Relationship between caregiver burden and levels of depression, anxiety, and stress among palliative care caregivers

Abstract

Aims: To assess the relationship between caregiver burden and levels of depression, anxiety, and stress among primary caregivers of patients hospitalized in a palliative care unit. Methods: In this descriptive cross-sectional study, 96 primary caregivers were enrolled. Data were obtained through face-to-face interviews using a sociodemographic data form, the 19-item Zarit Caregiver Burden Interview (ZBI-19), and the Depression Anxiety Stress Scale-21 (DASS-21). Nonparametric group comparisons were conducted with the Mann–Whitney U test and the Kruskal–Wallis test, followed by appropriate post-hoc pairwise analyses when needed. Relationships between variables were assessed using Spearman’s rank correlation. Independent predictors of caregiver burden were identified using multiple linear regression models. Results: Participants were predominantly female (72.9%), married (72. 9%), and unemployed (58.3%), with a mean age of 52.2 ± 11.7 years. Moderate-to-extremely severe symptoms were observed in 31.3% for depression, 39.6% for anxiety, and 18.8% for stress. Moderate-to-severe and severe caregiver burden was present in 33.3%. Female sex was associated with higher depression and anxiety scores, whereas unemployment, lower education, and lower income level were associated with higher psychological distress and higher caregiver burden (p < 0.05). In multivariable analysis, higher depression scores (p < 0.001) and longer caregiving duration (p = 0.050) independently predicted increased caregiver burden, explaining nearly half of the variance in burden scores. Conclusion: Primary caregivers in palliative care experience substantial psychological distress and caregiver burden, particularly those with socioeconomic vulnerabilities. Depression severity and caregiving duration are key determinants, highlighting the need for routine screening and targeted psychosocial support in clinical practice.