Subjective Burden Over Intensity: The Protective Role of Sense of Coherence in Chinese Dementia Caregivers’ Depression Status

Research on dementia caregiving in China remains limited. This cross-sectional study examined the relationships between caregiving intensity, subjective burden, depressive symptoms, and the mediating role of the sense of coherence (SOC) among 318 community-based caregiver–patient dyads. Structural equation modeling revealed that subjective burden was strongly associated with depressive symptoms (β = 0.334, p < 0.001), while caregiving intensity, including tasks, ADL time, and supervision time, showed no direct effect. However, ADL time had a significant indirect effect through SOC (95% CI [0.019, 0.136]), and its total effect on depressive symptoms was also significant, though smaller than that of subjective burden. SOC was negatively associated with depressive symptoms (β = -0.384, p < 0.001), and partially mediated the relationship between subjective burden and depressive symptoms (95% CI [0.124, 0.258]). These findings support the view that emotional responses to caregiving demands are more predictive of psychological outcomes than caregiving quantity. They also highlight SOC as a key psychological resource linking care stressors to depression. Interventions should focus on reducing perceived burden and strengthening SOC to improve caregiver mental health in the Chinese dementia caregiving context.