Full text of DOI:10.1093/geront/40.5.568

The Gerontologist
Copyright 2000 by The Gerontological Society of America
Vol. 40, No. 5, 568–573
Does Type of Disease Matter? Gender
Differences Among Alzheimer’s and Parkinson’s
Disease Spouse Caregivers
Karen Hooker, PhD,1 Margaret Manoogian-O’Dell, MEd,1
Deborah J. Monahan, PhD,2 Leslie D. Frazier, PhD,3 and Kim Shifren, PhD4
Purpose of study: Mental health outcomes are widely re-
ported among spouse caregivers, with wives generally faring
worse than husbands. We hypothesized that gender differ-
ences would not be as strong in a cognitively intact group be-
cause caring for cognitively intact spouses may involve less
severe reciprocity losses. We also examined gender differ-
ences in coping strategies within each group. Design and
method: 175 spouse caregivers for patients with Alzheimer’s
disease (AD; n ϭ 88) and Parkinson’s disease (PD; n ϭ 87)
were interviewed. Participants completed perceived stress
(PSS), depression (CES-D), state anxiety (STAI, Form Y), and
coping strategies (WCCL-R) measures. Results: Wives in the
AD group reported significantly worse mental health out-
comes than husbands, while wives and husbands in the PD
group showed no differences. AD caregiving wives were less
likely than husbands to use problem-focused coping strate-
gies. There were no significant gender differences in either group
for social support or emotion-focused coping. Implications:
Loss of reciprocity in marital relationships may affect women
more negatively than men. Future studies that address under-
lying mechanisms of gender differences and focus on similar
caregiving situations and contexts deserve attention.
Gold, Franz, Reis, & Senneville, 1994). Specifically,
researchers have reported that female caregivers ex-
perience higher levels of burden when compared
with male caregivers (e.g., Barush & Spaid, 1989; Gold
et al., 1994; Miller & Cafasso, 1992; Pruchno & Resch,
1989a; Rose-Rego, Strauss, & Smyth, 1998) and appear
to be at higher risk for depression (e.g. Collins, Stom-
mel, Wang, & Given, 1994; Dura, Haywood-Niler, &
Keicolt-Glaser, 1990; Fitting et al., 1986; Pruchno &
Resch, 1989a; Stuckey, Neundorfer, & Smyth, 1996).
However, differences reported by male and female
caregivers could be due to methodological reasons
such as a greater proportion of women than men in
most studies (Miller, 1990; Miller & Cafasso, 1992)
and less attentiveness to emotions resulting in a lack
of recognition or reporting of distress among male
caregivers (Lutzky & Knight, 1994). The fact that
women report depression more than men is widely
known (e.g. Nolen-Hoeksma, 1987) and implies that
gender differences in caregiving research may have
nothing to do with caregiving per se, but rather with
gender differences seen in the general population.
However, in a comprehensive synthesis of 31 empiri-
cal research articles on gender differences in caregiv-
ing, Yee and Schulz (2000) conclude that female care-
givers report greater excess psychiatric morbidity than
male caregivers when compared with noncaregiving
community samples.
It is also difficult to sort out the possible reasons
behind gender differences when studies have included
mixed caregiver–care recipient relationships (e.g.,
spouses, parent-child, other), mixed disease status of
care recipients, and residential situations that varied
widely (e.g., living with the care recipient and pro-
viding round-the-clock care vs care recipient living
outside the household). Caregiving research has reached
the point where more clearly defined samples are
necessary to advance knowledge further. The pur-
pose of this study was to examine gender differences
among sets of cleanly defined caregiving groups.
Specifically, spouses in two distinct disease catego-
ries, one that involved cognitive impairment and one
Key Words: Mental health, Coping strategies, Women,
Gender differences
Researchers who study caregivers have been in-
trigued by the findings in the caregiving literature that
seem to suggest that men experience fewer negative
outcomes than women regarding mental and physi-
cal health, social participation, and financial stability
when caregiving for older family members (e.g., Barush
& Spaid, 1989; Fitting, Rabins, Lucas, & Eastham, 1986;
This research was supported by the National Institute of Mental Health
(Grant R03-MH46637).
