Secondary traumatic stress and informal caregivers’ life satisfaction: A moderated mediation model of positive religious coping and gender

Introduction

Informal caregiving refers to the provision of unpaid assistance by relatives or friends to complement formal healthcare services. Such care typically includes activities such as assessing patients’ preferred meals, obtaining prescribed medications, sourcing funds, and providing personal care (e.g., bathing, toileting, feeding, and laundry), as well as running other essential errands. In subacute care settings, caregivers are often exposed to potentially traumatic events, such as patient death or severe and gruesome injuries, which may place them at risk for developing secondary traumatic stress (Lim et al., 2024; Ngamasana et al., 2023). Secondary traumatic stress comprises a cluster of symptoms that parallel posttraumatic stress disorder (PTSD), including re-experiencing, avoidance, and hyperarousal (Vagni et al., 2020), but it arises from indirect trauma exposure.

Despite their central role in patient care, informal caregivers are frequently overlooked by healthcare professionals, whose primary focus is often on patients. Contextual factors, such as cultural orientation and type of hospital care, may shape informal caregivers’ mental health outcomes. For example, caregivers from collectivistic cultures may experience heightened emotional demands due to stronger identification with the patient. In addition, gendered caregiving roles may influence both exposure to secondary trauma and the expression of secondary traumatic stress symptoms. In religion-oriented societies, informal caregivers may also differ in how they cope with trauma, yet these coping processes remain underexplored. The present study examined the association between secondary traumatic stress and life satisfaction among informal caregivers in subacute hospital settings, as well as the moderating and mediating roles of positive religious coping and gender in Nigeria.

Secondary trauma and satisfaction with life

Studies indicate that informal caregivers assisting relatives in orthopaedic hospital settings are at elevated risk for secondary traumatic stress (Longo et al., 2020; Muomah et al., 2021a; Muomah et al., 2021b). Such stress may negatively affect life satisfaction, defined as the extent to which individuals positively evaluate the overall quality of their present life (Veenhoven, 1996). Indeed, high caregiving demands have been associated with lower life satisfaction (Borg & Hallberg, 2006; Blaise & Dillenseger, 2020), and family caregivers generally report lower life satisfaction than professional caregivers (Sadowska et al., 2021). In orthopaedic care settings, informal caregivers may experience reduced life satisfaction due to close exposure to patients’ physical and emotional distress, as well as witnessing graphic injuries characteristic of these units. However, research on life satisfaction among informal or family caregivers in orthopaedic hospitals remains limited, particularly with respect to potential variations by religiously oriented coping strategies and caregiver gender.

Religious coping mediation

Religious coping is among the strategies informal caregivers use to manage adversity, traumatic events, and stressors (Farinha et al., 2021). It refers to the ways in which individuals draw on religious beliefs, practices, and behaviors to manage stress, facilitate problem-solving, and reduce the negative emotional impact of stressful life circumstances (Koenig et al., 1998). Religious coping serves five central functions: the search for meaning or purpose, the pursuit of control over situations, the seeking of comfort, intimacy, and social integration, and the facilitation of life transformation (Pargament et al., 2000).

Two specific patterns of religious coping have been identified: positive religious coping and negative religious coping (Pargament et al., 2011). Positive religious coping involves perceptions of a positive connection with God, collaboration with God, finding constructive meaning in a stressor or traumatic situation, and releasing negative emotions. Negative religious coping, in contrast, reflects perceptions of an insecure relationship with God and one’s faith community, loss of faith in God’s power, or belief that the stressor is caused by the devil (Cummings & Pargament, 2010). Positive religious coping has been found to be more commonly reported among informal caregivers of hospitalized patients (Machado et al., 2018; Vitória & Assis, 2015), and caregivers who engage in positive religious coping appear better able to adjust after experiencing secondary traumatic stress. Chardon et al. (2021) suggested that religious coping, in general, may be conceptualized as a universally adaptive coping strategy.

Informal caregivers who use positive religious coping may experience higher life satisfaction, perceiving themselves to be empowered by a benevolent higher power and gaining a sense of meaning, comfort, control, and personal growth while managing their patient’s orthopaedic problems (Schneider & Mannell, 2006; Shaw et al., 2005; Tarakeshwar et al., 2006). Similarly, caregivers in Nigeria who reported higher levels of religiosity demonstrated greater well-being, highlighting the potential role of positive religious coping in supporting adjustment in this cultural context (Ifeagwazi et al., 2021). Despite evidence that informal caregivers experience secondary traumatic stress and rely on religious coping, there is limited understanding of how these processes affect life satisfaction in orthopaedic hospital settings. These associations may also differ by caregiver gender, reflecting gendered patterns of coping and stress response.

