Family functioning and depressive symptoms among caregivers of disabled old people: A multiple mediation model

Caregivers of disabled people often face significant challenges that may adversely impact their psychological well-being. Understanding the relationship between family functioning and depressive symptoms, as well as the potential mediating roles of psychological resilience, caregiver burden, and life satisfaction, is critical for developing effective interventions to support this population. A survey questionnaire was completed face-to-face by 353 primary caregivers of older people with disabilities in east China. Pearlin's stress process model was used to examine the mediating effect of psychological resilience, caregiver burden, and life satisfaction on family functioning and caregiver depressive symptoms. A structural equation modeling (SEM) analysis using AMOS version 28 was conducted to examine the mediation effects. The findings revealed a significant negative association between family functioning and depressive symptoms (β = -0.868, P < 0.001). Psychological resilience, caregiver burden, and life satisfaction were all mediators, with caregiver burden having the strongest indirect effect. Analyses also showed that the stress process differs between spouse and non-spouse caregivers. In spouse caregivers model, only caregiver burden acted as a mediator between family functioning and depressive symptoms, with a significant effect of -0.201 (95%CI = -0.403, -0.059). In non-spouse caregivers model, both caregiver burden and life satisfaction acted as mediators, with caregiver burden showing a stronger effect (indirect effect = -0.354, 95%CI = -0.590, -0.168). This study highlighted the complex relationship between family functioning and depressive symptoms in caregivers of the disabled old people. By fostering a supportive and cohesive family environment, caregivers may experience lower levels of depressive symptoms. Psychological resilience and life satisfaction served as crucial protective factors, and reducing caregiving burden may help alleviate depressive symptoms and improve caregivers' overall well-being.