Seeing no way out: Exploring the connection between internalized caregiver stigma, entrapment, suicidal ideation and depressive symptoms among Canadian informal caregivers

Objectives Informal caregivers’ beliefs about caregiving for older adults (i.e. caregiver stigma) are associated with suicidal ideation and poor mental health. As only few studies have studied this association, the underlying mechanisms remain unclear. This study analyzed whether caregiver stigma is associated with suicidal ideation and depression via feelings of entrapment. Methods Canadian long-term caregivers of adults aged 60+ years (N = 175, 18-95+ years) were surveyed online with the internalized caregiver stigma scale (self-devaluing (negative) and self-affirming (positive) stereotypes, attitudes, and behaviors), about their feelings of entrapment (short entrapment scale), depressive symptoms and suicidal ideation (PHQ-9). Regression analysis with robust standard errors and causal mediation analysis with bootstrapped standard errors were conducted. Results Regression models indicated entrapment and negative care stigma were associated with more depressive symptoms, and entrapment with higher suicidal ideation. Significant indirect effects of positive and negative caregiver stigma components on suicidal ideation as well as depressive symptoms via entrapment were found in the causal mediation models. Additionally, positive caregiver stigma interacted with entrapment in the model for suicidal ideation. Discussion This study highlighted that the path from negative caregiver self-stigma to a higher level of suicidal ideation and depressive symptoms seems to be rooted through increased feelings of entrapment. Conversely, the self-affirming form of caregiver stigma had a hidden protective effect for both outcomes via lower feelings of entrapment. Targeting care-related stigma may thus help reduce the danger of negative mental health outcomes among caregivers of older adults by changing their constricting perception of being trapped.