Prevalence and clinical correlates of psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India

Yasir Hassan Rather, Mansoor Ahmad Dar, Fazle Roub Bhat, Majid Shafi Shah, Rayees Ahmad Wani


Background: Consequent to the high prevalence of psychiatric disorders in present day world, their caregivers form an important group in the public health. Research on the physical and psychological well-being of caregivers is being carried worldwide with varied results. Psychological health of these caregivers is usually ignored both by these persons themselves and the health-care providers. The objective of the study was to screen for psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India, and to study the clinical correlates of the same.

Methods: A total of 205 patients and their caregivers were consecutively recruited over a one month period. Sociodemographic and clinical information of patients was obtained either from the hospital records or from the caregiver. Scoring of the patient’s global assessment of functioning (GAF) was done by clinicians. The caregivers were administered a sociodemographic questionnaire, general health questionnaire (GHQ-12) and Zarit Burden interview. The presence of psychiatric morbidity was confirmed by a consultant psychiatrist.

Results: Among the caregivers, 32.2% had GHQ scores of 3 and above. Majority of caregivers in this study were females (59.0%) while as majority of the patients were males (61.9%). Factors associated with psychiatric morbidity among caregivers include the high level of subjective burden of care, low level of functioning, and comorbid medical and psychiatric conditions.

Conclusions: The study reveals a high level of psychiatric morbidity among the caregivers of patients with mental health problems.


Patient, Morbidity, Caregiver, Burden

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World Health Organization (WHO): The World Health Report 2001: Mental health- new understanding, new hope. Geneva. 2001. Available at: Accessed on 01st July 2020.

Thornicroft G, Tansella M. Growing recognition of the importance of service user involvement in mental health service planning and evaluation. Epidemiol Psichiatr Soc. 2005;14:1-3.

Belkin A, Albright K, Jeffrey J. A qualitative study of informal caregivers' perspectives on the effects of idiopathic pulmonary fibrosis. BMJ Open Resp Res. 2014;1(1):7.

Stein MD, Crystal S, Cunningham WE, Ananthanarayanan A, Andersen RM, Turner BJ et al. Delays in seeking HIV care due to competing caregiver responsibilities. Am J Public Health. 2000;90:1138-40.

Prigerson HG. Costs to society of family caregiving for patients with end-stage Alzheimer's disease. N Engl J Med. 2003;349:1891-2.

Schulz R, Mendelsohn AB, Haley WE, Mahoney D, Allen RS, Zhang S et al. Resources for enhancing Alzheimer’s caregiver health investigators: end-of-life care and the effects of bereavement on family caregivers of persons with dementia. N Engl J Med. 2003;349:1936-42.

Vaddadi KS, Soosai E, Gilleard CJ, Adlard S. Mental illness, physical abuse and burden of care on relatives: a study of acute psychiatric admission patients. Acta Psychiatr Scand. 1997;95:313-7.

Carod-Artal FJ, Egido-Navarro JA, Gonzalez-Gutierrez JL, Varela de SE. Perception of long term overload in caregivers of patients who have survived a stroke. Rev Neurol. 1999;28:1130-8.

Hughes SL, Giobbie-Hurder A, Weaver FM, Kubal JD, Henderson W. Relationship between caregiver burden and health-related quality of life. Gerontol. 1999;39:534-45.

Schulz R, Tompkins CA, Rau MT. A longitudinal study of the psychological impact of stroke on primary support persons. Psychol Aging. 1998;3:131-41.

Schulz R, O-Brien AT, Bookwals J, Fleissner K. Psychiatric and physical morbidity effects of dementia caregiving: prevalance, correlates, and causes. Gerontol. 1005;35:771-91.

Aneshensel CS, Pearlin LI, Schuler RH. Stress, role captivity, and the cessation of caregiving. J Health Soc Behav. 1993;34:54-70.

Schulz R, Williamson G. A 2-year longitudinal study of depression among Alzheimer’s caregivers. Psychol Aging. 1991;6:569-78.

Cochrane J, Goering P, Rogers J. The mental health of informal caregivers in ortario: an epidemiological survey. Am J Public Health. 1997;87:2002-7.

Smith M, Ellgring H, Oertel W. Sleep disturbances in Parkinson's disease patients and spouses. J Am Geriatr Soc. 1997;45:194-9.

Ingersoll-Dayton B, Raschick M. The relationship between care-recipient behaviours and spousal caregiving stress. Gerontol. 2004;44:318-27.

Kang SY. Predictors of emotional strain among spouse and adult child caregivers. J Gerontol Soc Work. 2006;47:107-31.

