{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T08:50:02Z","timestamp":1766134202010,"version":"3.46.0"},"reference-count":37,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Labor and Welfare Bureau of the Government of the Hong Kong Special Administrative Region of the People\u2019s Republic of China","award":["LWB: SF (1) to LWB R 3\/3939\/17","PTeC: P17-0335-RS"],"award-info":[{"award-number":["LWB: SF (1) to LWB R 3\/3939\/17","PTeC: P17-0335-RS"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,4,25]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Caregiving has been widely recognised as a potential risk factor for caregivers\u2019 psychological well-being in previous studies. The objective of this study is to examine the association between multiple factors of the caregiving process and the depression risk of caregivers, as well as the mediating effect of caregiver burden in these associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The Hong Kong Polytechnic University in Hong Kong Special Administrative Region, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>597 family caregivers of persons with disabilities in December 2020 under the Hong Kong governmental initiative, \u2018Persons with Disabilities and Rehabilitation Program\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome and measures<\/jats:title>\n                    <jats:p>Indications of depression were assessed through the application of the World Health Organization-Five Well-being Index (1998 version).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A structural equation model (SEM) was applied using Analysis of Moment Structure (AMOS) 28.0 to identify the association between a series of caregiving-related factors and depression risk, as well as test the mediating role of caregiver burden in these associations. 50% of care recipients needed assistance in all four care need categories, with daily living care being the most prominent (72.4%). Caregivers dedicated around 79.6\u2009hours (SD: 52.2) per week on caregiving duties. Nearly 44% of the caregivers had at least one diagnosed disease. Only 5% of caregivers considered that they had a poor caregiving ability, whereas 87.2% of them reported heightened caregiving pressure during the COVID-19 pandemic. In this study, the average caregiver burden score was 6.6 (SD: 3.3), and the average depression score was 6.7 (SD: 5.1). The results of the SEM model showed that care needs of care recipients (\u00df (95% CI): \u22120.201 (\u22120.355, \u20130.083), p=0.001), weekly caregiving hours (\u00df (95%\u2009CI): \u22120.126 (\u22120.215, \u20130.067), p=0.001) and presence of emotional issues (\u00df (95%\u2009CI): \u22120.329 (\u22120.538, \u20130.184), p=0.001) were positively associated with depression risk of caregivers, fully mediated by caregiver burden. Additionally, caregivers\u2019 health status had both direct (\u00df (95%\u2009CI): \u22120.234 (\u22120.388, \u20130.101), p=0.001) and indirect (\u00df (95%\u2009CI): \u22120.126 (\u22120.215, \u20130.067), p=0.001) effects on depression, indicating that caregiver burden partially mediated this pathway (proportion mediation is 35%). A higher self-evaluation of caregiving ability was related to a lower risk of depression (\u00df (95%\u2009CI): 0.281 (0.169, 0.396), p=0.001), and caregiver burden did not mediate this pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Care needs of care recipients, weekly caregiving hours, caregivers\u2019 health status and presence of emotional issues during the COVID-19 pandemic were adversely associated with an increased depression risk for caregivers, and these were either fully or partially mediated by caregiver burden. Additionally, caregivers\u2019 lower self-evaluation of their caregiving ability was an independent factor that directly contributes to an increased depression risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087397","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T16:05:20Z","timestamp":1747065920000},"page":"e087397","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association between caregiving factors and depression symptoms in family caregivers of persons with disabilities during the COVID-19 pandemic in Hong Kong: a structural equation analysis"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7831-6764","authenticated-orcid":false,"given":"Honglin","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiqi","family":"Xin","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector","family":"Tsang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China"},{"name":"Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"2025120618461991000_15.5.e087397.1","unstructured":"Census and Statistics Department . Social data collected via the general household survey: special topics report no.63\u2014Persons with disabilities and chronic diseases. Census and Statistics Department, Hong Kong SAR Government; 2021."