Caregiver burden, family resilience, and depressive and anxiety symptoms in parents of depressed adolescents: a cross-sectional mediation study

Background Parents of adolescents with depression experience substantial caregiving burden, contributing to an increased risk of psychological distress. While individual resilience has been associated with this relationship, the role of family-level resilience remains underexplored. This study explored whether family resilience statistically accounted for the association between caregiver burden and psychological distress, and whether social support moderated this pathway. Methods A cross-sectional study was conducted with 178 parents of adolescents diagnosed with depression. Participants completed measures of caregiver burden (Zarit Burden Interview, ZBI), family resilience (Family Resilience Assessment Scale, FRAS), social support (Social Support Rating Scale, SSRS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7). A moderated mediation model (PROCESS Model 7) was tested as the primary analysis, with 5,000 bootstrap resamples, adjusting for child age, child sex, illness duration, caregiver age, caregiver sex, caregiver education and economic status. All continuous predictors were standardized. Sensitivity analyses were re-run on the primary model excluding outliers and using 10,000 bootstrap resamples. Results The index of moderated mediation was not significant for depressive symptoms (β = −0.029, 95% CI [−0.086, 0.029], p = 0.262) or anxiety symptoms (β = −0.023, 95% CI [−0.073, 0.021], p = 0.266), indicating that social support did not moderate the indirect pathway. Conditional indirect effects of caregiver burden on depressive symptoms through family resilience were significant at low, mean, and high levels of social support (β = 0.132, 0.103, and 0.075, respectively), and similarly for anxiety symptoms (β = 0.106, 0.083, and 0.059). However, these effects did not differ significantly across levels. Social support was directly and positively associated with family resilience (β = 0.496, p < 0.001; r = 0.62, p < 0.001). Sensitivity analyses supported the robustness of these findings. Conclusions Family resilience partially accounted for the association between caregiver burden and psychological distress in parents of adolescents with MDD. Social support did not moderate this pathway but was independently associated with higher family resilience. Interventions targeting family resilience may be promising, with social support as a supplementary resource. Longitudinal studies are needed to establish causality and to clarify which aspects of social support are most valued by these caregivers.