The double-edged sword of filial piety: A moderated parallel mediation of caregiver burden, rumination, and psychological distress among Chinese family caregivers of cancer patients

Family caregivers of cancer patients in China experience substantial caregiver burden and psychological distress. However, the cognitive pathways linking caregiver burden to psychological distress, and the role of filial piety in this process, remain insufficiently understood. This study tested a moderated mediation model in which caregiver burden was linked to psychological distress through brooding and reflective rumination, with reciprocal filial piety (RFP) and authoritarian filial piety (AFP) as moderators. Data were collected from 738 caregivers in a cross-sectional survey. Results showed that caregiver burden was positively associated with psychological distress, partly through higher brooding rumination and lower reflective rumination. The indirect pathways varied by filial piety beliefs. RFP weakened these indirect pathways, whereas AFP strengthened them. These findings suggest that psychological distress among Chinese cancer caregivers is shaped by caregiving burden, cognitive responses, and culturally embedded filial beliefs, offering implications for identifying at-risk caregivers and developing culturally sensitive support.