Factors Associated with Life Satisfaction Among Mothers Caring for Children with Anorexia Nervosa from an exploratory online survey

Factors Associated with Life Satisfaction Among Mothers Caring for Children with Anorexia Nervosa from an exploratory online survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated with Life Satisfaction Among Mothers Caring for Children with Anorexia Nervosa from an exploratory online survey Kazuaki Hashimoto, Takeaki Takeuchi, Kaho Tanobe, Noriko Takeda, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9316793/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background/Objective Caregivers of individuals with anorexia nervosa (AN) are predominantly mothers who face chronic, multifaceted burdens. However, their life satisfaction remains understudied, and associated factors are unclear. Methods A cross-sectional online survey was conducted among mothers aged 30–59 years caring for individuals with AN. Participants were assessed for life satisfaction (SWLS), caregiving burden (MUIS-FM), mental health (K6), loneliness (TIL Scale), and social support (MSPSS). Participants were classified into high and low satisfaction groups based on SWLS scores, followed by group comparisons. Factors associated with life satisfaction were examined using multiple linear regression analysis. Results Of 102 participants, 82 were included in the analysis. No between-group differences were observed in background characteristics or care recipient clinical features. The Low Satisfaction group reported greater loneliness, lower social support, and poorer mental health than the High Satisfaction group. Multiple linear regression identified social support and caregiving burden as associated with life satisfaction. Conclusion Many mothers caring for individuals with AN experience elevated psychological distress, and life satisfaction is associated with social support and management of illness-related uncertainty. These findings highlight the importance of psychosocial support for this population. anorexia nervosa caregiving social support online survey cross sectional study Introduction Anorexia nervosa (AN) is a fatal disorder common in young women [ 1 ]. AN is characterized by an intense idealization of thinness, fear of weight gain, and severe eating disturbances [ 2 ]; in some cases, cognitive impairment reaches delusional levels [ 3 ]. Patients with AN exhibit psychological pathology that influences not only their own eating behaviors but also those of their families, and approximately 37% of family members become socially isolated [ 4 ]. Typically, a patient’s mother provides care [ 4 – 6 ], and the burden on the mother is particularly heavy [ 7 ]. In the treatment of AN, evidence supports the effectiveness of family therapy, such as family-based therapy [ 8 , 9 ]. Given that poor caregiver mental health is associated with poor treatment outcomes in AN [ 9 ], maternal psychological health is a critical factor in treatment. A systematic review on caregiving burden in eating disorders reported that caregivers of individuals with AN experience greater burden than those caring for individuals with bulimia nervosa [ 10 ]. The burden among parents of individuals with AN is multifaceted, encompassing physical, psychological, financial, and social dimensions [ 5 ]. Accordingly, caregivers of individuals with AN experience significant anxiety, depression, and impaired social functioning [ 11 ]. However, despite higher stress levels than those caring for individuals with schizophrenia or depression, they receive relatively limited support [ 4 , 12 ]. Life satisfaction is defined as an individual’s cognitive and holistic evaluation of overall quality of life [ 13 ], and declining mental health generally reduces life satisfaction [ 14 ]. Therefore, parents caring for children with mental illness tend to report lower life satisfaction. For example, caregivers of children with autism report low life satisfaction, which decreases further with greater severity [ 15 ]. A similar pattern has been reported among caregivers of children with emotional disorders [ 16 ]. Although no studies have investigated life satisfaction among families of individuals with AN, given that mental health problems affect approximately 70% of patients [ 4 ], their life satisfaction is presumed to be low. Caregivers often experience helplessness and burnout when caregiving is prolonged, particularly when awareness of AN and its effects is limited [ 17 ]. Poor prognosis in the care recipient is associated with caregiver burnout, high stress, and low life satisfaction; in turn, low life satisfaction may negatively impact the care recipient’s sense of accomplishment and satisfaction [ 18 ]. To help interrupt this cycle, this study focused on life satisfaction among mothers—who are the primary caregivers—and identified factors associated with it. Given the potential for social isolation due to AN psychopathology [ 4 ], this exploratory study used an online survey. Materials and Methods Participants This analysis followed the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology) for cross-sectional studies. The cross-sectional survey was conducted from 19 December to 23 December 2024 by a professional agency (Rakuten Insight, Inc., Tokyo, Japan; https://member.insight.rakuten.co.in/ (accessed on 1 December 2025)). The agency regularly updated and verified panel registration data. A survey link was distributed via email to panel members in line with national population distribution, accompanied by an explanation of the study. According to the inclusion criteria, we enrolled women aged 30–59 years who reported currently caring for a family member with AN. Exclusion criteria applied when respondents identified the care recipient as a parent, son, or other relative, due to the higher prevalence of AN among young women. The survey began with a page explaining its purpose and obtaining participants’ consent, followed by screening questions for eligibility. Participants were first asked whether they were currently