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. 2025 Dec 5:20:e20250367.
doi: 10.1590/1980-5764-DN-2025-0367. eCollection 2026.

Coping, stress, and burden among caregivers of older adults with Alzheimer's: a network analysis

Izabela Vitória Pereira Marques  1 , Chia Chen Lin  2 , Eduardo Quadros da Silva  1 , Bruno Fernando de Souza Tavares  1 , Talita Cezareti da Silva  3 , José Roberto Andrade do Nascimento  4 , Daniel Vicentini de Oliveira  5
Affiliations

Coping, stress, and burden among caregivers of older adults with Alzheimer's: a network analysis

Izabela Vitória Pereira Marques et al. Dement Neuropsychol. .

Abstract
in English, Portuguese

Caregiving for older adults with Alzheimer's disease (AD) has intensified in Brazil, highlighting the emotional and physical burden faced by caregivers. Understanding the factors contributing to this burden is essential for developing more effective and sustainable support strategies.

Objective: The aim of this study was to analyze the relationship between coping strategies, caregiver burden, and perceived stress using network analysis.

Methods: This was a quantitative, analytical, observational, and cross-sectional study with a final sample of 126 formal and informal caregivers from different regions of Brazil. Data were collected via an online questionnaire, using the Perceived Stress Scale, Zarit Burden Interview, and the Coping Strategies Inventory (EMEP). Statistical analysis was conducted with JASP software. Data showed non-parametric distribution, and Spearman's correlation and LASSO network analysis were applied.

Results: Results revealed weak but significant positive correlations (p<0.05; r<0.40) among coping domains. Problem-focused coping was negatively correlated with burden (r=-0.34) and stress (r=-0.60), while emotion-focused coping showed positive correlations with both (r=0.40; r=0.42). Religious/fantasy coping and seeking social support were also positively associated with burden. The LASSO network highlighted emotion-focused and religious coping as central nodes. Problem-focused coping was negatively associated with stress, while emotional and religious strategies were linked to increased burden and stress. Centrality indices indicated emotional coping and religious practices as highly influential.

Conclusion: These findings underscore the protective role of problem-focused coping and the need for targeted interventions to foster adaptive strategies and support caregiver well-being.

O cuidado de idosos com doença de Alzheimer tem se intensificado no Brasil, revelando a sobrecarga emocional e física enfrentada pelos cuidadores.

Objetivo: Analisar a relação entre estratégias de enfrentamento, sobrecarga do cuidador e estresse percebido utilizando análise de redes.

Métodos: Estudo transversal, com amostra final de 126 cuidadores formais e informais de diferentes regiões do Brasil. Os dados foram coletados por meio da Escala de Estresse Percebido, da Escala de Sobrecarga de Zarit e do Inventário de Estratégias de Enfrentamento. A análise estatística foi realizada pela correlação de Spearman e a análise de redes LASSO.

Resultados: O enfrentamento focado no problema apresentou correlação negativa com a sobrecarga (r=-0,34) e com o estresse (r=-0,60), enquanto o enfrentamento focado na emoção apresentou correlação positiva com ambos (r=0,40; r=0,42). As práticas religiosas/fantasiosas e a busca por suporte social também se associaram positivamente à sobrecarga. A análise de rede LASSO destacou o enfrentamento focado na emoção e o enfrentamento religioso como nós centrais. O enfrentamento focado no problema esteve negativamente associado ao estresse, enquanto as estratégias emocionais e religiosas se relacionaram ao aumento da sobrecarga e do estresse. Os índices de centralidade indicaram o enfrentamento emocional e as práticas religiosas como altamente influentes.

Conclusão: Os achados reforçam o papel protetivo do enfrentamento focado no problema e a necessidade de intervenções direcionadas para promover estratégias adaptativas e apoiar o bem-estar dos cuidadores.

Keywords: Aging; Dementia; Home Care Services; Subjective Stress.

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Conflict of interest statement

Disclosure: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Network structure (n=126) of coping strategy domains, stress, and burden level. Brazil, 2023.
Figure 2
Figure 2. Betweenness, closeness, strength of connections, and expected influence of the network variables. Brazil, 2023.
See this image and copyright information in PMC

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