Impact of Self-Reliance on Support and Psychosocial Distress in ICU Family Caregivers

Impact of Self-Reliance on Support and Psychosocial Distress in ICU Family Caregivers | 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 Impact of Self-Reliance on Support and Psychosocial Distress in ICU Family Caregivers Kirtideepa Subhadarsani, Usha Chivukula This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7343008/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Psychosocial distress is a common yet complex experience among families of ICU patients, influenced by a range of emotional, situational, and interpersonal factors. While social support is often linked to better psychological outcomes, its effectiveness may depend on personal traits such as self-reliance. This study investigates how self-reliance moderates the relationship between perceived support and psychosocial distress in this population. 312 participants were assessed on the study variables, viz., social support, self-reliance, and levels of distress. The data were analysed using the PROCESS analysis approach. The findings indicate that self-reliance significantly moderates the relationship between support and distress. Individuals with higher levels of self-reliance have been observed to be more capable of recognizing their potential in making informed choices and effectively implementing their plans. This inherent quality enables them to leverage external support more efficiently, which can significantly minimize emotional distress in times of crisis. ICU self- reliance support psychosocial distress process analysis Figures Figure 1 Introduction The emergence of a critical condition and subsequent admission to an intensive care unit (ICU), combined with the inherent uncertainty regarding patient prognosis and the high-stakes environment of ICUs, can lead to significant emotional distress for caregivers. This distress is often marked by heightened levels of anxiety, depression, fear, and feelings of helplessness. Factors such as poor communication from healthcare providers, disruption of daily routines, financial strain, and the emotional burden of making potentially life-altering decisions for the patient or family further intensify this psychological distress. Research has consistently demonstrated that the high-pressure nature of the ICU elevates the risk of developing long-term psychological challenges among caregivers of ICU patients [1]. The emotional toll of witnessing a life-and-death situation, coupled with the demands of providing unwavering support, can profoundly impact caregivers’ mental health, leaving them vulnerable to these enduring psychological effects: the risk of post-traumatic stress disorder (PTSD), complicated grief, and long-term psychological issues among caregivers [9]. Family members or caregivers of ICU patients play a vital role in patients' recovery and overall well-being, as their responsibilities extend beyond basic care. However, the challenging and high-stress nature of the ICU environment, combined with limited control over medical decisions and disruption to daily life, can lead to psychosocial distress [10, 12, 15]. Social support is essential for family caregivers of critical care patients, as it mitigates psychological distress and enhances caregivers’ capacity for effective decision-making. Additionally, such support contributes positively to patient outcomes and facilitates recovery and adaptation [19]. Support in these situations is multifaceted, encompassing psychological, emotional, informational, and structural dimensions. Whether provided by colleagues, friends, or healthcare professionals, adequate support can lessen the negative impacts of a crisis, foster resilience, and improve overall satisfaction. Its presence is associated with reduced distress, better family adjustment, improved care quality, and overall satisfaction [23, 28, 31]. Personality factors play an important role in enhancing an individual's ability to avail of support. Traits such as openness, adaptability, and effective communication make it easier for a person to seek help and collaborate with others [11]. Another important personality aspect that can hinder seeking help is self-reliance. Self-reliance is the ability to depend on oneself for making decisions, managing responsibilities, and solving problems without excessive reliance on others. It is a significant maturing process, fostered by independence, autonomy, and control over life choices. While excessive independence can discourage people from asking for assistance, adaptive self-reliance finds a balance between enabling one to maintain independence and being open to seeking support when needed. Adaptive self-reliance refers to the capacity to rely on one’s own abilities while also seeking support when circumstances require it. Individuals who exhibit adaptive self-reliance are able to do so because they possess secure attachment relationships that provide reliable support when needed [32, 30]. Studies have also shown that social support enhances the relationship between self-reliance and help-seeking behavior during psychological distress. This dynamic relationship between social support and self-reliance can also be understood as bidirectional. Evidence shows that individuals with a strong sense of self-reliance deeply trust their abilities. They actively engage in their social network and proactively seek the required assistance rather than passively depending on others. This reduces feelings of helplessness and ensures that the support they receive is more effective [14, 20]. While a growing body of literature has addressed the psychosocial distress experienced by family members of ICU patients , much of this research has focused on the prevalence of symptoms such as anxiety, depression, and post-traumatic stress [3, 24]. There is consensus that social support is protective against such distress [10], but less is known about the psychological mechanisms and individual difference factors that influence the