International journal of nursing sciences · 2026
Sequential mediation of social resources, affiliate stigma, loneliness, and positive aspects of caregiving among Chinese and Korean American dementia caregivers.
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Qi Xiang, Ko Eunjung, Ruan Jia Yin, Jung Ju Hye, Leong I Tek, Pei Yaolin, Mao Weiyu, Zheng Yaguang, Mittelman Mary S, Wu Bei
Аннотация
OBJECTIVES: This study aimed to examine whether Asian American dementia caregivers' affiliate stigma and loneliness sequentially account for the associations of social network and social support with positive aspects of caregiving (PAC).
METHODS: The sample included 162 Korean and 176 Chinese American caregivers enrolled in a randomized clinical trial and recruited from New York, US (February 2023 to September 2025). We measured social network using the Lubben Social Network Scale-6, social support using the NIH Toolbox Social Support scales, affiliate stigma using the modified Affiliate Stigma Scale, loneliness using the University of California, Los Angeles Loneliness Scale (UCLA), and PAC using the 9-item PAC scale. We tested sequential mediation models while adjusting for sociodemographics, health status, and caregiving context. We tested indirect effects and the proportion mediated using bias-corrected bootstrap confidence intervals (CIs; 5,000 resamples).
RESULTS: Both social network (β = 0.137, 95 % CI: 0.018 to 0.254) and support (β = 0.265, 95 %CI: 0.166 to 0.360) were significantly associated with higher PAC. Total indirect effects through affiliate stigma and loneliness accounted for 38.2 % and 27.8 % of the total effects, respectively. Loneliness was the only single mediator that reached significance (social network β = 0.036, 95 %CI: 0.012 to 0.076; social support β = 0.048, 95 %CI: 0.011 to 0.098). The sequential pathway, lower stigma followed by lower loneliness, was significant for social support (β = 0.012, 95 %CI: 0.003 to 0.029) but not for social network (β = 0.008, 95 % CI: -0.000 to 0.024).
CONCLUSIONS: In this study, social resources were associated with more positive caregiving appraisals, and loneliness was the principal intervening variable. Because all measures were obtained at a single time point, these indirect effects are correlational and cannot establish causal ordering. Culturally tailored interventions should strengthen social ties and incorporate loneliness-targeted strategies, with anti-stigma components requiring further evaluation in adequately powered studies.
METHODS: The sample included 162 Korean and 176 Chinese American caregivers enrolled in a randomized clinical trial and recruited from New York, US (February 2023 to September 2025). We measured social network using the Lubben Social Network Scale-6, social support using the NIH Toolbox Social Support scales, affiliate stigma using the modified Affiliate Stigma Scale, loneliness using the University of California, Los Angeles Loneliness Scale (UCLA), and PAC using the 9-item PAC scale. We tested sequential mediation models while adjusting for sociodemographics, health status, and caregiving context. We tested indirect effects and the proportion mediated using bias-corrected bootstrap confidence intervals (CIs; 5,000 resamples).
RESULTS: Both social network (β = 0.137, 95 % CI: 0.018 to 0.254) and support (β = 0.265, 95 %CI: 0.166 to 0.360) were significantly associated with higher PAC. Total indirect effects through affiliate stigma and loneliness accounted for 38.2 % and 27.8 % of the total effects, respectively. Loneliness was the only single mediator that reached significance (social network β = 0.036, 95 %CI: 0.012 to 0.076; social support β = 0.048, 95 %CI: 0.011 to 0.098). The sequential pathway, lower stigma followed by lower loneliness, was significant for social support (β = 0.012, 95 %CI: 0.003 to 0.029) but not for social network (β = 0.008, 95 % CI: -0.000 to 0.024).
CONCLUSIONS: In this study, social resources were associated with more positive caregiving appraisals, and loneliness was the principal intervening variable. Because all measures were obtained at a single time point, these indirect effects are correlational and cannot establish causal ordering. Culturally tailored interventions should strengthen social ties and incorporate loneliness-targeted strategies, with anti-stigma components requiring further evaluation in adequately powered studies.