][14][15][16][18][19][20][21][22][23][24]28,29,32,33 Other interventions included: a manual-based coping strategy program 25 ; photographs 27 ; Strategies for RelaTives -START intervention 7 ; videos adapted for Alzheimer disease or related dementias (ADRD); exercises and homework; and one telephone coaching call per week. 30 Moreover, one study collected five saliva samples daily for two days 17 ; and another used hypercoagulable D-dimer measurements at 3 time points. 26 The categorization of the articles according the type of the coping strategies is shown in Table 1.…”

Not by Bread Alone: Mobility Experiences, Religion, and Optimism about Future Mobility

“…There is some evidence, however, that optimism can be a double-edged sword. Although religion can promote optimism, optimism that bears little fruit can have negative physical and psychological consequences (Bennett et al 2004;Merritt and McCallum 2013;Peterson 2000). It is thus possible that people who believe that God will provide for them will become particularly discouraged if they experience downward mobility.…”