Serial Multiple Mediation of Mastery and Sleep Quality in the Relationship between Caregiving Burden and Anxiety among Parental Caregivers of Children with Leukemia in China

Objective. The emerging literature on caregiving posits that anxiety is fairly prevalent and could vary with factors such as caregiving burden, mastery, and sleep quality. Little work has explained the possible dynamics between those variables. This study therefore aims to investigate the multiple serial mediations of mastery and sleep quality in the relationship between caregiving burden and anxiety among Chinese parental caregivers of children with leukemia. Method. Data were taken from a convenient sample (n = 342) from a nonprofit organization that provides psycho-social support to oncological patients and their families nationwide in China. The following standardized self-reported questionnaires were administered to parents of children with leukemia: Zarit Care Burden Scale, Personal Mastery Scale, Insomnia Severity Index, and Generalized Anxiety Disorder. A serial multiple mediation model (PROCESS model 6) was employed to test the mediation hypothesis. Result. It was demonstrated that caregiving burden was positively and significantly correlated with caregivers' anxiety. Bootstrap analyses indicate that there were direct and indirect effects of caregiving burden on anxiety, and it was mediated by mastery. In addition, sleep quality mediated the effects of caregiving burden and mastery on anxiety, respectively. Conclusion. Taken together, for parental caregivers of children with leukemia in China, caregiving burden is a primary stressor and can trigger anxiety. Low mastery and poor sleep quality are the secondary stressors that could lead to negative psychological outcomes for the caregiver.