Prevalence and psychosocial correlates of depression, anxiety and stress among caregivers of children with childhood-onset systemic lupus erythematosus in China: a cross-sectional study.

Abstract

To investigate the prevalence of depression, anxiety and stress among primary caregivers of children with childhood-onset systemic lupus erythematosus (cSLE) in China and to explore their psychosocial correlates based on the stress process model. A cross-sectional study. 3 tertiary public hospitals in Hunan Province, China. 242 primary caregivers were invited, and 211 completed the study (87.2% response rate). Convenience sampling was used. Eligible participants were unpaid adult caregivers (aged ≥18 years) of children (aged <18 years) with cSLE, providing care for >1 month. Exclusion criteria included inability to complete questionnaires independently, cognitive impairment due to major physical or mental disorders and current participation in other psychological interventions. Primary outcomes (depression, anxiety and stress) were measured using the Depression Anxiety and Stress Scale-21. Correlates included threat/challenge appraisal, coping style and perceived social support. Among 211 caregivers (mean age 40.55±8.22 years; 77.3% female), 31.8% reported depression, 27.0% anxiety and 24.2% stress. Higher threat appraisal was consistently associated with depression (regression coefficients (B) =1.012, p<0.001), anxiety (B=0.514, p<0.001) and stress (B=1.091, p<0.001). A higher number of hospitalisations was associated with higher depression (B=0.118, p=0.005) and anxiety (B=0.099, p=0.012). Anxiety and stress were also associated with younger child age (anxiety: B=-0.339, p=0.028; stress: B=-0.393, p=0.024), lower challenge appraisal (anxiety: B=-0.252, p=0.044; stress: B=-0.421, p=0.002) and negative coping (anxiety: B=0.492, p<0.001; stress: B=0.311, p=0.019). Caregivers of children with cSLE face substantial psychological distress, with threat perception and negative coping as key modifiable correlates. Interventions to reshape cognitive appraisal and promote adaptive coping, alongside expanded health insurance coverage and optimised caregiving role distribution, are needed to alleviate caregiver burden.