The proposed study is a controlled, longitudinal trial of two preventive mutual support interventions for adult family caregivers: a cognitive adaptation intervention and a conventional educational-support self-help intervention. Evaluation of the cognitive adaptation intervention provides an empirical test of Taylor's (1983) model of adjustment to threatening life events which maintains that adaptation centers around the resolution of three cognitive tasks: (a) a search for meaning in the event, (b) attempts at gaining mastery over it, and (c) efforts to bolster self-esteem through self-enhancing perceptions, particularly through downward social comparisons and upward social contacts. Mutual support is hypothesized to provide a unique opportunity to test such a model because: a) a frequent criteria for group membership involves the experience of a common threatening life event (which usually threatens self-esteem), and b) groups organized on this basis already contain activities which promote resolution of the cognitive tasks identified. Mothers of children between the ages of 6-16 who are also the primary caregiver of an elderly parent or in-law in the home are the major target group in the proposed study. Dual primary caregivers are at considerable risk for mental disorders and behavioral dysfunction, particularly depression, anxiety disorders, and health-related problems. A second group in this study are the children of caregivers who are at risk for behavior problems because of the increased parental risk. The proposed study would be the first to examine systematically the health impact of parent-care on the grandchildren. The study has three specific aims: (1) to prevent mental disorders and behavioral dysfunctions and promote mental health among adult daughter and daughter-in-law caregivers; (2) to prevent problem behaviors and promote adaptive capabilities in the children of caregivers; and (3) to test a model of cognitive adaptation to threatening life events used to conceptualize the preventive impact of mutual support. A total of 240 caregivers will be recruited and randomly assigned to one of three conditions: (1) a cognitive adaptation mutual support group, (2) a conventional mutual support group, and (3) a no-intervention control group. Each intervention will consist of 12 sessions --delivered weekly for six weeks and then monthly for six months--with a trained caregiver. Assessments of psychiatric, health, and psychosocial functioning for caregivers and their children will be conducted at pretest, posttest, and six months follow-up.
