Caregiver Burden in Schizophrenia: Determinants, Assessment Tools, and Evidence-Based Interventions – A Narrative Review

Abstract

Background: Family caregivers provide long-term support for people with schizophrenia worldwide, especially in low- and middle-income countries where community mental health services remain limited. This narrative review examines contemporary and relevant historical and contextual evidence regarding caregiver burden in schizophrenia. Methods:A structured literature search was undertaken to identify contemporary evidence relevant to caregiver burden, assessment, and interventions. Seminal historical and contextual sources were added for relevance. Several sources — systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and cross-sectional analyses — were selected across three areas. Results:Caregiver burden is consistently associated with greater symptom severity, functional disability, and illness duration. Caregiver coping, expressed emotion, and perceived social support also appear to influence psychological distress. Several validated instruments — including the Zarit Burden Interview, Family Burden Interview Schedule, Burden Assessment Scale, Experience of Caregiving Inventory, and Involvement Evaluation Questionnaire — are widely used but are not psychometrically interchangeable, likely contributing to the variation in reported burden across studies. Structured family psychoeducation has evidenced benefits in reducing caregiver burden and indirectly lowering relapse risk. Other psychosocial and problem-solving approaches show moderate benefit, while digital and telepsychiatry-based interventions need to be explored as emerging interventions. Conclusion: Caregiver burden in schizophrenia is a measurable, multidimensional construct requiring standardized, disease-specific assessment and scalable, evidence-based family interventions to support integration into psychiatric care.