Resilience as an indirect pathway linking depressive symptoms and quality of life among family caregivers of hospitalized lung cancer patients in Northern Vietnam

BACKGROUND: This study assessed the relationship between depressive symptoms and quality of life, and the potential role of resilience as an indirect pathway, among family caregivers of hospitalized lung cancer patients in Northern Vietnam. METHODS: We recruited 213 adult caregivers at a provincial hospital between 2023 and 2024. Participants completed a cross-sectional survey on depressive symptoms (PHQ-9), resilience (CD-RISC-10), and quality of life (Q-LES-SF-15). Path analysis within structural equation modeling (SEM) adjusting for demographics (age, sex, education, and relationship to patient) was used to examine the indirect effect of depressive symptoms on quality of life through resilience. RESULTS: Mean quality of life was 50.3 (SD = 13.5) out of 100, with 27.2% of the sample reporting good/very good "overall life satisfaction and contentment." Over a third reported a very poor/poor mood (34.7%), work (35.2%) or economic status (36.2%). More than half exhibited very poor/poor leisure time activities (52.6%), and sexual drive/interest/performance (52.6%). Bivariate analyses revealed significant associations between quality of life and age, sex, educational level, current employment status, monthly income, and relationship to the patients (all p < 0.01). In the SEM, depressive symptoms were negatively associated with quality of life (standardized β = -0.334, SE = 0.05, p < 0.001), whereas resilience was positively associated with quality of life (β = 0.367, SE = 0.05, p < 0.001). A significant indirect association through resilience was observed in the relationship between depressive symptoms and quality of life, accounting for 15.5% of the total association. The bias-corrected indirect effect of depressive symptoms was -0.062 (SE = 0.03, p = 0.019). CONCLUSIONS: Family caregivers reported low quality of life, particularly regarding emotional/psychological well-being, work/economic well-being, and leisure and personal fulfillment. Our findings suggest that caregiver support programs may benefit from a dual-focus strategy of addressing depression screening and management and fostering resilience, though the effectiveness of such approaches warrants evaluation in future longitudinal and interventional studies.