Address correspondence to Karen Hooker, Oregon State University,
Human Development and Family Sciences, 323-A Milam Hall, Corvallis,
OR 97331-5102. E-mail: hookerk@orst.edu
1Department of Human Development and Family Sciences, Oregon
State University, Corvallis, OR.
2School of Social Work, Syracuse University, NY.
3Department of Psychology, Florida International University, Miami.
4Psychology Department, Towson University, MD.
568
The Gerontologist

that involved physical impairment, were utilized. Al-
though our samples are neither large nor nationally
representative of all caregivers, they are appropriate
for an exploratory study and no smaller than many
studies of gendered caregiving in the literature (see
Yee & Schulz, 2000).
The most common disorder in caregiving studies is
dementia (Murrel & Meeks, 1992), and those that
have focused on gender differences are also dispro-
portionately based on dementia caregiving samples
(Yee & Schulz, 2000). It may be that giving care to
someone who is losing his or her mental capacities is
especially burdensome for wife caregivers. One even-
tual outcome of a dementing illness on the marital re-
lationship is that the relationship loses the potential
for reciprocity and shared meaning (Wright 1991,
1993). Women are more distressed in inequitable ex-
changes than men (Sprecher, 1992).
This loss of shared meaning and reciprocity in the
marital relationship may affect overall psychological
well-being more greatly for women than for men. Re-
search on long-term marriages has found that wives’
physical and psychological health are correlated more
highly with marital satisfaction than are husbands’
(Gilford, 1986; Levenson, Carstensen, & Gottman,
1993). Acitelli and Antonucci (1994) provide data to
support this idea, as perceptions of social support in
marriage were more strongly related to the marital
satisfaction and general well-being of wives than of
husbands. This is not to deny the pain that men expe-
rience in losing the reciprocity of social support in
their long-term marital partner. However, based on
the studies cited above, it appears that men may be
able to “compartmentalize” this loss more effectively
so that the negative effect on their overall well-being
is not as damaging as it is for women. This “loss of
shared meaning” hypothesis, and expected gender
differences therein, is a plausible explanation for gender
differences among spouse caregivers caring for a
partner. A comparison caregiving sample that specifi-
cally excluded dementia would be necessary to exam-
ine this idea. Hence, we selected a sample that con-
tained dementia and nondementia groups of spouse
caregivers.
Some researchers have identified the use of coping
skills as a potential explanation for the mental health
differences that women and men express in the care-
giving relationship (Pruchno & Resch, 1989b). In their
study of coping skills utilized among spouses caring
for persons with Alzheimer’s disease, Rose, Strauss,
Neundorfer, Smyth, and Stuckey (1997) reported that
caregivers exhibiting higher distress utilized the emo-
tion-focused coping skill of wishfullness, a strategy
more often utilized by wives. Low-distress caregivers
reported greater use of acceptance and the problem-
focused strategy of instrumental coping, demonstrated
more often by husbands. According to Lutzky and
Knight (1994), gender differences in caregiver distress
appear to be related to differential coping styles, es-
pecially when trying to escape or avoid a problem.
Thus, a secondary focus of our study was to examine
coping strategies for each caregiving sample because
coping is a mediator between stress and mental
health.
We chose to contrast Alzheimer’s disease (AD)
spouse caregivers with Parkinson’s disease (PD)
spouse caregivers. These disease groups were tar-
geted because there are many potentially confound-
ing variables that are controlled for with these popu-
lations. Both AD and PD are chronic diseases in
which later life onset is most common and both show
variable and unpredictable patterns (which can be
stressful for caregivers). Neither disease is one in
which there is immediate danger of death and yet
symptoms manifested in both AD and PD are intru-
sive and would affect a caregiver’s daily routine (e.g.,
Levin & Weiner, 1987; Vernon & Stern, 1988). In ad-
dition, both diseases are progressive and irreversible.
In AD, the most common symptoms are the loss of
cognitive capacities, especially memory. In contrast,
PD produces progressive degeneration of motoric
function and primary symptoms include tremor, ri-
gidity, bradykinesia (slowness in activating move-
ment), stiffness, difficulty with balance, and difficulty
with walking (Delwaide & Gonce, 1988; Stern, 1988).
