Abstract
BACKGROUND: Severe mental illnesses (SMIs) have become one of the public health problems of great concern in society, which not only bring physical and mental pain to patients but also heavy burden to families. It is known that the health-related quality of life (HRQoL) of patients and caregivers' social support are correlated with caregivers' family burden of disease, but the interaction mechanism among them is not clear. The purpose of this study was to investigate the association between HRQoL in patients with SMIs and the family burden of disease and to examine the mediating role of caregivers' social support. METHODS: From January to July 2022, this cross-sectional study was conducted in 23 community health service centers in Nanjing, China. We recruited 924 patients with SMIs and their caregivers, using a random sampling method. Hayes' PROCESS macro was used to test the mediation effect of caregivers' social support in the relationship between patients' HRQoL and family burden of disease. Indirect effects were tested using bootstrapped confidence intervals (CI). RESULTS: The SF-36 score of patients with SMIs was 57.85 (49.59, 63.64), while the caregivers' social support was measured at 32.00 (27.00, 35.00), and the family burden of disease scored 16.00 (8.00, 24.00). Spearman correlation analysis revealed a negative correlation between the patients' HRQoL and the family burden of disease (r = -0.54, p < 0.01). Furthermore, caregivers' social support was negatively correlated with the family burden of disease (r = -0.19, p < 0.01). The mediating role of caregivers' social support between the patients' HRQoL and the family burden of disease was confirmed by the Bootstrap test (p < 0.01), with a mediating effect of 2.75% (β = -0.016, 95% CI = -0.031, -0.002). CONCLUSIONS: This study highlights that caregivers experience a heavy family burden of disease. The patients' HRQoL not only directly affects the family burden of disease but also indirectly influences it through the caregivers' social support. Therefore, relevant departments need to prioritize improving patients' HRQoL and expanding caregivers' social support networks when developing targeted intervention programs to reduce the family burden of SMIs.