Quality of life and care burden among family caregivers of people with severe mental illness: mediating effects of self-esteem and psychological distress

Abstract

Background: Family caregivers are important allies for healthcare providers in facilitating the recovery process among people with mental illness (PWMI). The present study examined the factors associated with quality of life (QoL) among family caregivers of PWMI.

Methods: A multi-center cross-sectional survey was conducted. Family caregivers of people with schizophrenia, major depressive disorder, and bipolar disorder were recruited using convenience sampling. A survey assessing their QoL, depression, anxiety, and self-esteem was completed with self-rated psychometric scales including the Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, Beck Anxiety Inventory, and World Health Organization Quality of Life Instrument Short Form. A mediation model was constructed with QoL as the dependent variable, care burden as the independent variable, and psychological distress (including depression and anxiety) with self-esteem as mediating variables.

Results: Family caregivers of people with schizophrenia had worse QoL compared with counterparts of people with major depression and bipolar disorder. The sociodemographic of both caregivers and PWMI had less impact on QoL when psychological factors were considered. Caregivers with lower self-esteem, higher levels of psychological distress, and heavier care burdens had poorer QoL. Care burden had a significant total effect on QoL. Both self-esteem and psychological distress were significant mediators.

Conclusion: The findings indicated that caregivers' psychological health and care burden influenced their QoL. Interventions that target family caregivers' self-esteem and psychological distress may attenuate the effect from care burden, and further improve their QoL.

Keywords: Bipolar disorder; Care burden; Family caregiver; Major depressive disorder; Quality of life; Schizophrenia; Self-esteem.

Fig. 1

Modified version of Pearlin’s stress process model Note: This model was modified from Pearlin’s Stress Process Model [17]. In this model, all variables used in the present study were placed in their supposed position and the arrows indicate the relationships between these variables.

Fig. 2

Proposed mediation model for the present study Note: Care burden, self-esteem, depression, and anxiety were proposed as having direct impacts on quality of life. Care burden was also proposed as affecting quality of life via self-esteem only, or via depression/anxiety only, or via self-esteem and depression/anxiety.

Fig. 3

Results of sequential mediation model describing the mediator roles of self-esteem and depression in the association between care burden and quality of life Note: Mediated effects of the level of quality of life (comprising four domains: physical health, psychological health, social relationships, and environment) on the associations between care burden, self-esteem, and depression. All the models used 5,000 bootstrapping resamples and controlled for people with mental illness (PWMI) diagnosis, psychiatric hospitalization, age of PWMI and caregiver, gender of PWMI and caregiver, and education years of PWMI and caregiver. All coefficients and effects are unstandardized coefficients/effects. All path coefficients were significant Abbreviations: PHY = physical health; PSY = psychological health; SR = social relationships; ENV = environment. *p < 0.05, **p < 0.01, ***p < 0.001

Fig. 4

Results of sequential mediation model describing the mediator roles of self-esteem and depression in the association between care burden and quality of life Note: Mediated effects of the level of quality of life (comprising four domains: physical health, psychological health, social relationships, environment) on the associations between care burden, self-esteem, and anxiety. All the models used 5,000 bootstrapping resamples and controlled for diagnosis of people with mental illness (PWMI), psychiatric hospitalization, age of PWMI and caregiver, gender of PWMI and caregiver, and education years of PWMI and caregiver. All coefficients and effects are unstandardized coefficients/effects. All path coefficients were significant Abbreviations: PHY = physical health; PSY = psychological health; SR = social relationships; ENV = environment. *p < 0.05, **p < 0.01, ***p < 0.001