Although a subset of PD patients develops dementia,
for the purposes of this study, only caregivers of PD
patients without coexisting dementia were included
in order to make a clean comparison of dementia
caregivers with caregivers of spouses exhibiting only
physical disabilities.
In sum, we were primarily interested in determin-
ing if there was a pattern of reported differences in
stress, depression, and anxiety among female and
male caregivers in the AD and PD groups. Because
the literature suggests that gender differences in men-
tal health outcomes may be due to gender differences
in coping differences, a secondary focus of our study
was to determine if women and men utilize signifi-
cantly different sets of specific coping strategies.
Methods
Sample
The analyses presented in this article are based on
data gathered from 175 spouse caregivers (88 AD, 87
PD) recruited from newspaper solicitations, physician
referrals, support groups, and a hospital-based demen-
tia evaluation clinic in upstate New York. Screening cri-
teria of participants selected for the study included:
(a) confirmation of diagnosis of AD or PD; (b) one
year (minimum) since spousal diagnosis of AD or PD;
(c) coresidence of couple in same household; and (d)
intact cognitive function among PD patients. Both
AD and PD patients were screened with the Folstein
Mini-Mental State Exam (MMSE; Folstein, Folstein,
& McHugh, 1975) to determine cognitive abilities.
Three of the PD patients who scored below 24 on the
MMSE were not considered cognitively intact and
were consequently not included in the data analyses.
Alzheimer’s disease group.—As shown in Table 1,
52 (59.1%) of the 88 AD caregivers were female.
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569

Most were Caucasian, 3 were African American, and
1 was Asian. Caregivers ranged in age from 39 to 89
years, with the average age of wife caregivers being
68.1 years (SD ϭ 9.7) and of husband caregivers be-
ing 73.1 years (SD ϭ 8.5). The average age of the fe-
male care recipients was 73.9 years (SD ϭ 10.1) and
the male care recipients was 73.5 years (SD ϭ 9.4),
with ages ranging from 40–93 years. Caregivers had
been married an average of 43.4 years (SD ϭ 13.8),
with wives caring for their spouse an average of 3.8
years (SD ϭ 2.7) and husbands caring for their
spouse an average of 5.3 years (SD ϭ 4.7). Female
caregivers averaged 13.2 years of education (SD ϭ
3.1) and male caregivers averaged 13.4 years of edu-
cation (SD ϭ 4.2).
item from this 14-item scale is: “In the last month,
how often have you been able to control the way you
spend your time?” Response categories are never (4),
almost never (3), sometimes (2), fairly often (1), and
very often (0), with higher scores indicating more
perceived stress. Cronbach’s alpha for the PSS used
in this study was .87.
Depression.—To determine levels of depression
among caregivers, we used the Center for Epidemio-
logical Studies–Depression Scale (CES-D; Radloff,
1977), a 20-item scale used to assess the overall level
of depression experienced in the past week. It has
shown strong psychometric characteristics in many
studies, including studies specifically using samples
of spouse caregivers (e.g., Hooker, Monahan, Shif-
ren, & Hutchinson, 1992; Pruchno & Resch, 1989a).
Higher scores on this scale indicate more depressive
symptomatology. The Cronbach’s alpha for the CES-D
with this sample was .86.
Parkinson’s disease group.—Of the 87 PD caregiv-
ers, 55 (63.2%) were female. All respondents were
Caucasian except for 1 African American. Caregivers’
ages ranged from 41 to 82 years with the average age
of the wife caregivers being 65.9 years (SD ϭ 9.4
years) and of the husband caregivers being 68.7 years
(SD ϭ 7.3). The average age of the female care recip-
ients was 70.2 years (SD ϭ 9.2) and the average age
of the male care recipients was 66.6 years (SD ϭ
7.5), with ages ranging from 45–85 years. Married an
average of 39.6 years (SD ϭ 12.6 years), caregivers
had been caring for their spouses an average of 7.6
years (SD ϭ 7.1 years), with wives caring for 7.7
years (SD ϭ 8.5) and husbands caring for 7.5 years
(SD ϭ 4.8). Female caregivers averaged 14.3 years of
education (SD ϭ 2.7 years) and male caregivers aver-
aged 13.4 years of education (SD ϭ 3.0).
