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Identifying factors that contribute to or buffer caregiver stress is therefore of critical importance. This study aimed to explore how caregiver burden and resilience jointly are associated with stress among ICs of PwD \u2013 a rarely adopted approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The sample consists of\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009172 ICs. To examine the associations between our dependent variable, stress (PSS), and caregiver burden (BIZA-D-PV), caregiver resilience (BRS), the quality of life of the PwD (QoL-AD), as well as the IC\u2019s sociodemographic characteristics, we conducted a hierarchical multivariate regression analysis. Resilience was included as a second block to assess changes in model fit and variable effects. Furthermore, an interaction model was calculated to investigate potential moderating effect of resilience.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In Block 1, without considering resilience, personal constraints of the IC (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), the QoL of the PwD (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and cohabitation of the IC and PwD (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.006) were significantly associated with stress. In Block 2, only personal constraints (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and the QoL of the PwD (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.001) remained significant, and, additionally, the explained variance (\n                      <jats:italic>R\u00b2<\/jats:italic>\n                      ) increased significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In the interaction model, only the main effects of resilience (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.004), personal constraints (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.002), and QoL of the PwD (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) were significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings might highlight important considerations for future interventions aimed at supporting ICs and PwD. Special attention could be given to cohabiting IC-PwD dyads, as these relationships often involve unique challenges and stressors that could be mitigated through tailored support strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>German Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 Retrospectively registered, https\/\/www.drks.de\/drks_web\/navigate.do? navigationId=trial.HTML&amp;TRIAL_ID=DRKS00023560.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07974-x","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T08:47:47Z","timestamp":1784018867000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Informal caregivers of people living with dementia as invisible second patients: examining the dual role of burden and resilience in perceived stress"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3897-7824","authenticated-orcid":false,"given":"Emre","family":"\u00d6zbulut","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Wuttke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Geschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Farin-Glattacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"issue":"2","key":"7974_CR1","doi-asserted-by":"publisher","first-page":"217","DOI":"10.31887\/DCNS.2009.11.2\/hbrodaty","volume":"11","author":"H Brodaty","year":"2009","unstructured":"Brodaty H, Donkin M. 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The study received approval from the Ethics Committee of the State Chamber of Physicians of Rhineland-Palatinate (Reference number: 2019\u201314427). All participants provided written informed consent before any data were collected in this study. If there was a legal guardian, the legal guardian had to give written consent in addition to the patient. All patients were required to have basic competency to consent; otherwise, they could not participate. To comply with the European data protection regulations (DSGVO), all patient-caregiver dyads received a double pseudonymization through an independent trust agency to prevent the linking of data from data acquisition and data evaluation.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"956"}}