Abstract
Background
Adolescent depressive patients generally have clinical manifestations such as emotional depression and cognitive decline, and family caregivers play an irreplaceable and important role in the disease management and rehabilitation process. Despite the heavy burden of caring for adolescent depressed patients, it is possible that family caregivers are also experiencing anxiety, which may increase their burden, and previous research has reported that psychological resilience plays an important role in reducing the physical and mental burden on caregivers.
Objective
This study aims to assess the current status of caregiver burden, psychological resilience, and anxiety among family caregivers of adolescents with depression and to explore whether psychological resilience mediates the relationship between caregiver burden and anxiety.
Methods
A cross-sectional study design was employed to recruit 256 family caregivers of adolescents with depression. The caregivers completed questionnaires, including general demographic information, the Zarit Caregiver Burden Scale, the Self-Rating Anxiety Scale, and the Psychological Resilience Scale. Data analysis was performed via SPSS 26.0.
Results
There was a significant positive correlation between care burden and anxiety (r = 0.561, P < 0.01), psychological resilience and care burden and anxiety showed a significant negative correlation (r = -0.895, -0.556, P < 0.01), and psychological resilience played a partial mediating role between care burden and anxiety (β = 0.198, P < 0.01), and the indirect effect accounted for 42.95%.
Conclusion
Perceived resilience plays a mediating role in the association between caregiving burden and anxiety among family caregivers of adolescent patients with depression, and it can be considered as a longitudinal follow-up or intervention study in the future.
Implications for clinical practice
This study emphasizes that caregiver burden is associated with higher anxiety levels, and psychological resilience may play a moderating role in this association, suggesting that clinicians need to include resilience assessment in routine screening and implement hierarchical interventions based on the “burden-resilience” combined risk: priority is given to providing structured psychological support to high-burden-low resilience groups. The final realization: (1) reduce the burden on caregivers (2) improve the quality of care.
Keywords: Adolescent depression, Caregiver burden, Anxiety, Psychological resilience
Introduction
Adolescent depression [1] is a public health problem that has attracted much attention worldwide. According to the World Health Organization (WHO), depression is one of the leading causes of disability among adolescents worldwide, with about 10%−20% of adolescents experiencing varying degrees of depressive symptoms during their growth stage [2, 3]. In China, the incidence of adolescent depression has shown a significant upward trend with the intensification of social competition, increased academic pressure, and changes in family structure [4]. Depression not only seriously affects patients’ learning, social, and physical and mental health, but also brings great psychological stress and burden to their family caregivers, mainly parents or other primary guardians [5].
Family caregivers play a crucial role in the recovery process for adolescent depressed patients [6]. They not only need to provide care for daily life, but also deal with problems such as mood swings, poor treatment adherence, and may even experience additional psychological pressure due to social prejudice [7, 8]. Long-term exposure to this high-load care environment can lead to psychological problems such as anxiety and depression [9]. Relevant studies have shown that the incidence of anxiety symptoms among family caregivers of depressed patients is significantly higher than that of the general population, which not only affects their own physical and mental health, but may also further aggravate the patient’s condition through negative interaction patterns, forming a vicious circle [10].
The core concept of caregiver burden [11] has gradually developed into an important theoretical construct across the field of disease research since it was first proposed by Grad and Sainbury in the mid-19th century. Caregiver burden refers to the multi-dimensional negative impact suffered by caregivers in the care process, including economic, work, social and other costs [12], and Montgomery et al. [13] divide the caregiver burden into two types, and the objective burden dimension refers to the various external challenges and practical difficulties actually faced by caregivers in the care process, which directly lead to a decline in their quality of life. The subjective burden dimension refers to the internal psychological experience and physiological response generated by caregivers in the care process. High levels of caregiving burden have been confirmed by several studies to be strongly associated with anxiety [14]. However, the internal mechanism of this association has not yet been fully elucidated. In recent years, psychological resilience has received widespread attention as an important psychological protective factor, but there are fewer studies on caregivers of adolescent depressed patients.
