The relationship among burden, anxiety, and depression among caregivers of elderly patients with chronic obstructive pulmonary disease: the chain-mediating effect of coping styles and social support

Purpose Although anxiety and depression are common among caregivers of elderly patients with chronic obstructive pulmonary disease (COPD), previous studies have mostly examined caregiving burden, coping strategies, and social support separately, and studies on how these factors act jointly—particularly the serial pathway from burden to psychological distress—remain limited. Therefore, this study aimed to investigate whether negative coping strategies and social support serve as chain mediators in the relationship between caregiving burden and psychological distress, among primary caregivers of elderly patients with COPD. Methods This was a cross-sectional study. A total of 240 primary caregivers of elderly patients with COPD, hospitalized in Ningxia, China, were recruited by convenience sampling between August 2025 and November 2025. Data were collected using a demographic questionnaire, the Zarit Caregivers Burden Interview (ZBI), the Hospital Anxiety and Depression Scale (HADS), the Simplified Coping Style Questionnaire–Negative Coping subscale (SCSQ-NCS), and the Social Support Rating Scale (SSRS). One-way analysis of variance (ANOVA) and Pearson correlation analyses were performed, and the chain mediation effects were estimated using the bootstrap method to test the proposed model. Results Among the 240 caregivers, the mean age was 53.13 years and 60.8% were female; the mean caregiving burden score was 71.00 (standard deviation [SD] = 11.70), and the mean total HADS score was 22.18 (SD = 4.45). Age, education, relationship with the patient, occupation, monthly income, number of chronic diseases, sleep quality, and health status were the main factors associated with caregivers’ anxiety and depression scores. Anxiety and depression were positively correlated with caregiving burden and negative coping styles. The model results showed that caregiving burden directly and positively predicted anxiety and depression, and also indirectly predicted anxiety and depression through the chain mediation of negative coping styles and social support. Conclusion Caregivers of elderly patients with COPD experienced a considerable caregiving burden along with anxiety and depression. Caregiving burden was directly associated with anxiety and depression and was also indirectly associated with them through serial mediation by negative coping styles and social support. These findings suggest that interventions to reduce maladaptive coping and strengthen perceived social support may help alleviate the psychological distress of these caregivers. Given that health literacy and care-related knowledge are generally limited among caregivers of patients with COPD, the future studies should examine whether such interventions remain effective when caregivers’ health literacy is low.