From Buffer to Conduit: Family Resilience as a Conditional Mediator Between Caregiver Burden and Patient Quality of Life in Chinese Stroke Families

Background: Family resilience is a critical protective factor for stroke survivors' quality of life (QoL), yet its role in mitigating the negative impact of caregiver burden remains underexplored, particularly regarding potential heterogeneous effects across different patient subgroups. Objective: This study aimed to examine the mediating role of family resilience between caregiver burden and patient QoL, and to test whether this mediation effect is conditional upon the patient's baseline QoL profile. Methods: In this cross-sectional study, a convenience sample of 311 stroke survivor-caregiver dyads was recruited from three hospitals in Zhejiang Province, China. Latent profile analysis (LPA) was conducted on the 12 domains of the Stroke-Specific Quality of Life (SS-QOL) scale to identify patient subgroups. A stratified mediation analysis using the bootstrap method was then performed to test the mediation model separately within each subgroup, adjusting for key demographic and clinical covariates. Results: Results: For the total sample, family resilience partially mediated the burden-QoL relationship (indirect effect β = -0.08, 95% CI [-0.12, -0.04]). Crucially, this mediation was conditional. It was significant only in the low QoL subgroup (indirect effect: β = -0.06, 95% CI [-0.11, -0.02]), where higher burden was linked to lower resilience, which in turn predicted poorer QoL. In the high QoL subgroup, this indirect pathway was non-significant (indirect effect β = -0.05, 95% CI [-0.09, 0.00]). Conclusion: Family resilience serves as a conditional mediator between caregiver burden and patient QoL, with its protective role being significant primarily for survivors who already have a compromised QoL. Interventions aimed at alleviating caregiver burden should be coupled with targeted efforts to bolster family resilience, especially in patients with low QoL.