Studies have found that “finding a balance point” is a culturally sensitive concept that influences the mental health outcomes and role strain for family caregiver of patients with dementia. It would be important to identify families who were not doing well in balancing between competing needs and at risk for poor mental health outcomes, specifically risk for depression. At the same time, the influence of “poor balance between competing needs” on the trajectories of health outcomes and role strain for family caregivers will need to be revealed. Therefore, the purposes of this study is to 1) identify the best cutoffs score in “finding a balance point” scale for predicting risk for depression; 2) explore the distinct courses, their levels and rate of changes for trajectories of risk for depression, health outcomes and roles strain for family caregivers of patients with dementia; 3) using the best cutoffs score to explore the influence of “finding a balance point” on the odds of following various paths of health outcomes and role strains.

 

Description correlational longitudinal design will be implemented for this study. A sample size of 200 will be obtained and followed for three years. In the first year, the best cutoff score for predicting risk for depression will be tentatively identified according to maximization of sensitivity and specificity. During the second and third year, the second and third wave of data will be collected. In the second year, the sensitivity and specificity of the cutoff scores of “finding a balance point” scale in predicting risk for depression will be re-examined using two waves of data. In the third year, the influences of “poor balance”, that identified by the “finding a balance point” scale with the best cutoff score, on longitudinal trajectories of caregiver’s risk for depression, health outcomes and role strain in comparison with those without “poor balance” will be explored.

 

 "Finding a balance point" scale developed by PI previously will be used to measure the balance between competing needs of the family caregivers, Role Strain Scale of Family Caregiving Inventory (FCI) will be used to measure caregiver role strain, health outcomes of the family caregiver will be measured by the Medical Outcomes Study Short Form (SF-36) and the Chinese version of the Center for Epidemiologic Studies Depression Scale (CES-D) will measure risk for depression, covariates will be measured using Caregiving Activity, Preparedness, Mutuality, Predictability, and Rewards scales of FCI.

 

Base on the suggested cutoff on CES-D from previous studies, the Receiver Operating Characteristics (ROC) analyses will be to be obtained against various cutoff scores on “finding a balance point” scale using the first two waves of data. Sensitivity and specificity for various cutoffs scores of “finding a balance point” scale were compared. Latent class growth modeling will be used to identify distinctive groups of individual trajectories of risk for depression, health outcomes and role strain and the effects of the “balance group” (whether the family caregiver are categorized as having poor balance or not) within the population. Based on results of this study, high risks family caregivers for depression in Taiwan can be identified earlier. Culturally sensitive nursing interventions can then be developed to facilitate balance between competing needs for these high risk family caregivers.