臺灣博碩士論文加值系統

研究目的：失智症不僅影響患者，也對家庭照顧者造成很大的壓力與重擔，過去研究皆顯示，多數失智症家庭照顧者有睡眠困擾。根據失眠3P模式，失眠或睡眠困擾之發生與維持，是由失眠脆弱特質、壓力事件、不良的因應型態共同造成。由於過去針對失智症照顧的研究重點多集中在探討照顧壓力及身心健康結果的關係，較少將前置因子納入討論，此外，因應型態在照顧壓力與睡眠之間所扮演的角色目前亦無定論。因此，本研究以Spielman(1986)的失眠3P模式為基礎，探討失智症家庭照顧者在照顧壓力之下，其失眠脆弱特質、因應型態、和睡眠的關係，以及失眠脆弱特質及因應型態在失智症照顧壓力與睡眠之間的影響及角色。
研究方法：通過輔仁大學及台北醫學大學附屬醫院聯合人體研究倫理委員會審核後，於衛生福利部雙和醫院失智症中心收案，亦在北部相關社區機構招募，參與者由醫師、心理師、個管師或社工師轉介，由研究人員確認符合條件後進入研究。參與者需填寫量表，包含基本資料、記憶與行為問題檢核表修訂版、因應方法檢核表修訂版、匹茲堡睡眠品質量表、福特壓力下失眠反應量表、短型多軸向疲倦量表、流行病學研究中心憂鬱量表，並配戴腕動儀測量三個晚上的睡眠並填寫睡眠日誌，共79位參與者完成研究。
研究結果：在控制疲倦與憂鬱後，失智症女性家庭照顧者所承受的客觀照顧壓力總量、以及主觀照顧壓力總分，皆能各自透過責備他人因應影響其整體主觀睡眠指標下降；顯示責備他人因應對於失智症女性家庭照顧者有降低主觀睡眠抱怨的作用。加入調節變項後，整體模式中責備他人因應中介不顯著，失眠脆弱特質調節作用顯著，顯示當失眠脆弱特質非常高時，若照顧者越容易因患者記憶症狀而困擾，可預測越多使用逃避因應、主觀入睡耗時下降。
結論與建議：本研究失智症女性家庭照顧者之主觀睡眠抱怨高於客觀測量，與過去研究相似；年齡僅與主觀睡眠參數相關，且壓力下易失眠之脆弱特質得分偏高，並且半數參與者具有憂鬱傾向。在照顧壓力與睡眠之間，責備他人因應會使主觀睡眠抱怨下降，而主觀照顧壓力與失眠脆弱特質會產生交互作用影響女性失智症照顧者的因應型態以及主觀入睡耗時，而高、低失眠脆弱特質的調節作用具有相反的方向性。失眠脆弱特質在失智症女性家庭照顧者之照顧壓力對因應和主觀睡眠的影響上扮演重要角色。

Purpose: The impacts of Dementia is not only on patients but also their family caregivers. For instance, many dementia caregivers had sleep disturbance. According to the 3P model of insomnia, main factors that cause and maintain one’s insomnia and sleep disturbances are sleepless vulnerabilities, stressful events and false coping behaviors. Currently, researches on Dementia caregivers in Taiwan mainly focus on the relationships between the stress of care-taking and health results. Only few of the researches study the predisposing factors (e.g. vulnerability to insomnia). In addition, there has no clear conclusion on the relation between coping and sleep. In our study, we explore the relationship among the insomnia vulnerability, coping, and sleep patterns of Dementia family caregivers, and the role of insomnia vulnerability and coping between the stress and sleep of Dementia family caregiver.
Method: Our study had approved by both Fu Jen Catholic University and Taipei Medical University Joint Institutional Review Board. The 79 participants in this study were referred by the doctors, clinical psychologists and social workers of either Taipei Medical University Shuang-Ho Hospital or community day care centers in northern Taiwan. All the participants completed a set of questionnaire, including demographic data, Revised Memory and Behavior Problems Checklist, Revised Ways of Coping Checklist, Chinese Pittsburgh Sleep Quality Index, Ford Insomnia Response to Stress Test, Multidimensional Fatigue Symptom Inventory-Short Form-Chinese version, Center for Epidemiologic Studies-Depression Scale. Sleep was measured for 3-days intervals using actigraphy and a sleep diary.