},{"key":"2025120618461991000_15.5.e087397.2","doi-asserted-by":"crossref","unstructured":"Schulz R , Eden J . Families caring for an aging America. Washington, DC National Academies Press; 2016.","DOI":"10.17226\/23606"},{"key":"2025120618461991000_15.5.e087397.3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/imj.14166","article-title":"Stress and burden faced by family caregivers of people with schizophrenia and early psychosis in Hong Kong","volume":"49 Suppl 1","author":"Wan","year":"2019","journal-title":"Intern Med J"},{"key":"2025120618461991000_15.5.e087397.4","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-psych-010419-050754"},{"key":"2025120618461991000_15.5.e087397.5","doi-asserted-by":"crossref","DOI":"10.1177\/23337214211020164","article-title":"Impact of COVID-19 on the Health and Well-being of Informal Caregivers of People with Dementia: A Rapid Systematic Review","volume":"7","author":"Hughes","year":"2021","journal-title":"Gerontol Geriatr Med"},{"key":"2025120618461991000_15.5.e087397.6","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1016\/S0140-6736(20)31254-X","article-title":"Informal home care providers: the forgotten health-care workers during the COVID-19 pandemic","volume":"395","author":"Chan","year":"2020","journal-title":"Lancet"},{"key":"2025120618461991000_15.5.e087397.7","unstructured":"World Health Organization . Dementia: a public health priority. 2012."},{"key":"2025120618461991000_15.5.e087397.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-016-0280-8","article-title":"A meta-review of stress, coping and interventions in dementia and dementia caregiving","volume":"16","author":"Gilhooly","year":"2016","journal-title":"BMC Geriatr"},{"key":"2025120618461991000_15.5.e087397.9","unstructured":"Lazarus RS , Folkman S . Stress, appraisal, and coping. Springer Publishing Company, 1984."},{"key":"2025120618461991000_15.5.e087397.10","doi-asserted-by":"crossref","first-page":"104162","DOI":"10.1016\/j.ijnurstu.2021.104162","article-title":"Effectiveness of psychoeducational interventions among caregivers of patients with cancer: A systematic review and meta-analysis","volume":"127","author":"Cheng","year":"2022","journal-title":"Int J Nurs Stud"},{"key":"2025120618461991000_15.5.e087397.11","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/0733464820971511","article-title":"Effects of COVID-19 on Informal Caregivers and the Development and Validation of a Scale in English and Spanish to Measure the Impact of COVID-19 on Caregivers","volume":"40","author":"Sheth","year":"2021","journal-title":"J Appl Gerontol"},{"key":"2025120618461991000_15.5.e087397.12","doi-asserted-by":"crossref","DOI":"10.1177\/2333721421990150","article-title":"Caregiving in Quarantine: Evaluating the Impact of the Covid-19 Pandemic on Adult Child Informal Caregivers of a Parent","volume":"7","author":"Archer","year":"2021","journal-title":"Gerontol Geriatr Med"},{"key":"2025120618461991000_15.5.e087397.13","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s12603-022-1730-y","article-title":"Factors Associated with Increased Caregiver Burden of Informal Caregivers during the COVID-19 Pandemic in Japan","volume":"26","author":"Otobe","year":"2022","journal-title":"J Nutr Health Aging"},{"key":"2025120618461991000_15.5.e087397.