Gender moderation

Previous studies have documented gender differences in caregiving (Navaie-Waliser et al., 2002; The National Alliance for Caregiving, AARP, 2020). For example, Riva et al. (2014) reported that 52% of mothers and 22% of fathers adjusted positively to their patient’s orthopaedic challenges, potentially experiencing posttraumatic growth through positive religious coping. Although both male and female caregivers are susceptible to secondary traumatic stress, women tend to assume caregiving roles more frequently, provide more intensive informal care, and experience a greater caregiving burden than men (The National Alliance for Caregiving, AARP, 2020). Similarly, women generally report higher levels of religiosity than men (Moon et al., 2022), which may explain why female caregivers are more likely to engage in positive religious coping to manage challenges and the negative experiences encountered during caregiving. While it might be expected that this pattern is stronger when caring for female patients, positive religious coping may exert the greatest impact when the caregiver is female and the patient is male.

The Nigerian orthopaedic care context

Informal caregivers of patients with musculoskeletal conditions often face substantial physical demands, including providing mobility assistance and managing pain (Alemu et al., 2025). In Nigerian orthopaedic hospital settings, informal caregivers frequently perform specific nursing tasks such as bathing and feeding patients, manually lifting and repositioning immobile patients, monitoring patients to prevent discomfort or hygiene issues, administering medications, paying medical bills, and transporting patients in wheelchairs (Diameta et al., 2018; Muomah et al., 2021a). In these settings, in-patient care often relies on informal caregivers who are typically family members or friends to supplement formal care, exposing them to secondary traumatic stress, which is often overlooked by healthcare professionals focused primarily on patients. Positive religious coping is particularly prevalent in Nigeria, especially among caregivers of individuals with chronic illnesses and high dependency levels (Faronbi, 2018). This positive religious coping may involve meaning-making of caregiving as a spiritual duty, reliance on prayer and faith-based practices, trust in divine support, and engagement with religious communities that provide emotional and practical assistance.

Cultural expectations regarding gender roles further influence caregiving patterns in Nigeria. Men are generally regarded as breadwinners, while women are expected to assume caregiving responsibilities. Female caregivers frequently engage in positive religious practices, such as singing praises, praying, and offering spiritual encouragement to themselves, whereas men tend to engage in these practices less often (Moon et al., 2022; Lopez-Anuarbe & Kohli, 2019). Additionally, it is uncommon to see male caregivers attending to female patients in hospital settings unless no alternative is available. These cultural and gendered dynamics highlight the importance of considering caregiver and patient gender in studies of informal caregiving, secondary traumatic stress, and coping (Penning & Wu, 2016). Gender dynamics and cultural context remain underexplored in studies on life satisfaction, particularly regarding the interplay of caregiver and patient gender, secondary traumatic stress, and positive religious coping. Addressing these gaps is essential to inform interventions that enhance caregiver well-being in Nigeria and similar contexts.

Goals of the study

This study examined the association between secondary traumatic stress and informal caregivers’ life satisfaction in subacute hospital care and the role of positive religious coping and gender in that relationship. We tested the following hypotheses regarding informal caregivers (See Figure 1):

1.    Secondary traumatic stress is associated with lower satisfaction with life.

2.    Positive religious coping mediates the association of secondary traumatic stress and satisfaction with life for higher satisfaction with life.

3.    Gender of caregiver moderates the association of secondary traumatic stress and positive religious coping and satisfaction with life.

Figure 1. Conceptual model of the association between secondary traumatic stress, religious coping, gender (of caregiver) and satisfaction with life

Method

Participants, setting and procedure

The sample consisted of 194 informal caregivers of inpatients at an orthopaedic hospital in South-East Nigeria (68 males, 126 females). Participants ranged in age from 15 to 70 years (M = 31.5, SD = 8.9). Half of the caregivers were married (50.0%), while 44.8% were single, 4.2% divorced, and 1.0% separated. Most caregivers (61.6%) had a secondary level of education or below, whereas 38.4% had education beyond secondary school. The patients under their care were predominantly male (54.3%), with females accounting for 45.7%. With respect to duration of caregiving, 50.5% had stayed with the patient for 1–6 months, 40.0% for 1–4 weeks, 5.8% for less than one week, and 3.7% for more than six months.