Results: Our results showed that the influence of both objective and subjective stress on subjective sleep quality is mediated by the blame of others coping after controlled depression and fatigue. It seems that if caregivers used more blame of others coping, the complaint of sleep latency would decrease. After entered moderator into analysis, there was a significant moderation effect of insomnia vulnerability. The influence of the average reaction rating on both subjective sleep latency and coping is moderated by vulnerability of insomnia. When the Ford Insomnia Response to Stress Test (FIRST) score was high(>34), their average reaction rating could predict more avoidance coping and decreased subjective sleep latency complaint, but avoidance coping couldn’t significant predict subjective sleep latency complaint.
Conclusions: In our study, the reported sleep quality of Dementia female family caregiver participants was higher than the objective sleep measurement. Also, the age of caregivers were significantly correlated with subjective sleep but not objective sleep data. The FIRST average score of the participants was higher than previous studies, and half of them showed tendency toward depression. We found that more blame of others coping might decrease the complaint to sleep quality, and higher interaction of the average reaction rating and FIRST could be used to predict more avoidance coping and less complaint to sleep latency. When further investigated the moderation effect, we found that high and low FIRST presented an opposite direction. However, significance in the moderation effect was only shown under high FIRST conditions. Taken together, this study suggested that vulnerability to insomnia played an important role in caregiving stress, coping, and subjective sleep.

目次
摘要..........................................................................................................................I
目次...........................................................................................................................V
表目錄.......................................................................................................................VII
圖目錄..........................................................................................................................X
第一章、研究緣起與動機.........................................................................................1
第二章、文獻回顧......................................................................................................3
第一節 失智症與失智症照顧之特性...................................................................3
第二節 失眠及其病因模式.................................................................................10
第三節 前置因子──失眠脆弱特質.................................................................14
第四節 促發因子──照顧壓力.........................................................................15
第五節 維持因子──因應型態.........................................................................23
文獻回顧總結.........................................................................................................29
第三章、研究方法.....................................................................................................31
第一節 研究問題與假設.....................................................................................31
第二節 研究程序.................................................................................................33
第三節 研究對象.................................................................................................35
第四節 研究工具.................................................................................................36
第五節 統計方法.................................................................................................45
第四章、結果..............................................................................................................47
第一節 人口學特性描述.....................................................................................47
第二節 量表結果之描述性統計.........................................................................50
