Abstract
BACKGROUND:
Common mental disorders (CMDs) are distress states manifesting with anxiety, depression, and unexplained somatic symptoms. CMD patients require care and attention, which places additional demands on the caregivers and the family members. This study aimed to determine the caregiver burden, social support, and family well-being among caregivers of CMD patients in Bhopal.
MATERIALS AND METHODS:
A cross-sectional survey was held among 236 caregivers of CMD patients presenting to a tertiary healthcare center in Bhopal. Primary caregivers aged 18 years and above and providing care for more than 1 month were included. Data were collected through interviews by using the sociodemographic proforma, Zarit burden interview scale, multidimensional scale of perceived social support, and family health scale.
RESULT:
About 31.3% of caregivers had a high burden, 53% had a mild-to-moderate burden, and 15.7% had a no-to-mild burden. Most caregivers (75.8%) perceived moderate social support, and 15.7% perceived high social support. A total of 48.3% of caregivers rated family well-being as moderate, 45.8% as poor, and only 5.9% as excellent. Perceived social support and family well-being showed a moderate, positive relationship (r = 0.584, P < 0.01), and both accounted for 18.5% of the variance in the caregiver burden. Perceived social support (r = −0.384) and family well-being (r = −0.394) demonstrated an inverse relationship with caregiver burden (P < 0.01).
CONCLUSION:
There is a need to enhance social support for caregivers and the family well-being of CMD patients. Healthcare providers at all levels should identify the need for social support for caregivers and plan suitable strategies for family-centered care of CMD patients.
Keywords: Caregiver burden, caregivers, common mental disorder, family health, social support
Introduction
Common mental disorders (CMD) refer to a group of psychiatric conditions that are widespread and significantly impact an individual’s functioning and quality of life. Depression and anxiety disorders, which are commonly classified as CMD.[1] CMD is the transient feeling of sadness, stress, or fear everyone may encounter at various points in life. According to the WHO, 970 million people around the world were living with a mental disorder in the year 2019, with anxiety and depressive disorders being the most common. A total of 56 million Indians suffer from depression, and another 38 million suffer from anxiety disorders.[2] Depression is a major contributor to mental illness in India. As late adolescence and early adulthood are crucial periods for making important life decisions, young people transitioning to adulthood are particularly susceptible to mental disorders.[3]
The overall weighted current prevalence of CMD among Indian adults was 5.1% (70 million), and the lifetime prevalence of depressive disorder, phobic anxiety disorder, other anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) was 5.3%, 3.7%, 1.3%, 0.8%, and 0.2%, respectively.[4] National Mental Health Survey 2015–16 reports that the lifetime prevalence of depressive disorder, phobic anxiety disorder, panic disorder, generalized anxiety disorder, other anxiety disorders, and OCD in Madhya Pradesh was 4.18%, 1.4%, 0.3%, 0.15%, 0.64%, and 0.4%, respectively.[5]
Living with and caring for an individual with a psychiatric disorder seems inherently stressful.[6] Koujalgi et al.[7] (2021) reported a notably high level of family care burden among caregivers of individuals with chronic mental disorders. Evidence from developed nations suggests that over 70% of individuals providing care for those with mental illness encounter a sense of burden. Almost 40% of primary caregivers for individuals with mental health issues experience this burden due to the responsibilities associated with caring for the patient. Family members could not go to work because of the care of the patient, and the treatment gap among the mentally ill was huge (90.7%).[5] Caregivers encountered challenges such as assisting the patient with self-care activities such as cooking, eating, maintaining personal hygiene, and grooming. They are also responsible for tasks related to treatment, such as visiting physicians, administering medication, and protecting the patient from engaging in high-risk behaviors such as aggression, violence, substance abuse, and risky sexual activities. These challenges are encompassed under the term “numerous caregiving tasks.”[8]
Study novelty
As there was no data on the caregiver burden, perceived social support, or family well-being status of caregivers of CMD patients in the Bhopal district of Madhya Pradesh, India, a study was planned to generate evidence in this direction. This study is a first of a kind in Madhya Pradesh measuring family well-being status among caregivers of CMD patients. The study aimed to assess the relationship between caregiver burden, social support, and family well-being of caregivers of CMD patients.
