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Associations between Affiliate Stigma and Quality of Life among Caregivers of Individuals with Dementia: Mediated Roles of Caregiving Burden and Psychological Distress
Yi-Ling Hu1, Chih-Cheng Chang2, Chiu-Hsiang Lee3, Chieh-Hsiu Liu4, Yi-Jung Chen5, Jian-An Su6, Chung-Ying Lin7, Mark D Griffiths8
1 Program in Occupational Therapy, Chang Gung University, Department of Ophthalmology, Chang Gung Memorial Hospital and College of Medicine, Tao-Yuan, Taiwan
2 Department of Psychiatry, Chi Mei Medical Center; Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
3 Department of Nursing, Chung Shan Medical University; Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
4 Department of Family Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
5 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
6 Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi; School of Medicine, Chang Gung University, Taoyuan; Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
7 Institute of Allied Health Sciences; Department of Public Health; Biostatistics Consulting Center, National Cheng Kung University Hospital; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
8 International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
Correspondence Address:
Chung-Ying Lin
Institute of Allied Health Sciences, Department of Occupational Therapy, Department of Public Health, Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 701
Taiwan
Jian-An Su
Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan. School of Medicine, Chang Gung University, Taoyuan, Taiwan. Department of Nursing, Chang Gung Institute of Technology, Taoyuan
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/shb.shb_67_23
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Introduction: The associations between affiliate stigma, caregiving burden, psychological distress, and quality of life (QoL) among family caregivers of people living with dementia (PwD) have been demonstrated in the literature. However, there is a dearth of literature regarding how these factors could form a psychological mechanism. The present study proposed a theoretical model to portray the relationships between these factors. Methods: Utilizing convenience sampling and cross-sectional study design, 275 family caregivers (145 females [52.7%]; mean age = 52.71 years) were recruited from a general hospital from October 2013 to September 2014. Each participant completed the following instruments in a quiet room in the general hospital without disturbance: Caregiver Burden Inventory, World Health Organization QoL Questionnaire-Brief, Affiliate Stigma Scale, and Beck Anxiety Inventory alongside the Taiwan Depression Questionnaire (assessing psychological distress). Structural equation modeling was used to examine the proposed theoretical model. Results: Affiliate stigma (standardized coefficient [β] = −0.338; P = 0.011) and psychological distress (β = −0.538; P < 0.001) were negatively associated with QoL, caregiving burden was positively associated with psychological distress (β = 0.818; P < 0.001), and affiliate stigma was positively associated with caregiving burden (β = 0.793; P < 0.001). Moreover, a significant mediated effect was observed between affiliate stigma and QoL via sequential mediators of caregiving burden and psychological distress (unstandardized coefficient = −1.17 and 95% confidence interval = −1.88, −0.46). Conclusion: Affiliate stigma, caregiving burden, and psychological distress are key factors contributing to low QoL among family caregivers of PwD. Health-care providers should design programs to help reduce affiliate stigma, caregiving burden, and psychological distress for family caregivers of PwD to facilitate their QoL.
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