第三節 主要變項之相關分析.............................................................................58
第四節 中介效果分析.........................................................................................66
第五節 調節效果分析…….................................................................................71
第六節 調節中介模式分析.................................................................................95
第五章、討論與建議...............................................................................................103
第一節 樣本特性與睡眠變項討論...................................................................103
第二節 主要變項間之相關討論.......................................................................107
第三節 中介效果討論…...................................................................................110
第四節 調節效果討論.......................................................................................113
第五節 調節中介模式討論...............................................................................119
第六節 研究限制…….......................................................................................122
第七節 總結與建議...........................................................................................124
參考文獻.................................................................................................................129
中文文獻...............................................................................................................129
英文文獻...............................................................................................................131
附錄
附錄一 IRB核准證明........................................................................................139
附錄二 基本資料表...........................................................................................142
附錄三 記憶與行為問題檢核表修訂版...........................................................149
附錄四 因應方法檢核表修訂版.......................................................................151
附錄五 中文版匹茲堡睡眠品質量表...............................................................155
附錄六 福特壓力下失眠反應量表...................................................................156
附錄七 中文版短型多軸向疲倦量表...............................................................157
附錄八 流行病學研究中心憂鬱量表...............................................................159
附錄九 睡眠日誌...............................................................................................160
附錄十 腕動儀(Actiwatch)配戴須知................................................................161

表目錄
表2.4.1 三種壓力取向觀點.....................................................................................16
表2.5.1 因應的分類................................................................................................25
表3.4.1 記憶與行為問題檢核表修訂版(RMBPC)內容........................................37
表3.4.2 因應方法檢核表修訂版(RWCCL)內容....................................................39
表4.1.1 照顧者人口學變項之描述統計量.............................................................48
表4.1.2 照顧者人口學變項之百分比.....................................................................48
表4.2.1 RMBPC分數之描述統計量.......................................................................50
表4.2.2 RWCCL分數之描述統計量.......................................................................51
表4.2.3 腕動儀睡眠數據之描述統計量.................................................................52
表4.2.4 腕動儀睡眠數據之百分比.........................................................................52
表4.2.5 CPSQI分數之描述統計量.......................................................................54
表4.2.6 CPSQI分數之百分比................................................................................55
表4.2.7 FIRST、MFSISFC、CESD分數之描述統計量..........................................56
表4.2.8 CESD分數之百分比...................................................................................56
表4.2.9 高、低失眠脆弱特質兩組在各變項上差異之t檢定................................57
表4.3.1 照顧壓力、睡眠、因應型態、失眠脆弱特質、疲倦、憂鬱分數之相關分析結果總表.............................................................................................62
表4.4.1 因應型態平行中介客觀照顧壓力總分對整體主觀睡眠指標的迴歸摘要表...66
表4.4.2 因應型態平行中介客觀照顧壓力總分對整體主觀睡眠指標的總效果、直接效果以及間接效果.............................................................................67
