Document Type


Date of Degree

Fall 2011

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Buckwalter, Kathleen

First Committee Member

Butcher, Howard

Second Committee Member

Dorfman, Lorraine T

Third Committee Member

Specht, Janet K

Fourth Committee Member

Zimmerman, Miriam B


Although findings from a pilot study indicate that caregivers of persons with dementia (PwD) report feeling stigmatized (Burgener, 2007; Burgener & Buckwalter, 2010), little research has been conducted on the effects of perceived stigma on fostering depressive symptoms among caregivers of PwD. The purpose of this study was to examine the relationship between perceived stigma and depressive symptoms among caregivers of PwD. The Modified Labeling Theory (MLT) developed by Link et. al. (1987; 1989) served as the organizing framework. The design of this study was a mixed methods approach including a descriptive longitudinal design with a qualitative interview. Caregivers of PwD (n=51) were interviewed regarding ethnic background, geographic location (rural and urban), knowledge of dementia, perceived stigma, depressive symptoms, and were asked to rate the extent of PwD's behavioral symptoms, while PwD (n=47) were assessed on their mental ability and disease stage. Caregivers were also asked to share their perceptions of stigma and mood change once their family members were diagnosed. Pearson product-moment correlations and a linear mixed model analysis determined the relationship between variables; for qualitative analysis, a directed approach to content analysis was applied.

Findings indicated that caregivers' perceptions of stigma were significantly associated with depressive symptoms, both at baseline (r = 0.357, p = 0.0175) and over 18 months (p = 0.0045). Results also indicated that caregivers of PwD felt more depressed when they perceived additional stigma (p = 0.0019), regardless of caregiver ethnicity/race and caregivers' reactions in response to PwD memory and behavior problems. Moreover, perceived stigma minimally mediated the effect between caregivers' reactions toward the PwD's memory and behavior problems and depressive symptoms (14.4% decrease in the coefficient). Analysis of the qualitative data provided preliminary validation of the MLT and an in-depth understanding of caregivers' mood change since the diagnosis of their family member. Together our findings suggest that depressive symptoms among caregivers of PwD in response to the stresses of perceived stigma underscore the seriousness of this social problem. There is a need for effective interventions to combat caregivers' perceived stigma in order to enhance their psychological well-being.


Caregiver, Dementia, Depressive Symptoms, Perceived Stigma


ix, 138 pages


Includes bibliographical references (pages 124-138).


Copyright 2011 Megan F. Liu

Included in

Nursing Commons