Materials and Methods
Study design and setting
The present study was a cross-sectional survey among caregivers of CMD patients presenting to a 1400-bed government tertiary care hospital in Madhya Pradesh.
Theoretical framework
The foundation of this study’s conceptual framework draws upon the principles of General System Theory, as articulated by Ludwig Von Bertalanffy in 1968. The framework encompasses key components such as input, process, output, and feedback. In this conceptual framework, a system is defined as a collection of elements that collaborate to attain a specific objective through interactions. The conceptual framework is presented in Figure 1.
Figure 1.
Conceptual framework based on ludwig von bertalanfy’s general system theory (1968)
Study participants and sampling
Caregivers aged 18 years and above, residing with and providing care to CMD patients for more than 1 month, without a history of mental illness in the past, able to respond in Hindi or English language, and willing to participate in the study were included. The sample size was calculated using the formula (n = z2 p*q/d2) based on the lifetime prevalence of mental morbidity and current mental disorders in the state of Madhya Pradesh (16.7%)[5] and the margin of error as 0.05. The estimated sample size, considering the non-response rate of 10%, was 236. A convenience sampling technique was used.
Ethical considerations
Ethical clearance was obtained from the institutional human ethical committee (Ref No.: IHEC-SR/July/22/MSc Nursing/26). Caregivers meeting the inclusion criteria were explained the purpose of the study, and informed consent was obtained. Privacy, anonymity, and confidentiality of the data were assured and maintained.
Data collection: Tools and techniques
Data were collected from October 2, 2023 to November 8, 2023 through interviews in a separate room (Psychiatry OPD/ward). The total time taken for the interview was 30–35 minutes. The following tools were used:
-
Sociodemographic proforma: The first section of this questionnaire included questions related to caregivers’ age (in years), gender, marital status, educational status, religion, relationship with the patient, residential area, employment status, occupation, family income per month, and attendance in any training program on the care of a person with mental illness.
The second part included information on CMD patients’ age, gender, and diagnosis, which were filled by reviewing patient’s charts.
Zarit burden interview scale: This standardized 12-item interview scale measures subjective and objective caregiver burdens and items are rated on five points: never (0), rarely (1), sometimes (2), frequently (3), and nearly always (4). The minimum score is 0, and the maximum is 48. The total scores obtained were classified as: no-to-mild burden (0–10), mild-to-moderate burden (10–20), and high burden (>20).[9] Permission to use the scale was obtained from the authors. The internal consistency reliability (Cronbach’s alpha) of the Hindi version of the Zarit burden interview was 0.80.
Multidimensional scale of perceived social support: This is a 12-item multidimensional standardized scale of perceived social support scale with response options ranging from very strongly disagree (1) to very strongly agree (7). The sum of 12 items was divided by 12, and the obtained score was interpreted as low support (1–2.9), moderate support (3–5), and high support (5.1–7).[10] The internal consistency reliability (Cronbach’s alpha) of the Hindi Version was 0.92. Permission for using the tool was obtained from the authors.
Family health scale: A 10-item family health scale developed by Crandall A. et al.[11] was used to assess the family’s well-being. The response options in the scale ranged from strongly disagree (1) to strongly agree (5). A score of 4 or 5 was coded as 1, and less than 4 as 0. The total scores were classified as poor family health (0–5), moderate family health (6–8), and excellent family health (9–10). Permission to use the scale was obtained from the authors. As the scale was available only in the English language, the forward (Hindi) and reverse translations of the scale were performed by bilingual experts. The internal consistency reliability (Cronbach’s alpha) of the Hindi version of the family health scale was 0.78.
Data analysis
The data were analyzed using SPSS software version 20. The data had a normal distribution. The level of significance was fixed at 0.05. Karl-Pearson correlation was used to determine the relationship between caregiver burden, social support, and family well-being. Linear regression was used to identify the predictors of caregiver burden.
Results
The mean age of the CMD patient was 36.02 years (standard deviation: 13.62). The minimum age of the patients with CMD was 14 years, and the maximum was 82 years. All 236 patients were from Madhya Pradesh. The mean age of caregivers was 39.73 (standard deviation: 13.05). Table 1 reveals that the majority of the caregivers were in the age group of 20–39 years, male, married, employed, Hindu, had an income above Rs. 18,229, and did not attend any training program on the care of the mentally ill.