caring for a family member receiving treatment for AN. Those who answered “yes” were asked to specify the relationship to the care recipient (parent, daughter, son, or other). Only participants who identified their child as a daughter were included. Participants who met all criteria proceeded to the main questionnaire; those who did not were exited from the survey. Informed consent was obtained before participation, and participants were allowed to discontinue at any time. The internet survey agency complied with the Act on the Protection of Personal Information in Japan. A total of 102 caregiving mothers of individuals with AN completed the survey. No cases of straight-lining (identical responses across all items) were observed. After excluding 15 participants with an age difference of less than 16 years between themselves and their child, and 5 participants who reported “other” as the AN subtype, 82 participants were included in the analysis. Questionnaires Mental health was assessed using the 6-item Kessler Psychological Scale (K6) [ 19 ]. The K6 is a screening tool consisting of six items assessing psychological distress, each rated from 0 to 5. The scale demonstrates strong reliability and internal consistency, with higher scores indicating greater psychological distress [ 20 ]. The Three-Item Loneliness Scale (TIL Scale) [ 21 ] is a shortened version of the 20-item Revised UCLA Loneliness Scale [ 22 ], designed to reduce respondent burden. It consists of three items assessing perceived loneliness. The Japanese version has confirmed reliability and validity and is suitable for online surveys [ 23 ]. Life satisfaction was assessed using the Japanese version of the Satisfaction with Life Scale (SWLS), a five-item scale measuring overall life satisfaction [ 24 ][ 25 ]. Each item is rated on a seven-point scale, with total scores ranging from 5 to 35. The SWLS is highly reliable and valid [ 25 , 26 ] and is suitable for internet-based surveys [ 27 ]. Consistent with Pavot and Diener’s interpretation of SWLS scores, we defined respondents scoring below 20 as dissatisfied with life [ 28 ]. Uncertainty in illness was included as part of caregiving burden assessment. Uncertainty is defined as a cognitive state in which illness-related events cannot be clearly interpreted [ 29 ]. It arises from ambiguity of the condition, treatment complexity, insufficient information regarding severity, and unpredictability of prognosis [ 29 ]. The Managing Uncertainty in Illness Scale Family Member Form (MUIS-FM) [ 30 ] is commonly used to assess this construct. As the original MUIS-FM contains 31 items rated on a 5-point scale, this study used a shortened three-item version to reduce respondent burden, based on a Japanese version with confirmed reliability and validity [ 31 ]. The Multidimensional Scale of Perceived Social Support (MSPSS) [ 32 – 34 ] is a 12-item scale measuring perceived social support from family, friends, and significant others, with strong reliability and validity across populations. Higher scores indicate higher perceived social support. The Japanese version has confirmed reliability and validity [ 35 ]. Ethics approval This study was approved by the Toho University Faculty of Medicine Ethics Committee (approval number: A24044) with due consideration of the Declaration of Helsinki. Data analyses There were no missing data for any of the variables, and all participants were included in the analyses. Following a previous study [ 28 ], participants were assigned to the low satisfaction group if their SWLS score was 19 or below. Background characteristics were compared between the low and high satisfaction groups. Given the sample size, educational history and caregiving period were compared using the chi-square test or Fisher’s exact test. Similarly, characteristics of daughters with AN, including age range, body mass index, and AN subtype, were compared using Fisher’s exact test. Based on distributional assumptions, Student’s t-test was used to compare K6 scores, and the Mann–Whitney U test was used to compare age and other questionnaire scores. Means and standard deviations were reported for normally distributed data, and medians and interquartile ranges for non-normally distributed data. Additionally, we extracted factors associated with satisfaction with life via a multiple linear regression analysis. The explanatory variables included three evaluate measures, with age and educational background included as confounding variables. A formal sample size calculation was not conducted due to the exploratory nature of the study. Assuming five adjustment variables, a minimum sample size of 50 was considered sufficient. EZR Ver. 1.54 [ 36 ] was used for all analyses, and 2-tailed P -values of less than 0.05 were considered statistically significant. Results A total of 54 participants were classified into the low satisfaction group and 28 into the high satisfaction group. Table 1 compares background characteristics between the two groups. No differences were observed in participant characteristics or in care recipient body mass index, age, or duration of care. Table 2 compares evaluation measures between the groups. The low satisfaction group had higher K6 scores than the high satisfaction group (p < 0.05) and higher TIL Scale scores (p < 0.05). For MSPSS, the low satisfaction group had lower total and subscale scores (p < 0.001). MUIS-FM scores did not differ significantly between groups. Table 3 presents the results of the multiple linear regression analysis. The overall model was significant and explained a substantial proportion of variance in SWLS (adjusted R² = 0.44). MSPSS (β = 0.58, p < 0.001) and MUIS-FM (OR = − 0.24, p < 0.05) were associated with SWLS scores. Discussion This study examined factors associated with life satisfaction among mothers caring for individuals with AN and suggests that greater social support and lower illness-related uncertainty are associated with higher life satisfaction. The K6, a widely used screening tool for mental disorders, has a cutoff