State anxiety.—Spielberger’s State-Trait Anxiety In-
ventory (STAI, Form Y; Spielberger, 1980) was used
to measure state anxiety. Each scale (trait and state)
contains 20 items and has been shown (e.g., Buros,
1978; Levitt, 1967) to have strong psychometric
properties. Higher scores indicate higher levels of
anxiety. Cronbach’s alpha for this sample was .92.
Coping strategies.—A revised version of the Ways
of Coping Checklist (WCCL-R; Vitaliano, Russo, Carr,
Maiuro, & Becker, 1985), which has been shown to
have better psychometric properties than the original
version, was used to assess five coping strategies:
Problem-Focused Coping, Social Support Coping,
Blamed Self, Avoidance, and Wishful Thinking. The
scales Blamed Self, Avoidance, and Wishful Think-
ing were combined into one scale labeled Emotion-
Focused Coping (as done in Vitaliano, DeWolfe,
Maiuro, Russo, & Katon, 1990). By combining these
three coping strategies, we were able to examine the
Measures
Perceived stress.—The Perceived Stress Scale (PSS),
an often-used, psychometrically sound measure de-
signed to assess the degree to which situations are
appraised as stressful (Cohen, Kamarck, & Mermel-
stein, 1983), was utilized for this study. An example
Table 1. Demographic Characteristics and Mental Health Outcomes of Alzheimer’s Disease and Parkinson’s Disease Caregivers
Type of Disease
Alzheimer’s Disease
Parkinson’s Disease
Husbands
Wives
(n ϭ 52)
Husbands
Wives
Variable
(n ϭ 36)
(n ϭ 55)
(n ϭ 32)
Mean age
Mean age of care recipient
Gender (%)
Years of education
Years caregiving
Years married
MMSE of spouse
CES-D
68.1 (9.7)
73.9 (10.1)
52 (59.1)
13.2 (3.1)
3.8 (2.7)
41.1 (14.9)
8.0 (8.4)
16.6 (12.0)
43.0 (13.7)
24.8 (11.3)
73.1 (8.5)
73.5 (9.4)
36 (40.9)
13.4 (4.2)
5.3 (4.7)
46.6 (11.6)
6.5 (8.2)
12.8 (9.3)
37.1 (12.4)
20.0 (7.6)
65.9 (9.4)
70.2 (9.2)
55 (63.2)
14.3 (2.7)
7.7 (8.5)
38.4 (13.2)
27.8 (3.0)
9.1 (7.1)
68.7 (9.7)
66.6 (7.5)
32 (36.8)
13.4 (3.0)
7.5 (4.8)
40.6 (11.6)
27.8 (4.0)
11.1 (8.1)
34.1 (10.7)
18.7 (8.2)
Stateanx
PSS
35.4 (11.4)
19.9 (8.1)
Notes: Values are means with standard deviations in parentheses. MMSE ϭ Mini-Mental State Exam; CES-D ϭ Center for Epidemio-
logic-Depression Scale; Stateanx ϭ State Anxiety Inventory; PSS ϭ Perceived Stress Scale.
570
The Gerontologist

construct of “emotion-focused coping” referred to so
often in the literature (e.g., Folkman & Lazurus, 1980;
Pearlin & Schooler, 1978). Additionally, having a sin-
gle measure for this coping strategy is more parsimo-
nious and reduces the number of variables for ana-
lytic purposes. Cronbach’s alpha for the combined
scale (Emotion-Focused Coping) was .84, Problem-
Focused Coping was .79, and Social Support Coping
was .80.
ferences on stress and anxiety. However, looking
within-group shows how potentially misleading these
overall regressions can be. Specifically, we found
that there were no significant gender effects for care-
givers in the PD group. Wives and husbands did not
differ significantly from one another on depressive
symptomatology, perceived stress, or state anxiety.
However, consistent with our prediction, we found
that there were significant gender differences among
wives and husbands in the AD caregiving group. AD
caregiving wives tended to report greater depression
and were significantly more stressed and anxious
than were AD caregiving husbands.