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-021-02741-6","article-title":"Family caregiving during the COVID-19 pandemic: factors associated with anxiety and depression of carers for community-dwelling older adults in Hong Kong","volume":"22","author":"Chiu","year":"2022","journal-title":"BMC Geriatr"},{"key":"2025120618461991000_15.5.e087397.15","first-page":"II27","article-title":"Validity of the five-item WHO Well-Being Index (WHO-5) in an elderly population","volume":"251 Suppl 2","author":"Bonsignore","year":"2001","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"2025120618461991000_15.5.e087397.16","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.jamda.2018.11.005","article-title":"A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview","volume":"20","author":"Liew","year":"2019","journal-title":"J Am Med Dir Assoc"},{"key":"2025120618461991000_15.5.e087397.17","doi-asserted-by":"publisher","DOI":"10.3758\/BF03193007"},{"key":"2025120618461991000_15.5.e087397.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2005.01.001"},{"key":"2025120618461991000_15.5.e087397.19","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1093\/ageing\/afy098","article-title":"Transitioning into spousal caregiving: contribution of caregiving intensity and caregivers\u2019 multiple chronic conditions to functional health","volume":"48","author":"Liu","year":"2019","journal-title":"Age Ageing"},{"key":"2025120618461991000_15.5.e087397.20","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18189577","article-title":"From Burden to Depressive Symptoms in Informal Caregivers during the COVID-19 Pandemic: A Path Analysis","volume":"18","author":"Rajovic","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025120618461991000_15.5.e087397.21","doi-asserted-by":"crossref","unstructured":"Wong BP , Kwok TC , Chui KC , et al . The impact of dementia daycare service cessation due to COVID\u201019 pandemic. Int J Geriat Psychiatry 2022;37. doi:10.1002\/gps.5621","DOI":"10.1002\/gps.5621"},{"key":"2025120618461991000_15.5.e087397.22","unstructured":"Sinha M . Portrait of caregivers. Statistics Canada= Statistique Canada; 2012."},{"key":"2025120618461991000_15.5.e087397.23","first-page":"529","article-title":"Characteristics and health of caregivers and care recipients\u2014North Carolina, 2005","volume":"56","author":"Neugaard","year":"2007","journal-title":"MMWR"},{"key":"2025120618461991000_15.5.e087397.24","doi-asserted-by":"publisher","DOI":"10.2190\/DRKJ-NQ3W-KNH2-GPW9"},{"key":"2025120618461991000_15.5.e087397.25","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gns062"},{"key":"2025120618461991000_15.5.e087397.26","doi-asserted-by":"publisher","DOI":"10.1177\/1049732302239408"},{"key":"2025120618461991000_15.5.e087397.27","doi-asserted-by":"publisher","DOI":"10.1177\/2158244014566365"},{"key":"2025120618461991000_15.5.e087397.28","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajgp.13.9.795"},{"key":"2025120618461991000_15.5.e087397.29","doi-asserted-by":"publisher","DOI":"10.1080\/13607860903483128"},{"key":"2025120618461991000_15.5.e087397.30","doi-asserted-by":"publisher","DOI":"10.1080\/07317115.2010.502817"},{"key":"2025120618461991000_15.5.e087397.31","doi-asserted-by":"publisher","DOI":"10.2190\/RT1W-2HD7-KG5X-K1FB"},{"key":"2025120618461991000_15.5.e087397.32","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnab049"},{"key":"2025120618461991000_15.5.e087397.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2020.10.009"},{"key":"2025120618461991000_15.5.e087397.34","unstructured":"Cherry K . Self-efficacy and why believing in yourself matters. VeryWellMind; 2020. Available: https:\/\/www verywellmind com\/what-is-self-efficacy-2795954 [Accessed Jan 2022]."},{"key":"2025120618461991000_15.5.e087397.35","doi-asserted-by":"publisher","DOI":"10.1037\/0882-7974.11.2.214"},{"key":"2025120618461991000_15.5.e087397.36","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022955817074"},{"key":"2025120618461991000_15.5.e087397.37","doi-asserted-by":"crossref","DOI":"10.1177\/2055102918810659","article-title":"Coping and adjustment in caregivers: A systematic review","volume":"5","author":"Hawken","year":"2018","journal-title":"Health Psychol Open"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-087397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T02:46:34Z","timestamp":1765075594000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-087397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,12]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bmjopen-2024-087397"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-087397","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2025,5]]}}}