efficacy of utilizing this support. Specifically, few studies have examined the moderating role of personality traits such as self-reliance in shaping the relationship between perceived support and distress outcomes. Although resilience factors have been increasingly studied in ICU contexts [25], self-reliance as a distinct and measurable construct has not been sufficiently integrated into models predicting family member outcomes in critical care environments. This is a notable omission given evidence that individual coping styles significantly influence how support is received and utilized [5, 8]. Moreover, existing models often treat social support as uniformly beneficial, without recognizing that self-reliant individuals may utilize support more effectively than others. This mismatch between support style and personal coping preferences remains under-investigated in the ICU context, where time-sensitive and emotionally charged decisions are often made under intense stress. This study addresses the gap by incorporating self-reliance as a moderating variable in the support–distress relationship. Hence, the study aimed to examine whether higher levels of perceived social support are associated with lower levels of psychosocial distress and whether higher levels of self-reliance are associated with lower levels of psychosocial distress among family members of ICU patients. Objectives To examine the relationship between self-reliance, support, and psychosocial distress among the families of ICU patients. To assess the moderating effect of self-reliance on the relationship between support and psychosocial distress in ICU patients’ families. METHOD Sample The study sample comprised 312 family members, aged 21 to 60, who were the primary caregivers of patients admitted to the Intensive Care Unit (ICU). Among the participants, 139 were male and 173 were female, with a mean age of 39.5 years (SD = ±6.83). Participants were recruited through purposive sampling from tertiary care hospitals in Odisha. Only family members directly involved in caregiving and medical decision-making were included in the study. Measures Self-Reliance Scale The Self-Reliance Scale, developed by Padhy et al. (2024) [22], is a standardized instrument consisting of 30 items designed to assess personal independence, problem-solving ability, emotional regulation, and individual responsibility in coping with life challenges. Each item is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), allowing for a nuanced understanding of how much individuals rely on themselves in difficult situations. The scale covers multiple dimensions of self-reliance, including confidence in decision-making, ability to manage stress without external help, and preference for autonomy. Higher scores indicate greater self-reliance. The scale has been validated for clinical and community populations and shows good internal consistency and construct validity. Caregiver Support Scale The Caregiver Support Scale is a 15-item tool specifically developed for the study and followed the prescribed steps of test construction. It measured the perceived level of support received by family members of ICU patients. Items are rated on a 3-point Likert scale (1 - support is not available 2. Support is available with effort, and 3—support is available, capturing how frequently participants receive different forms of support, including emotional, informational, and instrumental support. The scale includes items such as Someone to ….. “remind me about my medication, meal, diet and sleep” or “guide me about my patient’s health condition.” A higher total score reflects greater support they receive. The internal reliability (Cronbach’s Alpha is >0.77). ICU Caregiver Distress Scale ICU Psychosocial Distress Scale was particularly developed for this study. It consists of 20 items designed to measure the emotional and social difficulties experienced by family members of patients in the ICU. Each item is scored on a 5-point Likert scale (1 = Not at all distress to 5 = Extremely distress), allowing participants to indicate the severity of symptoms viz:- My distress level in a situation when “my patient is not responding to me when I visit him/her in the ICU” and “I observe the distress of attendants of other patients”. Reliability testing showed strong internal consistency (Cronbach’s alpha typically > 0.80). Procedures A total of thirteen out of twenty-seven hospitals located across the cities of Odisha were approached for permission to conduct the study. Six of these hospitals agreed to participate. After fulfilling the necessary administrative requirements, each participating institution designated an on-call physician and an intensive care unit nurse to assist the researcher in facilitating the process. Only family members of ICU patients from six selected hospitals were invited to participate. Before the study began, participants were informed about its purpose and provided written consent. The research was conducted in a controlled hospital environment, each session lasting 45 to 50 minutes and including two short breaks. The researchers facilitated the sessions to ensure participant comfort and accurate responses, while maintaining strict anonymity and confidentiality. Data Analysis This study employed a conditional process model utilizing observable variables to examine moderated mediation effects, following the methodological framework outlined by Hayes (2013). The PROCESS macro for SPSS [13] was employed for this analysis, as it is a widely recognized computational tool for estimating mediation, moderation, and moderated mediation models through Ordinary Least Squares (OLS) regression. Given that all variables in the analysis were measured rather than latent constructs, PROCESS was appropriate. Specifically, Model 1 of the PROCESS macro was utilized, with 5,000 bootstrap samples employed to assess the robustness of the estimates. Results This section presents the findings of the study, including descriptive statistics, correlations