The present study contributes to the scarce literature on personality-health links among caregivers by systematically examining the role of two theoretically implicated mediators: caregiver strain and multi-domain self-efficacy. In addition to replicating the mediating role of strain (Gallant & Connell, 2003
; Hooker et al., 1992
; Hooker et al., 1998
), our study is the first to demonstrate a significant role of self-efficacy. We also add to the small body of studies that examined the full range of five-factor traits among caregivers (Hollis-Sawyer, 2003
; Hooker, Frazier, & Monahan, 1994
; Renzetti et al., 2001
), and our study is the first to use comprehensive and well-validated measures of both personality traits and subjective health. Finally, the present sample is about 50% larger than those used in previous studies and fairly homogenous in demographic structure and caregiving experience, which addresses concerns about power and sample heterogeneity in prior research.
Overall, the observed associations between caregiver personality and subjective health converge with those found in the general population. Consistent with prior studies, mental and physical health were positively associated with extraversion and negatively associated with neuroticism. Our findings further suggest that whereas conscientiousness is linked to both mental and physical aspects of subjective health, agreeableness and openness are selectively linked to mental and physical health, respectively. In terms of effect size, the observed strength of the associations resembles those reported by Löckenhoff and colleagues (Löckenhoff, Sutin, et al., 2008
) for a general population sample drawn from the Baltimore Longitudinal Study of Aging, with moderate effects for neuroticism and conscientiousness but fairly small effects for the remaining traits. In contrast to prior studies, however, age did not moderate the associations between personality and subjective health. Conceivably, the shared caregiving responsibilities in the present sample may have served as a homogenizing force that overshadowed any differences across age groups.
Consistent with our hypotheses, both caregiver strain and multi-domain self-efficacy were found to play a role in mediating the observed associations between personality and health. In fact, the role of multi-domain self-efficacy was much more pervasive than we had hypothesized. It mediated not only the effects of neuroticism and conscientiousness but every single significant association between personality traits and subjective health that was observed in the correlational analyses. This suggests that one reason why personality traits matter for caregivers’ mental and physical health is that they influence caregivers’ perceptions of their ability to successfully manage the challenges of everyday life. With regard to specific personality dimensions, efficacy beliefs may reflect emotion-regulatory skills, dispositional mood, and energy levels (as captured by neuroticism and extraversion), but also interpersonal skills (agreeableness), organization and self-management (conscientiousness), as well as the ability to accommodate to novel situations (openness).
In this context, it is important to note that we used a comprehensive self-efficacy scale (Rodin & McAvay, 1992
) that spans multiple domains of functioning ranging from health and safety to finances and interpersonal relationships. Given the all-encompassing influence of the caregiving experience on virtually all aspects of life (Pearlin et al., 1990
), this approach may be at least as relevant for understanding caregiver well-being as the use of caregiving-specific self-efficacy scales (Fortinsky, Kercher, & Burant, 2002
; Rabinowitz et al., 2007
). Consistent with the view that the multi-domain efficacy measure captures some caregiving-related variance, we observed a moderate negative association with caregiver strain in the present sample. Nevertheless, caregiving-specific self-efficacy measures are of course better suited to capture caregivers’ responses to the unique challenges of caring for a dependent loved one. Ideally, future research should include multidomain and caregiving-specific assessments of both strain and self-efficacy to explore their relative association with caregivers’ personality traits and health-related outcomes. At a more general level, the pronounced association between multi-domain self-efficacy and caregivers’ subjective health highlights the need for further research that investigates protective and resilience-promoting factors in caregiving contexts.
In contrast to the pervasive role of multi-domain self-efficacy, caregiver strain selectively mediated the association of neuroticism and agreeableness with subjective mental health. This suggests that the stress response and associated detriments in mental health are not only positively associated with caregivers’ general propensity to experience negative emotions (i.e., neuroticism), but also negatively associated with altruistic and cooperative tendencies (i.e., agreeableness). Contrary to our hypotheses, caregiver strain did not mediate the effects of extraversion on mental health. This could be attributable to the fact that extraversion is focused on positive emotions whereas caregiver strain is selectively focused on negative emotional responses.