The study protocol was approved by the Health Research Ethics Committee of the University of Nigeria Teaching Hospital Enugu (NHREC/05/01/2008B-FWA00002458-IRB00002323) and the Institutional Review Board of National Orthopaedic Hospital Enugu (S. 313/IV). Informal caregivers willingly consented to the study. Data were gathered during normal hospital hours by two trained graduate psychology students.

Measures

Secondary traumatic stress scale (STSS)

The Secondary Traumatic Stress Scale (STSS; Bride et al., 2004) is a 17-item self-report measure assessing the frequency of intrusion, avoidance, and arousal symptoms experienced during the past 7 days in relation to indirect exposure to traumatic events or material. Items are rated on a 5-point Likert scale ranging from 1 (never) to 5 (very often). Total scores range from 17 to 85, with higher scores indicating greater severity of secondary traumatic stress symptoms. Previous studies have reported good to excellent internal consistency for the total scale (Cronbach’s α = 0.86–0.94) and acceptable to excellent reliability for the intrusion (α = 0.74–0.80), avoidance (α = 0.87), and arousal (α = 0.79–0.87) subscales (Beck & Gable, 2012; Bride et al., 2004; Choi, 2011; Vukčević Marković & Živanović, 2022). In the present study, the STSS demonstrated good internal consistency (α = 0.84).

Satisfaction with life scale (SWLS)

The Satisfaction with Life Scale (SWLS; Diener et al., 1985) is a 5-item questionnaire developed to measure the individual’s evaluation of satisfaction with life in general. Respondents indicate how much they agree or disagree with each of the five items using a 7-point scale that ranges from 1 “strongly disagree” to 7 “strongly agree”. The overall scores range from 5 to 35, with higher scores indicating satisfaction with life. Studies in other populations reported Cronbach’s α of 0.87 to 0.89, respectively (Diener, et al., 1985; Yun, et al., 2019). The present study, we found an α coefficient of 0.84.

Brief religious COPE (Brief RCOPE)

The Brief RCOPE (Pargament et al., 2011) is a 14-item scale designed to measure positive and negative religious coping with major life stressors. It has two subscales, each consisting of 7 items of positive religious coping and 7 items of negative religious coping. While positive religious coping subscales tap into a sense of connectedness with a transcendent force, a sense of spiritual connectedness with others and a benevolent worldview, negative religious coping subscales reflect underlying spiritual tensions and struggles within oneself, with others and with the divine. The items are scored as follows: 1 = A great deal, 2 = Quite a bit, 3 = Somewhat and 4 = Not at all. Pearce et al. (2006) in a study among caregivers, reported a reliability coefficient alpha of 0.91 on the positive religious coping, while this present study obtained Cronbach α of 0.77.

Statistical analyses

Analyses were conducted using the PROCESS macro for IBM SPSS (Version 3.0; Hayes, 2022). The analyses examined: (a) the direct and indirect effects of secondary traumatic stress on satisfaction with life, with positive religious coping specified as the mediator; (b) whether the association between secondary traumatic stress and positive religious coping was moderated by patients’ gender; and (c) whether the association between positive religious coping and satisfaction with life was moderated by caregivers’ gender. Indirect effects were tested using bias-corrected bootstrapping with 10,000 resamples and 95% confidence intervals (CIs). An indirect effect was considered statistically significant when the 95% bootstrapped CI did not include zero.

Results

Descriptive statistics

Results in Table 1 showed that majority of the caregivers were self-employed, and many of these self-employed persons indicated that they were in business/trading (37.63%). Most of them have also been the caregivers to the patient since hospital admission, and only very few of them were not immediate family members to the patient. They were caring for more male patients than females. Half of them have been caregivers to the patient for 1–6 months. They were also mostly urban residents.

Secondary trauma and satisfaction with life

The hypotheses were tested, controlling for the effects of age (See Table 2). The total effects of secondary traumatic stress effects on satisfaction with life were statistically significant (β = −0.21, SE = 0.06, p = 0.001), indicating that respondents with higher secondary traumatic stress symptoms were less satisfied with life, which supported Hypothesis 1. The association of secondary traumatic stress with positive religious coping was negative and statistically significant (β = −0.11, SE = 0.08, p = 0.001), confirming hypothesis 2.