表4.4.3 因應型態平行中介主觀照顧壓力總分對整體主觀睡眠指標的迴歸摘要表....68
表4.4.4 因應型態平行中介主觀照顧壓力總分對整體主觀睡眠指標的總效果、直接效果以及間接效果............................................................................................69
表4.5.1 失眠脆弱特質為憂鬱反應分數預測視為神之祝福因應之調節分析結果.......72
表4.5.2 在不同失眠脆弱特質時憂鬱反應分數對視為神之祝福因應的條件效果…...72
表4.5.3 失眠脆弱特質為總反應/問題平均預測逃避因應之調節分析結果.................74
表4.5.4 在不同失眠脆弱特質時總反應/問題平均對逃避因應的條件效果.................74
表4.5.5 失眠脆弱特質為記憶反應/問題平均預測逃避因應之調節分析結果..............76
表4.5.6 在不同失眠脆弱特質時記憶反應/問題平均對逃避因應的條件效果..............76
表4.5.7 失眠脆弱特質為客觀照顧壓力總分預測主觀入睡耗時之調節分析結果.......78
表4.5.8 在不同失眠脆弱特質時客觀照顧壓力總分對主觀入睡耗時的條件效果........79
表4.5.9 失眠脆弱特質為客觀照顧壓力總分預測整體主觀睡眠指標之調節分析結果......81
表4.5.10 在不同失眠脆弱特質時客觀照顧壓力總分對整體主觀睡眠指標的條件效果....81
表4.5.11 失眠脆弱特質為憂鬱發生分數預測主觀睡眠品質之調節分析結果...............83
表4.5.12 不同失眠脆弱特質時憂鬱發生分數對主觀睡眠品質的條件效果(Percentile法)......83
表4.5.13 失眠脆弱特質為干擾行為發生分數預測主觀入睡耗時之調節分析結果.......84
表4.5.14 在不同失眠脆弱特質時干擾行為發生分數對主觀入睡耗時的條件效果.......84
表4.5.15 失眠脆弱特質為主觀照顧壓力總分預測主觀入睡耗時之調節分析結果........86
表4.5.16 在不同失眠脆弱特質時主觀照顧壓力總分對主觀入睡耗時的條件效果........87
表4.5.17 失眠脆弱特質為記憶反應分數預測主觀入睡耗時之調節分析結果...............89
表4.5.18 在不同失眠脆弱特質時記憶反應分數對主觀入睡耗時的條件效果..............89
表4.5.19 失眠脆弱特質為干擾行為反應分數預測主觀入睡耗時之調節分析結果........91
表4.5.20 在不同失眠脆弱特質時干擾行為反應分數對主觀入睡耗時的條件效果.......91
表4.5.21 失眠脆弱特質為記憶反應/問題平均預測主觀入睡耗時之調節分析結果.......93
表4.5.22 在不同失眠脆弱特質時記憶反應/問題平均對主觀入睡耗時的條件效果......93
表4.6.1 調節中介模式分析內容.............................................................................95
表4.6.2 失眠脆弱特質和責備他人因應在客觀壓力總分預測整體主觀睡眠指標的調節中介模式檢驗結果.........................................................................96
表4.6.3 失眠脆弱特質和責備他人因應在主觀壓力總分預測整體主觀睡眠指標的調節中介模式檢驗結果.........................................................................98
表4.6.4 失眠脆弱特質和逃避因應在記憶/反應問題平均預測主觀入睡耗時的調節中介模式檢驗結果…...........................................................................100
表4.6.5 在不同失眠脆弱特質時記憶反應/問題平均對主觀入睡耗時的條件間接效果...........................................................................................................100
表4.6.6 在不同失眠脆弱特質時記憶反應/問題平均對主觀入睡耗時的條件直接效果...........................................................................................................101
表5.2.1 研究問題一至三之研究假設驗證結果摘要表…...................................107
表5.3.1 研究問題四之研究假設驗證結果摘要表...............................................110
表5.4.1 研究問題五至六之研究假設驗證結果摘要表.......................................113
表5.4.2 調節分析結果列表...................................................................................116
表5.5.1 研究問題七之研究假設驗證結果摘要表...............................................119
 
圖目錄
圖2.2.1 失眠3P模式圖............................................................................................13
圖2.4.1 阿茲海默照顧者壓力概念模式.................................................................19
圖2.4.2 壓力歷程模式.............................................................................................20
圖3.1.1 研究架構圖.................................................................................................33
圖3.2.1 研究及收案流程圖.....................................................................................34
圖4.5.1 憂鬱反應分數對視為神之祝福因應的調節效果圖.................................73
圖4.5.2 總壓力反應/問題平均對逃避因應的調節效果圖....................................75
圖4.5.3 記憶壓力反應/問題平均對逃避因應的調節效果圖................................77
圖4.5.4 客觀照顧壓力總分對主觀入睡耗時的調節效果圖.................................80
圖4.5.5 客觀照顧壓力總分對整體主觀睡眠指標的調節效果圖.........................82
圖4.5.6 干擾行為發生分數對主觀入睡耗時的調節效果圖.................................85
圖4.5.7 主觀照顧壓力總分對主觀入睡耗時的調節效果圖.................................88
圖4.5.8 記憶反應分數對主觀入睡耗時的調節效果圖.........................................90
圖4.5.9 干擾行為反應分數對主觀入睡耗時的調節效果圖.................................92
圖4.5.10記憶反應/問題平均對主觀入睡耗時的調節效果圖..................................94
圖4.6.1 調節中介模式概念圖1..............................................................................95
圖4.6.2 調節中介模式概念圖2..............................................................................97
圖4.6.3 調節中介模式概念圖3..............................................................................98
圖4.6.4 記憶反應/問題平均對主觀入睡耗時的條件間接效果圖......................102
圖4.6.5 記憶反應/問題平均對主觀入睡耗時的條件直接效果圖......................102

