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

Objectives Caregiving has been widely recognised as a potential risk factor for caregivers' 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. Design Cross-sectional study. Setting The Hong Kong Polytechnic University in Hong Kong Special Administrative Region, China. Participants 597 family caregivers of persons with disabilities in December 2020 under the Hong Kong governmental initiative, Persons with Disabilities and Rehabilitation Program'. Main outcome and measures Indications of depression were assessed through the application of the World Health Organization-Five Well-being Index (1998 version). Results 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 hours (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 (ß (95% CI):-0.201 (-0.355,-0.083), p=0.001), weekly caregiving hours (ß (95% CI):-0.126 (-0.215,-0.067), p=0.001) and presence of emotional issues (ß (95% CI):-0.329 (-0.538,-0.184), p=0.001) were positively associated with depression risk of caregivers, fully mediated by caregiver burden. Additionally, caregivers' health status had both direct (ß (95% CI):-0.234 (-0.388,-0.101), p=0.001) and indirect (ß (95% CI):-0.126 (-0.215,-0.067), 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 (ß (95% CI): 0.281 (0.169, 0.396), p=0.001), and caregiver burden did not mediate this pathway. Conclusions Care needs of care recipients, weekly caregiving hours, caregivers' 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' lower self-evaluation of their caregiving ability was an independent factor that directly contributes to an increased depression risk.