Procedure
Potential participants who agreed to participate in
the study received a phone call from a member of the
research team to describe the study and answer ques-
tions. Potential participants were also screened dur-
ing this phone conversation to ensure that the study
criteria were met. Once it was determined that par-
ticipants met the study requirements, trained female
doctoral students in psychology interviewed caregiv-
ers in their homes. Interviews typically lasted 1.5 hours
and participants also completed a mail-back instru-
ment on their own that was sent to the investigators
in the week following the interview. Caregivers were
paid $25.00 for their participation in the study.
Data were analyzed using multivariate analysis of
variance (MANOVA) to check for differences be-
tween caregiving groups on demographic variables.
Gender effects were analyzed using sets of regression
analyses. All analyses were conducted using SAS
(SAS Institute, 1985).
Gender and Coping Strategies
As suggested by the literature, a secondary focus
of this study was to examine whether it was plausible
that gender differences in coping strategies underlie dif-
ferences in outcome measures. In this set of regression
analyses, we controlled for number of years caregiving,
age, and socioeconomic status. We were surprised
to find no significant differences in coping strategies
by women or men in either the AD or PD caregiving
groups for social support and emotion-focused coping.
However, in the AD caregiving group, wives reported
using significantly less problem-focused coping than
did husbands (t [78] ϭ 2.04, p Ͻ .05, two-tailed).
Discussion
Many caregiving studies that examine gender dif-
ferences suggest that female caregivers, when com-
pared with male caregivers, experience higher levels
of burden (e.g. Barush & Spaid, 1989; Gold et al.,
1994; Miller & Cafasso, 1992; Pruchno & Resch,
1989a; Rose-Rego et al., 1998) and are at higher risk
for depression (e.g., Collins et al., 1994; Dura et al.,
1990; Fitting et al., 1986; Pruchno & Resch, 1989a;
Results
MANOVA results indicated that AD caregivers
and spouses were significantly older than PD care-
givers and spouses. The PD caregivers had known of
their spouse’s diagnosis for a significantly longer pe-
riod of time than had AD caregivers. There were no
other significant demographic differences between
these groups.
Table 2. Gender Regressed on Mental Health Variables
Gender and Mental Health
Parameter
Estimate (SE)
We predicted gender to have a stronger effect,
with women affected more negatively, in the AD
caregiving group. We ran a series of multiple regres-
sion analyses to examine the effect of gender in the
whole sample (both groups combined) and then to
focus more specifically on gender effects within care-
giving groups. Our intent here was to focus on the ef-
fect of gender on mental health, not to find the best
set of predictors for mental health. Because previous
research, however, had shown that age and number
of years caregiving were important variables to con-
sider, these were included in regressions. Accord-
ingly, the gender effect was partialled for these variables
(i.e., we “controlled for” age and years caregiving).
As shown in Table 2, the effect of gender on men-
tal health is dependent on which caregiving group is
in the analysis. The overall sample regressions (where
groups were combined) showed no gender difference
on depression, but did show significant gender dif-
Dependent Variable
t Value
pa
CES-D: Depression
Overall sample
PD group only
Ϫ1.77 (1.5)
1.22 (1.64)
Ϫ4.83 (2.58)
Ϫ1.16
0.74
Ϫ1.87
.246
.460
.064*
AD group only
PSS: Perceived Stress
Overall sample
PD group only
Ϫ3.49 (1.46)
Ϫ1.46 (1.85)
Ϫ5.76 (2.33)
Ϫ2.38
Ϫ0.79
Ϫ2.47
.018***
.433
.015***
AD group only
Stateanx: State Anxiety
Overall sample
PD group only
Ϫ4.31 (2.01)
Ϫ2.04 (2.55)
Ϫ6.78 (3.25)
Ϫ2.14
Ϫ0.80
Ϫ2.09
.034**
.426
.040**
AD group only
Notes: For overall sample, number of years caregiving, age,
and group were entered into regressions in addition to gender. For
group only, number of years caregiving and age were entered into
the regressions in addition to gender. PD ϭ Parkinson’s disease;
AD ϭ Alzheimer’s disease.
aSignificance tests are two-tailed.
*p Ͻ .10; **p Ͻ .05; ***p Ͻ .02.
Vol. 40, No. 5, 2000
571

Stuckey et al., 1996). However, because of the dis-
tinct delineation of our sample into two specific dis-
ease groups, we found that our data indicated that
only wives in the dementia caregiving group fared
significantly worse than husbands in terms of their
mental health. The data in the nondementia group in-
dicated that female and male spousal caregivers
showed no significant differences in any of the men-
tal health variables. Simply, women appeared to be
no worse off than men in spousal caregiving relation-
ships unless the impairment was cognitive.
