BACKGROUND: Caregivers of children with hematologic malignancies face significant physical and psychological challenges. Identifying psychological adaptation profiles and their influencing factors is essential for developing targeted interventions to support this vulnerable population. OBJECTIVE: This study aimed to identify distinct psychological adaptation profiles among caregivers of children with hematologic malignancies and explore the roles of family intimacy, social support and coping styles in psychological adaptation. METHODS: A cross-sectional study was conducted among caregivers of children with hematologic malignancies. Participants completed questionnaires focusing on sociodemographic information, medical information, coping style, social support, and family intimacy. Latent profile analysis was used to identify distinct psychological adaptation profiles. Mediation analysis was performed to explore the role of positive coping strategies in the relationship between family intimacy and psychological adaptation. RESULTS: Three psychological adaptation profiles were identified: the well-adapted group (35.8%), the general adaptation group (54.9%), and the maladaptive group (9.3%). Caregivers in the maladaptive group were more likely to have lower education levels and weaker family support networks. Mediation analysis revealed that family intimacy had both direct and indirect effects on psychological adaptation through positive coping strategies, with the indirect effect accounting for 31.62% of the total effect. These findings highlight the dynamic interplay between environmental factors and individual behaviors in shaping psychological adaptation. CONCLUSION: This study emphasizes the importance of designing interventions tailored to different psychological adaptation profiles. For caregivers in the maladaptive group, interventions should focus on improving coping skills. For the general adaptation group, enhancing family support and coping strategies could further improve their adaptation. Family-centered approaches and coping skills training are critical to promoting psychological resilience in caregivers.