Quality of Life and Relapse Prevention Behaviors among Family Caregivers of Individuals with Schizophrenia: The Mediating Role of Psychological Distress

Background: Caring for individuals with schizophrenia presents major emotional and psychological challenges, particularly in low-resource settings like Indonesia. Family caregivers often face high levels of burden and stress due to the lack of professional support and cultural expectations. Objective: To examine whether psychological distress mediates the relationship between caregivers’ quality of life (QoL) and relapse prevention behaviors with caregiver burden in the context of schizophrenia care. Methods: A cross-sectional study was conducted among 104 primary family caregivers at Puskesmas Sempor 1, Central Java. Data were collected through structured face-to-face interviews using validated instruments: WHOQOL-BREF for QoL, a self-developed 10-item relapse prevention behavior scale, the Perceived Stress Scale, and the Zarit Burden Interview (ZBI). Data were analyzed using ANOVA, multiple linear regression, and Hayes’ PROCESS Macro Model 4 with 5,000 bootstrap samples to test for mediation. Results: Most participants were female (78.8%), aged 36–55 (57.7%) and lived with the patient (92.3%). Mean scores reflected moderate levels across QoL (M=2.59), relapse prevention behavior (M=2.34), psychological distress (M=1.88), and caregiver burden (M=2.06). ANOVA indicated significant differences in psychological distress by QoL and relapse prevention levels (p < 0.001). Regression indicated that higher QoL and relapse prevention predicted lower distress, with distress partially mediating their effects on caregiver burden. Conclusions: Psychological distress partially mediates the association between quality of life, relapse prevention, and caregiver burden.