The present study utilized samples that were small
and fairly homogeneous in demographic characteris-
tics so that generalization to caregivers of other races
and living in different geographic areas is not possi-
ble. Like many caregiving studies, all of the measures
were based on self-report. These limitations are bal-
anced by the exploratory goals of this initial study
and by the fact that the samples were well defined in
terms of relationship and disease of the impaired care
recipient. In studies where relationship status and/or
disease of the care recipient are not considered (i.e.,
a mixed group of caregivers), there is a potential for a
confused understanding of the possible mechanisms
underlying any gender differences that are mani-
fested. Thus, the clear delineation of groups is an im-
portant strength of our study. Additionally, although
there were fewer men than women in our samples,
we had similar proportions of each sex in each dis-
ease group. We had multiple measures of mental
health, and findings were consistent across measures,
lending weight to our conclusions.
Ultimately the meaning of caregiving is constructed
in the relationships and contexts within which the
care recipients and caregivers interact. Marital rela-
tionships exist and flourish to serve a variety of indi-
vidual and family functions. Anecdotally, many of
our PD caregivers resisted the term “caregiver” prob-
ably because that term has come to signify depen-
dence and loss of reciprocity. None of our AD care-
givers hesitated to use this term for themselves. To
the extent that women are more likely than men to
fuse marital satisfaction with general well-being, they
will be at a disadvantage in the dementia caregiving
scenario because of the loss of reciprocity. This phe-
nomenon may be more common among women, but
is certainly not specific to them. Caregiving research
is becoming increasingly theoretically driven (e.g.
Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995;
Hooker, Monahan, Bowman, Frazier, & Shifren, 1998),
though writings about gender differences generally
remain at the descriptive level. We urge researchers
interested in exploring gender differences to design
research that can address the mechanisms that are
hypothesized to be operating in producing the dif-
ferences and to structure studies that look at gender
differences within similar caregiving situations and
contexts.
Because dementia caregiving studies are dispro-
portionately represented in the literature (Murrell &
Meeks, 1992), they may present a skewed picture of
gender differences in caregiving. Data from the Na-
tional Long-Term Care Channeling Demonstration
(Mui, 1995) also support this interpretation. Wife
caregivers had significantly higher emotional strain
scores than husband caregivers, and in that data set,
husband care recipients had greater cognitive impair-
ment than wife care recipients. A recent study of PD
caregivers for patients with mental impairments as
well as physical impairments showed that mental
symptoms of the PD patients were the most powerful
predictors of distress in caregivers (Aarsland, Larsen,
Karlsen, Lim, & Tandberg, 1999). We suggest that the
negative sequelae of marital relationship losses in the
dementia caregiving context (Wright 1991, 1993) may
spill over into general well-being to a greater extent
for wives than for husbands. Studies that have uti-
lized intensive interviews have hinted at both the
costs of managing emotions when caring for a person
with dementia (MacRae, 1998) and the potential
emotional strain that wives may experience in the
caregiving role when they assume authority positions
over their husbands (Miller, 1987). Clearly, we see a
need for more qualitative research in this area as we
attempt to more fully understand why women and
men differ in mental health outcomes when caring
for a spouse with cognitive impairments.
As a secondary focus of our study, we examined
coping strategies as possible contributing factors to
the gender differences of reported mental health out-
comes of the caregiving experience. Our results indi-
cated that, with the exception of problem-focused
coping among AD caregivers, women and men in
our study did not differ in their use of social support
or emotion-focused coping strategies. Although other
studies have indicated that women caregivers tend to
use more emotion-focused coping methods (Pruchno
& Resch, 1989b) with a consequential higher level of
distress (Pruchno, Burant, & Peters, 1997; Rose et al.,
1997), our data did not substantiate this conclusion.
Rose and colleagues (1997) also found that the use of
problem-focused coping strategies was associated with
lower levels of caregiving distress. Although we did
not find strong evidence that differential coping strat-
egies among female and male caregivers in the AD
group explained the differences in mental health
variables between women and men, practitioners
may want to target caregiving AD wives as good candi-
dates for training in problem-focused coping strategies.