中文文獻
孔繁鐘編譯（1999）。DSM-IV精神疾病的診斷與統計。台北市：合記圖書。
行政院主計處（2005）。93年臺灣地區社會發展趨勢調查（健康安全）統計結果。2014年6月1日取自http://win.dgbas.gov.tw/dgbas03/ca/society/index.html
台灣失智症協會（2012）。101~145年臺灣地區失智症人口推計報告。2014年6月1日取自http://www.tada2002.org.tw/tada_know_02.html#01
吳瓊滿（1999）。居家照顧者的負荷。美和專校學報，17，1-14。
吳念儒、杜怡君、林依璇、王鵬智、林慧麗（2009）。中老年女性的社會支持、憂鬱心情、和因應模式與睡眠品質的關係。「台灣心理學會第四十八屆年會」發表之論文，國立台灣大學。
胡海國、林信男（1996）。ICD-10 精神與行為障礙之分類。台北市：精神醫學會。
陳志豪、杜怡君、王鵬智（2015）。以壓力歷程模式探討女性失智症家庭照顧者其正向照顧經驗、因應模式及睡眠之相關研究。輔仁醫學期刊，13（1），27-40。
林詩淳（2007）。慢性失眠者與情境性失眠高危險族群之壓力因應與失眠的關係（碩士論文）。取自http://nccur.lib.nccu.edu.tw/handle/140.119/32485
林奕宇（2015）。女性失智症家庭照顧者之自我效能、積極因應、正向照顧經驗與幸福感之關係研究（未出版之碩士論文）。私立輔仁大學，新北市。
邱兆宏（2004）。壓力與健康：整合分析與模式驗證之研究（碩士論文）。取自http://www.airitilibrary.com/Publication/alDetailedMesh?docid=U0011-2903200613595161
邱麗蓉、謝佳容、蔡欣玲（2007）。失智症病患主要照護者的壓力源、評價和因應行為與健康之相關性探討。精神衛生護理雜誌，2（2），31-44。
邱逸榛、李怡濃、徐文俊、陳獻宗、李佳琳、王鵬智（2010）。失智症家庭照顧者睡眠障礙及其相關因素。護理雜誌，57（4），29-39。
陳冠宇（2011）。失智症家庭照顧者的壓力、因應方式及憂鬱之相關研究（未出版之碩士論文）。私立輔仁大學，新北市。
張慈君、徐亞瑛、陳明岐、邱逸榛、黃惠玲（2012）。失智症家庭照顧者問題處理能力預測因子之探討。護理雜誌，59（6），25-35。
張本聖（審譯）（2014）。變態心理學（原作者：Kring, A. M., Davison, G. C., Neale, J. M., & Johnson, S.）。台北市：雙葉。
湯麗玉、毛家舲、周照芳、陳榮基、劉秀枝（1992）。癡呆症老人照顧者的負荷及其相關因素之探討。護理雜誌，39（3），89-98。
黃正平（2006）。失智症之行為精神症狀。台灣精神醫學，20（1），3-18。
曾雯婷（2007）。探討失智者睡眠障礙與家庭照顧者睡眠品質相關性（碩士論文）。取自http://www.airitilibrary.com/Publication/alDetailedMesh?docid=U0001-19 11200713382000
傅中玲（2008）。台灣失智症現況。台灣老年醫學暨老年學雜誌，3（3），169-181。
詹雅雯（2016）。以壓力反應特性、注意力偏誤、與睡眠監控行為探討不同失眠病程發展之相關因素（未出版之博士論文）。國立政治大學，台北市。
鄭秀容、曾月霞（2008）。居家失智老人家屬照顧者照顧需求及需求被滿足情形之研究。榮總護理，25（4），386-392。
 
英文文獻
American Academy of Sleep Medicine. (2005). The International classification of sleep disorders, second edition (ICSD-2): diagnostic and coding manual. Westchester (IL): American Academy of Sleep Medicine.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA : American Psychiatric Association.
Beaudreau, S. A., Spira, A. P., Gray, H. L., Depp, C. A., Long, J., Rothkopf, M., & Gallagher-Thompson, D. (2008). The relationship between objectively measured sleep disturbance and dementia family caregiver distress and burden. Journal of geriatric psychiatry and neurology, 21(3), 159-165.
Berger, A. M., Wielgus, K. K., Young-McCaughan, S., Fischer, P., Farr, L., & Lee, K. A. (2008). Methodological challenges when using actigraphy in research. Journal of pain and symptom management, 36(2), 191-199.
Bolton, L. R., Harvey, R. D., Grawitch, M. J., & Barber, L. K. (2012). Counterproductive work behaviours in response to emotional exhaustion: A moderated mediational approach. Stress and Health, 28(3), 222-233.
Bonnet, M. H. & Arand, D. L. (1997). Physiological activation in patients with Sleep State Misperception. Psychosomatic Medicine, 59(5), 533-540.
Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193-213.
Cannon, W. B. (1932). The wisdom of the body. New York, NY: Norton & Co.
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of personality and social psychology, 56(2), 267-283.
Castro, C. M., Lee, K. A., Bliwise, D. L., Urizar, G. G., Woodward, S. H., & King, A. C. (2009). Sleep patterns and sleep-related factors between caregiving and non-caregiving women. Behavioral sleep medicine, 7(3), 164-179.
Cheng, S. T., & Chan, A. (2005). The center for epidemiologic studies depression scale in older Chinese: Thresholds for long and short forms. International journal of geriatric psychiatry, 20(5), 465-470.
Chiu, Y. C., Lee, Y. N., Wang, P. C., Chang, T. H., Li, C. L., Hsu, W. C., & Lee, S. H. (2013). Family caregivers' sleep disturbance and its associations with multilevel stressors when caring for patients with dementia. Aging and mental health, DOI: 10.1080/13607863.2013.837141
Chou, C., Yang, C. M., & Chen, H. (2007). Dysfunctional sleep cognition and vulnerability to stress related sleep disturbances. Sleep, 30 (suppl S), A380.
Chung, K. F. & Tang, M. K.(2006). Subjective sleep disturbance and its correlates in middle-aged Hong Kong Chinese women. Maturitas, 53(4), 396-404.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, N.J: L. Erlbaum.
