Affiliate stigma is associated with caregiver burden through reduced self-efficacy among caregivers of preschool children with autism spectrum disorder: a moderated mediation study

Objective Family caregivers of children with autism spectrum disorder (ASD) are vulnerable to affiliate stigma and caregiver burden, yet the psychological pathway linking stigma to burden and the family-level conditions that may buffer this pathway remain insufficiently understood. This study examined whether self-efficacy mediated the association between affiliate stigma and caregiver burden and whether caregiver support availability moderated this indirect association. Methods In this cross-sectional study, 456 primary family caregivers of children aged 3–7 years with ASD were recruited from tertiary hospitals in Shandong Province, China. Participants completed the Zarit Burden Interview, General Self-Efficacy Scale, Affiliate Stigma Scale, and a demographic and caregiving questionnaire. Correlation analysis, hierarchical regression, bootstrap mediation analysis, and conditional process analysis were performed. Results Affiliate stigma was positively correlated with caregiver burden (ρ = 0.28, p < 0.001) and negatively correlated with self-efficacy (ρ = -0.16, p < 0.001). Self-efficacy partially mediated the association between affiliate stigma and caregiver burden, accounting for 12.6% of the total effect (indirect effect = 0.031, 95% CI: 0.011-0.057). Caregiver support availability moderated the mediated pathway. The indirect effect was significant among caregivers with low support availability (effect = 0.044, 95% CI: 0.018-0.078) but not among those with high support availability (effect = 0.003, 95% CI: -0.029 to 0.033). Conclusion Affiliate stigma was associated with greater caregiver burden partly through lower self-efficacy, while higher co-caregiving support availability was associated with an attenuated indirect association. Stigma reduction, self-efficacy enhancement, and family support mobilization should be integrated into mental health support for caregivers of preschool children with ASD.