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      Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma


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          The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers’ burden can lead to a reduction in caregivers’ involvement. There is a relationship between caregivers’ involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers’ burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda.


          A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers.


          The findings indicate that affiliated stigma serves as a full mediator between the caregiver’s roles and involvement (β=15.97, p<0.001). Being female increased the caregivers’ burden of caregiving (β= -0.23, p<0.001).


          The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12888-023-04553-x.

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          Most cited references53

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          The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.

          In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
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            The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis.

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              The Zarit Burden Interview: a new short version and screening version.

              The purpose of the study was to develop a short and a screening version of the Zarit Burden Interview (ZBI) that would be suitable across diagnostic groups of cognitively impaired older adults, and that could be used for cross-sectional, longitudinal, and intervention studies. We used data from 413 caregivers of cognitively impaired older adults referred to a memory clinic. We collected information on caregiver burden with the 22-item ZBI, and information about dependence in activities of daily living (ADLs) and the frequency of problem behaviors among care recipients. We used factor analysis and item-total correlations to reduce the number of items while taking into consideration diagnosis and change scores. We produced a 12-item version (short) and a 4-item version (screening) of the ZBI. Correlations between the short and the full version ranged from 0.92 to 0.97, and from 0.83 to 0.93 for the screening version. Correlations between the three versions and ADL and problem behaviors were similar. We further investigated the behavior of the short version with a two-way analysis of variance and found that it produced identical results to the full version. The short and screening versions of the ZBI produced results comparable to those of the full version. Reducing the number of items did not affect the properties of the ZBI, and it may lead to easier administration of the instrument.

                Author and article information

                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                26 January 2023
                26 January 2023
                : 23
                : 72
                [1 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Department of Psychiatry, , Mbarara University of Science & Technology, ; Mbarara, 1410 Uganda
                [2 ]African Centre for Suicide Prevention and Research, Mbarara, 379 Uganda
                [3 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Psychiatry and Behavioural Neurosciences, , McMaster University, ; Hamilton, Canada
                [4 ]GRID grid.11194.3c, ISNI 0000 0004 0620 0548, Makerere University, College of Health Sciences, ; Kampala, Uganda
                [5 ]CHINTA Research Bangladesh, Savar, Dhaka 1342 Bangladesh
                [6 ]GRID grid.411808.4, ISNI 0000 0001 0664 5967, Department of Public Health and Informatics, , Jahangirnagar University, ; Savar, Dhaka 1342 Bangladesh
                [7 ]GRID grid.12361.37, ISNI 0000 0001 0727 0669, Psychology Department, , Nottingham Trent University, ; 50 Shakespeare Street, Nottingham, NG1 4FQ United Kingdom
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                : 12 June 2022
                : 17 January 2023
                Funded by: National Insitutes of Health
                Award ID: K43TW011929-02.
                Award Recipient :
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                © The Author(s) 2023

                Clinical Psychology & Psychiatry
                affiliated stigma,informal caregivers,mental illness,marital status,caregivers’ burden,caregivers’ involvement


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