Caregiver burden, family resilience, and depressive and anxiety symptoms in parents of depressed adolescents: a cross-sectional mediation study
- 1Department of Psychiatry, Shanghai Jiading District Mental Health Center
- 2Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
Abstract
Background: Parents of adolescents with depression experience substantial caregiving burden, contributing to an increased risk of psychological distress. While individual resilience has been associated with this relationship, the role of family-level resilience remains underexplored. This study explored whether family resilience statistically accounted for the association between caregiver burden and psychological distress, and whether social support moderated this pathway.
Methods: A cross-sectional study was conducted with 178 parents of adolescents diagnosed with depression. Participants completed measures of caregiver burden (Zarit Burden Interview, ZBI), family resilience (Family Resilience Assessment Scale, FRAS), social support (Social Support Rating Scale, SSRS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7). A moderated mediation model (PROCESS Model 7) was tested as the primary analysis, with 5,000 bootstrap resamples, adjusting for child age, child sex, illness duration, caregiver age, caregiver sex, caregiver education and economic status. All continuous predictors were standardized. Sensitivity analyses were re-run on the primary model excluding outliers and using 10,000 bootstrap resamples.
Results: The index of moderated mediation was not significant for depressive symptoms (β = −0.029, 95% CI [−0.086, 0.029], p = 0.262) or anxiety symptoms (β = −0.023, 95% CI [−0.073, 0.021], p = 0.266), indicating that social support did not moderate the indirect pathway. Conditional indirect effects of caregiver burden on depressive symptoms through family resilience were significant at low, mean, and high levels of social support (β = 0.132, 0.103, and 0.075, respectively), and similarly for anxiety symptoms (β = 0.106, 0.083, and 0.059). However, these effects did not differ significantly across levels. Social support was directly and positively associated with family resilience (β = 0.496, p < 0.001; r = 0.62, p < 0.001). Sensitivity analyses supported the robustness of these findings.
Conclusions: Family resilience partially accounted for the association between caregiver burden and psychological distress in parents of adolescents with MDD. Social support did not moderate this pathway but was independently associated with higher family resilience. Interventions targeting family resilience may be promising, with social support as a supplementary resource. Longitudinal studies are needed to establish causality and to clarify which aspects of social support are most valued by these caregivers.
Related
- Association between discretionary screen time and depressive symptoms in Chinese adolescents: a cross-sectional study
- Suicidal ideation, depressive experiences, and resilience among adolescents living with HIV in rural Ghana: a qualitative exploration of psychological experiences and coping
- Attachment-Based Family Therapy for Suicidal and Depressed Adolescents in Child and Adolescent Psychiatry
- Inconclusive mediated effect of adverse childhood experiences on suicide risk among depressed adolescents: A reanalysis of Ye et al. (2026)
- Depressive symptoms and viral load suppression among adolescents and youth living with HIV in Malawi: a cross-sectional analysis of MPHIA 2020-2021
BibTeX
@article{meng2026caregiver,
title = {{Caregiver burden, family resilience, and depressive and anxiety symptoms in parents of depressed adolescents: a cross-sectional mediation study}},
author = {Meiling Meng and Hongyan Shen and Jing Zhang and Yanli Han and Xiaoping Fang and Yi Wen and Cheng Cheng and Yue Yuan and Chongze Wang and Qinyu Lv and Zhenghui Yi},
journal = {Frontiers in Psychiatry},
year = {2026},
month = nov,
doi = {10.3389/fpsyt.2026.1992552},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1992552/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Caregiver burden, family resilience, and depressive and anxiety symptoms in parents of depressed adolescents: a cross-sectional mediation study
AU - Meiling Meng
AU - Hongyan Shen
AU - Jing Zhang
AU - Yanli Han
AU - Xiaoping Fang
AU - Yi Wen
AU - Cheng Cheng
AU - Yue Yuan
AU - Chongze Wang
AU - Qinyu Lv
AU - Zhenghui Yi
PY - 2026
DA - 2026/11/03
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1992552
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1992552/full
AB - Background: Parents of adolescents with depression experience substantial caregiving burden, contributing to an increased risk of psychological distress. While individual resilience has been associated with this relationship, the role of family-level resilience remains underexplored. This study explored whether family resilience statistically accounted for the association between caregiver burden and psychological distress, and whether social support moderated this pathway. Methods: A cross-sectional study was conducted with 178 parents of adolescents diagnosed with depression. Participants completed measures of caregiver burden (Zarit Burden Interview, ZBI), family resilience (Family Resilience Assessment Scale, FRAS), social support (Social Support Rating Scale, SSRS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7). A moderated mediation model (PROCESS Model 7) was tested as the primary analysis, with 5,000 bootstrap resamples, adjusting for child age, child sex, illness duration, caregiver age, caregiver sex, caregiver education and economic status. All continuous predictors were standardized. Sensitivity analyses were re-run on the primary model excluding outliers and using 10,000 bootstrap resamples. Results: The index of moderated mediation was not significant for depressive symptoms (β = −0.029, 95% CI [−0.086, 0.029], p = 0.262) or anxiety symptoms (β = −0.023, 95% CI [−0.073, 0.021], p = 0.266), indicating that social support did not moderate the indirect pathway. Conditional indirect effects of caregiver burden on depressive symptoms through family resilience were significant at low, mean, and high levels of social support (β = 0.132, 0.103, and 0.075, respectively), and similarly for anxiety symptoms (β = 0.106, 0.083, and 0.059). However, these effects did not differ significantly across levels. Social support was directly and positively associated with family resilience (β = 0.496, p < 0.001; r = 0.62, p < 0.001). Sensitivity analyses supported the robustness of these findings. Conclusions: Family resilience partially accounted for the association between caregiver burden and psychological distress in parents of adolescents with MDD. Social support did not moderate this pathway but was independently associated with higher family resilience. Interventions targeting family resilience may be promising, with social support as a supplementary resource. Longitudinal studies are needed to establish causality and to clarify which aspects of social support are most valued by these caregivers.
SN - 1664-0640
ER -