A cross-sectional investigation conducted among 305 family caregivers of individuals with dementia in Henan Province, China, has identified family resilience and sense of coherence as key mediating factors in the relationship between caregiver burden and psychological distress. Reporting in Frontiers in Public Health, the researchers observed that while the strain of long-term caregiving is closely linked to psychological distress, adaptive resources at both the family and individual levels play significant independent and sequential roles in explaining that association. In particular, the sequential indirect pathway operating jointly through family resilience and sense of coherence accounted for 5.4 percent of the total effect of caregiver burden on psychological distress.
The investigation addressed a critical concern in public health and dementia care, noting that family caregivers of people with dementia often experience substantial psychological distress due to the ongoing burden associated with long-term caregiving. Although previous studies had identified a clear association between caregiver burden and psychological distress, the precise functions of adaptive resources within this relationship remained insufficiently understood. To clarify these mechanisms, the authors designed the study to examine the association between caregiver burden and psychological distress and to explore the independent and sequential mediating roles of family resilience and sense of coherence among family caregivers.
The study was authored by Shuang Zhang and Mengli Yang from the Henan Provincial Key Medicine Laboratory of Nursing at Zhengzhou University People’s Hospital and the Department of Neurology at Henan Provincial People’s Hospital, together with Yanming Ma from the School of English Studies at Tianjin Foreign Studies University and Liniu Pan from the School of Nursing at Zhengzhou Health Vocational College. For their cross-sectional design, the investigators recruited a cohort of 305 family caregivers of people with dementia from two tertiary hospitals located in Henan Province, China, providing an empirical sample drawn directly from clinical hospital settings.
To measure the relevant psychological constructs, data collection was conducted using the Chinese versions of four established evaluation instruments. The Zarit Burden Interview was administered to evaluate the level of caregiver burden. Adaptive resources were captured through the Family Resilience Assessment Scale to gauge family resilience, while the Sense of Coherence Scale was employed to measure individual sense of coherence. Caregiver psychological distress was quantified using the 10-item Kessler Psychological Distress Scale. Together, these four instruments provided the standardized measurement scores necessary to analyze burden, family and individual resources, and psychological outcomes.
Analytical procedures began with Pearson’s correlation analysis to evaluate the bivariate associations among caregiver burden, family resilience, sense of coherence, and psychological distress. The statistical results revealed significant correlations across all of the measured variables, with each correlation demonstrating statistical significance at p < 0.001. Following the correlation analysis, the researchers assessed the direct and indirect effects among the variables using sequential mediation analysis. This mediation testing was executed using Model 6 of the SPSS PROCESS macro version 4.2, enabling the authors to model both parallel and chained indirect relationships.
The sequential mediation analysis demonstrated that family resilience and sense of coherence each exhibited significant indirect associations in the relationship between caregiver burden and psychological distress. Beyond these independent indirect pathways, the statistical model identified a significant sequential indirect association that operated consecutively through family resilience and sense of coherence. This sequential mediating path accounted for 5.4 percent of the total effect linking caregiver burden to psychological distress, confirming that family-level resilience and individual-level sense of coherence operate in a connected, stepwise manner within the caregiving context.
In their conclusions, the investigators stated that family resilience and sense of coherence serve as important mediating resources in the association between caregiver burden and psychological distress among family caregivers of people with dementia. The authors highlighted that these findings point to the interconnected roles of family-level and individual-level psychological resources in caregivers’ psychological adaptation to dementia caregiving stress. They noted that interventions targeting family resilience and sense of coherence may represent potential approaches for supporting caregivers’ psychological well-being. However, given the cross-sectional design of the present study, the authors emphasized that these potential approaches warrant further investigation through future longitudinal and intervention studies.
Subject of Research: Psychological adaptation and mediating resources among family caregivers of people with dementia
Article Title: Caregiver burden and psychological distress among family caregivers of people with dementia: the mediating roles of family resilience and sense of coherence
Article References: Zhang, S., Ma, Y., Pan, L., & Yang, M. (2026). Caregiver burden and psychological distress among family caregivers of people with dementia: the mediating roles of family resilience and sense of coherence. Frontiers in Public Health, 14, Article 1999212. https://doi.org/10.3389/fpubh.2026.1999212
Image Credits: AI Generated
DOI: 10.3389/fpubh.2026.1999212
Keywords: caregiver burden, dementia, family resilience, sense of coherence, psychological distress, sequential mediation, family caregivers, cross-sectional study, Caregiver, burden, psychological, distress
