Exploring the Mediating Role of Self-Efficacy in the Relationship Between Caregiver Contribution and Resilience in Inflammatory Bowel Disease
Mattia Bozzetti, Ilaria Marcomini, Alessio Lo Cascio, Maria Rosaria Magurano, Eleonora Ribaudi, Monica Petralito, Ilaria Milani, Shelly Amato, Nicoletta Orgiana, Simone Parello, Pierluigi Puca, Franco Scaldaferri, Marianna Mazza, Giuseppe Marano, Daniele Napolitano
Abstract
Inflammatory bowel disease (IBD) affects not only patients but also their informal caregivers. Enhancing caregiver resilience may improve both caregiver well-being and patient outcomes. This study aimed to assess resilience levels in caregivers of individuals with IBD and identify key psychological and contextual predictors, including caregiver contributions to self-care, self-efficacy, and perceived care load. A multicentre cross-sectional study was conducted across nine IBD outpatient clinics in Italy. Caregiver resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC 25). Additional tools included the Caregiver Contribution to Self-Care of Chronic Illness Inventory (CC-SC-CII) and Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Robust regression models identified predictors of total resilience and its subdomains. Among 275 caregivers (median age 53; 58.2% female) CD-RISC-25 levels were moderately high (median = 74 [IQR = 65-84]), with no significant differences between those caring for patients with Crohn's disease or ulcerative colitis. SEM analyses showed that self-efficacy significantly predicted contributions to disease monitoring and management, but not maintenance. In turn, the management dimension was significantly associated with higher levels of resilience across four of five domains (trust, control, acceptance of change, and spirituality), while maintenance was uniquely associated with personal competence. Predictors including education and employment status showed no significant direct or indirect effects on CC-SC-CII. In conclusion, caregiver resilience in IBD is positively associated with self-efficacy and active engagement in disease management. Targeted support strategies may strengthen caregiver resources and promote sustainable care.