among key variables, and the results of the moderation analysis. Statistical analyses were conducted using SPSS and PROCESS Macro, and significance was assessed at 0.05 level. The following results provide an overview of the data distribution and test the hypothesized interaction effects. Table 1 Descriptive Statistics and Pearson Correlation Between Variables Variables 1 2 3 Mean SD Self-Reliance - 15.81 3.72 Caregiver Support .47** - 10.17 2.15 Psychosocial Distress − .65** − .46** - 21.95 5.23 Note : SD—Standard Deviation The results of the descriptive statistics show that the average score for self-reliance was 15.81 (SD = 3.72), for support it was 10.17 (SD = 2.15), and for psychosocial distress the mean was 21.95 (SD = 5.23). The correlation analysis revealed significant relationships among the variables. Self-Reliance was positively correlated with Support (r = .47, p < .01). Both self-reliance and support were negatively correlated with psychosocial distress (r = − .65 and r = − .46, respectively, both p < .01),. A moderation analysis was conducted to examine whether self-reliance moderates the relationship between support and psycho-social distress. The model included support, self-reliance, and their interaction ( Support × Self-Reliance ) as predictors of distress. Table 2 Regression Coefficients for the Moderation Model of Self-Reliance and Support on Distress Model Constant Coefficient SE T LlCI UlCI Significance Caregiver Support -0.741 .0715 -13.17 -1.08 − .80 SIG Self-Reliance -0.295 .0515 5.14 .18 .40 SIG Int-1 0.833 .0069 12.80 .07 .10 SIG Note. SE-Standard Error, t-T value, LlCI—Lower limit Confidence Interval HlCI—Higher limit Confidence Interval p < 0.05 The moderation analysis showed that caregiver support and self-reliance significantly negatively affected distress (b = − 0.74, t = − 13.17, p < .001, b=-0.29, t = 5.14, p < .001). The interaction term (Support × Self-Reliance) was also significant but positive (b = 0.83, t = 12.80, p < .001), indicating that self-reliance moderates the effect of support on distress. All effects were statistically significant, with confidence intervals not crossing zero; further, these findings indicate that higher self-reliance strengthens the impact of support on distress. Figure 2 illustrates the results of the simple slope analysis (Johnson-Neyman, 1936), which aims to elucidate the moderating effects. As depicted, the slope is significantly steeper at high levels of Self-Reliance (SR), indicating that, the impact of support on distress is stronger when the level of SR is increased. Furthermore, Fig. 2 reveals that as SR increases, the strength of the relationship between support and distress also intensifies. Table 3 Moderation Analysis Summary for the Interaction Between Support and Self-Reliance on Psycho-Social Distress Interactions R-square R-square change MSE F Df1 Df2 P Support*Self-Reliance 0.4193 0.1546 187.5 163.95 3 309 0.000 Note : MSE-Mean Square Error, F—F-statistic, Df—degree of Freedom, p- level of significance. The interaction model examining the effect of Support × Self-Reliance on the outcome explained 41.93% of the total variance (R2 = 0.4193R2 = 0.4193). Including the interaction accounted for an additional 15.46% of variance(ΔR2 = 0.1546ΔR2 = 0.1546), indicating a meaningful improvement in model fit. The model was statistically significant overall, F(3,309) = 163.95F(3,309) = 163.95, p < .001, with a mean squared error (MSE) of 187.5. These results suggest that the interaction between support and self-reliance contributes significantly to making changes in distress. DISCUSSION Social support plays a critical role in alleviating distress among caregivers. The study highlights the crucial role that emotional and social support play in buffering the stress and anxiety that caregivers frequently face in such challenging environments. Research shows that structured support for ICU caregivers, through clear communication, emotional support, and ongoing engagement, reduces psychological burden and strengthens coping abilities. Such support is linked to lower rates of PTSD, anxiety, and depression among family caregivers [ 2 , 6 , 21 ]. In a situation of crisis, it is essential for individuals to recognize their need for support and understand how and where to access it. The study's findings reveal that self-reliance influences the relationship between support and distress. This suggests that self-reliant individuals are attuned to their emotional and practical needs, allowing them to recognize the appropriate sources of support, whether from family, friends, or healthcare professionals. The adaptive quality of self-reliance empowers individuals to comprehend the nature of available support, identify where to find appropriate assistance, and enhance the effectiveness of that support. This understanding ultimately reduces psychological distress, enabling them to face challenges of caregiving effectively while leveraging a network of meaningful relationships and resources. This relationship between self-reliance and support fosters better coping, allowing the individual to maintain a sense of control while benefiting from assistance. Support and self-reliance are intricately linked in managing stressful situations [ 14 ]; during the ICU stay, this dual strategy of inner strength bolstered by outside support can result in much improved stress management and less psychological suffering [ 17 , 33 ]. Self-reliance not only serves as a personal strength but also amplifies the positive effects of the support they receive. This subtle interaction reinforces the importance of considering both dispositional and contextual factors when examining responses to stress. The findings of this study also highlight that individuals with higher levels of self-reliance derive greater benefit from available support, leading to reduced experiences of psychosocial distress, emphasizing the adaptive value of personal resilience in managing stress [ 4 ]. Critical care involves significant psychological