score of 13 [ 19 ]. In this study, mean K6 scores exceeded 13 in both groups, suggesting elevated psychological distress among many mothers caring for individuals with AN. These findings are consistent with previous studies [ 10 , 37 ]. Regarding loneliness, prior research among caregivers of individuals with dementia reported a TIL-3 cutoff of 6.5 for harmful loneliness [ 38 ]. In this study, median scores in both groups exceeded this threshold, suggesting high levels of loneliness. Mothers may experience loneliness due to perceived lack of support from partners or healthcare providers or disruption in their relationship with their child [ 37 ]. No differences were observed in clinical characteristics of AN or caregiving duration by life satisfaction level. Previous research reported that longer contact time between patients and caregivers was associated with poorer caregiver mental health [ 39 ]. Although many participants reported caregiving for one year or more, this study did not assess contact time or total caregiving duration in detail. Future studies should further stratify long-term caregiving and evaluate contact time to clarify these relationships. Uncertainty related to AN was associated with lower life satisfaction. Because individuals with AN strongly resist treatment, caregivers may experience stress due to unclear prognosis [ 40 ]. Prolonged caregiving may also increase critical emotional expression, which can strain family relationships [ 10 ]. This suggests that uncertainty, particularly lack of a clear outlook, contributes to psychological burden and reduced quality of life. Life satisfaction is an indicator of quality of life [ 41 ] and is associated with health status and work performance [ 42 ]. Previous studies reported a positive association between social support and life satisfaction, particularly among women [ 43 ], with similar findings among pregnant women [44]. In this study, the TIL Scale was not significant in regression analysis, suggesting that social isolation may have a stronger association with quality of life than subjective loneliness. Emotional support from trusted friends and relatives is particularly important for caregivers’ mental health [ 39 ], highlighting the need for support systems that maintain social connections. Our study has several limitations. First, this study was limited by its use of an online survey. Although this methodology enabled data collection from diverse residential areas across Japan and allowed sample selection based on data consistency, the high level of anonymity inherent in the survey may limit response reliability. Second, insufficient information was obtained regarding the participants’ physical health status, and its potential influence cannot be ruled out. Third, because mothers caring for individuals with other conditions were not included as a control group, it remains unclear whether these findings are specific to caregivers of individuals with AN. Finally, the exploratory design and small sample size limit generalizability, and larger-scale studies are necessary. Conclusion Life satisfaction among mothers caring for individuals with AN was associated with illness-related uncertainty and perceived social support. Healthcare providers may support these mothers by maintaining communication, providing clear information about prognosis, and encouraging sustained social connections. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Faculty of Medicine, Toho University (approval number: A24044) and conducted in accordance with the Declaration of Helsinki. All participants provided informed consent prior to participation, and consent was obtained electronically before the survey began. Participation was voluntary, and respondents could withdraw at any time. The survey was conducted in compliance with the Act on the Protection of Personal Information in Japan Informed consent was obtained before the participants responded to the online question form via. Consent for publication Not applicable. Declaration of Interests The authors have no conflicts of interest to declare. Funding This work was supported by a JSPS Grant- in- Aid for Scientific Research 24K16847. Author Contribution KH designed the study protocol and wrote the manuscript. TT, KT, NT, and AK collected, analyzed, and discussed the interpretation of the data. MH designed the study and discussed the interpretation of the data. All authors reviewed the manuscript. Acknowledgement We would like to thank Editage (www.editage.jp) for English language editing. Data Availability Data supporting the findings of this study are not publicly available due to residual privacy concerns, but are available from the corresponding author on reasonable request. Metadata describing the datasets will be publicly accessible via KAKEN and CiNii Research in accordance with KAKENHI data management policies. References Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National comorbidity survey replication. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9316793","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619058913,"identity":"781ec021-2122-4fde-8aca-cb0dbf21cacf","order_by":0,"name":"Kazuaki Hashimoto","email":"data:image/png;base64,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","orcid":"","institution":"Toho University","correspondingAuthor":true,"prefix":"","firstName":"Kazuaki","middleName":"","lastName":"Hashimoto","suffix":""},{"id":619058915,"identity":"d99aa690-7b18-41ef-8f32-81f2fcd57e88","order_by":1,"name":"Takeaki Takeuchi","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Takeaki","middleName":"","lastName":"Takeuchi","suffix":""},{"id":619058917,"identity":"6bd1d061-bce5-48a9-b666-c4d21fed3d99","order_by":2,"name":"Kaho Tanobe","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Kaho","middleName":"","lastName":"Tanobe","suffix":""},{"id":619058920,"identity":"2533bd81-ae9e-4ecd-8dc8-7f1ed4b4488a","order_by":3,"name":"Noriko Takeda","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Noriko","middleName":"","lastName":"Takeda","suffix":""},{"id":619058922,"identity":"a5127650-4c49-4e2b-8dd2-9f722c7627fd","order_by":4,"name":"Akiko