Clinical Scholarship The Influence of Caregiver Mastery on Depressive Symptoms Paula R. Sherwood, Barbara A. Given, Charles W. Given, Rachel F. Schiffman, Daniel L. Murman, Alexander von Eye, Mary Lovely, Lisa R. Rogers, Sandy Remer Purpose: The purpose of this study was to explore how the relationship between care re- cipients’ problem behaviors and caregivers’ depressive symptoms varies as a function of caregiver mastery, controlling for the effects of caregiver age, gender, and relationship to the care recipient in caregivers of people with primary malignant brain tumor (PMBT). Design: A cross-sectional design was used to gather data via telephone interviews from 95 caregivers of people with primary malignant brain tumor, recruited from 2003 to 2004 from a brain tumor treatment center, two national support groups, and a statewide cancer registry. Methods: Measures for the study included the Neuropsychiatric Inventory-Questionnaire, Caregiver Mastery, and the Center for Epidemiologic Studies–Depression. A stepwise re- gression procedure was used to evaluate potential moderating and mediating relationships. Findings: Data did not indicate that caregiver mastery was a moderating variable. The anal- ysis showed caregiver mastery as a partial mediator, with both a direct effect of care recipi- ents’ problem behaviors on caregivers’ depressive symptoms and an indirect effect through caregiver mastery. Concerning the indirect effect, care recipients’ problem behaviors were related to lower levels of caregiver mastery, which in turn were related to more depressive symptoms in caregivers. Conclusions: Findings showed a link between care recipients’ problem behaviors and care- givers’ depressive symptoms, a relationship that has not been well established in oncology. This association indicates one mechanism through which problem behaviors in the care recipient might lead to caregiver depressive symptoms. JOURNAL OF NURSING SCHOLARSHIP, 2007; 39:3, 249–255. C 2007 SIGMA THETA TAU INTERNATIONAL. [Key words: caregiver, oncology, mastery, mediating, brain tumor] * * * M uch caregiver research has been devoted to de- scribing changes in the physical and emotional health of family members who provide care to someone with a chronic illness. Outcomes such as depres- sive symptoms, perceived burden, anxiety, and changes in immune function have all been linked to providing care (Kiecolt-Glaser et al., 2003; Kozachik et al., 2001; Pinquart & S¨ orensen, 2004). Investigators have also identified spe- cific care demands, such as care recipients’ behavioral and cognitive problems that are strongly associated with changes in caregivers’ health (Pinquart & S ¨ orensen, 2004). Not all caregivers respond similarly to the challenges of provid- ing care. For example, in the presence of similar stressors, some caregivers develop high levels of depressive symptoms, but others do not (Mahoney, Regan, Katona, & Livingston, 2005). Caregiver characteristics such as age, gender, and re- lationship to the care recipient have been shown to help identify caregivers at risk for negative consequences as a result of providing care (Bookwala & Schulz, 2000; Paula R. Sherwood, RN, PhD, CNRN, Alpha Psi , Assistant Professor, Uni- versity of Pittsburgh School of Nursing, Pittsburgh, PA; Barbara A. Given, RN, PhD, FAAN, Alpha Psi , University Distinguished Professor; College of Nursing, Michigan State University, East Lansing, MI; Charles W. Given, PhD, Professor; College of Medicine, Michigan State University, East Lans- ing, MI; Rachel F. Schiffman, RN, PhD, FAAN, Alpha Psi and Eta Nu, Professor and Associate Dean for Research; College of Nursing, Univer- sity of Wisconsin-Milwaukee, WI; Daniel L. Murman, MD, MS, Associate Professor; Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE; Alexander von Eye, PhD, Professor; Depart- ment of Psychology, East Lansing, MI; Mary Lovely, RN, PhD, Medical Information Specialist, Supported by the Gullikson Foundation; National Brain Tumor Foundation, CA; Lisa R. Rogers, DO, Professor of Neurol- ogy, University of Michigan, Ann Arbor, MI; Sandy Remer, RN, BS, OCN  , CCRP, Neuro-Oncology Coordinator; Josephine Ford Cancer Center, Henry Ford Hospital, Detroit, MI. Support for the project was provided by the National Institute of Nursing Research (F31NR8069); Oncology Nursing Society, the American Brain Tumor Association, American Cancer Society, Sigma Theta Tau International, Mary Margaret Walther Cancer Institute, and Michigan State University College of Nursing. Correspondence to Dr. Sherwood, University of Pittsburgh, School of Nursing, 336 Victoria Bldg, 3500 Victoria St.; Pittsburgh, PA 15261. E-mail: prs11@pitt.edu Accepted for publication April 5, 2007. Journal of Nursing Scholarship Third Quarter 2007 249