Psychological resilience [15] refers to an individual’s core ability to maintain psychological homeostasis and achieve adaptive development under adversity conditions. Studies have shown that individuals with high psychological resilience show significant problem-oriented coping characteristics in the face of stressful events, and their cognitive behavioral patterns have positive optimistic tendencies. while individuals with low psychological toughness are prone to form learned helpless coping patterns, showing the characteristics of insufficient coping effectiveness. Studies have shown that the protective effect of psychological resilience has a stress-intensity-dependent modulation phenomenon, and the protective effect may be weakened under high stress [16]. Xie et al. [17] found that the level of resilience was significantly positively correlated with the self-regulation ability of executive function, which can effectively improve the individual’s resistance to negative triggers. Existing research evidence [18] shows that emotional self-efficacy, as an important predictor of resilience, is reflected in the following mechanisms: individuals with high emotional self-efficacy have stronger metacognitive regulation ability to stress situations, and can flexibly use emotion regulation strategies to maintain psychological homeostasis, so as to effectively buffer the negative impact of stress response.
Caregivers with higher levels of psychological resilience tend to exhibit a more positive coping attitude, a trait that not only buffers the negative effects of caregiving stress, but may also prevent psychological distress by improving the individual’s self-perception of quality of life [19, 20]. To date, most studies have demonstrated a relationship between burden and anxiety, but little is known about the mediating role of psychological resilience as a mediating role between caregiving burden and anxiety in Asian adolescent caregivers with depression. Changes in anxiety may be directly influenced by the moderating effects of psychological resilience. Therefore, people with high psychological resilience have stronger emotional regulation, more positive cognitive patterns, and more effective social support systems, which together form an important protective barrier against anxiety caused by the burden of caregiving. In the context of Asian culture, this protection mechanism may exhibit unique cultural characteristics and deserve in-depth study.
This study aims to explore the relationship between care burden and anxiety among family caregivers of adolescent depressed patients, and focuses on the mediating role of psychological resilience. Based on resource conservation theory [21], we construct a mediating effect model that assumes that psychological resilience levels can moderate the strength of the relationship between caregiving burden and anxiety. Specifically, hypothesis 1: Caregiving burden is associated with anxiety. Hypothesis 2: psychological resilience plays a mediating role between caregiving burden and anxiety. This means that the burden of caring can affect both anxiety directly and indirectly by weakening the psychological resource of psychological resilience. The results of the study may provide a clear target for psychological interventions for family caregivers.
Methods
Study design
This cross-sectional study employed a questionnaire-based survey design with convenience sampling. Participants were recruited from a tertiary Grade A hospital in Shaanxi Province between May 2023 and December 2023. Based on clinical inference, the inclusion criteria for caregivers are as follows: (1) have primary school education or above and be able to understand the content of the questionnaire; (2) Continuous care time ≥ 1 month; (3) Be familiar with the patient’s family environment and living conditions after illness. Exclusion criteria: (1) History of mental illness; (2) Combined with severe physical diseases; (3) Communication disorders: There are hearing and language deficits, and they cannot effectively cooperate with the research.
Sample size determination
Based on the sample size estimation principle proposed by Kendall [22], it is recommended that the sample size should be 5–10 times the number of independent variables. Considering factors such as ineffective responses in the questionnaire collection process, an additional 20% sample size is recommended. The questionnaire for this study contains a total of 18 variable items, so the required sample size is calculated as follows: N = [18 × 5 × (120%)] = 108. It indicates that at least 108 participants are needed for this study, and a total of 256 caregivers in this study met the criteria and were included in our study.
Measurement instruments
Sociodemographic factors: Gender, age, marital status, education level, occupation, residence location, relationship to patient, care experience, daily care duration, monthly income, medical expenses, and payment methods. Zarit Burden Interview (ZBI), Chinese version adapted by Wang Lie et al. (2006) [23].
This scale measures multidimensional caregiver stress,22 items across 2 domains: personal strain (12 items) and role strain (10 items), a 4-point Likert scale (0 = never to 4 = nearly always), and reliability, Cronbach’s α = 0.88. Burden severity classification: 0–20: no significant burden; 21–40: mild burden; 41–60: moderate burden; ≥61: severe burden.