Positive religious coping mediation

Our hypothesis of a moderated mediation was supported as evidenced by a significant indirect effect of secondary traumatic stress on satisfaction with life through positive religious coping among female caregivers [B = −0.01, 95%CI = (−0.00, −0.12)], but not males [B = 0.00, 95%CI = (−0.01, 0.01)]. Note that the moderated mediation is significant when the 95% CI does not encompass zero, as shown in the case of males. The index of moderated mediation observed was also significant [B = −0.01, 95% CI = (−0.03, −0.00)]. The predictors accounted for 36% of the variance in satisfaction with life [R2 = 0.36, F(2,192) = 3.64, p = 0.00].

Gender moderation

Gender of caregivers moderated the association of positive religious coping and satisfaction with life. The slope of the conditional effect of positive religious coping on satisfaction with life (see Figure 2) indicated that positive religious coping in female caregivers predicted more satisfaction with life {B = 0.14, t = 4.21, 95% CI = [0.05, 0.41], p < 0.001}, than for male caregivers {B = 0.01, t = 1.41, 95% CI = [−0.00, 0.11], p = 0.90}.

Figure 2. Slope of the interaction effect of positive religious coping and gender of caregivers on satisfaction with life

Discussion

We found that informal caregivers who reported higher symptoms of secondary traumatic stress were less satisfied with life. Previous research has documented anxious feelings, worry, flashbacks, and nightmares among informal caregivers (Ferrell et al., 2019), and these symptoms that can negatively affect overall life satisfaction (Muomah et al., 2021a). This relationship may be explained by the way secondary traumatic stress threatens caregivers’ subjective well-being, thereby reducing their satisfaction with life (Perstling & Rothmann, 2012). Our findings also showed that positive religious coping reduces the likelihood of diminished life satisfaction among informal caregivers. This aligns with earlier studies by Pargament et al. (1998) and Skalski-Bednarz et al. (2022), which found that positive religious coping enhances satisfaction with life and mitigates secondary traumatic stress. This effect may stem from the nature of positive religious coping, which often involves a secure and comforting relationship with God and a strong sense of community among fellow believers.

Positive religious coping can help individuals maintain life satisfaction by promoting a sense of meaning, finding purpose in adversity, fostering hope, and encouraging more constructive interpretations of negative experiences (Matthews et al., 1998). In contrast, negative religious coping in times of hardship often involves feelings of divine punishment, perceptions of abandonment by God or the religious community, attributing misfortunes to malevolent spiritual forces, or questioning God’s power and love. Such forms of negative religious coping may signal harmful spiritual struggles and a conflicted worldview (Roggenbaum et al., 2023; Abu-Raiya et al., 2018). These struggles—such as doubting God’s nature or interpreting suffering as divine punishment—reflect deep religious conflict that can undermine psychological well-being. However, findings in the literature are not entirely consistent. For example, Park et al. (2017) reported that both positive and negative religious coping were associated with higher levels of traumatic stress, including perceived traumatic stress. This suggests that the relationship between religious coping and psychological outcomes may be more complex than a simple positive–negative distinction, and that the context and intensity of stressors may influence how religious coping functions.

We found that caregiver gender predicted life satisfaction, with female caregivers reporting higher satisfaction with life than their male counterparts. This pattern may reflect women’s tendency to have stronger social support networks and higher engagement in positive religious coping. The combined influence of biological, psychological, and sociocultural factors may serve as protective mechanisms that buffer against stress and psychological distress. Social norms often encourage women to express emotions openly and seek social support, whereas men are more likely to be socialized toward stoicism and self-reliance (Taylor et al., 2000). Additionally, religious practice and spiritual engagement are often more deeply integrated into women’s daily lives, contributing to greater use of positive religious coping strategies that support life satisfaction (Levin et al., 1995). This interpretation aligns with findings from Penning and Wu (2016), who reported that female caregivers tend to have stronger support networks and higher levels of positive religious coping compared to male caregivers.

Implications for practice and research

Targeted interventions should incorporate tailored education and training on caregiving practices and navigation of the healthcare system, alongside accessible emotional and social support services, to enhance informal caregivers’ overall life satisfaction and well-being. Further research is needed, particularly longitudinal studies and studies focused on the Southeast region of Nigeria, to better understand how secondary traumatic stress and coping processes unfold over time and across cultural contexts. Exploring the benefits of positive religious coping may support the development of more effective, contextually grounded caregiver support programs. Additionally, a deeper understanding of gender differences in caregiving experiences is essential, especially regarding the unique challenges faced by informal male caregivers.