vulnerability as patients and families face high stress and uncertainty. During this time, psychological support is essential for enhancing coping abilities and managing situational demands. While self-reliance helps individuals utilize available resources effectively, it does not negate the need for social and emotional connections. It also shows that combining personal autonomy with meaningful support networks best protects against psychosocial distress. Understanding the relationship between personality traits and support mechanisms allows interventions to be tailored effectively, ensuring individuals receive appropriate support to foster resilience during crisis. The insights from this study have significant implications for self-reliance in high-stress caregiving environments. It is essential to help caregivers recognize the strength of self-reliance and use it to seek the appropriate support.. However, limitations must be acknowledged. Self-reliance effects may vary across cultural contexts, age groups, and situations, and research often relies on potentially biased self-reported measures. The dynamic nature of stress and support interactions is not adequately captured in cross-sectional studies, highlighting the need for longitudinal research to understand how these relationships impact psychological outcomes. Declarations Author Contributions Conceptualization: Kirtideepa Subhadarsani, Usha Chivukula Investigation: Kirtideepa Subhadarsani. Formal analysis: Kirtideepa Subhadarsani. Methodology: Usha Chivukula, Kirtideepa Subhadarsani. Project administration: Kirtideepa Subhadarsani Supervision: Usha Chivukula. Validation: Usha Chivukula Writing original draft: Kirtideepa Subhadarsani. Writing, review & editing: Usha Chivukula, Kirtideepa Subhadarsani Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethical approval and consent to participate This study was approved by the Institutional Ethics Committee of the University of Hyderabad (approval number: UH/IEC/2023/559). 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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-7343008","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513041598,"identity":"7557d128-f0d0-4918-8093-a3811fdfedad","order_by":0,"name":"Kirtideepa Subhadarsani","email":"","orcid":"","institution":"University of Hyderabad","correspondingAuthor":false,"prefix":"","firstName":"Kirtideepa","middleName":"","lastName":"Subhadarsani","suffix":""},{"id":513041599,"identity":"41c8b17f-c9bd-4170-980d-48bcac3222ee","order_by":1,"name":"Usha Chivukula","email":"data:image/png;base64,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","orcid":"","institution":"University of Hyderabad","correspondingAuthor":true,"prefix":"","firstName":"Usha","middleName":"","lastName":"Chivukula","suffix":""}],"badges":[],"createdAt":"2025-08-11 06:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7343008/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7343008/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91487223,"identity":"5adbd1b0-55ac-4d03-8f2e-bdf133eb1a2c","added_by":"auto","created_at":"2025-09-17 05:01:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26305,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematic model of Self-Reliance as a moderator between support and psychosocial distress\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: b- Beta weights\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7343008/v1/eb616af3d8a549eb080b77c8.png"},{"id":98622394,"identity":"7a68adb4-7f47-48c5-a030-0f5f68097d85","added_by":"auto","created_at":"2025-12-19 16:53:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":829625,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7343008/v1/c784b646-53f0-4e96-ad34-d79247399bef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Self-Reliance on Support and Psychosocial Distress in ICU Family Caregivers","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe emergence of a critical condition and subsequent admission to an intensive care unit (ICU), combined with the inherent uncertainty regarding patient prognosis and the high-stakes environment of ICUs, can lead to significant emotional distress for caregivers. This distress is often marked by heightened levels of anxiety, depression, fear, and feelings of helplessness. Factors such as poor communication from healthcare providers, disruption of daily routines, financial strain, and the emotional burden of making potentially life-altering decisions for the patient or family further intensify this psychological distress. Research has consistently demonstrated that the high-pressure nature of the ICU elevates the risk of developing long-term psychological challenges among caregivers of ICU patients [1]. The emotional toll of witnessing a life-and-death situation, coupled with the demands of providing unwavering support, can profoundly impact caregivers’ mental health, leaving them vulnerable to these enduring psychological effects: the risk of post-traumatic stress disorder (PTSD), complicated grief, and long-term psychological issues among caregivers [9]. \u003c/p\u003e\n\u003cp\u003eFamily members or caregivers of ICU patients play a vital role in patients' recovery and overall well-being, as their responsibilities extend beyond basic care. However, the challenging and high-stress nature of the ICU environment, combined with limited control over medical decisions and disruption to daily life, can lead to psychosocial distress [10, 12, 15]. Social support is essential for family caregivers of critical care patients, as it mitigates psychological distress and enhances caregivers’ capacity for effective decision-making. Additionally, such support contributes positively to patient outcomes and facilitates recovery and adaptation [19]. Support in these situations is multifaceted, encompassing psychological, emotional, informational, and structural dimensions. Whether provided by colleagues, friends, or healthcare professionals, adequate support can lessen the negative impacts