Studies indicate that informal caregivers assisting relatives in orthopaedic hospital settings are at elevated risk for secondary traumatic stress (Longo et al., 2020; Muomah et al., 2021a; Muomah et al., 2021b). Such stress may negatively affect life satisfaction, defined as the extent to which individuals positively evaluate the overall quality of their present life (Veenhoven, 1996). Indeed, high caregiving demands have been associated with lower life satisfaction (Borg & Hallberg, 2006; Blaise & Dillenseger, 2020), and family caregivers generally report lower life satisfaction than professional caregivers (Sadowska et al., 2021). In orthopaedic care settings, informal caregivers may experience reduced life satisfaction due to close exposure to patients’ physical and emotional distress, as well as witnessing graphic injuries characteristic of these units. However, research on life satisfaction among informal or family caregivers in orthopaedic hospitals remains limited, particularly with respect to potential variations by religiously oriented coping strategies and caregiver gender.

Religious coping is among the strategies informal caregivers use to manage adversity, traumatic events, and stressors (Farinha et al., 2021). It refers to the ways in which individuals draw on religious beliefs, practices, and behaviors to manage stress, facilitate problem-solving, and reduce the negative emotional impact of stressful life circumstances (Koenig et al., 1998). Religious coping serves five central functions: the search for meaning or purpose, the pursuit of control over situations, the seeking of comfort, intimacy, and social integration, and the facilitation of life transformation (Pargament et al., 2000).

Two specific patterns of religious coping have been identified: positive religious coping and negative religious coping (Pargament et al., 2011). Positive religious coping involves perceptions of a positive connection with God, collaboration with God, finding constructive meaning in a stressor or traumatic situation, and releasing negative emotions. Negative religious coping, in contrast, reflects perceptions of an insecure relationship with God and one’s faith community, loss of faith in God’s power, or belief that the stressor is caused by the devil (Cummings & Pargament, 2010). Positive religious coping has been found to be more commonly reported among informal caregivers of hospitalized patients (Machado et al., 2018; Vitória & Assis, 2015), and caregivers who engage in positive religious coping appear better able to adjust after experiencing secondary traumatic stress. Chardon et al. (2021) suggested that religious coping, in general, may be conceptualized as a universally adaptive coping strategy.

Informal caregivers who use positive religious coping may experience higher life satisfaction, perceiving themselves to be empowered by a benevolent higher power and gaining a sense of meaning, comfort, control, and personal growth while managing their patient’s orthopaedic problems (Schneider & Mannell, 2006; Shaw et al., 2005; Tarakeshwar et al., 2006). Similarly, caregivers in Nigeria who reported higher levels of religiosity demonstrated greater well-being, highlighting the potential role of positive religious coping in supporting adjustment in this cultural context (Ifeagwazi et al., 2021). Despite evidence that informal caregivers experience secondary traumatic stress and rely on religious coping, there is limited understanding of how these processes affect life satisfaction in orthopaedic hospital settings. These associations may also differ by caregiver gender, reflecting gendered patterns of coping and stress response.

Previous studies have documented gender differences in caregiving (Navaie-Waliser et al., 2002; The National Alliance for Caregiving, AARP, 2020). For example, Riva et al. (2014) reported that 52% of mothers and 22% of fathers adjusted positively to their patient’s orthopaedic challenges, potentially experiencing posttraumatic growth through positive religious coping. Although both male and female caregivers are susceptible to secondary traumatic stress, women tend to assume caregiving roles more frequently, provide more intensive informal care, and experience a greater caregiving burden than men (The National Alliance for Caregiving, AARP, 2020). Similarly, women generally report higher levels of religiosity than men (Moon et al., 2022), which may explain why female caregivers are more likely to engage in positive religious coping to manage challenges and the negative experiences encountered during caregiving. While it might be expected that this pattern is stronger when caring for female patients, positive religious coping may exert the greatest impact when the caregiver is female and the patient is male.

Informal caregivers of patients with musculoskeletal conditions often face substantial physical demands, including providing mobility assistance and managing pain (Alemu et al., 2025). In Nigerian orthopaedic hospital settings, informal caregivers frequently perform specific nursing tasks such as bathing and feeding patients, manually lifting and repositioning immobile patients, monitoring patients to prevent discomfort or hygiene issues, administering medications, paying medical bills, and transporting patients in wheelchairs (Diameta et al., 2018; Muomah et al., 2021a). In these settings, in-patient care often relies on informal caregivers who are typically family members or friends to supplement formal care, exposing them to secondary traumatic stress, which is often overlooked by healthcare professionals focused primarily on patients. Positive religious coping is particularly prevalent in Nigeria, especially among caregivers of individuals with chronic illnesses and high dependency levels (Faronbi, 2018). This positive religious coping may involve meaning-making of caregiving as a spiritual duty, reliance on prayer and faith-based practices, trust in divine support, and engagement with religious communities that provide emotional and practical assistance.

Cultural expectations regarding gender roles further influence caregiving patterns in Nigeria. Men are generally regarded as breadwinners, while women are expected to assume caregiving responsibilities. Female caregivers frequently engage in positive religious practices, such as singing praises, praying, and offering spiritual encouragement to themselves, whereas men tend to engage in these practices less often (Moon et al., 2022; Lopez-Anuarbe & Kohli, 2019). Additionally, it is uncommon to see male caregivers attending to female patients in hospital settings unless no alternative is available. These cultural and gendered dynamics highlight the importance of considering caregiver and patient gender in studies of informal caregiving, secondary traumatic stress, and coping (Penning & Wu, 2016). Gender dynamics and cultural context remain underexplored in studies on life satisfaction, particularly regarding the interplay of caregiver and patient gender, secondary traumatic stress, and positive religious coping. Addressing these gaps is essential to inform interventions that enhance caregiver well-being in Nigeria and similar contexts.

