Literature review for Richard Lazarus and Susan Folkman on Stress, Appraisal and
Coping as it relates to Caregiver Stress. Please include the reliability of the use of The
Kingston Caregiver Stress Scale in caregivers’ appraisals and outcome in stress

Appraising stress for home visited caregivers of persons with dementia
Folkman and Lazarus (1988) provide an insight on the relationship between coping and
emotions in relation to caregivers. Historically, coping was viewed as response to emotions. The
studies provide a broader view based on the cognitive and relational principles concerning the
process of emotion. In the article Folkman and Lazarus argues that coping usually mediates
emotions in three different ways. One way is through cognitive activity that influences attention.
The caregiver must come to the senses that he or she is stressed to be in a position to come up
with a strategy to address the problem (Folkman & Lazarus, 1988). Therefore, stress affects the
mind meaning that the caregiver will only cope with the stress through emotions. The second is
by altering the subjective meaning of an encounter. Caregivers must be in a position to overcome
the subjective or the impediment to be able to cope with the stressful situation. Lastly is by
actions that alter terms of person-environment relationship (Folkman & Lazarus, 1988). The
relationship of an individual with the environment also does affects or impacts on the level of
stress. Variation or by addressing this factor allows or enhances copping (Folkman & Lazarus,
1988). This finding is supported by a survey carried out amongst 75 married couples interviewed
on their stressful events, and emotions at the time of rendering care services to persons with

dementia. It is also important to note that situations or encounters unfold in stages as
emotions and coping processes also charge as these stages also change.
The Kingston Caregiver Stress Scale is one of the instruments used to measure
caregiver’s stress. It is a self-report scale that is informal caregivers use measures their perceived
stress in the situation or in their home care environments. The tool has 10-items with a 5-point
Likert response. The response/answers range from ‘extreme stress’ to ‘no stress’ (Kilik &
Hopkins, 2011). When the scores are higher, it shows the level of stress is higher and vice versa.
The measures are categorized in three sub sections including, family issues, caregiving issues,
and financial issues.
The tool by the fact that it is self reported, it is reliable in appraising caregivers and
outcome in stress. It allows the caregiver to understand the issues that are contributing to the
stress and hence helping to enhance coping mechanism. It is also an exceptional tool as it
provides comprehensive screening in few minutes around 15 without the need or support of a
trained personnel (Kilik & Hopkins, 2011). The reliability of this tool is also supported by the
fact that it is psychometric proprieties have been published indicating its validity and potential to
help caregivers to appraise their stress.
The tool also tries to establish the level of stress that caregivers are experiencing by
assigning of stress values the various caregiving activities (Kilik & Hopkins, 2011). The scores
sometimes do not correlate well with the level of stress an individual is experiencing and this is
meant to be understood that scores of some caregivers cannot be necessarily the same to that of
another caregivers. The situation and circumstances of the caregivers do vary. Therefore, it is
important that the caregivers use this scale for quite some time to monitor the level of stress as

different caregivers attribute their stress to different sources. If well used, the tool can help
caregivers in appraisal of their stress outcomes.


Folkman, S., & Lazarus, R. S. (1988). The relationship between coping and emotion:
Implications for theory and research. Social Science & Medicine, 26 (3), 309-317.
Kilik, A., & Hopkins, W., (2011). Caregiver stress and behaviour, The American Journal
of Alzheimer’s Disease and Other Dementias, 2(3): 1-23.