Table 1.
Sociodemographic profile of caregiver’s characteristics n=236
| Characteristic | Category | Frequency (%) | ||
|---|---|---|---|---|
| Age (in years) | 20–39 40–59 >60 |
131 (55.5) 91 (38.6) 14 (5.9) |
||
| Gender | Male Female |
168 (71.2) 68 (28.8) |
||
| Relationship with patients | Mother/Father Son/Daughter Spouse Sister/brother |
76 (32.2) 52 (22) 51 (21.7) 57 (24.1) |
||
| Marital status | Single Married Widowed Separated but not divorced |
45 (19.1) 188 (79.7) 2 (0.8) 1 (0.4) |
||
| Educational status | Post-graduation/Graduation Diploma Senior Secondary Upper Primary Primary school Not gone to school |
110 (46.7) 17 (7.2) 56 (23.7) 30 (12.7) 20 (8.5) 3 (1.2) |
||
| Religion | Hindu Muslim Christian |
221 (93.6) 11 (4.7) 4 (1.7) |
||
| Residential area | Rural Urban |
118 (50) 118 (50) |
||
| Occupation | Professional Semi-professional Clerical, shop owner, farmer Skilled worker Semi-skilled worker Unskilled Not an occupation |
7 (2.9) 29 (12.3) 76 (32.2) 14 (5.9) 30 (12.7) 42 (17.8) 38 (16.2) |
||
| Employment status | Employed Unemployed |
198 (83.8) 38 (16.2) |
||
| Monthly income (in rupees) | >18,229 9115–18,229 6836–9114 4557–6835 2734–4556 921–2733 |
106 (44.9) 70 (29.7) 33 (13.9) 20 (8.5) 5 (2.2) 2 (0.8) |
||
| Have you attended any training program on the care of person with mental illness? | Yes No |
5 (2.1) 231 (97.9) |
Table 2 presents the level of caregiver burden, perceived social support, and family well-being. The majority of the caregivers expressed mild-moderate burden (53%), moderate social support (75.8%), and moderate family well-being (48.3%). However, 45.8% with poor family well-being and 31.3% with high caregiver burdens are of equal concern.
Table 2.
Frequency and percentage distribution of the level of caregiver burden, social support and family well-being n=236
| Variable | Category | Frequency (%) | ||
|---|---|---|---|---|
| Caregiver burden | ||||
| No-to-mild burden | 0–10 | 37 (15.7) | ||
| Mild-to-moderate burden | >10–20 | 125 (53) | ||
| High burden | >20 | 74 (31.3) | ||
| Social support | ||||
| Low support | 1–2.9 | 20 (8.5) | ||
| Moderate support | 3–5 | 179 (75.8) | ||
| High support | 5.1–7 | 37 (15.7) | ||
| Family well-being | ||||
| Poor | 0–5 | 108 (45.8) | ||
| Moderate | 6–8 | 114 (48.3) | ||
| Excellent | 9–10 | 14 (5.9) |
Table 3 informs that there is a negative, moderate relationship between caregiver burden with perceived social support and family well-being at a 0.05 level of significance; thus, the null hypothesis is rejected. It can be inferred that as the caregiver burden increased, the perceived social support and family well-being decreased. A positive moderate relationship between perceived social support and family well-being depicts the potential of social support in improving family well-being.
Table 3.
Relationship between caregiver burden, social support, and family well-being among caregivers of patients with CMDs n=236
| Social support | Family well-being | |||
|---|---|---|---|---|
| Caregiver burden | r=−0.384 (P<0.01) | r=−0.394 (P<0.01) | ||
| Social support | r=0.584 (P<0.01) |
Table 4 shows the frequency distribution of the level of caregiver burden, social support, and family well-being against the age, gender, and diagnosis of CMD patients. The data reveals that the majority of the patients with CMDs were male (62.3%), aged 20–39 years (59.3%), and had anxiety and fear-related disorders (47.5%). High caregiver burden and poor family well-being were noted among patients diagnosed with PTSD, followed by depression. However, the majority of caregivers received moderate social support irrespective of age, gender, or diagnosis of patients
Table 4.