Goals of the study

This study examined the association between secondary traumatic stress and informal caregivers’ life satisfaction in subacute hospital care and the role of positive religious coping and gender in that relationship. We tested the following hypotheses regarding informal caregivers (See Figure 1):

Secondary traumatic stress is associated with lower satisfaction with life.

The sample consisted of 194 informal caregivers of inpatients at an orthopaedic hospital in South-East Nigeria (68 males, 126 females). Participants ranged in age from 15 to 70 years (M = 31.5, SD = 8.9). Half of the caregivers were married (50.0%), while 44.8% were single, 4.2% divorced, and 1.0% separated. Most caregivers (61.6%) had a secondary level of education or below, whereas 38.4% had education beyond secondary school. The patients under their care were predominantly male (54.3%), with females accounting for 45.7%. With respect to duration of caregiving, 50.5% had stayed with the patient for 1–6 months, 40.0% for 1–4 weeks, 5.8% for less than one week, and 3.7% for more than six months.

The study protocol was approved by the Health Research Ethics Committee of the University of Nigeria Teaching Hospital Enugu (NHREC/05/01/2008B-FWA00002458-IRB00002323) and the Institutional Review Board of National Orthopaedic Hospital Enugu (S. 313/IV). Informal caregivers willingly consented to the study. Data were gathered during normal hospital hours by two trained graduate psychology students.

Analyses were conducted using the PROCESS macro for IBM SPSS (Version 3.0; Hayes, 2022). The analyses examined: (a) the direct and indirect effects of secondary traumatic stress on satisfaction with life, with positive religious coping specified as the mediator; (b) whether the association between secondary traumatic stress and positive religious coping was moderated by patients’ gender; and (c) whether the association between positive religious coping and satisfaction with life was moderated by caregivers’ gender. Indirect effects were tested using bias-corrected bootstrapping with 10,000 resamples and 95% confidence intervals (CIs). An indirect effect was considered statistically significant when the 95% bootstrapped CI did not include zero.

Results in Table 1 showed that majority of the caregivers were self-employed, and many of these self-employed persons indicated that they were in business/trading (37.63%). Most of them have also been the caregivers to the patient since hospital admission, and only very few of them were not immediate family members to the patient. They were caring for more male patients than females. Half of them have been caregivers to the patient for 1–6 months. They were also mostly urban residents.

The hypotheses were tested, controlling for the effects of age (See Table 2). The total effects of secondary traumatic stress effects on satisfaction with life were statistically significant (β = −0.21, SE = 0.06, p = 0.001), indicating that respondents with higher secondary traumatic stress symptoms were less satisfied with life, which supported Hypothesis 1. The association of secondary traumatic stress with positive religious coping was negative and statistically significant (β = −0.11, SE = 0.08, p = 0.001), confirming hypothesis 2.

Our hypothesis of a moderated mediation was supported as evidenced by a significant indirect effect of secondary traumatic stress on satisfaction with life through positive religious coping among female caregivers [B = −0.01, 95%CI = (−0.00, −0.12)], but not males [B = 0.00, 95%CI = (−0.01, 0.01)]. Note that the moderated mediation is significant when the 95% CI does not encompass zero, as shown in the case of males. The index of moderated mediation observed was also significant [B = −0.01, 95% CI = (−0.03, −0.00)]. The predictors accounted for 36% of the variance in satisfaction with life [R² = 0.36, F(2,192) = 3.64, p = 0.00].

Gender of caregivers moderated the association of positive religious coping and satisfaction with life. The slope of the conditional effect of positive religious coping on satisfaction with life (see Figure 2) indicated that positive religious coping in female caregivers predicted more satisfaction with life {B = 0.14, t = 4.21, 95% CI = [0.05, 0.41], p < 0.001}, than for male caregivers {B = 0.01, t = 1.41, 95% CI = [−0.00, 0.11], p = 0.90}.

Targeted interventions should incorporate tailored education and training on caregiving practices and navigation of the healthcare system, alongside accessible emotional and social support services, to enhance informal caregivers’ overall life satisfaction and well-being. Further research is needed, particularly longitudinal studies and studies focused on the Southeast region of Nigeria, to better understand how secondary traumatic stress and coping processes unfold over time and across cultural contexts. Exploring the benefits of positive religious coping may support the development of more effective, contextually grounded caregiver support programs. Additionally, a deeper understanding of gender differences in caregiving experiences is essential, especially regarding the unique challenges faced by informal male caregivers.

This cross-sectional study does not establish temporal ordering among the variables in our model; therefore, causal inferences cannot be made. For example, caregivers (both female and male) who reported lower life satisfaction may already be experiencing higher levels of secondary traumatic stress, rather than the reverse. Second, the study was limited to orthopaedic inpatients and their informal caregivers in a single orthopaedic hospital in Nigeria, which may constrain the generalizability of the findings. Third, the study did not include caregivers of patients receiving care in local treatment settings prevalent in the eastern region of the country, making it unclear whether these caregivers experience similar levels of secondary traumatic stress or utilize positive religious coping in comparable ways. Future longitudinal studies, incorporating samples from multiple orthopaedic units and diverse treatment contexts, are needed to clarify these relationships and strengthen the external validity of the findings.