Abstract
BACKGROUND: Major depressive disorder (MDD) in adolescents is increasingly prevalent and associated with high recurrence, suicide risk, and disease burden. Family caregivers, typically parents or close relatives, often internalize public stigma, resulting in affiliate stigma-shame and distress arising from their association with patients. This stigma impairs caregivers' mental health, quality of life, and patients' recovery. However, few studies have explored how psychosocial factors such as social support, coping style, and family functioning influence affiliate stigma. This study therefore examines its score level, influencing factors, and the mediating roles of family functioning and coping style. METHODS: A cross-sectional study we conducted at a mental health center in Inner Mongolia, China. A total of 308 family caregivers of adolescents diagnosed with MDD were recruited. Demographic information, affiliate stigma, social support, family functioning, and coping styles were assessed using validated instruments. Data we analyzed using IBM SPSS Statistics 26.0 and AMOS 24.0 to examine the influencing factors of affiliate stigma and the underlying mechanisms through structural equation modeling. RESULTS: The average affiliate stigma score among caregivers was74.922 ± 9.834. Multiple regression analysis showed that social support, family functioning, positive and negative coping styles, gender, education level, household income, and whether the adolescent was experiencing a first depressive episode independently predicted of affiliate stigma (P < 0.05), explaining 65.5% of the variance (R² = 0.655). The structural equation model showed acceptable fit with room for improvement (χ² = 2431.24, df = 1394,; χ²/df = 1.744; RMSEA = 0.075; CFI = 0.905; GFI = 0.914;IFI = 0.916;TLI = 0.913). Social support had indirect effects on affiliate stigma via family functioning (-6.5%) and coping styles (-9.5%), with all pathways being statistically significant (P < 0.01). CONCLUSIONS: Family caregivers of adolescents with MDD experience moderately high levels of affiliate stigma. Social support not only directly influences stigma but also exerts indirect effects through family functioning and coping strategies. Interventions should focus on improving family functioning and promoting adaptive coping to reduce affiliate stigma.