Dwyer JW, Lee GR, Jankowski TB. Reciprocity, elder satisfaction, and caregiver stress and burden: the exchange of aid in the family caregiving relationship. J Marr Fam. 1994;56:35-43.

Molyneux G, McCarthy G, McEniff MC, Conroy R. Prevalence and predictors of carer burden and depression in carers of patients referred to an old age psychiatric service. Int Psychogeriatr. 2008;20:1193-202.

Aldwin CM. Does age affect the stress and coping process? Implications of age differences in perceived control. J Gerontol. 1991;46:174-80.

Gureje O, Obikoya B. The GHQ-12 as a screening tool in a primary care setting. Soc Psychiatr Psychiatric Epidem. 1990;25:276-80.

Kuruvilla A, Pothen M, Philip K, Braganza D, Joseph A, Jacob K. The validation of the Tamil version of the 12 item general health questionnaire. Ind J Psychiatr. 1999;41:217-21.

Chadda RK, Singh TB, Ganguly KK. A prospective study of relationship of caregivers′ mental health with the perceived burden and coping in schizophrenia and bipolar affective disorder. Indian J Soc Psychiatr. 2010;25:45-51.

Okewole A, Dada MU, Ogun O, Bello-Mojeed M, Usoh, T. Prevalence and correlates of psychiatric morbidity among caregivers of children and adolescents with neuropsychiatric disorders in Nigeria. Af J Psychiatr. 2011;14:306-9.

Eicher PS, Batshaw ML. Cerebral palsy. Pediatr Clin North Am. 1993;40:537-51.

Caserta MS, Lund DA, Wright SD. Exploring the caregiver burden inventory (CBI): further evidence for a multidimensional view of burden. Int J Aging Hum Dev. 1996;43:21-34.

Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB, Glaser R. Chronic stress and age-related increases in the pro-inflammatory cytokine IL-6 proc. Nat Acad Sci. USA. 2003;100(15):9090-5.

Kendler K S, Gruenberg AM, Tsuang M T. Psychiatric illness in first-degree relatives of schizophrenic and surgical control patients: a family study using DSM-III criteria. Arch Gen Psychiatr. 1985;42:770-9.

Yee J L, Schulz R. Gender differences in psychiatric morbidity among family caregivers a review and analysis. Gerontol. 2000;40:147-64.

Yates ME, Tennstedt S, Chang BH. Contributors to and mediators of psychological well-being for informal caregivers. J Gerontol. 1999;54:12-22.

De Bellis MD, Broussard ER, Herring D J, Wexler S, Moritz G, Benitez JG. Psychiatric co-morbidity in caregivers and children involved in maltreatment: a pilot research study with policy implications. Child abuse & neglect. 2001;25:923-44.

Greenberg JS, Kim HW, Greenley JR. Factors associated with subjective burden in siblings of adults with severe mental illness. Am J Orthopsychiatry. 1997;67:231-41.

US Department of Health and Human Services. Informal caregiving: Compassion in action. Washington, DC: US Government Printing Office. 1998. Available at: Accessed on: 31 June 2020.

Omigbodun OO. Psychosocial issues in a child and adolescent psychiatry clinic. Soc Psychiatry Psychiatric Epidem. 2004;39:667-72.

Neal MB, Ingersoll-Dayton B, Starrels ME. Gender and relationship differences in caregiving patterns and consequences among employed caregivers. Gerontol. 1997;37:804-16.

Stephens MAP, Townsend AL, Martire LM, Druley JA. Balancing parent care with other roles: Interrole conflict of adult daughter caregivers. J Gerontol. 2001;56:24-34.

Brown AMW. Women in the middle: their parent care years (2nd edition) by Elaine M. Brody. 2015;41(6):467-9.

Navaie-Waliser M, Spriggs A, Feldman PH. Informal caregiving: differential experiences by gender. Medical Care. 2002;40:1249-59.

Tsuang, MT, Winokur G, Crowe RR. Morbidity risks of schizophrenia and affective disorders among first degree relatives of patients with schizophrenia, mania, depression and surgical conditions. Brit J Psychiatry. 1980;137:497-504.

Beach SR, Schulz R, Yee JL,Jackson S. Negative and positive health effects of caring for a disabled spouse: longitudinal findings from the caregiver health effects study. Psychol aging. 2000;15:259-71.

Marks NF, Lambert JD, Choi H. Transitions to caregiving, gender, and psychological well‐being: a prospective us national study. J Marr Fam. 2002;64:657-67.