Frequency distribution of caregiver burden, social support, and family well-being in relation to CMD patient’s age, gender, and diagnosis n=236
| Variables | Age (in years) | Gender | Diagnosis | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
||||||||||||||||||
| 14–19 (n=15) | 20–39 (n=140) | 40–59 (n=67) | >60 (n=14) | Male (n=147) | Female (n=89) | Depression (n=67) | AFRD (n=112) | OCD (n=39) | PTSD (n=18) | |||||||||||
| Caregiver burden | ||||||||||||||||||||
| No-to-mild burden | 5 | 16 | 13 | 3 | 24 | 13 | 5 | 24 | 5 | 3 | ||||||||||
| Mild-to-moderate | 7 | 79 | 30 | 9 | 73 | 52 | 35 | 58 | 23 | 6 | ||||||||||
| Burden | ||||||||||||||||||||
| High burden | 3 | 45 | 24 | 2 | 50 | 24 | 27 | 30 | 11 | 9 | ||||||||||
| Social support | ||||||||||||||||||||
| Low support | 0 | 13 | 7 | 0 | 12 | 8 | 6 | 8 | 3 | 3 | ||||||||||
| Moderate support | 13 | 106 | 47 | 13 | 112 | 67 | 51 | 86 | 30 | 12 | ||||||||||
| High support | 2 | 21 | 13 | 1 | 23 | 14 | 10 | 18 | 6 | 3 | ||||||||||
| Family well-being | ||||||||||||||||||||
| Poor | 2 | 65 | 36 | 5 | 72 | 36 | 32 | 48 | 18 | 10 | ||||||||||
| Moderate | 12 | 68 | 26 | 8 | 70 | 44 | 32 | 57 | 18 | 7 | ||||||||||
| Excellent | 1 | 7 | 5 | 1 | 5 | 9 | 3 | 7 | 3 | 1 | ||||||||||
AFRD=Anxiety and Fear-Related Disorder, OCD=Obsessive-compulsive disorder, PTSD=Post-traumatic stress disorder
A stepwise linear regression analysis was conducted to determine the predictors of caregiver burden, with caregiver burden score as the dependent variable. The multiple regression model, which included all predictors for the caregiver burden of patients with CMD, yielded an adjusted R² of 0.185, indicating that the predictors accounted for 18.5% of the variance in the outcome variable. This model was also statistically significant in identifying the predictors (F (2, 233) =2.99, P < 0.001).
After applying a two-step linear regression model to the caregiver burden score for patients with CMDs, significant predictors were identified: social support score (B = −0.149, P < 0.001) and family well-being score (B = −0.938, P < 0.001). Both social support and family well-being have a significant negative impact on caregiver burden. This means that as social support and family well-being improve, caregiver burden decreases [Table 5].
Table 5.
Linear regression analysis of predictors of caregiver burden with social support and family well-being n=236
| Unstandardized Coefficients | Standardized Coefficients | t | Significance | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
|
||||||||||
| Model | B | SE | Beta | |||||||
| (Constant) | 29.908 | 1.900 | 15.741 | <0.001 | ||||||
| Social Support | −0.149 | 0.046 | −0.234 | −3.222 | <0.001 | |||||
| Family well-being | −0.938 | 0.264 | −0.258 | −3.557 | <0.001 | |||||
Adjusted R2 for caregiver’s burden with social support and family well-being=0.185; P<0.05 is considered statistically significant. SE=Standard error
Discussion
The availability of 236 patients with CMDs at the tertiary care hospital within a month’s duration at the psychiatry OPD/ward reveals the magnitude of CMDs in the region. The National Mental Health Survey report of 2016 in India recommended the use and strengthening of mental health facilities in India to decrease the burden of mental health illness. The use of mental health services at the tertiary care facility by the CMD patients in this study informs that services are used, treatment-seeking behavior is promoted, and caregivers in the region are concerned for the care of the mentally ill.
