Associations between Affiliate Stigma and Quality of Life among Caregivers of Individuals with Dementia: Mediated Roles of Caregiving Burden and Psychological Distress

Introduction: The associations between affiliate stigma, caregiving burden, psychological distress, and quality of life (QoL) among family caregivers of people living with dementia (PwD) have been demonstrated in the literature. However, there is a dearth of literature regarding how these factors could form a psychological mechanism. The present study proposed a theoretical model to portray the relationships between these factors. Methods: Utilizing convenience sampling and cross-sectional study design, 275 family caregivers (145 females [52.7%]; mean age = 52.71 years) were recruited from a general hospital from October 2013 to September 2014. Each participant completed the following instruments in a quiet room in the general hospital without disturbance: Caregiver Burden Inventory, World Health Organization QoL Questionnaire-Brief, Affiliate Stigma Scale, and Beck Anxiety Inventory alongside the Taiwan Depression Questionnaire (assessing psychological distress). Structural equation modeling was used to examine the proposed theoretical model. Results: Affiliate stigma (standardized coefficient [β] = -0.338; P = 0.011) and psychological distress (β = -0.538; P < 0.001) were negatively associated with QoL, caregiving burden was positively associated with psychological distress (β = 0.818; P < 0.001), and affiliate stigma was positively associated with caregiving burden (β = 0.793; P < 0.001). Moreover, a significant mediated effect was observed between affiliate stigma and QoL via sequential mediators of caregiving burden and psychological distress (unstandardized coefficient = -1.17 and 95% confidence interval = -1.88, -0.46). Conclusion: Affiliate stigma, caregiving burden, and psychological distress are key factors contributing to low QoL among family caregivers of PwD. Health-care providers should design programs to help reduce affiliate stigma, caregiving burden, and psychological distress for family caregivers of PwD to facilitate their QoL.