Background <p>Adolescent depressive patients generally have clinical manifestations such as emotional depression and cognitive decline, and family caregivers play an irreplaceable and important role in the disease management and rehabilitation process. Despite the heavy burden of caring for adolescent depressed patients, it is possible that family caregivers are also experiencing anxiety, which may increase their burden, and previous research has reported that psychological resilience plays an important role in reducing the physical and mental burden on caregivers.</p> Objective <p>This study aims to assess the current status of caregiver burden, psychological resilience, and anxiety among family caregivers of adolescents with depression and to explore whether psychological resilience mediates the relationship between caregiver burden and anxiety.</p> Methods <p>A cross-sectional study design was employed to recruit 256 family caregivers of adolescents with depression. The caregivers completed questionnaires, including general demographic information, the Zarit Caregiver Burden Scale, the Self-Rating Anxiety Scale, and the Psychological Resilience Scale. Data analysis was performed via SPSS 26.0.</p> Results <p>There was a significant positive correlation between care burden and anxiety (<i>r</i> = 0.561, <i>P</i> &lt; 0.01), psychological resilience and care burden and anxiety showed a significant negative correlation (<i>r</i> = -0.895, -0.556, <i>P</i> &lt; 0.01), and psychological resilience played a partial mediating role between care burden and anxiety (β = 0.198, <i>P</i> &lt; 0.01), and the indirect effect accounted for 42.95%.</p> Conclusion <p>Perceived resilience plays a mediating role in the association between caregiving burden and anxiety among family caregivers of adolescent patients with depression, and it can be considered as a longitudinal follow-up or intervention study in the future.</p> Implications for clinical practice <p>This study emphasizes that caregiver burden is associated with higher anxiety levels, and psychological resilience may play a moderating role in this association, suggesting that clinicians need to include resilience assessment in routine screening and implement hierarchical interventions based on the “burden-resilience” combined risk: priority is given to providing structured psychological support to high-burden-low resilience groups. The final realization: (1) reduce the burden on caregivers (2) improve the quality of care.</p>