Coping strategies, anxiety and depression in caregivers of people with Alzheimer’s disease Claudia Cooper 1 * , Cornelius Katona 2 , Martin Orrell 1 and Gill Livingston 1 1 Department of Mental Health Sciences, University College London, UK 2 Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent, UK SUMMARY Objectives There have been few longitudinal studies investigating the impact of coping on psychological morbidity in caregivers of people with dementia. Findings have been inconsistent and little attention has been paid to anxiety in caregivers. We explored the hypothesis that the relationship between caregiver burden and anxiety and depression is mediated by coping style. Methods As part of the LASER-AD study, 93 (73.8%) people with Alzheimer’s disease and their family caregivers recruited at baseline were re-interviewed 1 year later. Sampling aimed to ensure that the participants were representative of people living in the UK with Alzheimer’s disease in terms of dementia severity, gender and care setting. We used the Hospital Anxiety and Depression Scale, the Zarit Burden scale and the Brief COPE to measure coping strategies. Results Using fewer emotion-focused strategies and more problem-focused strategies (but not dysfunctional strategies) mediated the relationship between caregiver burden and anxiety a year later, after controlling for potential confounders, in a well-fitting structural equation model (x 2 ¼ 0.93, df ¼ 3, p ¼ 0.82; NFI ¼ 1.0, RFI ¼ 0.97, IFI ¼ 1.0, TLI ¼ 1.1, RMSEA ¼ 0.0). Using fewer emotion focused strategies also predicted higher psychological morbidity in general. The hypothesised relationship was not proved for depression. Conclusions Using emotion-focussed coping strategies in response to caregiver burden seemed to protect caregivers from developing higher anxiety levels a year later; however using problem-focussed strategies did not. Our results suggest that a psychological intervention package to emphasise emotion-focused coping may be a rational approach to reduce anxiety in dementia caregivers. Studies are needed to test such interventions. Copyright # 2008 John Wiley & Sons, Ltd. key words — caregiver; dementia; coping strategies; anxiety INTRODUCTION Caregivers of people with dementia experience high rates of clinically significant anxiety (10–35%) and depression (10–34%) (Cooper et al., 2007a), but a focus on depression has meant that little is known about risk factors for caregiver anxiety. Coping strategies are behavioural and psychological efforts employed to overcome, tolerate or reduce the impact of stressful events (Figure 1 describes strategy types). Using more dysfunctional (Cooper et al., 2006; Mausbach et al., 2006) and fewer emotion-focused coping strategies (Morano, 2003) have been shown to mediate the relationship between primary stressors and dementia caregiver depression or anxiety cross- sectionally, but there are few longitudinal studies determining the impact of coping on future morbidity. Goode et al. (1998) found that approach (problem- and emotion-focused) coping mediated an effect between primary stressors and decreased depression a year later; and Vitaliano et al. (1991) that emotion-focused but not problem-focused strategies predicted burden 15–18 months later. Vedhara et al. (2001) reported in a small longitudinal study of dementia caregivers recruited from clinical studies that dysfunctional, but not emotion- or problem-focused coping strategies predicted greater anxiety and depression on a INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2008; 23: 929–936. Published online 27 March 2008 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/gps.2007 *Correspondence to: Dr C. Cooper, Department of Mental Health Sciences, University College London, Hampstead Campus, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK. E-mail: c.cooper@medsch.ucl.ac.uk Copyright # 2008 John Wiley & Sons, Ltd. Received: 3 August 2007 Accepted 29 January 2008