Self-Rating Anxiety Scale (SAS) [24], 20-item assessment of anxiety symptoms, scoring methodology: 15 positively worded items, 5 reverse-scored items, 4-point Likert scale (1 = Occasionally to 4 = Always), standardized score = Raw sum*1.25. Clinical cutoff: A score of ≥ 50 indicates anxiety symptoms. Reliability and validity in Chinese populations should be established.In this study, the scale had a Cronbach’s α coefficient of 0.900.
In this study, the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) was used to evaluate [25]. The scale consists of three core dimensions: (1) optimism (4 items); (2) Toughness dimension (13 items); (3) Strength dimension (8 items), a total of 25 evaluation items. All items were scored on a 5-point Likert scale (0 = never, 4 = always), with a theoretical total score ranging from 0 to 100, and the level of the score was positively correlated with the individual’s resilience strength. The study confirmed the satisfactory psychometric properties of the CD-RISC in Chinese [26], and in this study, Cronbach’s alpha coefficient ranged from 0.80 to 0.89 for the three dimensions.
Ethical approval
This study was conducted in strict compliance with the ethical guidelines of the Declaration of Helsinki. Notably, this study did not involve human clinical trials or procedures related to animal experiments. Prior to the implementation of the study, all participants signed an anonymously handled written informed consent form and were explicitly informed of the right to withdraw from the study at any time and without conditions. The identifiers contained in the medical records were destroyed at the time the data was collected, and the study involved minimal risk to the subject.The study protocol was independently reviewed and approved by the Ethics Committee of the First Affiliated Hospital of the Fourth Military Medical University (approval number: KY20242108-F-1).
Data analysis
SPSS 26.0 was used for data analysis in this study. Quantitative data were presented in the form of mean ± standard deviation, and the calculative data were described as frequency (n) and composition ratio (%), and the correlation between psychological resilience, caregiving burden and anxiety was evaluated using Pearson correlation analysis. The process plug-in in SPSS Statistics 26.0 software was used to analyze the mediating effect. The Bootstrap sampling method (5000 repeated sampling) was used to test the significance of the mediating effect. If the 95% confidence interval (95% CI) for the mediating effect does not include 0, the pathway is considered statistically significant.
Results
General demographic information
256 adolescent patients with depression participated in the study. Among them, the mean age was 15.37 years (SD = 1.749), 149 (58.2%) were female, 194 (75.8%) were Han Chinese, 163 (63.7%) had moderate depression, and 129 (50.4%) had mild dependence on self-care. 189 (73.8%) patients were from the inpatient department.Among the 256 adolescent caregivers with depression, 73.4% were female, with a mean age of 43.23 years (SD = 5.409); 63.7% were between the ages of 41 and 50 years; 91% were married; and 84% were completely self-funded. See Table 1.
Table 1.
General information description of adolescent depressed patients and caregivers (n = 256)
| Variable | Category | N | % |
|---|---|---|---|
| Gender | Male | 107 | 41.8 |
| Female | 149 | 58.2 | |
| ethnicity | Han | 194 | 75.8 |
| others | 62 | 24.2 | |
| depression severity | mild | 61 | 23.8 |
| moderate | 163 | 63.7 | |
| severe | 32 | 12.5 | |
| self-care ability | independent | 28 | 10.9 |
| mildly dependent | 129 | 50.4 | |
| moderately dependent | 90 | 35.2 | |
| completely dependent | 9 | 3.5 | |
| Source | Outpatient Department | 67 | 26.2 |
| Inpatient Department | 189 | 73.8 | |
| Caregiver gender | Male | 68 | 26.6 |
| Female | 188 | 73.4 | |
| Age (years) | 30–40 | 72 | 28.1 |
| 41–50 | 163 | 63.7 | |
| > 50 | 21 | 8.2 | |
| Marital status | Unmarried | 2 | 0.8 |
| Married | 233 | 91 | |