The majority of the caregivers had a moderate burden in the present study in central India, and the caregiver burden was higher when the CMD patient’s diagnosis was PTSD or depression. Similar studies in South and Northeast India have also reported moderate caregiver burden among chronically ill mental patients (57.3% in Kerala, 59.1% in Karnataka, and 52.2% in Imphal).[12,13,14] The findings across north Indian cities such as Delhi and Lucknow varied: mild-to-moderate caregiver burden while caring for OCD patients[15] moderate caregiver burden while caring for schizophrenia patients,[6] and higher caregiver burden among fear and anxiety patients.[16] A study among depressive patients in south India reported that the burden increased when depressive patients were hospitalized.[17] By and large, caregiver burden was associated with caregiver age, educational status, marital status, occupation, relationship with a patient, and the duration of caregiving.[18]
Chakraborty et al.[19] (2023) revealed that nearly half of caregivers in India are more prone to depression and have poorer self-rated health compared to non-caregivers. Higher levels of subjective caregiver burden were linked to increased depressive symptoms in patients.[20] Many caregivers reported having less time for themselves due to caregiving duties, feeling embarrassed, encountering social life challenges, facing financial strain, and receiving inadequate support from healthcare facilities.[21] Caregiving was associated with the patient’s gender, age, marital status, duration of illness, and type of illness.[18] Studies in Spain and Egypt reported severe burdens among caregivers looking after severe mental disorder patients.[22,23] Khan et al.[24] in India found that the social support perceived by the male and female caregivers was equal. Studies across countries (India, Egypt, Shanghai, and China) report that caregivers received moderate social support while caring for the mentally ill.[24,25,26,27]
In the present study, nearly half of the caregivers (45.8%) expressed poor family well-being, a finding contradictory to the observations of Nalini et al.[28] in South India where only a quarter of participants perceived (23%–25%) low family well-being. It is noteworthy to mention here that there is a vast difference in the healthcare infrastructure and population characteristics of South and Central India. While bridging this gap may be a challenge in the current scenario for India, strengthening the caring abilities of the caregiver may be a cost-effective alternative. The majority of the caregivers lack training in the care of the mentally ill; the present study reveals that the healthcare providers of Central India must focus attention toward training and empowering caregivers in the family with requisite knowledge and skills. In the present study, social support and family well-being predicted caregiver burden, a finding similar to the studies reported in different regions.[29,30,31,32] A study in Iran concluded that caregivers of patients with mental illness were found to require social support from family and emotional domains.[31] Thus, a focus on social support and family-centered care delivered at the doorsteps through the Health and Wellness Center team would be the most appropriate strategy to rebuild family health and reduce caregiver burden in India. Nursing and allied healthcare professionals placed in both health centers or the periphery should take an active part in rendering social support to the caregivers and ensuring family health. Nurses function with the important role of facilitating communication, identification, and cooperation between caregivers of CMD patients to decrease the burden. Guidance and counseling of caregivers should be considered as a priority intervention along with other patient care.
The present study reveals the present situation of caregiver burden, social support, and family well-being of caregivers of CMD patients in the Bhopal district of Madhya Pradesh. Policymakers can use our findings to create more targeted programs to enhance social support and well-being, despite encountering challenges in accessing healthcare facilities. Training may also be organized for nurses and healthcare workers on early identification of caregiver’s burden. Social support may be extended to the caregivers of CMD patients by the peripheral healthcare providers to improve the family health of CMD patients and their caregivers.
Limitation and recommendation
The major limitation of the present study findings may be interpreted in the context of the sampling technique used and the likely social desirability bias from the use of the rating scales. The majority of the caregivers are male and the majority of interviews place in OPD.
Strength of the study
The findings of the present study could be important to see the present situation of caregiver’s burden, social support, and family well-being in Madhya Pradesh.
A study using a mixed-method design may be planned to explore the relationship between social support, family well-being, and caregiver burden beyond the Bhopal district or across Madhya Pradesh.
Intervention can be planned to improve family well-being, and its effectiveness can be assessed.
The caregiver burden may be assessed through qualitative approaches to supplement data collected using standardized tools.
Conclusion
The study revealed that the caregivers perceived moderate caregiver burden, social support, and family well-being. Social support and family well-being had an inverse relationship with the caregiver burden. Enhancing social support would reduce the caregiver burden and in turn improve family well-being. There is a need to reduce caregiver burden if the burden of mental illness is reduced. Healthcare providers have a greater responsibility to address the problem of caregiver burden now than later, especially in Central India. Providing social support and training the caregivers on the care of the mentally ill should be considered a priority measure to improve family health and reduce the caregiver burden and the magnitude of mental illness in India.