Limitations of the study and future directions

This cross-sectional study does not establish temporal ordering among the variables in our model; therefore, causal inferences cannot be made. For example, caregivers (both female and male) who reported lower life satisfaction may already be experiencing higher levels of secondary traumatic stress, rather than the reverse. Second, the study was limited to orthopaedic inpatients and their informal caregivers in a single orthopaedic hospital in Nigeria, which may constrain the generalizability of the findings. Third, the study did not include caregivers of patients receiving care in local treatment settings prevalent in the eastern region of the country, making it unclear whether these caregivers experience similar levels of secondary traumatic stress or utilize positive religious coping in comparable ways. Future longitudinal studies, incorporating samples from multiple orthopaedic units and diverse treatment contexts, are needed to clarify these relationships and strengthen the external validity of the findings.

Conclusion

The present study aimed to examine the relationship between secondary traumatic stress and satisfaction with life among informal caregivers. It also explored whether positive religious coping serves as a mediator and whether caregiver gender moderates these associations. The results showed that informal caregivers experiencing higher levels of secondary traumatic stress reported lower life satisfaction. Furthermore, positive religious coping reduced the likelihood of diminished life satisfaction and predicted greater life satisfaction among female caregivers compared to male caregivers. These findings suggest that integrating positive religious coping strategies into support programmes for informal caregivers may be beneficial, particularly during periods of inpatient care.

Acknowledgement: The authors are grateful to the study participants who completed the survey and to the management of the National Orthopeadic Hospital Enugu for their support and permission to carry out this study in their center.

Funding Statement: Authors did not receive any funding for this study.

Author Contributions: The authors confirm contribution to the paper as follows: Conceptualization, Rosemary C. Muomah, Sampson K. Nwonyi and Paul C. Odinka; Methodology, Rosemary C. Muomah and Theclar O. Iyidiobi; Formal analysis, Sampson K. Nwonyi and JohnBosco C. Chukwuorji; Resources, Rosemary C. Muomah, Tobias C. Obi, Jaclyn I. Odinka, Kennedy U. Amadi; writing—original draft preparation, Rosemary C. Muomah; writing—review and editing, JohnBosco C. Chukwuorji, Sampson K. Nwonyi, Paul C. Odinka, Theclar O. Iyidiobi, Tobias C. Obi, Jaclyn I. Odinka, Kennedy U. Amadi. All authors reviewed and approved the final version of the manuscript.

Availability of Data and Materials: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval: The study protocol was approved by the Health Research Ethics Committee of the University of Nigeria Teaching Hospital Enugu (NHREC/05/01/2008B-FWA00002458-IRB00002323) and the Institutional Review Board of National Orthopaedic Hospital Enugu (S. 313/IV). Informal caregivers willingly consented to the study.

Conflicts of Interest: The authors declare no conflicts of interest.

References

Abu-Raiya, H., Ayten, A., Tekke, M., & Agbaria, Q. (2018). On the links between positive religious coping, satisfaction with life and depressive symptoms among a multinational sample of Muslims. International Journal of Psychology, 54(5), 678–686. https://doi.org/10.1002/ijop.12521. [Google Scholar] [PubMed] [CrossRef]

Alemu, N. L., Das, N., Watts, J. J., Robinson, S., Chen, G. et al. (2025). The burden of informal caregiving for adults with musculoskeletal conditions: A systematic review. PharmacoEconomics, 43(10), 1179–1204. https://doi.org/10.1007/s40273-025-01523-x. [Google Scholar] [CrossRef]

Beck, C. T., & Gable, R. K. (2012). A mixed methods study of secondary traumatic stress in labor and delivery nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing, 41(6), 747–760. https://doi.org/10.1111/j.1552-6909.2012.01386.x. [Google Scholar] [CrossRef]

Blaise, M., & Dillenseger, L. (2020). Informal caregivers and life satisfaction: Empirical evidence from the Netherlands. Bureau d’Economie Théorique et Appliquée, UDS, Strasbourg. Retrieved from: https://ideas.repec.org/p/ulp/sbbeta/2020-55.html. [Google Scholar]

Borg, C., & Hallberg, I. R. (2006). Life satisfaction among informal caregivers in comparison with non-caregivers. Scandinavian Journal of Caring Sciences, 20(4), 427–438. https://doi.org/10.1111/j.1471-6712.2006.00424.x. [Google Scholar] [PubMed] [CrossRef]

Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. M. (2004). The development and validation of the secondary traumatic stress scale. Research on Social Work Practice, 14(1), 27–35. https://doi.org/10.1177/1049731503254106 [Google Scholar] [CrossRef]

Chardon, M. L., Brammer, C., Madan-Swain, A., Kazak, A. E., & Pai, A. L. H. (2021). Religious coping and posttraumatic responses in pediatric hematopoietic stem cell transplant. Journal of Pediatric Psychology, 46(4), 465–473. https://doi.org/10.1093/jpepsy/jsaa126. [Google Scholar] [PubMed] [CrossRef]

Choi, G.-Y. (2011). Secondary traumatic stress of service providers who practice with survivors of family or sexual violence: A national survey of social workers. Smith College Studies in Social Work, 81(1), 101–119. https://doi.org/10.1080/00377317.2011.543044 [Google Scholar] [CrossRef]

Cummings, J. P., & Pargament, K. I. (2010). Medicine for the spirit: Religious coping in individuals with medical conditions. Religions, 1(1), 28–53. https://doi.org/10.3390/rel1010028 [Google Scholar] [CrossRef]

Diameta, E., Adandom, I., Jumbo, S. U., Nwankwo, H. C., Obi, P. C. et al. (2018). The burden experience of formal and informal caregivers of older adults with hip fracture in Nigeria. SAGE Open Nursing, 4, 2377960818785155. https://doi.org/10.1177/2377960818785155. [Google Scholar] [PubMed] [CrossRef]

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75. https://doi.org/10.1207/s15327752jpa4901_13. [Google Scholar] [PubMed] [CrossRef]

Farinha, F. T., Bom, G. C., Manso, M. M. F. G., Razera, A. P. R., Mondini, C. C. D. S. D. et al. (2021). Factors related to the use of religious coping by informal caregivers: An integrative review. Revista Brasileira de Enfermagem, 74(3), e20201227. https://doi.org/10.1590/0034-7167-2020-1227. [Google Scholar] [PubMed] [CrossRef]

Faronbi, J. O. (2018). Correlate of burden and coping ability of caregivers of older adults with chronic illness in Nigeria. Scandinavian Journal of Caring Sciences, 32(4), 1288–1296. https://doi.org/10.1111/scs.12572. [Google Scholar] [PubMed] [CrossRef]

Ferrell, E. L., Russin, S. E., & Hardy, R. M. (2019). Informal caregiving experiences in posttraumatic stress disorder: A content analysis of an online community. Journal of Community Psychology, 47(4), 757–771. https://doi.org/10.1002/jcop.22151. [Google Scholar] [CrossRef]

Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (vol. 3). New York, NY, USA: The Guilford Press. [Google Scholar]

Ifeagwazi, M. C., Ekeh, O. H., Chukwuorji, J. C., & Omeh, E. O. (2021). Social support, religious commitment, hardiness and psychological well-being of psychiatric patients’ caregivers: A Nigerian study. Journal of Clinical and Medical Images, 5(11), 1–5. [Google Scholar]

Koenig, H. G., Pargament, K. I., & Nielsen, J. (1998). Religious coping and health status in medically ill hospitalized older adults. The Journal of Nervous and Mental Disease, 186(9), 513–521. https://doi.org/10.1097/00005053-199809000-00001. [Google Scholar] [PubMed] [CrossRef]

Levin, J. S., Chatters, L. M., & Taylor, R. J. (1995). Religious effects on health status and life satisfaction among Black Americans. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 50(3), S154–S163. https://doi.org/10.1093/geronb/50b.3.s154. [Google Scholar] [PubMed] [CrossRef]

Lim, J. M., Barlas, J., Kaur, D., & Ng, P. (2024). Unmasking the Struggle: A scoping review exploring post-traumatic stress symptoms in caregivers of individuals with neurodevelopmental, psychiatric and neurocognitive disorders. Trauma, Violence, & Abuse, 25(4), 3191–3210. https://doi.org/10.1177/15248380241241018. [Google Scholar] [PubMed] [CrossRef]

Longo, U. G., Matarese, M., Arcangeli, V., Alciati, V., Candela, V. et al. (2020). Family caregiver strain and challenges when caring for orthopedic patients: A systematic review. Journal of Clinical Medicine, 9(5), 1497. https://doi.org/10.3390/jcm9051497. [Google Scholar] [PubMed] [CrossRef]

