Social support, self-efficacy, and distress on health-related quality of life in Chinese dementia caregivers: a serial multiple mediation analysis

Background: Little is known about the psychosocial pathways linking social support to health-related quality of life (HRQoL) in family caregivers of people with dementia (PwD). This study aimed to explore how self-efficacy and caregiver distress mediate the relationship between social support and caregivers’ HRQoL.

Methods: This study utilized baseline data from a randomized controlled trial involving 266 Chinese dementia caregivers recruited from China and Australia. Four self-report scales were used: the Chinese version of the Carers of Older People in Europe Index-Quality of Social Support, the Revised Scale for Caregiving Self-efficacy, the Revised Memory and Behavior Problem Checklist and the 12-Item Short-Form Health Survey. Structural equation modeling was conducted using AMOS 26.0 to examine the mediating roles of self-efficacy and caregiver distress in mediating the relationship between social support and HRQoL.

Results: Social support was significantly associated with HRQoL. It also indirectly predicted physical HRQoL through caregiving self-efficacy (β = 0.062) and caregiver distress (β = 0.070), accounting for 38.88 % of the total effect. Besides, social support indirectly predicted mental HRQoL through self-efficacy (β = 0.182) and caregiver distress (β = 0.041), contributing to 58.1 % of the total effect. Self-efficacy and caregiver distress functioned as sequential mediators in this association. Conclusion: Social support was positively associated with HRQoL, both directly and indirectly, through the serial mediating role of self-efficacy and caregiver distress among family caregivers of PwD. Our findings highlight the importance of providing psychosocial interventions to improve HRQoLfor dementia caregivers.