Abbreviations
CMD = Common Mental Disorders
WHO = World Health Organization
OCD = Obsessive-Compulsive Disorder
OPD = Outpatient Department
PTSD = Post-Traumatic Stress Disorder
SPSS = Statistical Package for Social Sciences
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
The authors are grateful to the Administration of the tertiary care hospital for permitting us to undertake the study and to the authors of the tools for permitting us to use them in our study.
Funding Statement
Nil.
References
- 1.Nataraj M, Kumble CN, Ganjekar S, Desai G. Common mental disorders. In: Bhugra D, Moussaoui D, Craig TJ, Bhugra D, Moussaoui D, Craig TJ, editors. Oxford Textbook of Social Psychiatry [Internet] Oxford University Press; 2022. [cited 2024 Dec 16]. p. 0 Available from: https://doi.org/10.1093/med/9780198861478.003.0037 . [Google Scholar]
- 2.Institute of Health Metrics and Evaluation Global Health Data Exchange (GHDx) Global burden of disease. 2019. Available from: https://www.vizhub.healthdata.org/gbd-results/ . [Last accessed on 2024 Apr 08]
- 3.Kosalram K, Elizabeth J, Kumar D. A cross-sectional study to assess the magnitude of depression among young adults at selected higher educational institutions in Tamil Nadu, India: A study protocol. J Edu Health Promot. 2023;12:180. doi: 10.4103/jehp.jehp_1287_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Gururaj G, Varghese M, Benegal V, Rao G, Pathak K, Singh L, et al. National mental health survey of India, 2015–16 Prevalence, pattern and outcomes 2017. Int J Soc Psychiatry. 2020 Jun;66(4):361–372. doi: 10.1177/0020764020907941. [DOI] [PubMed] [Google Scholar]
- 5.Kokane A, Pakhare A, Gururaj G, Varghese M, Benegal V, Rao GN, et al. Mental health issues in Madhya Pradesh: Insights from national mental health survey of India 2016. Healthcare (Basel) 2019;7:53. doi: 10.3390/healthcare7020053. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Soni A, Kumar R, Das A. Experiences of the family caregivers of persons with schizophrenia in north Indian region: A qualitative inquiry. Arch Psychiatr Nurs. 2024;5:17–24. doi: 10.1016/j.apnu.2024.05.005. [DOI] [PubMed] [Google Scholar]
- 7.Koujalgi SR, Nayak RB. Family burden among caregivers of patients with chronic mental disorders. BLDE Univ J Health Sci. 2021;6:164–7. [Google Scholar]
- 8.Tamizi Z, Fallahi-Khoshknab M, Dalvandi A, Mohammadi-Shahboulaghi F, Mohammadi E, Bakhshi E. Caregiving burden in family caregivers of patients with schizophrenia: A qualitative study. J Edu Health Promot. 2020;9:12. doi: 10.4103/jehp.jehp_356_19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Anthony-Bergstone CR, Zarit SH, Gatz M. Symptoms of psychological distress among caregivers of dementia patients. Psychol Aging. 1988;3:245–8. doi: 10.1037//0882-7974.3.3.245. [DOI] [PubMed] [Google Scholar]
- 10.Zimet G, Dahlem N, Zimet S, Farley G. The Multidimensional scale of perceived social support. J Pers Assess. 1988;52:30–41. [Google Scholar]
- 11.Crandall A, Weiss-Laxer NS, Broadbent E, Holmes EK, Magnusson BM, Okano L, et al. The family health scale: Reliability and validity of a short- and long-form. Front Public Health. 2020;8:587125. doi: 10.3389/fpubh.2020.587125. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Roby A, Adavalath D, Cherukunnath P. Hospital based cross sectional study on caregiver burden in chronic mentally ill patients in Northern Kerala. J Evid Based Med Healthc. 2021;8:2138–42. [Google Scholar]
- 13.Walke SC, Chandrasekaran V, Mayya SS. Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms. J Neurosci Rural Pract. 2018;9:180–5. doi: 10.4103/jnrp.jnrp_312_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Chothe S. A Study to assess the level of burden among the caregivers of mentally ill patients in selected hospitals of Imphal (Manipur) Nurs J India. 2023;CXIV:116–23. [Google Scholar]
- 15.Roy P, Kumar A, Shekhawat LS. Disability in obsessive-compulsive disorder and its impact on caregiver’s burden and quality of life. Indian J Soc Psych. 2023;39:292. [Google Scholar]
