A mediating role of cognitive fusion in the relationship between pre-death grief and depressive symptoms among family caregivers of people with dementia

Family caregivers often experience pre-death grief while caring for individuals with dementia, which may contribute to depressive symptoms. Within the psychological flexibility model, cognitive fusion (i.e., the tendency to become entangled with distressing thoughts) may be especially salient, as caregivers become fused with grief-related thoughts about their loved one's decline, exacerbating depressive symptoms. This study examined whether cognitive fusion mediates the relationship between pre-death grief and depressive symptoms in 191 family caregivers of individuals with dementia in the United States. Path analysis was conducted, controlling for behavioral and psychological symptoms of dementia. Pre-death grief was significantly associated with cognitive fusion, which was also significantly associated with depressive symptoms. The indirect effect via cognitive fusion was significant, accounting for 32.2% of the total effect. The direct effect remained significant, indicating partial mediation. Findings support targeting cognitive fusion in interventions for caregivers who often experience pre-death grief.