Caregiver strain among African American and Caucasian family members caring for children with emotional and behavioral problems: the role of race

Abstract

Caregiver strain is a complex phenomenon with the potential to have a deleterious effect on caregivers’ ability to perform their caregiving duties. Previous research has suggests that differences in race influence caregivers’ reported level of strain, with African Americans tending to report lower levels of strain than their Caucasian counterpart. The present study examines racial differences in and measurement-related issues regarding caregiver strain, as measured by the Caregiver Strain Questionnaire (Brannan, Heflinger, & Bickman, 1997), as well as the contribution of caregiver substance use and mental health problems to strain. Regression analysis was used to examine objective and subjective caregiver strain outcomes collected from Medicaid family caregivers (N = 1089) of children with emotional and behavioral problems from four sites (New York, Ohio, Pennsylvania, Tennessee/Mississippi). Selection of explanatory variables was guided primarily by the Double ABCX Model of adaptation. Propensity score methods were used to minimize confounds among race, demographic variables, and ABCX constructs. The propensity score adjustment strategies limit comparison groups and stratify on the propensity score to balance observed risks between African Americans (n = 414) and Caucasians (n = 675). Ordinary least squares regression results using the unadjusted covariates showed that African American caregivers reported less strain than Caucasians. However, after using propensity score analysis, African American caregivers with similar risk profiles to Caucasian caregivers were shown to report similar levels of caregiver strain. Although there were no differences in perceptions by race, caregivers with higher levels of self-reported mental health problems reported more strain; and caregivers’ substance abuse problems were not a significant predictor of strain for African Americans or Caucasians. Results from this study provide evidence that perceptions of caregiver strain when caring for a child with emotional and behavioral problems are similar for African Americans and Caucasians when differences in observed covariates are controlled, demonstrating that caregiver strain may be universal among U.S. caregivers. These results warrant additional study to determine if these differences are true of other child and adolescent populations.