Family caregivers' willingness to use online psychological therapy for individuals with mental illness in China: a cross-sectional study.

INTRODUCTION

In China, family caregivers often serve as gatekeepers to mental health services, influencing whether patients initiate or continue treatment. Understanding their attitudes toward digital interventions is therefore critical for the successful implementation of online psychotherapy programs.

OBJECTIVES

To exploratorily examine caregivers' willingness to support online psychotherapy, preferred delivery formats, and perceived benefits and barriers.

METHODS

A structured questionnaire was administered to 291 family caregivers recruited in psychiatric settings across multiple Chinese cities. The instrument assessed caregiver demographics, technology access, patient characteristics, and attitudes toward online psychotherapy, including willingness (0-100 visual analog scale), treatment preferences, perceived benefits and barriers and help-seeking stigma. Responses were analyzed using descriptive statistics, multiple linear regression, and deductive content categorization.

RESULTS

Caregivers reported moderate-to-high willingness (mean = 70.2 ± 26.7). The most preferred delivery format was therapist-guided individual online counseling (37.8%). The key perceived benefit was time savings, while unstable internet connectivity emerged as a primary barrier. Caregivers also favored brief treatment courses (≤10 sessions) and considered modest session fees (≤55.4 USD) acceptable. Multiple linear regression identified small-city residence (β = 0.216, p = 0.007) and female gender (β = -0.127, p = 0.042) as independent predictors of willingness, with modest explained variance (R2 = 0.081).

CONCLUSION

Family caregivers in China are active decision-makers in mental health service utilization, not passive supporters. Their openness to online therapy is shaped by practical needs and confidence in clinician-led models. Caregivers in resource-scarce smaller cities show greater willingness, likely reflecting unmet local need, whereas female caregivers-who bear disproportionate care responsibilities-express more cautious attitudes. The modest explained variance highlights other influencing factors, necessitating further exploration. Successful digital mental health interventions must be co-designed with families, embedded in trusted healthcare institutions, and tailored to diverse socioeconomic contexts.