Creese, J., Bédard, M., Brazil, K., & Chambers, L. (2008). Sleep disturbances in spousal caregivers of individuals with Alzheimer's disease. International Psychogeriatrics, 20(1), 149-161.
Cummings, J. L. (1997). The Neuropsychiatric Inventory Assessing psychopathology in dementia patients. Neurology, 48(5), 10-16.
Cupidi, C., Realmuto, S., Coco, G. L., Cinturino, A., Talamanca, S., Arnao, V., Perini, V., D’Amelio, M., Savettieri, G., & Coco, D. L. (2012). Sleep quality in caregivers of patients with Alzheimer's disease and Parkinson's disease and its relationship to quality of life. International Psychogeriatrics, 24(11), 1827-1835.
Dagan, Y., Zinger, Y., & Lavie, P. (1997). Actigraphic sleep monitoring in posttraumatic stress disorder (PTSD) patients. Journal of Psychosomatic Research, 42(6), 577-581.
de Souza, L., Benedito-Silva, A. A., Pires, M. N., Poyares, D., Tufik, S., & Calil, H. M. (2003). Further validation of actigraphy for sleep studies. Sleep, 26(1), 81-85.
Drake, C., Richardson, G., Roehrs, T., Scofield, H., & Roth, T. (2004). Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep, 27(2), 285-292.
Edinger, J. D., & Means, M. K. (2005). Cognitive-behavioral therapy for primary insomnia. Clinical Psychology Review, 25(5), 539-558.
Fernández-Mendoza, J., Vela-Bueno, A., Vgontzas, A. N., Ramos-Platón, M. J., Olavarrieta-Bernardino, S., Bixler, E. O., & De la Cruz-Troca, J. J. (2010). Cognitive-emotional hyperarousal as a premorbid characteristic of individuals vulnerable to insomnia. Psychosomatic medicine, 72(4), 397-403.
Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. Journal of Health and Social Behavior, 21(3), 219-239.
Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. Journal of personality and social psychology, 50(5), 992-1003.
Folkman, S., & Lazarus, R. S. (1988). Manual for the ways of coping questionnaire. Consulting Psychologists Press.
Friedman, E. M., Hayney, M. S., Love, G. D., Urry, H. L., Rosenkranz, M. A., Davidson, R. J., Singer, B. H., & Ryff, C. D. (2005). Social relationships, sleep quality, and interleukin-6 in aging women. Proceedings of the National Academy of Sciences of the United States of America, 102(51), 18757-18762.
Fuh, J. L., Liu, C. Y., Wang, S. J., Wang, H. C., & Liu, H. C. (1999). Revised memory and behavior problems checklist in Taiwanese patients with Alzheimer's disease. International Psychogeriatrics, 11(02), 181-189.
Garnefski, N., Kraaij, V., & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30, 1311–1327.
Gross, R. T., & Borkovec, T. D. (1982). Effects of a cognitive intrusion manipulation on the sleep-onset latency of good sleepers. Behavior Therapy, 13(1), 112-116.
Hall, M., Buysse, D.J., Reynolds, C.F., Kupfer, D.J., & Baum, A. (1996). Stress- related intrusive thoughts disrupt sleep onset and continuity. Sleep Research 25, 163.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilgord press, NY, London.
Hilgeman, M. M., Durkin, D. W., Sun, F., DeCoster, J., Allen, R. S., Gallagher-Thompson, D., & Burgio, L. D. (2009). Testing a theoretical model of the stress process in Alzheimer's caregivers with race as a moderator. The Gerontologist,49(2), 248-261.
Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. Journal of psychosomatic research, 11(2), 213-218.
Jarrin, D. C., Chen, I. Y., Ivers, H., & Morin, C. M. (2014). The role of vulnerability in stress‐related insomnia, social support and coping styles on incidence and persistence of insomnia. Journal of sleep research, 23(6), 681-688.
Kiecolt-Glaser, J. K., Dura, J. R., Speicher, C. E., Trask, O. J., & Glaser, R. (1991). Spousal caregivers of dementia victims: longitudinal changes in immunity and health. Psychosomatic medicine, 53(4), 345-362.
Krohne, H. W. (2001). Stress and coping theories. The international encyclopedia of the social and behavioral sciences, 22, 15163-15170.
