Understanding the Psychological Well-Being of Black American Family Caregivers: A Multi-Method Investigation of Choice, Stressors, Coping, Adverse Psychological Impacts, and Meaning-Making

The psychological well-being of 53 million American family caregivers, individuals who support their families and friends with care needs (e.g., cancer survivors, elderly relatives), is a significant public health issue. As caregivers encounter multi-dimensional stressors associated with caregiving demands, caregiving leads to adverse psychological impacts (e.g., loneliness) while providing an opportunity to make meaning in life. Across racial groups, Black/African American populations have the highest prevalence of caregiving and distinct caregiving characteristics (e.g., high intensity, providing care for cultural reasons). However, Black caregivers remain underrepresented in research despite Black populations being disproportionately affected by the burdens of multiple serious illnesses requiring intensive care (e.g., cancer, dementia).This dissertation takes a multi-method approach to examine Black caregivers’ caregiving and stress-coping experiences. In Study 1, using the 2020 Caregiving in the U.S. Study data (n=1,000), I examined associations among caregivers’ choice, purpose, emotional stress, and loneliness and explored the racial differences through ordinal logistic regression analyses. In Study 2, through in-depth interviews with twelve Black cancer caregivers, I explored their perceptions of caregiver roles, choice, stressful experiences, and meaning-making. In Study 1, Black caregivers (n=199) reported lower loneliness and emotional stress levels than White caregivers (n=801), controlling for caregiving (e.g., caregiving hours) and sociodemographic (e.g., sex) characteristics. Reporting having no choice and a lower sense of purpose were significantly associated with higher levels of loneliness and emotional stress. No significant moderation effect of race on these associations was found. In Study 2, most Black caregivers reported that their caregiver roles aligned with community norms, yet this perception was not universal. Multiple personal and family factors (e.g., reciprocity) influenced caregivers’ choices. Caregivers identified multiple stressors (e.g., financial stress) and psychological impacts (e.g., powerlessness). Many identified effective coping strategies (e.g., practicing self-care, utilizing social support) and positive meanings from caregiving (e.g., life lessons). Taken together, this dissertation highlights the resilience of Black caregivers, affirms the necessity of understanding the heterogeneity in caregiving across and within racial groups, and advocates for greater inclusion of diverse caregivers in research and supportive, personalized interventions for caregivers in the context of cancer and other serious illnesses.