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British Journal of Healthcare and Medical Research - Vol. 9, No. 2
Publication Date: April, 25, 2022
DOI:10.14738/jbemi.92.11984. Nasir, M., Uroosa, T., & Farooq, N. (2022). Level of Depression and Anxiety among Caregivers of Patients with Schizophrenia. British
Journal of Healthcare and Medical Research, 9(2). 252-263.
Services for Science and Education – United Kingdom
Level of Depression and Anxiety among Caregivers of Patients
with Schizophrenia
Mehmood Nasir
Karwan e Hayat Institute of Mental Health Care, Karachi, Pakistan
Talib Uroosa
Karwan e Hayat Institute of Mental Health Care, Karachi, Pakistan
Naeem Farooq
University of Toronto, Toronto, Canada
ABSTRACT
Caregivers of patients with mental health problems experience many emotional
problems like depression, anxiety, anger, shame and guilt. Incorporating the role of
care into pre-existing roles, along with the stigma associated with mental illness,
creates psychological and financial stress for caregivers. This study aims at
assessing the level of depression and anxiety among caregivers of schizophrenic
patients. It was a cross-sectional study. Participants (n = 65) were approached in in- patient and out-patient units of private hospitals. Depression and Anxiety were
assessed through Hamilton Rating Scale for Depression and anxiety. Results were
analyzed using SPSS. 24.6% of caregivers are in the moderate to the severe category
while 38.5% of caregivers are in the mild category of anxiety on the Hamilton
Anxiety Rating Scale. On Hamilton Rating Scale for Depression, 61.5% of caregivers
were in the moderate to severe category of depression. Caregivers of patients with
severe mental illness experience high level of depression and anxiety. Appropriate
interventions should be targeted to improve the psychological well-being of
caregivers.
Keywords: depression, anxiety, caregivers, schizophrenia, mental health
INTRODUCTION
A caregiver as a term refers to anyone who provides support to a person in need to meet his or
her daily needs and for companionship [1]. The WHO definition of caregiver burden states that
it is ‘the emotional, physical and financial demands and responsibilities of an individual’s illness
that are placed on the family members, friends or other individuals involved with the individual
outside the health care system [2].
Providing care to family members who deal with people with a mental illness can cause careers
to feel a burden or stress that can reduce their quality of life [3]. Similarly, family careers of
people with a mental illness suffer significant stress, experience a great deal of stress, and do
not receive adequate help from mental health professionals regarding their problems [3].
Although the term 'caring burden' is generally considered unnecessarily negative, it is
important to know that there are both rewards and difficulties associated with the caring
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Nasir, M., Uroosa, T., & Farooq, N. (2022). Level of Depression and Anxiety among Caregivers of Patients with Schizophrenia. British Journal of
Healthcare and Medical Research, 9(2). 252-263.
URL: http://dx.doi.org/10.14738/jbemi.92.11984
experience. A sense of satisfaction can be gained from caregivers knowing that they can help
improve the quality of life of their loved one [4]. Caregivers may also report benefits from a
sense of satisfaction, love, and pride [5].
In severe mental illnesses, patients, as well as families, experience far-reaching consequences.
During the process of providing care to a mentally ill relative, families experience certain
negative emotions like feelings of grief, shame, guilt and anger[6]. An intense feeling of being
stigmatized leads to social isolation. In presence of already existing family roles, the addition of
the caregiving role results in increased stress, not only psychologically but also financially [7,8].
Along with emotional distress, there are various other demands of caregiving like arranging
and paying for psychiatric treatment, providing supervision to the psychiatric patient, and
dealing with the stigma associated with mental illness [9]. Evidence support that the level of
burden among caregivers of schizophrenic patients is equivalent to the burden experienced by
the families of patients with neurological disorders like Alzheimer’s disease [10] and physical
disorders like Diabetes and Cancer [11] .
Despite the demise of the traditional family system in developing countries, more than 60% of
schizophrenics live with their caregivers [12,13]. Research studies indicate that 25% of the
caregivers of patients with schizophrenia, either living with or apart from their patients, met
the criterion of the General Health Questionnaire for a psychiatric disorder [14]. Studies [15,16]
reported that caregivers of schizophrenic patients experience significantly high levels of
depression. Another study was conducted on Latino family caregivers of schizophrenic patients
and findings of this study reported that 40% of the sample met the criteria for depression [17].