Lopez-Anuarbe, M., & Kohli, P. (2019). Understanding male caregivers’ emotional, financial, and physical burden in the United States. Healthcare, 7(2), 72. https://doi.org/10.3390/healthcare7020072. [Google Scholar] [PubMed] [CrossRef]

Machado, B. M., Dahdah, D. F., & Kebbe, L. M. (2018). Caregivers of family members with chronic diseases: Coping strategies used in everyday life. Cadernos Brasileiros de Terapia Ocupacional, 26(2), 299–313. https://doi.org/10.4322/2526-8910.ctoAO1188 [Google Scholar] [CrossRef]

Matthews, D. A., McCullough, M. E., Larson, D. B., Koenig, H. G., Swyers, J. P. et al. (1998). Religious commitment and health status: A review of the research and implications for family medicine. Archives of Family Medicine, 7(2), 118–124. https://doi.org/10.1001/archfami.7.2.118. [Google Scholar] [PubMed] [CrossRef]

Moon, J. W., Tratner, A. E., & McDonald, M. M. (2022). Men are less religious in more gender-equal countries. Proceedings of the Royal Society B: Biological Sciences, 289(1968), 20212474. https://doi.org/10.1098/rspb.2021.2474. [Google Scholar] [PubMed] [CrossRef]

Muomah, R. C., Ndukuba, A. C., Odinka, P. C., Amadi, K. U., Nduanya, C. U. et al. (2021a). Indirect exposure to trauma: Does resilience explain the link between optimism and secondary traumatic stress among in-patient carers? Journal of Psychology in Africa, 31(3), 267–271. https://doi.org/10.1080/14330237.2021.1927351 [Google Scholar] [CrossRef]

Muomah, R. C., Odinka, P. C., Ndukuba, A. C., Amadi, K. U., Ifeagwazi, C. M. et al. (2021b). Caregiver characteristics, social support and psychological distress among informal caregivers. Nigerian Journal of Psychological Research, 17(1), 21–33. [Google Scholar]

Navaie-Waliser, M., Feldman, P. H., Gould, D. A., Levine, C., Kuerbis, A. N. et al. (2002). When the caregiver needs care: The plight of vulnerable caregivers. American Journal of Public Health, 92(3), 409–413. https://doi.org/10.1371/journal.pone.0247596. [Google Scholar] [PubMed] [CrossRef]

Ngamasana, E. L., Zarwell, M., & Gunn, L. H. (2023). Physical and mental health of informal caregivers before and during the COVID-19 pandemic in the United States. BMC Public Health, 23(1), 2349. https://doi.org/10.1186/s12889-023-17164-8. [Google Scholar] [PubMed] [CrossRef]

Pargament, K., Feuille, M., & Burdzy, D. (2011). The Brief RCOPE: Current psychometric status of a short measure of religious coping. Religions, 2(1), 51–76. https://doi.org/10.3390/rel2010051 [Google Scholar] [CrossRef]

Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543. https://doi.org/10.1002/(sici)1097-4679(200004)56:4%3C519::aid-jclp6%3E3.0.co;2-1 [Google Scholar] [CrossRef]

Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez., L. (1998). Patterns of positive and negative religious coping with major life stressors. Journal For the Scientific Study of Religion, 37(4), 710–724. https://doi.org/10.2307/1388152. [Google Scholar] [PubMed] [CrossRef]

Park, C. L., Smith, P. H., Lee, S. Y., Mazure, C. M., McKee, S. A. et al. (2017). Positive and negative religious/spiritual coping and combat exposure as predictors of posttraumatic stress and perceived growth in Iraq and Afghanistan Veterans. Psychology of Religion and Spirituality, 9(1), 13–20. https://doi.org/10.1037/rel0000086. [Google Scholar] [PubMed] [CrossRef]

Pearce, M. J., Singer, J. L., & Prigerson, H. G. (2006). Religious coping among caregivers of terminally ill cancer patients: Main effects and psychosocial mediators. Journal of Health Psychology, 11(5), 743–759. https://doi.org/10.1177/1359105306066629. [Google Scholar] [PubMed] [CrossRef]

Penning, M. J., & Wu, Z. (2016). Caregiver stress and mental health: Impact of caregiving relationship and gender. The Gerontologist, 56(6), 1102–1113. https://doi.org/10.1093/geront/gnv038. [Google Scholar] [PubMed] [CrossRef]