- 16.Agarwal M, Kushwaha A, Nischal A, Kar S, Gupta B, Tripathi A, et al. Burden of care in the caregivers of patients with anxiety disorders. Indian J Soc Psych. 2017;33:22. [Google Scholar]
- 17.Thakur V, Nagarajan P, Rajkumar RP. Coping and burden among caregivers of patients with major mental illness. Indian J Soc Psych. 2022;38:63–8. [Google Scholar]
- 18.Dhami J, Tuladhar S. Burden of care among caregivers of mentally ill patients. J Pharma Pract Community Med. 2021;7:52–8. [Google Scholar]
- 19.Chakraborty R, Jana A, Vibhute VM. Caregiving: A risk factor of poor health and depression among informal caregivers in India- A comparative analysis. BMC Public Health. 2023;23:42. doi: 10.1186/s12889-022-14880-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Del-Pino-Casado R, Rodrı×guez Cardosa M, Lo'pez-Mart'ınez C, Orgeta V. The association between subjective caregiver burden and depressive symptoms in carers of older relatives: A systematic review and meta-analysis. PLoS One. 2019;14:e0217648. doi: 10.1371/journal.pone.0217648. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Pandey A, Pandey AK, Singh A, Sureka P. A Comparative study of caregiver burden in relatives of persons with schizophrenia and obsessive compulsive disorder. Int J Health Sci Res. 2020;10:306–310. [Google Scholar]
- 22.Pérez JJN, Marqués ÁC. Family burden, social support and community health in caregivers of people with serious mental disorder. Rev Esc Enferm USP. 2018;52:e03351. doi: 10.1590/S1980-220X2017029403351. [DOI] [PubMed] [Google Scholar]
- 23.El-Slamon MAEA, Al-Moteri M, Plummer V, Alkarani AS, Ahmed MG. Coping strategies and burden dimensions of family caregivers for people diagnosed with obsessive-compulsive disorder. Healthcare (Basel) 2022;10:451. doi: 10.3390/healthcare10030451. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Khan SM, Panday R, Kiran M. Social support of male and female care givers of individuals suffering from schizophrenia. Int J Indian Psychol. 2022;4:2349–3429. [Google Scholar]
- 25.Mohamed Abdelaal H, Hassnin Eita L, Mohamed Khedr M. Resilience and perceived social support among family caregivers of patients with schizophrenia. Egypt J Health Care. 2021;12:1108–22. [Google Scholar]
- 26.Sun X, Ge J, Meng H, Chen Z, Liu D. The influence of social support and care burden on depression among caregivers of patients with severe mental illness in rural areas of Sichuan, China. Int J Environ Res Publ Health. 2019;16:1961. doi: 10.3390/ijerph16111961. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Lamiaa H, Lamiaa E. Resilience and perceived social support among family caregivers of patients with schizophrenia. Egypt J Health Care. 2021;12:1108–1122. [Google Scholar]
- 28.Nalini S, Santhi S, Neelakshi G, Santhi M. Family wellbeing among caregivers of patients with mental illness. Anna Rom Soc Cell Biol. 2021;25:17313–7. [Google Scholar]
- 29.Del-Pino-Casado R, Frías-Osuna A, Palomino-Moral PA, Ruzafa-Martínez M, Ramos- Morcillo AJ. Social support and subjective burden in caregivers of adults and older adults: A meta-analysis. PLoS One. 2018;13:e0189874. doi: 10.1371/journal.pone.0189874. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Perceived social support and family members of patients with mental disorders: A mixed method study-PMC. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9939439/ . [Last accessed on 2024 Aug 29] [DOI] [PMC free article] [PubMed]
- 31.Sustrami D, Yusuf A, Fitryasari R, Efendi F, Aysha RF. Relationship between social support and family caregiver burden in schizophrenia patients. J Pak Med Assoc. 2023;73(Suppl 2):S42–5. doi: 10.47391/JPMA.Ind-S2-10. [DOI] [PubMed] [Google Scholar]
- 32.Mohammed SFM, Ghaith RFAH. Relationship between burden, psychological well-being, and social support among caregivers of mentally ill patients. Egypt Nurs J. 2018;15:268. [Google Scholar]