A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia
Open accessAbstract
BACKGROUND: Caregiving for people with dementia has consistently been linked with psychological problems, usually in terms of caregiver burden, general psychological distress and depressive symptomatology, while morbidity due to anxiety has been relatively neglected in this group. METHODS: We conducted a systematic review of the literature, searching electronic databases, reference lists, relevant systematic reviews and contacting experts in the field. We used Centre for Evidence Based Medicine (CEBM) criteria for inclusion and rating the validity of all studies that reported (1) the prevalence, predictors and covariates of anxiety disorders or anxiety caseness, and (2) covariates and predictors of the level of anxiety symptoms. RESULTS: Thirty-three studies met our inclusion criteria. Clinically, significant anxiety affects about a quarter of caregivers for people with dementia and was more common than in matched controls. Such caregivers have higher anxiety levels than controls, and that confrontative and escape avoidance coping, caregiver burden and poorer caregiver physical health are factors associated with higher anxiety levels from cross-sectional studies. CONCLUSIONS: Coping style may be more associated with anxiety than depression while other covariates (burden and poor physical health) are similar to those for caregiver depression. We found no conclusive evidence about factors associated with anxiety disorders or predicting anxiety from longitudinal studies. Neither care recipient cognition nor ADL impairment; nor caregiver age nor duration of caring are associated with caregiver anxiety levels. Good quality cohort studies are needed to determine whether these factors also predict anxiety disorders.
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Some studies suggest that the prevalence of anxiety symptoms among family carers of people with dementia is greater than that of depressive symptoms.
“with some studies suggesting that the prevalence is even greater than that of depressive symptoms (Cooper et al., 2007; Sallim et al., 2015).”
From The role of experiential avoidance and cognitive fusion in the development of anxiety symptoms among family carers of people with dementia (2024) · cites this paper as Cooper et al., 2007
ADRD caregivers report higher distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering, than caregivers of people with other chronic diseases such as heart failure or cancer.
“ADRD caregivers report higher distress, including symptoms of anxiety and depression [5–9], caregiving burden [10], and existential suffering [11], than caregivers of people with other chronic diseases, such as heart failure or cancer.”
Anxiety is unusually prevalent among dementia caregivers, with estimates around 25%-44%.
“It is both unusually prevalent with estimates around 25%–44% among dementia caregivers (Cooper et al., 2007; Sallim et al., 2015)”
From Mindfulness and rumination: stress pathways for caregivers of persons living with dementia. (2026) · cites this paper as Cooper et al., 2007
Depressive symptoms and anxiety frequently co-occur, but the overlap is asymmetric: most depressed caregivers report anxiety, whereas many anxious caregivers do not show depressive symptoms.
“a systematic review by Cooper et al. (2007) found that while depressive symptoms and anxiety frequently co-occur, the overlap is asymmetric, wherein most depressed caregivers report experiencing anxiety, whereas many anxious caregivers do not show depressive symptoms.”
From Mindfulness and rumination: stress pathways for caregivers of persons living with dementia. (2026) · cites this paper as Cooper et al., 2007
Elevated symptoms of anxiety, depression, and burden in dementia carers are very common and are associated with poor quality of life.
“Elevated symptoms of anxiety, depression, and burden in dementia carers are very common and are associated with poor quality of life (QoL) (Abdollahpour et al. , 2015; Cooper et al. , 2007; Cuijpers, 2005).”
From Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. (2018) · cites this paper as Cooper et al. , 2007
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“Consistent with this distinction, a systematic review by Cooper et al. (2007) found that while depressive symptoms and anxiety frequently co-occur, the overlap is asymmetric, wherein most depressed caregivers report experiencing anxiety, whereas many anxious caregivers do not show depressive…”
- Authors
- Cooper, C., Balamurali, T. B. S., & Livingston, G.
- Affiliations
- University College London (GB)
- Camden and Islington NHS Foundation Trust (GB)
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2007-04
- Volume
- 19
- Issue
- 2
- Pages
- 175-195
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W1978338051
- Cited by
- 410
- References
- 40
- Citations by year
- 2026: 15 · 2025: 12 · 2024: 23 · 2023: 27 · 2022: 47 · 2021: 39 · 2020: 25 · 2019: 31 · 2018: 29 · 2017: 19 · 2016: 21 · 2015: 14 · 2014: 31 · 2013: 20 · 2012: 14
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- dementia caregivers, caregiver anxiety, anxiety prevalence, risk factors for anxiety, coping styles, escape-avoidance, caregiver burden, caregiver physical health, caregiver depression, activities of daily living
- MeSH terms
- Aged, Aged, 80 and over, Anxiety Disorders, Dementia, Female, Humans, Male, Severity of Illness Index, Prevalence, Caregivers, Evidence-Based Medicine
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