The Relationship between Stigma and Burden: A Case Study in Miaoli, Taiwan

Abstract This study examined the relationship between stigma perception and caregiving burden among family caregivers of persons with dementia in Taiwan, a rapidly ageing society. A quantitative, cross-sectional survey design was used, adhering to the STROBE guidelines. A total of 268 primary caregivers were recruited from a dementia shared care center in rural Miaoli County, central Taiwan, using convenience sampling. Participants completed structured questionnaires including the Taiwanese version of the Family Stigma in Dementia Scale (TWFS-DS) and the Chinese Caregiver Burden Inventory (CCBI). Descriptive and inferential analyses showed that caregivers’ overall stigma perception was low-to-moderate (standardized mean = 45.63/100), with courtesy stigma (concern about others’ judgments) being more prominent than affiliate stigma (self-stigma). Caregiving burden was moderate (standardized mean = 51.28/100), with time burden and physical burden ranking highest. Caregiver age, marital status, years of caregiving, self-rated health, and the number of patients’ behavioural and psychological symptoms of dementia (BPSD) were significantly associated with perceived stigma. Caregiving burden was influenced by relationship quality with the patient, self-rated health, patient gender, dementia severity, and number of BPSD. In a multiple linear regression model adjusting for potential confounders, overall stigma perception was the strongest predictor of caregiving burden (β = 0.395, p < .001), followed by self-rated health status (β = 0.313, p < .001), explaining 42% of the total variance (adjusted R² = 0.406). These findings highlight that stigma – particularly courtesy stigma – is a modifiable and policy-relevant determinant of caregiver burden. We recommend integrating routine stigma screening into dementia case management, extending caregiver follow up to at least five years, and implementing population level anti stigma campaigns to foster dementia friendly communities. Such interventions are essential for sustainable family caregiving in ageing societies like Taiwan.