Perceived stress and depressive symptoms—not neuropsychiatric symptoms—predict caregiver burden in Alzheimer’s disease: A cross-sectional study
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BACKGROUND: Caregiver burden affects the caregiver's health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer's Disease (AD) and to investigate the predictors for caregiving burden. METHODS: A cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations. RESULTS: A higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001). CONCLUSION: Caregiver burden is associated with patients' neuropsychiatric symptoms indirectly through the caregiver's depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.
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The PHQ-9 has been extensively validated among family caregivers, including those supporting persons with dementia.
“The PHQ-9 has been extensively validated among family caregivers, including those supporting persons with dementia (Alfakhri et al., 2018; Lou et al., 2015; Pinyopornpanish et al., 2021).”
From Mindfulness and rumination: stress pathways for caregivers of persons living with dementia. (2026) · cites this paper as Pinyopornpanish et al., 2021
The Methods (Participants and procedure) report using the PHQ-9 to assess depressive symptoms in caregivers of people with Alzheimer’s disease. The Methods (Measures) say the Thai version has good psychometric properties, but do not establish that the PHQ-9 has been extensively validated specifically among family caregivers or dementia caregivers. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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- Authors
- Pinyopornpanish, M., Pinyopornpanish, K., Soontornpun, A., Tanprawate, S., Nadsasarn, A., Wongpakaran, N., & Wongpakaran, T.
- Affiliations
- Chiang Mai University (TH)
- Corresponding author
- Wongpakaran, Tinakon
- ORCID
- Venue
- BMC Geriatrics
- Published
- 2021-03-12
- Volume
- 21
- Issue
- 1
- Pages
- 180-180
- ISSN
- 1471-2318 (ISSN-L)
- PMC
- PMC7953798
- OpenAlex
- W3133784969
- Cited by
- 46
- References
- 51
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 11 · 2023: 12 · 2022: 8 · 2021: 2
- FWCI
- 5.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Geriatrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Faculty of Medicine, Chiang Mai University (066-2561)
- 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
- caregiver burden, Alzheimer's disease, perceived stress, depressive symptoms, neuropsychiatric symptoms, mediation, Zarit Burden Interview, PHQ-9, Clinical Dementia Rating, activities of daily living, family caregivers
- MeSH terms
- Caregiver Burden, Alzheimer Disease, Cross-Sectional Studies, Depression, Humans, Psychiatric Status Rating Scales, Caregivers, Cost of Illness
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