Lavie, P., Carmeli, A., Mevorach, L., & Liberman, N. (1991). Sleeping under the threat of the Scud: War-related environmental insomnia. Israel Journal of Medical Sciences, 27, 681-686.
Lazarus, R. S. (1983). The costs and benefits of denial. In S. Breznitz (Ed.), The denial of stress (pp.1-30). New York: International Universities Press.
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York, NY: Springer Press.
Lazarus, R. S., & Folkman, S. (1991). The concept of coping. In Monat, A., & Lazarus, R. S. (Eds.), Stress and coping: An anthology (pp. 189-206). New York, NY: Columbia University Press.
Matud, M. P. (2004). Gender differences in stress and coping styles. Personality and individual differences, 37(7), 1401-1415.
McCurry, S. M., Logsdon, R. G., Teri, L., & Vitiello, M. V. (2007). Sleep disturbances in caregivers of persons with dementia: contributing factors and treatment implications. Sleep medicine reviews, 11(2), 143-153.
McCurry, S. M., Pike, K. C., Vitiello, M. V., Logsdon, R. G., & Teri, L. (2008). Factors associated with concordance and variability of sleep quality in persons with Alzheimer’s disease and their caregivers. Sleep, 31(5), 741-748.
McCurry, S. M., Vitiello, M. V., Gibbons, L. E., Logsdon, R. G., & Teri, L. (2006). Factors associated with caregiver reports of sleep disturbances in persons with dementia. The American journal of geriatric psychiatry, 14(2), 112-120.
McKibbin, C. L., Ancoli-Israel, S., Dimsdale, J., Archuleta, C., von Kanel, R., Mills, P., Paterson, T. L., & Grant, I. (2005). Sleep in spousal caregivers of people with Alzheimer's disease. Sleep, 28(10), 1245-1250.
Merrilees, J., Hubbard, E., Mastick, J., Miller, B. L., & Dowling, G. A. (2014). Sleep in Persons With Frontotemporal Dementia and Their Family Caregivers. Nursing research, 63(2), 129-136.
Mikulincer, M., Florian, V., & Weller, A. (1993). Attachment styles, coping strategies, and posttraumatic psychological distress: the impact of the Gulf War in Israel. Journal of personality and social psychology, 64(5), 817-826.
Morin, C. M., Rodrigue, S., & Ivers, H. I. (2003). Role of stress, arousal, and coping skill in primary insomnia. Psychosomatic medicine, 65, 259-267.
Nazemi, H., & Dager, S. R. (2003). Coping strategies of panic and control subjects undergoing lactate infusion during magnetic resonance imaging confinement. Comprehensive psychiatry, 44(3), 190-197.
Nygaard, H. A.(1988). Stain on caregivers of demented elderly people living at home. Scandinavian journal of primary health care, 6(1), 33-37.
Ory, M. G., Hoffman, R. R., Yee, J. L., Tennstedt, S., & Schulz, R. (1999). Prevalence and impact of caregiving: A detailed comparison between dementia and nondementia caregivers. The Gerontologist, 39(2), 177-186.
Perlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist,30(5), 583-591.
Petersen, H., Kecklund, G., D'onofrio, P., Nilsson, J., & Åkerstedt, T. (2012). Stress vulnerability and the effects of moderate daily stress on sleep polysomno- graphy and subjective sleepiness. Journal of sleep research, 22(1), 50-57.
Pien, L. C., Chu, H., Chen, W. C., Chang, Y. S., Liao, Y. M., Chen, C. H., & Chou, K. R. (2011). Reliability and validity of a Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C). Journal of clinical nursing, 20(15‐16), 2224-2232.
Pillar, G., Malhotra, A., & Lavie, P. (2000). Post-traumatic stress disorder and sleep—what a nightmare!. Sleep Medicine Reviews, 4(2), 183-200.
Pruchno, R. A., & Resch, N. L. (1989). Mental health of caregiving spouses: Coping as mediator, moderator, or main effect?. Psychology and Aging, 4(4), 454-463.
Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied psychological measurement, 1(3), 385-401.
Roepke, S. K., Mausbach, B. T., von Känel, R., Ancoli-Israel, S., Harmell, A. L., Dimsdale, J. E. Aschbacher, K., Mills, P. J., Patterson, T. L., & Grant, I. (2009). Relations between personal mastery, chronic caregiving stress, and multiple dimensions of fatigue. International journal of geriatric psychiatry, 24(12), 1453-1462.