| Divorced | 21 | 8.2 | |
| Educational levels | Junior high school or below | 82 | 32 |
| High school | 43 | 16.8 | |
| College or above | 131 | 51.2 | |
| Relationship to Patient | Grandparents | 10 | 3.9 |
| Parents | 235 | 91.8 | |
| Siblings | 3 | 1.2 | |
| Other relatives/Others | 8 | 3.1 | |
| Occupation | Administrative staff | 49 | 19.1 |
| Worker | 13 | 5.1 | |
| Farmer | 88 | 34.4 | |
| Others | 106 | 41.4 | |
| Residence | Rural area | 60 | 23.4 |
| County town | 121 | 47.3 | |
| Urban city | 75 | 29.3 | |
| Monthly income (RMB) | < 2000 | 41 | 16 |
| 2000–4999 | 153 | 59.8 | |
| > 4999 | 62 | 24.2 | |
| Caregiving Experience | Yes | 90 | 35.2 |
| No | 166 | 64.8 | |
| Daily Care Duration (hours) | < 4 h | 112 | 43.8 |
| 4–6 h | 48 | 18.8 | |
| 6–8 h | 16 | 6.3 | |
| > 8 h | 80 | 31.3 | |
| Monthly Medical Expenses(RMB) | < 500 | 78 | 30.5 |
| 500–1000 | 65 | 25.4 | |
| 1000–2000 | 105 | 41 | |
| > 2000 | 8 | 3.1 | |
| Payment Method | Fully out-of-pocket | 215 | 84 |
| Partially covered by medical insurance | 41 | 16 |
Descriptive statistics and correlation analysis of caregiver caregiving burden, anxiety, and psychological resilience
The mean and standard deviation between the variables are shown in Table 2. The total scores of caregiving burden, anxiety and resilience were 24.44 points ± 12.07, 55.14 ± 9.904 and 55.98 ± 6.046, respectively. Resilience was negatively correlated with caregiving burden and anxiety (r = −0.895, −0.556, P < 0.01), and care burden was positively correlated with anxiety (r = 0.561, P < 0.01) as shown in Table 3.
Table 2.
Descriptive statistics of caregiver caregiving burden, anxiety, and psychological resilience (n = 256)
| Variables | Subsections | Max | Min | Mean | SD | Items | Score range per item |
|---|---|---|---|---|---|---|---|
| Caregiver burden | 77 | 3 | 24.44 | 12.07 | 22 | 0 ~ 4 | |
| Personal burden | 45 | 1 | 9.68 | 6.738 | 11 | ||
| Responsibility burden | 24 | 0 | 14.77 | 8.647 | 6 | ||
| anxiety | 89 | 36 | 55.14 | 9.904 | 20 | 1 ~ 4 | |
| psychological resilience | 44 | 66 | 55.98 | 6.046 | 25 | 0 ~ 4 | |
| Optimism | 16 | 4 | 29.94 | 3.188 | 4 | ||
| Tenacity | 52 | 10 | 14.66 | 3.162 | 13 | ||
| Strength | 32 | 4 | 11.38 | 2.958 | 8 |
descriptive statistics, SD indicates standard deviation; ZBI、SAS、CD-RISC
Table 3.
Correlations between caregiver burden of care, anxiety, and psychological resilience (n = 256)
| Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
|---|---|---|---|---|---|---|---|---|
| 1.Caregiver burden | 1 | |||||||
| 2.Personal burden | 0.715** | 1 | ||||||
| 3.Responsibility burden | 0.839** | 0.219** | 1 | |||||
| 4.anxiety | 0.561** | 0.418** | 0.458** | 1 | ||||
| 5.psychological resilience | − 0.895** | − 0.605** | − 0.779** | − 0.556** | 1 | |||
| 6.Optimism | − 0.342** | − 0.328** | − 0.221** | − 0.143** | 0.499** | 1 | ||
| 7.Tenacity | − 0.535** | − 0.283** | − 0.526** | − 0.433** | 0.496** | − 0.484** | 1 | |
| 8.Strength | − 0.891** | − 0.580** | − 0.791** | − 0.520** | 0.976** | 0.460** | 0.467** | 1 |
Personal burden, responsibility burden under caregiver burden; optimism, tenacity, strength under psychological resilience Correlation analysis: Pearson
**P < 0.01
Analysis of the mediating role of psychological resilience
The model 4 of the process plug-in in SPSS Statistics 26.0 software was used to test the mediating effect model, and the mediating effect was analyzed by Bootstrap. Anxiety was used as the dependent variable, caregiver burden as the independent variable, and psychological resilience as the mediating variable, and the mediating effect was tested by the Bootstrap method at 95% confidence intervals. The upper and lower limits of the 95% confidence interval for direct and indirect effects do not include 0, indicating that there is a mediating effect, and psychological resilience is a mediating variable between caregiver burden and anxiety, of which the indirect effect and direct effect account for 42.95% and 57.05%, respectively (Tables 4 and 5; Fig. 1).
