Association between neuroticism and depression in dementia caregivers: The mediating role of attribution style and the moderating role of family attitude

Background: Family caregivers of persons with dementia experience elevated rates of depression, yet the mechanisms linking personality risk factors to depressive symptoms remain incompletely understood. This study examined whether attribution style mediates the relationship between caregiver neuroticism and depression, and whether family attitude moderates these associations within a moderated mediation framework.

Methods: A cross-sectional sample of 127 family caregivers of persons with dementia was recruited from a hospital in XXX. Caregivers completed the Neuroticism subscale of the NEO-FFI-N, an adapted version of the ASSB, the FAS-C, and the PHQ-9. PLS-SEM with bootstrapping (5,000 resamples) was used to test the hypothesized moderated mediation model.

Results: Neuroticism showed a strong positive association with depressive symptoms (β=0.950, p<0.001). Attribution style significantly mediated the neuroticism–depression relationship (indirect effect=0.0016, 95% CI [0.0003, 0.0029]). Family attitude significantly moderated the attribution depression pathway (interaction β=0.017, p=0.008). Simple slope analysis revealed that maladaptive attribution associated with depression only under high negative family attitudes (+1 SD; β=0.027, p=0.003). Conditional indirect effects were significant at high and moderate levels of negative family attitudes, but not at low levels. Demographically, younger caregivers, unemployed caregivers, and daughters-in-law reported disproportionately severe depressive symptoms.

Discussions: Neuroticism was strongly associated with depressive symptoms of depression in dementia caregivers. Attribution style plays a statistically significant but quantitatively modest mediating role that is strictly conditional upon the family emotional climate—activated only when caregivers face moderate to high levels of negative family attitudes. Furthermore, effective interventions should integrate individual cognitive-behavioral approaches with systemic family therapy, prioritizing culturally vulnerable subgroups such as daughters-in-law.