Koyama","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Akiko","middleName":"","lastName":"Koyama","suffix":""},{"id":619058923,"identity":"c59865a5-c287-4026-bfb7-8c7b819a464a","order_by":5,"name":"Masahiro Hashizume","email":"","orcid":"","institution":"Toho University","correspondingAuthor":false,"prefix":"","firstName":"Masahiro","middleName":"","lastName":"Hashizume","suffix":""}],"badges":[],"createdAt":"2026-04-04 01:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9316793/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9316793/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106959932,"identity":"5abc7b45-69c4-45f6-89d7-29c9ba631d1c","added_by":"auto","created_at":"2026-04-15 09:17:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":484248,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9316793/v1/023baf0f-ef98-4074-a51d-d50281060448.pdf"},{"id":106792180,"identity":"503e30f4-db56-43da-8f9b-ec1faaa2c392","added_by":"auto","created_at":"2026-04-13 13:29:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23949,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-9316793/v1/f3fea4c741dbb11bd64d67fa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Associated with Life Satisfaction Among Mothers Caring for Children with Anorexia Nervosa from an exploratory online survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnorexia nervosa (AN) is a fatal disorder common in young women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. AN is characterized by an intense idealization of thinness, fear of weight gain, and severe eating disturbances [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]; in some cases, cognitive impairment reaches delusional levels [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Patients with AN exhibit psychological pathology that influences not only their own eating behaviors but also those of their families, and approximately 37% of family members become socially isolated [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Typically, a patient\u0026rsquo;s mother provides care [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and the burden on the mother is particularly heavy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the treatment of AN, evidence supports the effectiveness of family therapy, such as family-based therapy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Given that poor caregiver mental health is associated with poor treatment outcomes in AN [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], maternal psychological health is a critical factor in treatment. A systematic review on caregiving burden in eating disorders reported that caregivers of individuals with AN experience greater burden than those caring for individuals with bulimia nervosa [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The burden among parents of individuals with AN is multifaceted, encompassing physical, psychological, financial, and social dimensions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Accordingly, caregivers of individuals with AN experience significant anxiety, depression, and impaired social functioning [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, despite higher stress levels than those caring for individuals with schizophrenia or depression, they receive relatively limited support [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLife satisfaction is defined as an individual\u0026rsquo;s cognitive and holistic evaluation of overall quality of life [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and declining mental health generally reduces life satisfaction [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, parents caring for children with mental illness tend to report lower life satisfaction. For example, caregivers of children with autism report low life satisfaction, which decreases further with greater severity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A similar pattern has been reported among caregivers of children with emotional disorders [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although no studies have investigated life satisfaction among families of individuals with AN, given that mental health problems affect approximately 70% of patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], their life satisfaction is presumed to be low.\u003c/p\u003e \u003cp\u003eCaregivers often experience helplessness and burnout when caregiving is prolonged, particularly when awareness of AN and its effects is limited [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Poor prognosis in the care recipient is associated with caregiver burnout, high stress, and low life satisfaction; in turn, low life satisfaction may negatively impact the care recipient\u0026rsquo;s sense of accomplishment and satisfaction [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. To help interrupt this cycle, this study focused on life satisfaction among mothers\u0026mdash;who are the primary caregivers\u0026mdash;and identified factors associated with it. Given the potential for social isolation due to AN psychopathology [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], this exploratory study used an online survey.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e This analysis followed the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology) for cross-sectional studies. The cross-sectional survey was conducted from 19 December to 23 December 2024 by a professional agency (Rakuten Insight, Inc., Tokyo, Japan; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://member.insight.rakuten.co.in/\u003c/span\u003e\u003cspan address=\"https://member.insight.rakuten.co.in/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed on 1 December 2025)). The agency regularly updated and verified panel registration data. A survey link was distributed via email to panel members in line with national population distribution, accompanied by an explanation of the study.