Dear Editor,
We read with great interest the article by Egesh Aryal et al[1] titled “Depression and anxiety in family caregivers of cancer patients: A cross-sectional study in Nepal” published in Annals of Medicine and Surgery (Vol. 87, August 2025). The mental health of caregivers is often overlooked in South Asian families, and we commend the authors for addressing this important issue.
However, we wish to highlight several methodological considerations that could enhance the interpretability and generalizability of such studies. The sample size of 101 participants, though feasible, is relatively small compared with similar studies[2,3], potentially reducing statistical power. Additionally, the single-center design and use of non-probability convenience sampling may limit generalizability and introduce selection bias. A multicenter approach, as demonstrated by Sharma et al[3], using purposive sampling could yield more representative findings.
Although validated tools such as PHQ-9 and GAD-7 were appropriately used, the study might have benefited from assessing caregiver burden using the Zarit Burden Interview (ZBI). Previous research[4] integrating ZBI with PHQ-9 and GAD-7 has demonstrated stronger associations between caregiver burden, anxiety, and depression.
This study is a valuable contribution to understanding caregiver mental health in Nepal. Incorporating larger, multicenter samples and multidimensional assessments of caregiver burden in future research could provide more comprehensive insights.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Published online 25 November 2025
Contributor Information
Zainab Salam, Email: zainabsalam471@gmail.com.
Minahil Salam, Email: minahilmirza1070@gmail.com.
Malik Olatunde Oduoye, Email: malikolatunde36@gmail.com, olihealthmagazinewestafrica@gmail.com.
Declarations
This manuscript is prepared according to the TITAN 2025 Guidelines for ethical and transparent use of AI in scholarly publishing[5].
Ethical approval
Not applicable.
Consent
Not applicable.
Sources of funding
None.
Author contributions
Conceptualization, project administration, software, and supervision: M.O.O. Writing of initial draft: Z.S., M.S., and M.O.O. Writing – review editing and funding acquisition: M.O.O.
Conflicts of interest disclosure
The author declares no conflict of interest.
Research registration unique identifying number (UIN)
Not applicable.
Guarantor
Malik Olatunde Oduoye.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Data availability statement
Not applicable.
References
- [1].Aryal E, Adhikari SP, Lageju N, et al. Depression and anxiety in family caregivers of cancer patients: a cross-sectional study in Nepal. Ann Med Surg 2025. doi: 10.1097/MS9.0000000000003679. [DOI] [Google Scholar]
- [2].Tang B, Yu Y, Liu Z, et al. Factor analyses of the Chinese Zarit Burden Interview among caregivers of patients with schizophrenia in a rural Chinese community. BMJ Open 2017;7:e015621 [Google Scholar]
- [3].Sharma BP, Haque MI, Hossain MB, et al. Depression and anxiety status among informal caregivers of patients with cancer treated at selected tertiary hospitals in Nepal. J Taibah Univ Med Sci 2024;19:482–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Yao H, Li K, Li C, et al. Caregiving burden, depression, and anxiety in informal caregivers of people with mental illness in China: a cross-sectional survey. BMC Psychiatry 2024;24:824. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Agha RA, Mathew G, Rashid R, et al. Transparency in the Reporting of Artificial Intelligence – the TITAN Guideline. Premi J Sci 2025;10:100082. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Not applicable.