Family carers of people with dementia in Japan, Spain, and the UK: A cross-cultural comparison of the relationships between experiential avoidance, cognitive fusion, and carer depression

Naoko Kishita, Hiroshi Morimoto, María Márquez-González, Samara Barrera-Caballero, Carlos Vara-García, Elien Van Hout, Milena Contreras, Andrés Losada-Baltar

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This study investigated whether the relationship between experiential avoidance and carer depression is mediated by cognitive fusion using path analysis and whether this model differs between family carers from Japan, Spain, and the UK using multi-group path analysis. The whole sample model (N=745) showed a good fit to the data. The direct effect of experiential avoidance on carer depression (β=.10) and its indirect effect on carer depression through cognitive fusion (β=.15) were significant. Examined variables accounted for 45% of the variance of depression. Multi-group path analysis confirmed the same pattern of indirect path across three countries, while the direct path was no longer significant in Spanish and UK samples. These findings suggest that targeting cognitive fusion may be particularly critical in culturally diverse carers and pre-emptive efforts to reduce experiential avoidance using psychological techniques may be beneficial among family carers prone to cognitive fusion regardless of cultural differences.
Original languageEnglish
Pages (from-to)254-264
Number of pages11
JournalJournal of Geriatric Psychiatry and Neurology
Issue number3
Early online date19 Oct 2022
Publication statusPublished - May 2023


  • acceptance and commitment therapy
  • alzheimer's disease
  • caregivers
  • cultural-comparison
  • depression

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