Ross, A., Yang, L., Klagholz, S. D., Wehrlen, L., & Bevans, M. F. (2015). The relationship of health behaviors with sleep and fatigue in transplant caregivers. Psycho‐Oncology, 25, 506-512.
Roth, S., & Cohen, L. J. (1986). Approach, avoidance, and coping with stress. American psychologist, 41(7), 813-819.
Roth, D. R., Gitlin, L. N., Coon, D. W., Gitlin, L. N., Stevens, A. B., Burgio, L. D., Gallagher-Thompson, D., Belle, S. H., & Burns, R. (2003). Psychometric analysis of the Revised Memory and Behavior Problems Checklist: factor structure of occurrence and reaction ratings. Psychology and aging, 18(4), 906-915.
Rowe, M. A., Kairalla, J. A., & McCrae, C. S.(2010). Sleep in dementia caregivers and the effect of a nighttime monitoring system. Journal of Nursing Scholarship, 42(3), 338-347.
Sadeh, A., Keinan, G., & Daon, K. (2004). Effects of stress on sleep: the moderating role of coping style. Health Psychology, 23(5), 542-545.
Sbarra, D. A., & Emery, R. E. (2005). The emotional sequelae of nonmarital relationship dissolution: Analysis of change and intraindividual variability over time. Personal Relationships, 12(2), 213-232.
Schulz, R., & Martire, L. M. (2004). Family caregiving of persons with dementia: prevalence, health effects, and support strategies. The American journal of geriatric psychiatry, 12(3), 240-249.
Selye, H. (1956). The stress of life. New York, NY: McGraw-Hill.
Spielman, A. J. (1986). Assessment of insomnia. Clinical Psychology Review, 6(1), 11-25.
Spielman, A. J., & Glovinsky, P. (1991). The varied nature of insomnia. In Hauri, P. J. (Eds.), Case studies in insomnia (pp. 1-15). New York, NY: Plenum Press.
Stein, K. D., Jacobsen, P. B., Blanchard, C. M., & Thors, C. (2004). Further validation of the multidimensional fatigue symptom inventory-short form. Journal of pain and symptom management, 27(1), 14-23.
Storms, M. D., & Nisbett, R. E. (1970). Insomnia and the attribution process. Journal of personality and social psychology, 16(2), 319-328.
Sweeton, J., & Deerrose, B. (2009). Causal attributions: A review of the past and directions for the future. The New School Psychology Bulletin, 7(1), 31-41.
Taylor, B. J., Irish, L. A., Martire, L. M., Siegle, G. J., Krafty, R. T., Schulz, R., & Hall, M. H. (2015). Avoidant Coping and Poor Sleep Efficiency in Dementia Caregivers. Psychosomatic medicine, 77(9), 1050-1057.
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S., & Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychology and aging, 7(4), 622-631.
Troxel, W. M., Buysse, D. J., Monk, T. H., Begley, A., & Hall, M. (2010). Does social support differentially affect sleep in older adults with versus without insomnia?. Journal of Psychosomatic research, 69(5), 459-466.
Tsai, P. S., Wang, S. Y., Wang, M. Y., Su, C. T., Yang, T. T., Huang, C. J., & Fang, S. C. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943-1952.
Van Egeren, L., Haynes, S. N., Franzen, M., & Hamilton, J. (1983). Presleep cognitions and attributions in sleep-onset insomnia. Journal of Behavioral Medicine, 6(2), 217-232.
Vitaliano, P. P. (1991). Revised ways of coping checklist (RWCCL) and appraisal dimensions scale (ADS) manual. Seattle: University of Washington.
Wang, P. C. (2012). Screening Instruments of Sleep Disorders: Actigraphy. In Introduction to Modern Sleep Technology (pp. 33-48). Springer.
World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva, Switzerland: World Health Organization.
World Health Organization & Alzheimer’s Disease International (2012). Dementia: a public health priority. ISBN:978-92-4-156445-8
Yang, C. M., Spielman, A. J., & Glovinsky, P. (2006). Nonpharmacologic strategies in the management of insomnia. Psychiatric Clinics of North America, 29(4), 895-919.
Zarit, S. H., Todd, P. A., & Zarit, J. M. (1986). Subjective burden of husbands and wives as caregivers: a longitudinal study. The Gerontologist, 26(3), 260-266.