References
Aarsland, D., Larsen, J. P., Karlsen, K., Lim, N. G., & Tandberg, E. (1999).
Mental symptoms in Parkinson’s disease are important contributors to
caregiver distress. International Journal of Geriatric Psychiatry, 10,
866–874.
Acitelli, L. K., & Antonucci, T. C. (1994). Gender difference in the link be-
tween marital support and satisfaction in older couples. Journal of
Personality and Social Psychology, 67, 688–698.
Aneshensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H., & Whitlatch, C. J.
(1995). Profiles in caregiving: The unexpected career. San Diego, CA:
Academic.
Barusch, A. S., & Spaid, W. M. (1989). Gender differences in caregiving:
Why do wives report greater burden? The Gerontologist, 29, 667–676.
Buros, O. K. (1978). The eighth mental measurements year book. Highland
Park, NJ: Grython.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of
perceived stress. Journal of Health and Social Behavior, 24, 385–396.
Collins, C., Stommel, M., Wang, S., & Given, C. W. (1994). Caregiving
572
The Gerontologist

transitions: Changes in depression among family caregivers of relatives
with dementia. Nursing Research, 43, 220–225.
Pruchno, R. A., Burant, C. J., & Peters, N. D. (1997). Coping strategies of
people living in multigenerational households: Effects on well-being.
Psychology and Aging, 12, 115–124.
Pruchno, R. A., & Resch, N. L. (1989a). Husbands and wives as caregivers:
Antecedents of depression and burden. The Gerontologist, 29, 159–
165.
Pruchno, R. A., & Resch, N. L. (1989b). Mental health of caregiving
spouses: Coping as mediator, moderator, or main effect? Psychology
and Aging, 4, 454–463.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for
research in the general population. Applied Psychological Measure-
ment, 1, 385–401.
Rose, S. K., Strauss, M. E., Neundorfer, M. M., Smyth, K. A., & Stuckey,
J. C. (1997). The relationship of self-restraint and distress to coping
among spouses caring for persons with Alzheimer’s disease. Journal of
Applied Gerontology, 16, 91–103.
Rose-Rego, S. K., Strauss, M. E., & Smyth, K. A. (1998). Differences in the
perceived well-being of wives and husbands caring for persons with
Alzheimer’s disease. The Gerontologist, 38, 224–230.
SAS Institute, Inc. (1985). SAS Users Guide: Basics, Version 5 Edition.
Cary, NC: Author.
Spielberger, C. D. (1980). Manual for the State-trait Anxiety Inventory.
Palo Alto: CA: Consulting Psychologists Press.
Sprecher, S. (1992). How men and women expect to feel and behave in re-
sponse to inequity in close relationships. Social Psychology Quarterly,
55, 57–69.
Stern, M. B. (1988). The clinical characteristics of Parkinson’s disease and
Parkinsonian syndromes: Diagnosis and assessment. In M. B. Stern &
H. I. Hurtig (Eds.), The comprehensive management of Parkinson’s dis-
ease (pp. 3–50). New York: PMA Publishing Corp.
Stuckey, J. C., Neundorfer, M. M., & Smyth, K. A. (1996). Burden and well-
being: The same coin or related currency? The Gerontologist, 36, 686–
693.
Vernon, G. M., & Stern, M. B. (1988). The comprehensive approach to
Parkinson’s disease. In M. B. Stern & H. I. Hurtig (Eds.), The compre-
hensive management of Parkinson’s disease (pp. 103–115). New York:
PMA Publishing Corp.
Vitaliano, P. P., DeWolfe, D. J., Maiuro, R. D., Russo, J., & Katon, W.
(1990). Appraised changeability of a stressor as a modifier of the rela-
tionship between coping and depression: A test of the hypothesis of fit.
Journal of Personality and Social Psychology, 59, 582–592.
Vitaliano, P. P., Russo, J., Carr, J. E., Maiuro, R. D., & Becker, J. (1985). The
ways of coping checklist: Revision and psychometric properties. Multi-
variate Behavioral Research, 20, 3–26.
Delwaide, P. J., & Gonce, M. (1988). Pathophysiology of Parkinson’s signs.
