Determinants of Spousal Loneliness Among Caregivers for Patients with Proliferative Diabetic Retinopathy: A Cross-Sectional Study.

OBJECTIVE

Proliferative diabetic retinopathy (PDR), the most severe form of diabetic retinopathy, imposes overwhelming caregiving demands on family caregivers, with spouses typically assuming the primary caregiving role. However, their psychosocial well-being, particularly loneliness-a major modifiable risk factor for adverse health outcomes-remains severely understudied. Guided by the relational model of stress, this study aimed to assess the prevalence of loneliness and identify its multilevel determinants among spousal caregivers of patients with PDR.

METHODS

In this cross-sectional study, a convenience sample of 239 spousal caregivers of PDR patients was recruited from four tertiary hospitals in Changsha, China, between March and August 2024. Participants completed validated standardized instruments measuring loneliness (6-item Short-Form UCLA Loneliness Scale, ULS-6), psychological resilience (Connor-Davidson Resilience Scale, CD-RISC), dyadic coping (Dyadic Coping Inventory, DCI), and caregiver burden (Zarit Caregiver Burden Interview, ZBI). Hierarchical linear regression analysis was conducted to examine the independent associations of individual, environmental, and behavioral factors with loneliness.

RESULTS

The mean ULS-6 score was 14.89 ± 3.77, indicating a moderate level of loneliness among spousal caregivers; 10.0% reported severe loneliness. The final hierarchical regression model explained 41.6% of the variance in loneliness. Significant independent risk factors included severe patient cognitive impairment (β = 0.202, P = 0.004), longer disease duration (β = 0.177, P = 0.003), greater visual impairment (β = 0.349, P = 0.004), older caregiver age (β = 0.178, P = 0.011), living alone with the patient (β = 0.057, P = 0.008), poorer marital relationship quality (β = 0.355, P = 0.003), and higher caregiver burden (β = 0.242, P = 0.009). Conversely, higher psychological resilience (β = -0.217, P = 0.009) and more effective dyadic coping (β = -0.159, P < 0.001) were significant protective factors.

CONCLUSION

Loneliness is highly prevalent among spousal caregivers of PDR patients, driven by a complex interplay of patient illness severity, caregiver demographics, environmental conditions, and modifiable psychosocial resources. Couple-centered interventions targeting dyadic coping enhancement and psychological resilience building may effectively reduce loneliness and improve the overall well-being of this vulnerable caregiver population.