Psychological distress and family stress in Alzheimer’s caregivers: a forgiveness longitudinal mediation model

Background: The present study examined how family stress, distress, and forgiveness influenced the quality of life (QoL) of family caregivers (FCs) of persons living with Alzheimer’s disease over time. Method: Using a longitudinal design, data were collected at baseline (T1), 6 months (T2), and 12 months (T3). Results: Family stress at T1 predicted family stress at T2, while forgiveness at T1 predicted family stress at T2. Forgiveness (T1 and T2) mediated the relationship between distress (T1) and mental QoL (T3). Additionally, forgiveness (T1 and T2), along with mental QoL (T3), were mediators between distress (T1) and physical QoL (T3). Multigroup analysis revealed that the effects of forgiveness on distress and QoL were moderated by disease severity, with stronger mediation effects in the moderate and severe groups. Conclusion: The study underscores the importance of early distress screening and forgiveness-based interventions to enhance both mental and physical QoL in FCs, particularly as the disease progresses.