Table 4.
Analysis of the mediating role of psychological resilience (n = 256)
| Dependent variable | Independent variable | △R2 | F | Coeff | SE | t | LLCI | ULCI |
|---|---|---|---|---|---|---|---|---|
| 1.anxiety | Caregiver burden | 0.315 | 116.919*** | 0.461 | 0.043 | 10.813 | 0.377 | 0.545 |
| 2.psychological resilience | Caregiver burden | 0.802 | 1027.530*** | −0.449 | 0.014 | −32.055 | −0.476 | −0.421 |
| 3.anxiety | Caregiver burden | 0.330 | 62.204** | 0.263 | 0.095 | 2.766 | 0.076 | 0.450 |
| psychological resilience | −0.442 | 0.189 | −2.333* | −0.815 | −0.069 |
***P<0.001, **P<0.01, *P<0.05
Table 5.
Decomposition table of total effects, direct effects, and mediating effects (n = 256)
| Coeff | Boot SE | 95%CI | Proportion | ||
|---|---|---|---|---|---|
| LLCI | ULCI | ||||
| Total effect | 0.461 | 0.043 | 0.377 | 0.545 | |
| Direct effect | 0.263 | 0.095 | 0.076 | 0.449 | 57.05% |
| Indirect effect | 0.198 | 0.112 | 0.039 | 0.402 | 42.95% |
Fig. 1.
Pathmap of mediating effects ***P<0.001, *P<0.05
Discussion
Levels of caregiving burden, anxiety, and psychological resilience
Our findings suggest that the burden of care among family caregivers of adolescent patients with depression is at a mild burden level, with a total score of 24.44 ± 12.07, which is slightly lower than reported by some caregivers of patients with severe disease [27]. However, it is close to the report of Zhang et al. [19] on adolescent psychiatric caregivers. This difference may be explained by several factors: First, differences in disease characteristics may be an important cause. Compared with life-threatening physical diseases such as cancer [28], the symptoms of depression are fluctuating and insidious, and adolescents generally retain better physiological functions [29], which together reduce the objective burden of daily care. This finding supports Francesco Tramonti [30] suggesting that caregiver burdens differ for different diseases. Second, cultural factors may influence the perception of burden. The characteristic of “internalization of family responsibilities” in Asian cultures [31] may predispose caregivers to underestimate the degree of burden, whereas Western studies more often report explicit feelings of burden [32]. This difference echoes the different emotion regulation strategies in different cultural contexts and the impact of emotion regulation on psychological burden in collectivist culture [33].
According to our analysis of the results, the average score of anxiety level of adolescent depressed caregivers was 55.14 ± 9.904, which was higher than the clinical cut-off, suggesting that the anxiety symptoms of family caregivers had reached a severity that required clinical attention. Consistent with the findings of Rabia et al. [34], it suggests that emotional stress should be the focus of intervention. We hypothesize that this high level of anxiety may be related to the following multidimensional factors: (1) Disease management stress may be the core trigger. Adolescent depression is characterized by a fluctuating course and a high risk of suicide [35], and caregivers have been in a state of “crisis warning” for a long time. This constant state of high alertness directly leads to increased anxiety levels. (2) Social role conflicts exacerbate emotional burden. Most of the caregivers in this study were working and needed to balance multiple roles of work, childcare and caregiving. This role overload is associated with anxiety levels [36]. Of particular concern is the fact that the incidence of these symptoms increases more significantly when the caregiver is the patient’s parent [37]. Studies [38] have highlighted that failure to effectively intervene in a timely manner for caregivers’ negative emotions such as anxiety and depression may lead to a series of serious consequences, including but not limited to persistent emotional stress, increased social isolation, impaired cognitive function, and deterioration of social skills. Therefore, while focusing on the recovery of patients with depression, we should also pay attention to the mental health of caregivers.