In J. Jankovic & E. Tolosa (Eds.), Parkinson’s disease and movement
disorders (pp. 59–73). Baltimore: Urban and Schwarzenberg.
Dura, J. R., Haywood-Niler, E., Kiecolt-Glaser, J. K., (1990). Spousal care-
givers of persons with Alzheimer’s and Parkinson’s disease dementia:
A preliminary comparison. The Gerontologist, 30, 332–336.
Fitting, M., Rabins, P., Lucas, M. J., & Eastham, J. (1986). Caregivers for de-
mentia patients: A comparison of husbands and wives. The Gerontologist,
26, 248–252.
Folkman S., & Lazarus, R. S. (1980). An analysis of coping in a middle-
aged community sample. Journal of Health and Social Behavior, 21,
219–239.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental
state”: A practical method for grading the cognitive state of patients for
the clinician. Journal of Psychiatric Research, 12, 189–198.
Gilford, R. (1986). Marriages in later life. Generations, 10, 16–20.
Gold, D. P., Franz, E., Reis, M., & Senneville, C. (1994). The influence of
emotional awareness and expressiveness on care-giving burden and
health complaints in women and men. Sex Roles, 31, 205–224.
Hooker, K., Monahan, D. J., Bowman, S. R., Frazier, L. D., & Shifren, K.
(1998). Personality counts for a lot: Predictors of mental and physical
health of spouse caregivers in two disease groups. Journal of Gerontol-
ogy: Psychological Sciences, 53B, P73–P85.
Hooker, K., Monahan, D. J., Shifren, K., & Hutchinson, C. (1992). Mental
and physical health of spouse caregivers: The role of personality. Psy-
chology and Aging, 7, 367–375.
Levenson, R. W., Carstensen, L.L., & Gottman, J. M. (1993). Long-term
marriage: Age, gender, and satisfaction. Psychology and Aging, 8,
301–313.
Levin, B. E., & Weiner, W. J. (1987). Psychosocial aspects. In W. O. Koller
(Ed.), Handbook of Parkinson’s disease (pp. 465–474). New York: Mar-
cel Dekker.
Levitt, E. E. (1967). The psychology of anxiety. Indianapolis: Bobbs–
Merrills.
Lutzky, S. M., & Knight, B. G. (1994). Explaining gender differences in care-
giver distress: The roles of emotional attentiveness and coping styles.
Psychology and Aging, 9, 513–519.
MacRae, H. (1998). Managing feelings: Caregiving as emotion work. Re-
search on Aging, 20, 137–160.
Miller, B. (1987). Gender and control among spouses of the cognitively
impaired: A research note. The Gerontologist, 27, 447–453.
Miller, B. (1990). Gender differences in spouse caregiver strain: Socializa-
tion and role explanations. Journal of Marriage and the Family, 52,
311–321.
Wright, L. K. (1991). The impact of Alzheimer’s disease on the marital rela-
tionship. The Gerontologist, 31, 224–237.
Miller, B., & Cafasso, L. (1992). Gender differences in caregiving: Fact or
artifact? The Gerontologist, 32, 498–507.
Mui, A. (1995). Multidimensional predictors of caregiver strain among
older persons caring for frail spouses. Journal of Marriage and the Fam-
ily, 57, 733–740.
Wright, L. K. (1993). Alzheimer’s disease and marriage: An intimate ac-
count. Newbury Park, CA: Sage Publications.
Yee, J. & Schulz, R. (2000). Gender differences in psychiatric morbidity
among family caregivers: A review and analysis. The Gerontologist,
40, 147–164.
Murrell, S. A., & Meeks, S. (1992). Depressive symptoms in older adults:
Predispositions, resources, and life experiences. In K. W. Schaie & M. P.
Lawton (Eds.), Annual review of gerontology and geriatrics (pp. 261–
286). New York: Springer.
Nolen-Hoeksema, S. (1987). Sex differences in unipolar depression: Evi-
dence and theory. Psychological Bulletin, 101, 259–282.
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of
Health and Social Behavior, 19, 2–21.
Received January 20, 2000
Accepted May 19, 2000
Decision Editor: Laurence G. Branch, PhD
Vol. 40, No. 5, 2000
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