\u003c/p\u003e \u003cp\u003eAccording to the inclusion criteria, we enrolled women aged 30\u0026ndash;59 years who reported currently caring for a family member with AN. Exclusion criteria applied when respondents identified the care recipient as a parent, son, or other relative, due to the higher prevalence of AN among young women.\u003c/p\u003e \u003cp\u003eThe survey began with a page explaining its purpose and obtaining participants\u0026rsquo; consent, followed by screening questions for eligibility. Participants were first asked whether they were currently caring for a family member receiving treatment for AN. Those who answered \u0026ldquo;yes\u0026rdquo; were asked to specify the relationship to the care recipient (parent, daughter, son, or other). Only participants who identified their child as a daughter were included. Participants who met all criteria proceeded to the main questionnaire; those who did not were exited from the survey.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003ewas obtained before participation, and participants were allowed to discontinue at any time. The internet survey agency complied with the Act on the Protection of Personal Information in Japan.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA total of 102 caregiving mothers of individuals with AN completed the survey. No cases of straight-lining (identical responses across all items) were observed. After excluding 15 participants with an age difference of less than 16 years between themselves and their child, and 5 participants who reported \u0026ldquo;other\u0026rdquo; as the AN subtype, 82 participants were included in the analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuestionnaires\u003c/h3\u003e\n\u003cp\u003eMental health was assessed using the 6-item Kessler Psychological Scale (K6) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The K6 is a screening tool consisting of six items assessing psychological distress, each rated from 0 to 5. The scale demonstrates strong reliability and internal consistency, with higher scores indicating greater psychological distress [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Three-Item Loneliness Scale (TIL Scale) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] is a shortened version of the 20-item Revised UCLA Loneliness Scale [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], designed to reduce respondent burden. It consists of three items assessing perceived loneliness. The Japanese version has confirmed reliability and validity and is suitable for online surveys [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLife satisfaction was assessed using the Japanese version of the Satisfaction with Life Scale (SWLS), a five-item scale measuring overall life satisfaction [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e][\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Each item is rated on a seven-point scale, with total scores ranging from 5 to 35. The SWLS is highly reliable and valid [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and is suitable for internet-based surveys [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Consistent with Pavot and Diener\u0026rsquo;s interpretation of SWLS scores, we defined respondents scoring below 20 as dissatisfied with life [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUncertainty in illness was included as part of caregiving burden assessment. Uncertainty is defined as a cognitive state in which illness-related events cannot be clearly interpreted [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It arises from ambiguity of the condition, treatment complexity, insufficient information regarding severity, and unpredictability of prognosis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The Managing Uncertainty in Illness Scale Family Member Form (MUIS-FM) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] is commonly used to assess this construct. As the original MUIS-FM contains 31 items rated on a 5-point scale, this study used a shortened three-item version to reduce respondent burden, based on a Japanese version with confirmed reliability and validity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Multidimensional Scale of Perceived Social Support (MSPSS) [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] is a 12-item scale measuring perceived social support from family, friends, and significant others, with strong reliability and validity across populations. Higher scores indicate higher perceived social support. The Japanese version has confirmed reliability and validity [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Toho University Faculty of Medicine Ethics Committee (approval number: A24044) with due consideration of the Declaration of Helsinki.\u003c/p\u003e\n\u003ch3\u003eData analyses\u003c/h3\u003e\n\u003cp\u003eThere were no missing data for any of the variables, and all participants were included in the analyses. Following a previous study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], participants were assigned to the low satisfaction group if their SWLS score was 19 or below. Background characteristics were compared between the low and high satisfaction groups. Given the sample size, educational history and caregiving period were compared using the chi-square test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003cp\u003eSimilarly, characteristics of daughters with AN, including age range, body mass index, and AN subtype, were compared using Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003cp\u003eBased on distributional assumptions, Student\u0026rsquo;s t-test was used to compare K6 scores, and the Mann\u0026ndash;Whitney U test was used to compare age and other questionnaire scores.\u003c/p\u003e \u003cp\u003eMeans and standard deviations were reported for normally distributed data, and medians and interquartile ranges for non-normally distributed data.