of a crisis, foster resilience, and improve overall satisfaction. Its presence is associated with reduced distress, better family adjustment, improved care quality, and overall satisfaction [23, 28, 31]. Personality factors play an important role in enhancing an individual's ability to avail of support. Traits such as openness, adaptability, and effective communication make it easier for a person to seek help and collaborate with others [11]. Another important personality aspect that can hinder seeking help is self-reliance. \u003cstrong\u003eSelf-reliance\u003c/strong\u003e is the ability to depend on oneself for making decisions, managing responsibilities, and solving problems without excessive reliance on others. It is a significant maturing process, fostered by independence, autonomy, and control over life choices. While excessive independence can discourage people from asking for assistance, adaptive self-reliance finds a balance between enabling one to maintain independence and being open to seeking support when needed. \u003cstrong\u003eAdaptive self-reliance\u003c/strong\u003e refers to the capacity to rely on one’s own abilities while also seeking support when circumstances require it. Individuals who exhibit adaptive self-reliance are able to do so because they possess secure attachment relationships that provide reliable support when needed [32, 30]. Studies have also shown that social support enhances the relationship between self-reliance and help-seeking behavior during psychological distress. This dynamic relationship between social support and self-reliance can also be understood as bidirectional. Evidence shows that individuals with a strong sense of self-reliance deeply trust their abilities. They actively engage in their social network and proactively seek the required assistance rather than passively depending on others. This reduces feelings of helplessness and ensures that the support they receive is more effective [14, 20].\u003c/p\u003e\n\u003cp\u003eWhile a growing body of literature has addressed the \u003cstrong\u003epsychosocial distress experienced by family members of ICU patients\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e much of this research has focused on the \u003cstrong\u003eprevalence\u003c/strong\u003e of symptoms such as anxiety, depression, and post-traumatic stress [3, 24]. There is consensus that \u003cstrong\u003esocial support\u003c/strong\u003e is protective against such distress [10], but \u003cstrong\u003eless is known about the psychological mechanisms and individual difference factors\u003c/strong\u003e that influence the efficacy of utilizing this support. Specifically, \u003cstrong\u003efew studies have examined the moderating role of personality traits such as self-reliance\u003c/strong\u003e in shaping the relationship between perceived support and distress outcomes. Although resilience factors have been increasingly studied in ICU contexts [25], \u003cstrong\u003eself-reliance as a distinct and measurable construct has not been sufficiently integrated\u003c/strong\u003e into models predicting family member outcomes in critical care environments. This is a notable omission given evidence that individual coping styles significantly influence how support is received and utilized [5, 8]. Moreover, existing models often treat social support as uniformly beneficial, without recognizing that self-reliant individuals may utilize support more effectively than others. This mismatch between \u003cstrong\u003esupport style and personal coping preferences\u003c/strong\u003eremains under-investigated in the ICU context, where time-sensitive and emotionally charged decisions are often made under intense stress. This study addresses the gap by incorporating \u003cstrong\u003eself-reliance as a moderating variable\u003c/strong\u003e in the support–distress relationship. Hence, the study aimed to examine whether higher levels of perceived social support are associated with lower levels of psychosocial distress and whether higher levels of self-reliance are associated with lower levels of psychosocial distress among family members of ICU patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eTo examine the relationship between self-reliance, support, and psychosocial distress among the families of ICU patients.\u003c/li\u003e\n\u003cli\u003eTo assess the moderating effect of self-reliance on the relationship between support and psychosocial distress in ICU patients’ families.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"METHOD","content":"\u003cp\u003e\u003cem\u003eSample\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study sample comprised 312 family members, aged 21 to 60, who were the primary caregivers of patients admitted to the Intensive Care Unit (ICU). Among the participants, 139 were male and 173 were female, with a mean age of 39.5 years (SD = ±6.83). \u003cstrong\u003eParticipants were recruited through purposive sampling from tertiary care hospitals in Odisha. Only family members directly involved in caregiving and medical decision-making were included in the study.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeasures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eSelf-Reliance Scale\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;Self-Reliance Scale, developed by Padhy et al. (2024) [22], is a standardized instrument consisting of\u0026nbsp;30 items\u0026nbsp;designed to assess personal independence, problem-solving ability, emotional regulation, and individual responsibility in coping with life challenges. Each item is rated on a\u0026nbsp;5-point Likert scale\u0026nbsp;ranging from 1 (strongly disagree) to 5 (strongly agree), allowing for a nuanced understanding of how much individuals rely on themselves in difficult situations. The scale covers multiple dimensions of self-reliance, including confidence in decision-making, ability to manage stress without external help, and preference for autonomy. Higher scores indicate greater self-reliance. The scale has been validated for clinical and community populations and shows good internal consistency and construct validity.