Moving beyond family: unequal burden across mental health patients’ social networks



Although the family burden of mental health problems on patients’ close relatives was widely acknowledged, little was known about how mental health problems affected the quality of life of other types of social relationships of patients, through what mechanisms, and under what conditions. The study aims to explore the burden on all types of relationships of mental health patients and explain why and when the burden is unequal across different relationships.


The association between different types of relationships and the levels of burden was examined with dyadic data of 1178 patient-acquaintance relationships in the United States and random effects multilevel models. Frequency of contacts was tested as a mediator. The severity of mental health problems was tested as a moderator.


All types of relationships of patients borne a significant burden. Close relatives including parents, spouses, children, and siblings suffered a greater burden than distant relatives and non-relatives. The unequal burden was partly explained by the frequency of contacts with patients. The burden of close relatives significantly increased when patients’ mental health problems were more severe.


Mental health patients put a burden on their frequent contacts outside core families, especially when their problems were more severe. Public health policies should attend to the quality of life of mental health patients’ all types of acquaintances in the wider society.

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Fig. 1

Data availability

The data used in the study are publicly available on the NORC General Social Survey website:

Code availability

STATA codes available upon request from the authors.


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The authors appreciate comments on the draft from Florencia Torche, Amy L. Johnson, Joshua Hurwitz, Jonathan Atwell, and Xueguang Zhou.


We declare no funding.

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All authors designed the study and performed the analyses. L.L. and S.W. wrote the manuscript. The authors contribute equally.

Corresponding author

Correspondence to Senhu Wang.

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Li, L.Z., Bian, J.Y. & Wang, S. Moving beyond family: unequal burden across mental health patients’ social networks. Qual Life Res (2021).

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  • Family burden
  • Caregiver
  • Social networks
  • Stress process
  • United states