Perstling, M., & Rothmann, S. (2012). Secondary traumatic stress, psychological wellbeing and life satisfaction of social workers in Namibia. Journal of Psychology in Africa, 22(1), 1–9. https://doi.org/10.1080/14330237.2012.10874515 [Google Scholar] [CrossRef]

Riva, R., Forinder, U., Arvidson, J., Mellgren, K., Toporski, J. et al. (2014). Patterns of psychological responses in parents of children that underwent stem cell transplantation. Psycho-Oncology, 23(11), 1307–1313. https://doi.org/10.1002/pon.3567. [Google Scholar] [PubMed] [CrossRef]

Roggenbaum, L., Wang, D. C., Dryjanska, L., Holmes, E., Lewis, B. A. et al. (2023). Secondary traumatic stress, religious coping, and medical mistrust among African American clergy and religious leaders. Religions, 14(6), 793. https://doi.org/10.3390/rel14060793 [Google Scholar] [CrossRef]

Sadowska, A., Wyczalkowska-Tomasik, A., Zegarow, P., & Czarkowska-Paczek, B. (2021). Depression but not inflammatory markers are increased in family versus nonfamily caregivers of persons with dementia. Journal Geriatric Psychiatry and Neurology, 34(1), 29–36. https://doi.org/10.1177/0891988720901782. [Google Scholar] [PubMed] [CrossRef]

Schneider, M. A., & Mannell, R. C. (2006). Beacon in the storm: An exploration of the spirituality and faith of parents whose children have cancer. Issues in Comprehensive Pediatric Nursing, 29(1), 3–24. https://doi.org/10.1080/01460860500523731. [Google Scholar] [PubMed] [CrossRef]

Shaw, A., Joseph, S., & Linley, P. A. (2005). Religion, spirituality, and posttraumatic growth: A systematic review. Mental Health, Religion & Culture, 8(1), 1–11. https://doi.org/10.1080/1367467032000157981 [Google Scholar] [CrossRef]

Skalski-Bednarz, S. B., Konaszewski, K., Toussaint, L. L., Büssing, A., & Surzykiewicz, J. (2022). Positive religious coping acts through perception of nature and silence in its association with well-being and life satisfaction among Polish Catholics. Frontiers in Public Health, 10, 1020007. https://doi.org/10.3389/fpubh.2022.1020007. [Google Scholar] [PubMed] [CrossRef]

Tarakeshwar, N., Vanderwerker, L. C., Paulk, E., Pearce, M. J., Kasl, S. V. et al. (2006). Religious coping is associated with the quality of life of patients with advanced cancer. Journal of Palliative Medicine, 9(3), 646–657. https://doi.org/10.1089/jpm.2006.9.646. [Google Scholar] [PubMed] [CrossRef]

Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. et al. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411–429. https://doi.org/10.1037/0033-295x.107.3.411. [Google Scholar] [PubMed] [CrossRef]

The National Alliance for Caregiving, AARP (2020). Caregiving in the United States 2020. Washington, DC, USA: AARP. https://doi.org/10.26419/ppi.00103.001 [Google Scholar] [CrossRef]

Vagni, M., Maiorano, T., Giostra, V., & Pajardi, D. (2020). Hardiness, stress and secondary trauma in Italian healthcare and emergency workers during the COVID-19 pandemic. Sustainability, 12(14), 5592. https://doi.org/10.3390/su12145592 [Google Scholar] [CrossRef]

Veenhoven, R. (1996). The study of life satisfaction. In: W. E. Saris, R. Veenhoven, A. C. Scherpenzeel, B. Bunting (Eds.), A comparative study of satisfaction with life in Europe (pp. 11–48), Budapest, Hungary: EOtvOs University Press. [Google Scholar]

Vitória, A. L. D., & Assis, C. L. D. (2015). Experiences and strategies for coping in family companions of hospitalized in a hospital unit of Cacoal-RO. Aletheia, (46), 16–33. [Google Scholar]

Vukčević Marković, M., & Živanović, M. (2022). Coping with secondary traumatic stress. International Journal of Environmental Research and Public Health, 19(19), 12881. https://doi.org/10.3390/ijerph191912881. [Google Scholar] [PubMed] [CrossRef]

Yun, Y. H., Rhee, Y. E., Kang, E., & Sim, J. A. (2019). The satisfaction with life scale and the subjective well-being inventory in the general Korean Population: Psychometric properties and normative data. International Journal of Environmental Research and Public Health, 16(9), 1538. https://doi.org/10.3390/ijerph16091538. [Google Scholar] [PubMed] [CrossRef]