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCaregiver Support Scale\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Caregiver Support Scale is a 15-item tool specifically developed for the study and followed the prescribed steps of test construction. It measured the perceived level of support received by family members of ICU patients. Items are rated on a 3-point Likert scale (1 -\u0026nbsp;support is not available 2. Support is available with effort, and 3—support is available,\u0026nbsp;capturing how frequently participants receive different forms of support, including emotional, informational, and instrumental support. The scale includes items such as \u0026nbsp;\u003cstrong\u003eSomeone to …..\u003c/strong\u003e “remind me about my medication, meal, diet and sleep” or “guide me about my patient’s health condition.” A higher total score reflects greater support they receive. The internal reliability (Cronbach’s Alpha is \u0026gt;0.77).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eICU Caregiver Distress Scale\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eICU Psychosocial Distress Scale was particularly developed for this study. It consists of\u0026nbsp;20 items\u0026nbsp;designed to measure the emotional and social difficulties experienced by family members of patients in the ICU. Each item is scored on a\u0026nbsp;5-point Likert scale\u0026nbsp;(1 = Not at all distress to 5 = Extremely distress), allowing participants to indicate the severity of symptoms viz:- My distress level in a situation when “my patient is not responding to me when I visit him/her in the ICU” and “I observe the distress of attendants of other patients”. Reliability testing showed strong internal consistency (Cronbach’s alpha typically \u0026gt; 0.80).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of thirteen out of twenty-seven hospitals located across the cities of Odisha were approached for permission to conduct the study. Six of these hospitals agreed to participate. After fulfilling the necessary administrative requirements, each participating institution designated an on-call physician and an intensive care unit nurse to assist the researcher in facilitating the process. Only family members of ICU patients from six selected hospitals were invited to participate. Before the study began, participants were informed about its purpose and provided written consent. The research was conducted in a controlled hospital environment, each session lasting 45 to 50 minutes and including two short breaks. The researchers facilitated the sessions to ensure participant comfort and accurate responses, while maintaining strict anonymity and confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a conditional process model utilizing observable variables to examine moderated mediation effects, following the methodological framework outlined by Hayes (2013). The PROCESS macro for SPSS [13] was employed for this analysis, as it is a widely recognized computational tool for estimating mediation, moderation, and moderated mediation models through Ordinary Least Squares (OLS) regression. Given that all variables in the analysis were measured rather than latent constructs, PROCESS was appropriate. Specifically, Model 1 of the PROCESS macro was utilized, with 5,000 bootstrap samples employed to assess the robustness of the estimates.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis section presents the findings of the study, including descriptive statistics, correlations among key variables, and the results of the moderation analysis. Statistical analyses were conducted using SPSS and PROCESS Macro, and significance was assessed at 0.05 level. The following results provide an overview of the data distribution and test the hypothesized interaction effects.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive Statistics and Pearson Correlation Between Variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Reliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaregiver Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.47**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychosocial Distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.65**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.46**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cem\u003eNote\u003c/em\u003e: SD\u0026mdash;Standard Deviation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe results of the descriptive statistics show that the average score for self-reliance was 15.81 (SD\u0026thinsp;=\u0026thinsp;3.72), for support it was 10.17 (SD\u0026thinsp;=\u0026thinsp;2.15), and for psychosocial distress the mean was 21.95 (SD\u0026thinsp;=\u0026thinsp;5.23). The correlation analysis revealed significant relationships among the variables. Self-Reliance was positively correlated with Support (r\u0026thinsp;=\u0026thinsp;.47, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Both self-reliance and support were negatively correlated with psychosocial distress (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.65 and r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.46, respectively, both p\u0026thinsp;\u0026lt;\u0026thinsp;.01),.\u003c/p\u003e\n\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n \u003cp\u003eA moderation analysis was conducted to examine whether self-reliance moderates the relationship between support and psycho-social distress. The model included support, self-reliance, and their interaction \u003cstrong\u003e(\u003c/strong\u003eSupport \u0026times; Self-Reliance\u003cstrong\u003e)\u003c/strong\u003e as predictors of distress.