Caregiver Burden Mediates the Association Between Patient Self-Care Behaviors and Psychological Distress in Diabetic Foot Ulcer Care.

Background: Home-based wound care is an important care model for patients with diabetic foot ulcers. In this setting, family caregivers often undertake daily supervision, wound observation, treatment coordination, and care-related decision-making. However, the relationship between patient self-care behaviors and caregiver psychological outcomes remains insufficiently understood. Aim: To examine the associations among patient self-care behaviors, caregiver burden, and caregiver psychological distress, and to explore whether caregiver burden mediated the relationship between patient self-care behaviors and caregiver anxiety and depression. Methods: A cross-sectional study was conducted among 567 patient-caregiver dyads receiving home-based wound care for diabetic foot ulcers. Patient self-care behaviors were assessed using the Summary of Diabetes Self-Care Activities Scale. Caregiver burden was measured using the Zarit Burden Interview. Caregiver anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale. Correlation, multiple regression, and bootstrap mediation analyses were performed. Results: The mean patient self-care score was 43.83 ± 15.44, and the mean caregiver burden score was 52.16 ± 18.82. Anxiety and depressive symptoms were identified in 48.0% and 72.5% of caregivers, respectively. Patient self-care behaviors were negatively correlated with caregiver burden, anxiety, and depression, whereas caregiver burden was positively correlated with anxiety and depression. Caregiver burden mediated the association between patient self-care behaviors and caregiver anxiety (indirect effect = -0.222, 95% CI: -0.393 to -0.053) and depression (indirect effect = -0.893, 95% CI: -0.948 to -0.837). Conclusion: Better patient self-care behaviors were associated with lower caregiver burden and psychological distress. Caregiver burden may represent a potential pathway linking patient self-care behaviors to caregiver anxiety and depression, although causal inference cannot be made from this cross-sectional study. Home-based diabetic foot ulcer care should integrate patient self-management support with caregiver burden assessment and psychological support.