Patient's disability and caregiver burden among Chinese family caregivers of individual living with schizophrenia: mediation effects of potentially harmful behavior, affiliate stigma, and social support

Evidence on the associations between patient's disability and caregiver burden among Chinese family caregivers of individual living with schizophrenia is lacking. This study aimed at explore the underlying mechanisms between patient's disability and caregiver burden among Chinese family caregivers of individual living with schizophrenia. A cross-sectional study was carried out in four Chinese cities (Wuhan, Changsha, Guangzhou, and Shenzhen), between April, 2021 and March, 2022. A total of 493 patients and their family caregivers were invited to report related data. The Zarit burden interview, WHODAS 2.0, the Potentially harmful behavior scale, the Affiliate Stigma Scale, and the Multidimensional Scale of perceived social support were used to collect data. Linear regression analysis and bootstrapping analysis were conducted. The adjusted regression results showed that patients' disability (B=0.616; 95% CI: 0.479-0.753), potentially harmful behavior on caregivers (B=0.474; 95% CI: 0.232-0.716), and caregiver's low social support (B= -0.079; 95% CI: -0.158--0.002), high level of affiliate stigma (B = 13.045; 95% CI: 10.227-15.864) were associated with higher level of caregiver burden (p < 0.05). In the mediation model, the direct path from patient's disability to caregiver burden (B=0.428, β= 0.371, p < 0.001) was significant and positive. Patient's disability was indirectly associated with caregiver burden through patient's potentially harmful behavior, caregiver's affiliate stigma, and social support, the standardized regression coefficients ranged from 0.026-0.049 (p<0.05). Patient's potentially harmful behavior, caregiver's affiliate stigma, and social support mediated the relationship between patients' disability and caregiver burden. Future intervention studies designed to target these three factors may be beneficial for family caregivers of persons living with schizophrenia.