In this study, we discovered that the mean psychological resilience score for family caregivers of adolescent patients with depression was 55.98 ± 6.046, indicating that this group’s psychological resilience was generally at a medium level. Previous studies have reported that caregivers’ psychological resilience was at a medium-to-low level [39], a finding that contrasts with our current study. The discrepancy may stem from the fact that caregivers of adolescents, such as parents, potentially possess greater adaptive potential than those caring for adult patients, like spouses looking after elderly patients. These adult caregivers often have better physiological and psychological functioning, enabling them to cope more effectively. Additionally, there might be a chronic suppression of personal emotions due to social expectations, characterized by an outward appearance of “moderate resilience” that masks an inner depletion.
The primary caregivers of adolescents with depression who exhibit a high level of psychological resilience are able to adopt a positive coping attitude in the face of illness, its exacerbation, and the stress of self-harming and suicidal behaviors. They adapt to and accept the reality of the illness and gradually free themselves from negative emotions such as anxiety and fear, which can effectively alleviate the psychological crisis [40, 41]. This moderate psychological resilience suggests that this group is neither completely helpless nor exceptionally strong but rather occupies a “middle ground” that necessitates targeted support [42]. Medical and social support systems should aim to:
Assist caregivers in establishing realistic expectations and avoiding self-criticism in the pursuit of “perfect care”;
Provide ongoing psychoeducation to enhance illness awareness and coping skills; and.
Establish peer support networks to reduce social isolation.
Notably, early intervention with caregivers who exhibit moderate resilience may prevent them from falling into psychological exhaustion.
Correlations between caregiving burden, anxiety, and psychological resilience
This study found a significant positive correlation between caregiving burden and anxiety (r = 0.561), and a significant negative correlation between psychological resilience and caregiving burden and anxiety (r = −0.895, −0.556), which is consistent with the findings of domestic scholars [7].
Caregiving burden is positively correlated with anxiety, i.e., the level of anxiety increases with increasing burden. This suggests that adolescent depressed patients often require caregivers to invest a lot of time and energy, and this constant stress may lead to emotional problems such as anxiety and helplessness in caregivers, which is consistent with the results of relevant foreign studies ([43]. Surveys by domestic scholars such as Guo Zhengjun ([44] and Lu Rui ([45] have shown that the detection rate of anxiety symptoms is higher among caregivers of patients with mental disorders. This is the same as the results of foreign scholars, who believe that psychological burden will significantly affect the burden of care ([46]. In addition, adolescent depressed caregivers may face insufficient social support, economic pressure, and concerns about the prognosis of the disease [14], which will further exacerbate anxiety levels, and the patient’s continuous high-intensity care needs directly consume psychological resources, resulting in impaired emotional regulation function. On the other hand, long-term burden experiences trigger negative cognitive biases, forming a vicious cycle of “burden-anxiety”.
psychological resilience is inversely correlated with anxiety, i.e., caregivers with greater psychological resilience show lower levels of anxiety. It shows that psychological resilience, as an important psychological resource, can help individuals maintain emotional stability in the face of stress and adopt positive coping strategies [21]. Specifically, resilient caregivers typically have higher emotional regulation skills, stronger perceptions of social support, and a more optimistic attitude towards life, which can effectively buffer the negative effects of caregiving burden and family conflicts, thereby reducing the risk of anxiety [47]. This is consistent with the results of relevant studies suggesting that psychological resilience can help alleviate psychological distress such as anxiety among caregivers, thereby improving the quality of life of caregivers and optimizing the overall family situation [48, 49]. This suggests that high psychological resilience may alleviate caregiving stress through multiple pathways, including promoting the use of adaptive coping strategies, enhancing emotional regulation, and improving the efficiency of social support utilization. Our findings confirm this, with family caregivers with high psychological resilience scoring low in anxiety. This result suggests that enhancing psychological resilience may be an effective entry point in future interventions.