\u003c/p\u003e \u003cp\u003eAdditionally, we extracted factors associated with satisfaction with life via a multiple linear regression analysis. The explanatory variables included three evaluate measures, with age and educational background included as confounding variables.\u003c/p\u003e \u003cp\u003eA formal sample size calculation was not conducted due to the exploratory nature of the study. Assuming five adjustment variables, a minimum sample size of 50 was considered sufficient.\u003c/p\u003e \u003cp\u003eEZR Ver. 1.54 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] was used for all analyses, and 2-tailed \u003cem\u003eP\u003c/em\u003e-values of less than 0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 54 participants were classified into the low satisfaction group and 28 into the high satisfaction group. Table\u0026nbsp;1 compares background characteristics between the two groups. No differences were observed in participant characteristics or in care recipient body mass index, age, or duration of care.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2 compares evaluation measures between the groups. The low satisfaction group had higher K6 scores than the high satisfaction group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and higher TIL Scale scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For MSPSS, the low satisfaction group had lower total and subscale scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). MUIS-FM scores did not differ significantly between groups.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the results of the multiple linear regression analysis. The overall model was significant and explained a substantial proportion of variance in SWLS (adjusted R\u0026sup2; = 0.44). MSPSS (\u0026beta;\u0026thinsp;=\u0026thinsp;0.58, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and MUIS-FM (OR\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.24, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were associated with SWLS scores.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined factors associated with life satisfaction among mothers caring for individuals with AN and suggests that greater social support and lower illness-related uncertainty are associated with higher life satisfaction.\u003c/p\u003e \u003cp\u003eThe K6, a widely used screening tool for mental disorders, has a cutoff score of 13 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this study, mean K6 scores exceeded 13 in both groups, suggesting elevated psychological distress among many mothers caring for individuals with AN. These findings are consistent with previous studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding loneliness, prior research among caregivers of individuals with dementia reported a TIL-3 cutoff of 6.5 for harmful loneliness [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In this study, median scores in both groups exceeded this threshold, suggesting high levels of loneliness. Mothers may experience loneliness due to perceived lack of support from partners or healthcare providers or disruption in their relationship with their child [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNo differences were observed in clinical characteristics of AN or caregiving duration by life satisfaction level. Previous research reported that longer contact time between patients and caregivers was associated with poorer caregiver mental health [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Although many participants reported caregiving for one year or more, this study did not assess contact time or total caregiving duration in detail. Future studies should further stratify long-term caregiving and evaluate contact time to clarify these relationships.\u003c/p\u003e \u003cp\u003eUncertainty related to AN was associated with lower life satisfaction. Because individuals with AN strongly resist treatment, caregivers may experience stress due to unclear prognosis [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Prolonged caregiving may also increase critical emotional expression, which can strain family relationships [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This suggests that uncertainty, particularly lack of a clear outlook, contributes to psychological burden and reduced quality of life.\u003c/p\u003e \u003cp\u003eLife satisfaction is an indicator of quality of life [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and is associated with health status and work performance [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Previous studies reported a positive association between social support and life satisfaction, particularly among women [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], with similar findings among pregnant women [44]. In this study, the TIL Scale was not significant in regression analysis, suggesting that social isolation may have a stronger association with quality of life than subjective loneliness. Emotional support from trusted friends and relatives is particularly important for caregivers\u0026rsquo; mental health [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], highlighting the need for support systems that maintain social connections.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, this study was limited by its use of an online survey. Although this methodology enabled data collection from diverse residential areas across Japan and allowed sample selection based on data consistency, the high level of anonymity inherent in the survey may limit response reliability. Second, insufficient information was obtained regarding the participants\u0026rsquo; physical health status, and its potential influence cannot be ruled out. Third, because mothers caring for individuals with other conditions were not included as a control group, it remains unclear whether these findings are specific to caregivers of individuals with AN. Finally, the exploratory design and small sample size limit generalizability, and larger-scale studies are necessary.