Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders

Abstract Background Psychological distress is common in family caregivers of individuals with neurocognitive disorders (NCDs). This study examined the prevalence of suicidal ideation in this population, and explored the moderating role of positive aspects of caregiving (PAC) in mitigating such sever...

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Main Authors: Zhaohua Huo, Benjamin Hon-Kei Yip, Allen Ting-Chun Lee, Sheung-Tak Cheng, Wai Chi Chan, Ada Wai-Tung Fung, Suk Ling Ma, Calvin Pak-Wing Cheng, Frank Ho-Yin Lai, Samuel Yeung-Shan Wong, Linda Chiu-Wa Lam
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Geriatrics
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Online Access:https://doi.org/10.1186/s12877-025-06147-6
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author Zhaohua Huo
Benjamin Hon-Kei Yip
Allen Ting-Chun Lee
Sheung-Tak Cheng
Wai Chi Chan
Ada Wai-Tung Fung
Suk Ling Ma
Calvin Pak-Wing Cheng
Frank Ho-Yin Lai
Samuel Yeung-Shan Wong
Linda Chiu-Wa Lam
author_facet Zhaohua Huo
Benjamin Hon-Kei Yip
Allen Ting-Chun Lee
Sheung-Tak Cheng
Wai Chi Chan
Ada Wai-Tung Fung
Suk Ling Ma
Calvin Pak-Wing Cheng
Frank Ho-Yin Lai
Samuel Yeung-Shan Wong
Linda Chiu-Wa Lam
author_sort Zhaohua Huo
collection DOAJ
description Abstract Background Psychological distress is common in family caregivers of individuals with neurocognitive disorders (NCDs). This study examined the prevalence of suicidal ideation in this population, and explored the moderating role of positive aspects of caregiving (PAC) in mitigating such severe psychological difficulties. Methods 445 older adults (NCDs: 322, normal cognition: 123) and their family caregivers were recruited from the population-based Hong Kong Mental Morbidity Survey for Older Persons. Caregivers’ suicidal ideation was screened by positive response to Item 9 of the Patient Health Questionnaire-9: thoughts of being better off dead or self-harm in the past two weeks. PAC were measured using a validated scale. A conceptual model was developed to test the mediation and moderation effects among caregiving burden, psychological distress, suicidal ideation, and PAC. Results Nearly one in ten (9%) dementia caregivers reported suicidal ideation in the past two weeks. Higher prevalence was observed among female carers, those with comorbid mood disorders, and those caring for individuals with high comorbidity or functional dependence. Psychological distress significantly mediated the relationship between caregiving burden and suicidal ideation (80.5%, p = 0.023). PAC moderated this pathway: higher levels of PAC were associated with reduced suicidal ideation among carers with moderate-to-high caregiving burden (p < 0.05). However, a rebound in suicidal ideation was observed in caregivers experiencing both high burden and high PAC. Conclusions Suicidal ideation among NCD caregivers is closely linked to caregiving burden and psychological distress. PAC plays a complex and non-linear moderating role in this relationship. Psychological intervention that strengthens PAC should be integrated into comprehensive caregiver support programmes, particularly for those experiencing high burden and high distress.
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spelling doaj-art-ae9266fc15904b22a978cd3eb32b7ffc2025-08-20T04:02:55ZengBMCBMC Geriatrics1471-23182025-07-0125111310.1186/s12877-025-06147-6Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disordersZhaohua Huo0Benjamin Hon-Kei Yip1Allen Ting-Chun Lee2Sheung-Tak Cheng3Wai Chi Chan4Ada Wai-Tung Fung5Suk Ling Ma6Calvin Pak-Wing Cheng7Frank Ho-Yin Lai8Samuel Yeung-Shan Wong9Linda Chiu-Wa Lam10Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong KongThe Jockey Club School of Public Health and Primary Care, The Chinese University of Hong KongDepartment of Psychiatry, Faculty of Medicine, The Chinese University of Hong KongDepartment of Health and Physical Education, The Education University of Hong KongDepartment of Psychiatry, University of Hong KongDepartment of Sports and Health Sciences, Hong Kong Baptist UniversityDepartment of Psychiatry, Faculty of Medicine, The Chinese University of Hong KongDepartment of Psychiatry, University of Hong KongDepartment of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria UniversityThe Jockey Club School of Public Health and Primary Care, The Chinese University of Hong KongDepartment of Psychiatry, Faculty of Medicine, The Chinese University of Hong KongAbstract Background Psychological distress is common in family caregivers of individuals with neurocognitive disorders (NCDs). This study examined the prevalence of suicidal ideation in this population, and explored the moderating role of positive aspects of caregiving (PAC) in mitigating such severe psychological difficulties. Methods 445 older adults (NCDs: 322, normal cognition: 123) and their family caregivers were recruited from the population-based Hong Kong Mental Morbidity Survey for Older Persons. Caregivers’ suicidal ideation was screened by positive response to Item 9 of the Patient Health Questionnaire-9: thoughts of being better off dead or self-harm in the past two weeks. PAC were measured using a validated scale. A conceptual model was developed to test the mediation and moderation effects among caregiving burden, psychological distress, suicidal ideation, and PAC. Results Nearly one in ten (9%) dementia caregivers reported suicidal ideation in the past two weeks. Higher prevalence was observed among female carers, those with comorbid mood disorders, and those caring for individuals with high comorbidity or functional dependence. Psychological distress significantly mediated the relationship between caregiving burden and suicidal ideation (80.5%, p = 0.023). PAC moderated this pathway: higher levels of PAC were associated with reduced suicidal ideation among carers with moderate-to-high caregiving burden (p < 0.05). However, a rebound in suicidal ideation was observed in caregivers experiencing both high burden and high PAC. Conclusions Suicidal ideation among NCD caregivers is closely linked to caregiving burden and psychological distress. PAC plays a complex and non-linear moderating role in this relationship. Psychological intervention that strengthens PAC should be integrated into comprehensive caregiver support programmes, particularly for those experiencing high burden and high distress.https://doi.org/10.1186/s12877-025-06147-6DementiaCognitive impairmentCarerPositive gainSuicide
spellingShingle Zhaohua Huo
Benjamin Hon-Kei Yip
Allen Ting-Chun Lee
Sheung-Tak Cheng
Wai Chi Chan
Ada Wai-Tung Fung
Suk Ling Ma
Calvin Pak-Wing Cheng
Frank Ho-Yin Lai
Samuel Yeung-Shan Wong
Linda Chiu-Wa Lam
Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders
BMC Geriatrics
Dementia
Cognitive impairment
Carer
Positive gain
Suicide
title Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders
title_full Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders
title_fullStr Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders
title_full_unstemmed Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders
title_short Moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community-dwelling older adults with neurocognitive disorders
title_sort moderating role of positive aspects of caregiving in the relationship between caring burden and suicidal ideation in family caregivers of community dwelling older adults with neurocognitive disorders
topic Dementia
Cognitive impairment
Carer
Positive gain
Suicide
url https://doi.org/10.1186/s12877-025-06147-6
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