The mediating effect of psychological resilience on the relationship between caregiving burden and anxiety
This study verifies the mediating effect of psychological resilience on the relationship between care burden and anxiety in family caregivers of adolescent depressed patients. The key protective value of psychological resilience in maintaining caregivers’ mental health under heavy caregiving burdens is highlighted. The study found that heavy caregiving burden significantly increases caregiver anxiety levels, while psychological resilience can effectively buffer this negative impact, which has important theoretical and practical implications.
The mediating role of psychological resilience can be explained from two perspectives: stress cognition theory and resource conservation theory. First, according to Lazarus [50]’s cognitive evaluation model of stress, individuals with strong psychological resilience tend to rate the burden of care as a manageable challenge rather than an uncontrollable threat, thereby reducing the activation of anxiety. Secondly, resource conservation theory [51] points out that psychological resilience, as a psychological resource, can help individuals maintain emotional stability when coping with the burden of caregiving, avoiding anxiety caused by excessive resource consumption. Adolescent depressed caregivers face persistent caregiving stress and emotional challenges, and psychologically resilient caregivers are better able to adapt to this long-term stress and reduce the psychological impact of caregiving burden through positive cognitive reappraisal and effective emotional regulation [52, 53]. This suggests that we should fully recognize the great pressure experienced by adolescent depression caregivers, improve the level of psychological resilience of caregivers, and help them better relieve anxiety.
Caregivers should focus on the critical role of adolescent depression caregivers in reducing caregiving burden and anxiety. Simply reducing the objective care burden may not be enough to completely alleviate anxiety, as the level of psychological resilience determines an individual’s subjective experience of the burden. Therefore, effective interventions need to be two-pronged: on the one hand, provide practical support (e.g., respite services, financial assistance) to reduce the objective burden; on the other hand, psychological toughness is enhanced through cognitive behavioral therapy, mindfulness training, etc. Of particular note is that for individuals with a heavy care burden but low psychological resilience, targeted interventions, such as emotion regulation training and social support network construction, should be prioritized to break the “burden-anxiety” cycle.
Limitations
Our study has the following limitations, firstly, the cross-sectional design cannot determine the causal relationship between variables, which may affect the interpretation of the mediation model, and it is unclear whether the burden of care causes anxiety, or whether anxious caregivers perceive a greater burden. Second, we recruited participants using convenience sampling, and a representative sample was not available. Therefore, the external validity of the results of this study may be limited; Third, all data were collected using self-rating scales, which may be affected by reporting bias and lack of control for potential confounding factors (e.g., patient severity, caregiver mental health history). Finally, our study was conducted in only one province in China, did not systematically evaluate the moderating effect of traditional cultural values on the relationship between variables, did not record the specific composition of family support systems in detail, did not cover the sample of special family structures such as single-parent families and intergenerational upbringing, and the results may not be applicable to other regions and countries, and the representativeness of the sample may be limited.
Conclusion
This study found that anxiety was positively correlated with caregiving burden and negatively correlated with psychological resilience. This study confirms the mediating role of resilience in the relationship between caregiving burden and anxiety among family caregivers of adolescent patients with depression, revealing the important role of resilience in alleviating caregiving burden. This finding provides an empirical basis for the study of family caregiver’s mental health in the context of Asian culture, and points out a potential direction for future intervention research. It is suggested that clinicians can design localized resilience training courses, provide medical insurance to cover resilience assessment and intervention costs, establish community-family mental health files, and regularly screen high-risk caregivers.
Acknowledgements
We thank all the family caregivers of the adolescents with depression and the psychosomatic nurses who participated in this study for their support and assistance.
Authors’ contributions
Y-tW, W-tH, and YZ designed the study and were responsible for analyzing the data and writing the article.Y-tW was responsible for collecting the data.W-tH and Y-cF checked the data.YZ provided guidance on the statistical aspects.W-tH and YZ guided the study design and interpretation. All authors approved the final paper.
Funding
This study was supported by the Fourth Military Medical University (Grant No. 2023KXKT048).
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study strictly followed the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Review Committee of the First Affiliated Hospital of Air Force Military Medical University. All participants signed a written informed consent form before the study was conducted.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yu-ting Wu and Wan-ting Hao contributed equally to this work.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.