Results of a comparative study indicated that 18.33% of caregivers of schizophrenics
experienced depressive symptoms as compared to 3.33% of the control group [18].
In Pakistan, the family is the major resource in providing care to their relative having a
psychiatric illness. The reason behind the major responsibility of caregiving on family members
in Pakistan can be the paucity of mental health professionals with only 2-3 psychiatrists per
million the population [19]. Findings from a study conducted in Pakistan with caregivers of
psychiatric patients (Schizophrenia, Drug abuse, and depression) reported significantly high
rates of depression and anxiety among caregivers [20]. Gender differences were also observed
like depression and anxiety were significantly high among caregivers of young male psychiatric
patients as compared to young female patients. Results of a cross-sectional study conducted in
Lahore reported that 86% of the caregivers of psychiatric patients scored high on anxiety and
85% of caregivers scored above a cutoff of HADS for Depression [21].
Family members include patients who do not understand mental illness specifically
schizophrenia and at the same time, some articles prove that lack of insight into mental illness
such as schizophrenia affects the patient, his family and the community. Causes negative
behavior on the part of others recited by mojalefa[22]. Even focusing on the family improves
the psychological problems related to the illness of a family member.
Objective & Hypothesis
The aim of this study was to investigate the psychological impact of schizophrenia on family
members in Pakistan. Study objectives were;
1. To assess the level of depression among caregivers of patients with Schizophrenia.
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British Journal of Healthcare and Medical Research (BJHMR) Vol 9, Issue 2, April - 2022
Services for Science and Education – United Kingdom
2. To assess the level of anxiety among caregivers of patients with Schizophrenia.
Our hypotheses were as follows;
1. Female caregivers’ have more anxiety and Depression symptoms as compared to males.
2. Young age group caregivers have more anxiety and depression symptoms as compared to
the adult age group.
3. Long duration of illness patients’ caregivers has more anxiety and depression symptoms as
compared to the short duration of illness patients’ caregivers.
METHODOLOGY
Research design
A cross sectional descriptive design was used on the study. The study was conducted in the in- patient and out-patient psychiatric units of Karwan e Hayat Institute of mental health care. The
subjects of the study consisted of 65 caregivers of patients with schizophrenia in the in-patient
and out-patient psychiatric units of the psychiatric hospital of Karachi, Pakistan. Subjects were
included in the study according to purposive non-probability sampling.
Inclusion criteria
Subjects with the following characteristics were included:
1. Taking care of a patient who is diagnosed with Schizophrenia.
2. Caregiver of a schizophrenic patient who was in the active phase of illness.
3. Caregiver of schizophrenic patients who was receiving stable psychiatric treatment.
4. Living with the patient in the same environment for at least the last 12 months.
Exclusion criteria
Subjects with the following characteristics were excluded;
1. Caregiver of a patient who is not receiving stable psychiatric treatment.
2. Caregivers of patients with more than one person available for providing care.
3. Caregivers of patients having more than one diagnosis.
4. If the caregiver is not living with the patient for the last 12 months.
Assessment tools
Demographic form
Demographic variables were assessed through a written questionnaire including patient
information; name, age, gender, education, occupation, marital status, religion, duration of
illness, duration of time since first received treatment, duration of untreated illness, number of
hospital admissions, number of disease-free episodes (duration of at least one month in which
patient was symptom-free), and caregiver information; name, age, gender, education,
occupation, marital status, religion, relationship with the patient, and duration of caregiving.
The Hamilton Rating Scale for Depression (HRSD)
This scale was developed by Max Hamilton in 1960 and was revised in 1967. There are 21 items
on this scale. Out of 21, 10 items are rated on 0-4 Likert Scale, 2 items are rated on 0-3, and 9
items are rated on a 02 point scale. Scoring categories of HRSD are; 0-7 Normal, 8-13 Mild
Depression, 14-18 Moderate depression, 19-22 Severe depression, greater than 23 Very severe
depression [23]. Internal consistency coefficient for HAM-D is 0.88 and inter-rater reliability is
0.80-0.98[24].