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRegression Coefficients for the Moderation Model of Self-Reliance and Support on Distress\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLlCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUlCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaregiver Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.0715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSIG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Reliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.0515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSIG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInt-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.0069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSIG\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e SE-Standard Error, t-T value, LlCI\u0026mdash;Lower limit Confidence Interval HlCI\u0026mdash;Higher limit Confidence Interval p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe moderation analysis showed that caregiver support and self-reliance significantly negatively affected distress (b\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.74, t\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;13.17, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, b=-0.29, t\u0026thinsp;=\u0026thinsp;5.14, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The interaction term (Support \u0026times; Self-Reliance) was also significant but positive (b\u0026thinsp;=\u0026thinsp;0.83, t\u0026thinsp;=\u0026thinsp;12.80, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), indicating that self-reliance moderates the effect of support on distress. All effects were statistically significant, with confidence intervals not crossing zero; further, these findings indicate that higher self-reliance strengthens the impact of support on distress.\u003c/p\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the results of the simple slope analysis (Johnson-Neyman, 1936), which aims to elucidate the moderating effects. As depicted, the slope is significantly steeper at high levels of Self-Reliance (SR), indicating that, the impact of support on distress is stronger when the level of SR is increased. Furthermore, Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e reveals that as SR increases, the strength of the relationship between support and distress also intensifies.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eModeration Analysis Summary for the Interaction Between Support and Self-Reliance on Psycho-Social Distress\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInteractions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR-square\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR-square change\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDf1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDf2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport*Self-Reliance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e187.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e163.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e\u003cem\u003eNote\u003c/em\u003e: MSE-Mean Square Error, F\u0026mdash;F-statistic, Df\u0026mdash;degree of Freedom, p- level of significance.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe interaction model examining the effect of Support \u0026times; Self-Reliance on the outcome explained 41.93% of the total variance (R2\u0026thinsp;=\u0026thinsp;0.4193R2\u0026thinsp;=\u0026thinsp;0.4193). Including the interaction accounted for an additional 15.46% of variance(\u0026Delta;R2\u0026thinsp;=\u0026thinsp;0.1546\u0026Delta;R2\u0026thinsp;=\u0026thinsp;0.1546), indicating a meaningful improvement in model fit. The model was statistically significant overall, F(3,309)\u0026thinsp;=\u0026thinsp;163.95F(3,309)\u0026thinsp;=\u0026thinsp;163.95, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, with a mean squared error (MSE) of 187.5. These results suggest that the interaction between support and self-reliance contributes significantly to making changes in distress.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSocial support plays a critical role in alleviating distress among caregivers. The study highlights the crucial role that emotional and social support play in buffering the stress and anxiety that caregivers frequently face in such challenging environments. Research shows that structured support for ICU caregivers, through clear communication, emotional support, and ongoing engagement, reduces psychological burden and strengthens coping abilities. Such support is linked to lower rates of PTSD, anxiety, and depression among family caregivers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn a situation of crisis, it is essential for individuals to recognize their need for support and understand how and where to access it. The study's findings reveal that self-reliance influences the relationship between support and distress. This suggests that self-reliant individuals are attuned to their emotional and practical needs, allowing them to recognize the appropriate sources of support, whether from family, friends, or healthcare professionals. The adaptive quality of self-reliance empowers individuals to comprehend the nature of available support, identify where to find appropriate assistance, and enhance the effectiveness of that support. This understanding ultimately reduces psychological distress, enabling them to face challenges of caregiving effectively while leveraging a network of meaningful relationships and resources. This relationship between self-reliance and support fosters better coping, allowing the individual to maintain a sense of control while benefiting from assistance. Support and self-reliance are intricately linked in managing stressful situations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; during the ICU stay, this dual strategy of inner strength bolstered by outside support can result in much improved stress management and less psychological suffering [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Self-reliance not only serves as a personal strength but also amplifies the positive effects of the support they receive. This subtle interaction reinforces the importance of considering both dispositional and contextual factors when examining