Dyadic relationship between caregiving burden and perceived stress among people with HIV: moderated mediation analysis

People with HIV (PWH) and their family members (FM) function as an interdependent system, where the experience and resources of one member may shape the psychological outcomes of the other. While existing studies have shown caregiving burden of FM might negatively affect mental health of PWH, few research examined the underlying mechanism of this association at a dyadic perspective. This study aimed to examine the association between FM's caregiving burden and PWH's perceived stress, and the potential mediating role of FM's resilience and moderating effect of FM's HIV status. Study data were extracted from the baseline survey of an ongoing clinical trial in Guangxi, China. A total of 800 PWH-FM dyads were included in this study. FM's caregiving burden, resilience, HIV status and PWH's perceived stress were measured by self-reported instruments. A moderated mediation model was conducted to explore whether FM's resilience mediated the effect of FM's caregiving burden on PWH's perceived stress and whether such mediation effect varied by FM's HIV status, adjusting for demographic characteristics. The results showed that when FM experienced more caregiving burden, PWH reported higher levels of perceived stress. This relationship was partially explained by FM's resilience; that is, greater caregiving burden reduced FM's resilience, which in turn increased the perceived stress of PWH. This pathway differed by FM's HIV status. Specifically, the indirect effect of FM's resilience existed only in FM with HIV-positive status, while no significant indirect effect was found among FM without HIV. These findings underscore that FM's caregiving burden and PWH's mental health are not isolated variables; interventions should consider PWH and their families as interdependent systems. Effective family-based interventions targeting improving PWH's mental health might consider placing greater emphasis on reducing the caregiving burden and improving family resilience, especially for HIV-seroconcordant families.