Importantly, only three of the eight mediation models were indicative of full mediation. The remaining models merely suggested partial mediation. Thus, although multi-domain self-efficacy and strain appear to explain some of the associations of personality traits with caregiver health, they do not fully account for the observed findings. Also, as in previous studies (e.g., Monahan & Hooker, 1995
; Hooker et al., 1998
; Bookwala & Schulz, 1998
), the percentage of variance in caregiver health that was explained by personality traits was only small to moderate in size. To address this issue, future research should include additional mediators that have been implicated in prior research (including coping and health behaviors; Gallant & Connell, 2003
; Hooker et al., 1992
; Hooker et al., 1998
; Kim et al., 2005
; Patrick & Hayden, 1999
) and identify previously overlooked variables (e.g., resilience-related concepts such as mindfulness) that may play a mediating role as well.
In interpreting the results of this study, several important limitations need to be acknowledged. First, our data are cross-sectional in nature and do not allow for the testing of temporal relationships or causal hypotheses. So far, only a handful of studies have examined longitudinal associations between personality traits and caregiver health (Jang et al., 2004
; Nijboer et al., 2001
; Rabins et al., 1990
; Reis et al., 1994
), and their results are equivocal. Ideally, future research would assess personality traits at the onset of the caregiving relationship and examine lagged effects on potential mediators and subjective health.
Another limitation is the exclusive focus on subjective health ratings. Although subjective health has been linked to a plethora of objective health outcomes (Benyamini & Idler, 1999
; Branch & Ku, 1989
; Idler & Benyamini, 1997
; Kaplan, Strawbridge, Camacho, & Cohen, 1993
; Maddox & Douglass, 1973
), future studies need to include measures of both objective and subjective health. Moreover, more comprehensive measures of care recipients’ characteristics such as behavioral problems and required hours of care should be considered.
Finally, there are some concerns about the nature of the sample. Although the present sample is fairly representative of the population in the Medicare PCDC study area, its selective nature does not reflect the racial and ethnic diversity of the U.S. population. Importantly, a recent meta-analysis indicates that stress and resilience in response to caregiving-related demands differ across ethnic groups (Pinquart & Sörensen, 2005
). Future studies should therefore aim to recruit more diverse samples with particular emphasis on the inclusion of racial/ethnic minorities. Another sampling consideration that is harder to address concerns the possibility that individuals self-select into the caregiving role based on their personality characteristics (Anthony-Bergstone, Gatz, & Zarit, 1988
). To address this issue, more information about the conditions of entry into the caregiving role as well as the availability of alternative caregivers is needed.
In spite of these limitations, the present study makes important contributions to the scarce literature on personality-health links among caregivers by addressing methodological limitations of previous studies and by systematically examining the mediating role of caregiver strain and multi-domain self-efficacy. Because personality traits are relatively stable over time (Roberts, Walton, & Viechtbauer, 2006
; Terracciano et al., 2005
), personality assessments can help in identifying at-risk populations for health-promoting interventions. At the same time, a better understanding of mediators can inform the development of specific intervention strategies. Our findings suggest that interventions ought to focus on modifying self-efficacy beliefs, which are susceptible to change as a result of verbal instruction, personal experience, and observation of others (Bandura, 1977
). As the experience of caregiving can make vulnerable individuals feel particularly ineffective and reduce sense of mastery (Skaff, Pearlin, & Mullan, 1996
), setting challenging but highly achievable goals in caregiving or leisure contexts could have salutary effects. Similarly, caregiver strain may be mitigated through social support, respite care, and other services (Wolff et al., 2009
). Thus, although each caregiver has a relatively stable profile of personality traits that predisposes towards or protects from caregiving-related health risks, the mechanisms by which personality translates into subjective health can be addressed through appropriate interventions. To maximize success, such interventions could be tailored to the individual personality profile of a given care provider. For instance, caregivers high in extraversion might benefit more from social support groups, whereas those low in extraversion might prefer one-on-one settings. Thus, our findings set the stage for future research exploring how information about caregivers’ personality traits can be leveraged to identify at-risk individuals and guide individually tailored strategies for intervention.