responses to stress. The findings of this study also highlight that individuals with higher levels of self-reliance derive greater benefit from available support, leading to reduced experiences of psychosocial distress, emphasizing the adaptive value of personal resilience in managing stress [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCritical care involves significant psychological vulnerability as patients and families face high stress and uncertainty. During this time, psychological support is essential for enhancing coping abilities and managing situational demands. While self-reliance helps individuals utilize available resources effectively, it does not negate the need for social and emotional connections. It also shows that combining personal autonomy with meaningful support networks best protects against psychosocial distress. Understanding the relationship between personality traits and support mechanisms allows interventions to be tailored effectively, ensuring individuals receive appropriate support to foster resilience during crisis.\u003c/p\u003e\u003cp\u003eThe insights from this study have significant implications for self-reliance in high-stress caregiving environments. It is essential to help caregivers recognize the strength of self-reliance and use it to seek the appropriate support.. However, limitations must be acknowledged. Self-reliance effects may vary across cultural contexts, age groups, and situations, and research often relies on potentially biased self-reported measures. The dynamic nature of stress and support interactions is not adequately captured in cross-sectional studies, highlighting the need for longitudinal research to understand how these relationships impact psychological outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u0026nbsp;Conceptualization: Kirtideepa Subhadarsani, Usha Chivukula\u003c/p\u003e\n\u003cp\u003eInvestigation: Kirtideepa Subhadarsani.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFormal analysis: Kirtideepa Subhadarsani.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethodology: Usha Chivukula, Kirtideepa Subhadarsani.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProject administration: Kirtideepa Subhadarsani\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Supervision: Usha Chivukula.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eValidation: Usha Chivukula\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Writing original draft: Kirtideepa Subhadarsani.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting, review \u0026amp; editing: Usha Chivukula, Kirtideepa Subhadarsani\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eapproval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Ethics Committee of the University of Hyderabad (approval number: UH/IEC/2023/559). All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe, the authors, consent to the publication of this work and confirm that all co-authors approve its submission. We affirm the work is original, meets ethical standards, and does not infringe on any rights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential competing interest regarding the research, authorship, or publication of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e: Not Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdul Halain, A., Tang, L. Y., Chong, M. C., Ibrahim, N. A., \u0026amp; Abdullah, K. L. (2022). Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review. \u003cem\u003eJournal of clinical nursing\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(5-6), 497-507.\u003c/li\u003e\n\u003cli\u003eAshana, D. C., Hart, J., Johnson, K. S., Briggs, E. C., Parish, A., Olsen, M. K., \u0026amp; Cox, C. E. (2025). 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Perceived social support and mental health among Chinese college students: The mediating roles of self-esteem and emotional regulation. \u003cem\u003ePsychology, Health \u0026amp; Medicine, 25\u003c/em\u003e(9), 1039\u0026ndash;1047. https://doi.org/10.1080/13548506.2020.1717551\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ICU, self- reliance, support, psychosocial distress, process analysis","lastPublishedDoi":"10.21203/rs.3.rs-7343008/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7343008/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePsychosocial distress is a common yet complex experience among families of ICU patients, influenced by a range of emotional, situational, and interpersonal factors. While social support is often linked to better psychological outcomes, its effectiveness may depend on personal traits such as self-reliance. This study investigates how self-reliance moderates the relationship between perceived support and psychosocial distress in this population. 312 participants were assessed on the study variables, viz., social support, self-reliance, and levels of distress. The data were analysed using the PROCESS analysis approach. The findings indicate that self-reliance significantly moderates the relationship between support and distress. Individuals with higher levels of self-reliance have been observed to be more capable of recognizing their potential in making informed choices and effectively implementing their plans. This inherent quality enables them to leverage external support more efficiently, which can significantly minimize emotional distress in times of crisis.\u003c/p\u003e","manuscriptTitle":"Impact of Self-Reliance on Support and Psychosocial Distress in ICU Family Caregivers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 05:01:32","doi":"10.21203/rs.3.rs-7343008/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f3644b6-43a1-4d0d-8450-8eb53374bcc5","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-11T07:54:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 05:01:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7343008","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7343008","identity":"rs-7343008","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}