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLife satisfaction among mothers caring for individuals with AN was associated with illness-related uncertainty and perceived social support. Healthcare providers may support these mothers by maintaining communication, providing clear information about prognosis, and encouraging sustained social connections.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Ethics Committee of the Faculty of Medicine, Toho University (approval number: A24044) and conducted in accordance with the Declaration of Helsinki. All participants provided informed consent prior to participation, and consent was obtained electronically before the survey began. Participation was voluntary, and respondents could withdraw at any time. The survey was conducted in compliance with the Act on the Protection of Personal Information in Japan Informed consent was obtained before the participants responded to the online question form via.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eDeclaration of Interests\u003c/h2\u003e \u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by a JSPS Grant- in- Aid for Scientific Research 24K16847.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKH designed the study protocol and wrote the manuscript. TT, KT, NT, and AK collected, analyzed, and discussed the interpretation of the data. MH designed the study and discussed the interpretation of the data. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Editage (www.editage.jp) for English language editing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData supporting the findings of this study are not publicly available due to residual privacy concerns, but are available from the corresponding author on reasonable request. Metadata describing the datasets will be publicly accessible via KAKEN and CiNii Research in accordance with KAKENHI data management policies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National comorbidity survey replication. 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Acta Psychol (Amst). 2025;259:105360. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.actpsy.2025.105360\u003c/span\u003e\u003cspan address=\"10.1016/j.actpsy.2025.105360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\n\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"biopsychosocial-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsm","sideBox":"Learn more about [BioPsychoSocial Medicine](http://bpsmedicine.biomedcentral.com/)","snPcode":"13030","submissionUrl":"https://submission.nature.com/new-submission/13030/3","title":"BioPsychoSocial Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"anorexia nervosa, caregiving, social support, online survey, cross sectional study","lastPublishedDoi":"10.21203/rs.3.rs-9316793/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9316793/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCaregivers of individuals with anorexia nervosa (AN) are predominantly mothers who face chronic, multifaceted burdens. However, their life satisfaction remains understudied, and associated factors are unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional online survey was conducted among mothers aged 30–59 years caring for individuals with AN. Participants were assessed for life satisfaction (SWLS), caregiving burden (MUIS-FM), mental health (K6), loneliness (TIL Scale), and social support (MSPSS). Participants were classified into high and low satisfaction groups based on SWLS scores, followed by group comparisons. Factors associated with life satisfaction were examined using multiple linear regression analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 102 participants, 82 were included in the analysis. No between-group differences were observed in background characteristics or care recipient clinical features. The Low Satisfaction group reported greater loneliness, lower social support, and poorer mental health than the High Satisfaction group. Multiple linear regression identified social support and caregiving burden as associated with life satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany mothers caring for individuals with AN experience elevated psychological distress, and life satisfaction is associated with social support and management of illness-related uncertainty. These findings highlight the importance of psychosocial support for this population.\u003c/p\u003e","manuscriptTitle":"Factors Associated with Life Satisfaction Among Mothers Caring for Children with Anorexia Nervosa from an exploratory online survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 13:29:48","doi":"10.21203/rs.3.rs-9316793/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-14T23:19:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T14:54:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151978105281452527094539971239886779801","date":"2026-04-07T05:44:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132978113778947463588927618237130819885","date":"2026-04-07T00:46:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79235447778856817076041250703220283545","date":"2026-04-06T23:46:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-06T23:43:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T17:04:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T17:03:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BioPsychoSocial Medicine","date":"2026-04-04T01:32:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"biopsychosocial-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsm","sideBox":"Learn more about [BioPsychoSocial Medicine](http://bpsmedicine.biomedcentral.com/)","snPcode":"13030","submissionUrl":"https://submission.nature.com/new-submission/13030/3","title":"BioPsychoSocial Medicine","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8eb854b-795e-40f6-889e-3a72ce89addf","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T13:29:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 13:29:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9316793","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9316793","identity":"rs-9316793","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}