Cited by 288Dementia and Cognitive Impairment ResearchNursing care and researchFamily Caregiving in Mental Illness

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Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden

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Seng, Boon Kheng, Luo, Nan, Ng, Wai Yee, Lim, June, Chionh, Hui Ling, Goh, Jenny, Yap, Philip·2010·Annals of the Academy of Medicine Singapore

DOI 10.47102/annals-acadmedsg.v39n10p758

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Abstract

INTRODUCTION: This study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore. MATERIALS AND METHODS: Adult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer's Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey. RESULTS: A total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson's correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach's alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149). CONCLUSION: The results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore.

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“The ZBI has demonstrated high correlations with other psychological tools [17, 23-25, 29].”
BackgroundMethod
Implementation of social prescribing: lessons learnt from contextualising an intervention in a community hospital in Singapore
Lee, K. H., Low, L. L., Lu, S. Y., & Lee, C. E. (2022) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2022.100561 · Cited by 24
Neighborhood Characteristics and the Mental Health of Caregivers Cohabiting with Care Recipients Diagnosed with Alzheimer’s Disease
Alhasan, D. M., Hirsch, J. A., Jackson, C. L., Miller, M. C., Cai, B., & Lohman, M. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18030913 · Cited by 23
“Caregiver mental health was greatly associated with care recipients’ NPSs and disease progression; in cases where NPSs persisted, they increased the burden on the caregiver indirectly by increasing the risk for institutionalization, comorbidities, and mortality [54].”
BackgroundMethod
Caregiver Burden
Lau, S., Chong, M. S., Ali, N. B., Chan, M. Y., Chua, K. C., & Lim, W. S. (2015) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000085 · Cited by 23
Predicting institutional long‐term care admission in dementia: a mixed‐methods study of informal caregivers’ reports
Afram, B., Verbeek, H., Bleijlevens, M. H. C., Challis, D., Leino‐Kilpi, H., Karlsson, S., Soto, M. E., Guiteras, A. R., Saks, K., Zabalegui, A., et al. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12479 · Cited by 23
Detecting pre-death grief in family caregivers of persons with dementia: measurement equivalence of the Mandarin-Chinese version of Marwit-Meuser caregiver grief inventory
Liew, T. M., Yap, P. L. K., Luo, N., Hia, S. B., Koh, G. C., & Tai, B. C. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0804-5 · Cited by 23
“ZBI and CES-D have previously been validated in Singapore [30, 31].”
Background
Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study
Tyagi, S., Koh, G. C., Luo, N., Tan, K. B., Hoenig, H., Matchar, D. B., Yoong, J., Chan, A. W.-M., Lee, K. E., Venketasubramanian, N., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-036631 · Cited by 23
Generating real‐world evidence in Alzheimer's disease: Considerations for establishing a core dataset
Galvin, J. E., Cummings, J. L., Benea, M. L., de Moor, C., Allegri, R., Atri, A., Chertkow, H. M., Paquet, C., Porter, V. R., Ritchie, C. W., et al. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.13785 · Cited by 22
A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview
Liew, T. M., & Yap, P. L. K. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.11.005 · Cited by 22
Evaluation of Anxiety, Depression and Burden on Caregivers of Children with Cerebral Palsy
Barutçu, A., Barutçu, S., Kolkiran, S., & Özdener, F. (2021) · Developmental Neurorehabilitation · doi:10.1080/17518423.2021.1917718 · Cited by 21
“89, respectively).(17) Lastly, Functional Independence Measure (FIM) was used to measure the level of assistance required by the patient.”
Method
Time to move? Factors associated with burden of care among informal caregivers of cognitively impaired older people facing housing decisions: secondary analysis of a cluster randomized trial
Boucher, A., Haesebaert, J., Freitas, A., Adekpedjou, R., Landry, M., Bourassa, H., Stacey, D., Croteau, J., Guérard, G. P., & Légaré, F. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1249-1 · Cited by 22
Person-centred creative dance intervention for persons with dementia living in the community in Singapore
Koh, W. L. E., Low, F., Kam, J. W., Rahim, S., Ng, W. F., & Ng, L. L. (2019) · Dementia · doi:10.1177/1471301218823439 · Cited by 28
“It had also demonstrated to be a valid and reliable tool to measure the burden of family caregivers of persons with dementia in Singapore (Seng et al., 2010).”
Method
Depression and psychosocial burden among caregivers of children with chronic kidney disease
Mahmoud, D. A. M., Saad, A. E., Abdelhamid, Y. H., & Hawary, Y. E. (2021) · Middle East Current Psychiatry · doi:10.1186/s43045-021-00092-x · Cited by 20
Factors influencing depression in individuals with traumatic spinal cord injury and caregivers’ perceived burden in a low-income country: a cross-sectional study
Adhikari, S. P., Gurung, G., Khadka, B., & Rana, C. (2020) · Spinal Cord · doi:10.1038/s41393-020-0451-5 · Cited by 20
Caregiver burden of Alzheimer’s disease among informal caregivers: a cross-sectional study in Malaysia
Tay, L. X., Ong, S. C., Ong, H. M., Teh, E. E., Ch’ng, A. S. H., Tiong, I. K., Razali, R. M., & Parumasivam, T. (2025) · Scientific Reports · doi:10.1038/s41598-025-95210-8 · Cited by 21
“In terms of reliability and validity, Boon et al. demonstrated good consistency (Cronbach’s alpha of 0.93) and good test-retest reliability (alpha of 0.89) 59 .”
Influential
Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics
Tyagi, S., Koh, G. C., Luo, N., Tan, K. B., Hoenig, H., Matchar, D. B., Yoong, J., Chan, A. W.-M., Lee, K. E., Venketasubramanian, N., et al. (2019) · BMC Neurology · doi:10.1186/s12883-019-1510-4 · Cited by 19
“Validated previously in Singapore [22], we used the abbreviated 12-item version for the current study with a total score ranging from 0 to 48.”
Method
Are mobile apps meeting the needs of caregivers of people living with dementia? An evaluation of existing apps for caregivers
Castillo, L. I. R., Tran, V., & Hadjistavropoulos, T. (2023) · Aging & Mental Health · doi:10.1080/13607863.2023.2177832 · Cited by 19
“The ZBI (Zarit et al., 1985) is a reliable and valid 22-item questionnaire designed to measure the burden experienced in various dimensions life as a result of caregiving (Yap, 2010).”
Method
Informal caregiver burden in middle-income countries Results from Memory Centers in Lima - Peru
Custodio, N., Lira, D., Herrera‐Pérez, E., del Prado, L. N., Parodi, J. F., Guevara‐Silva, E. A., Castro‐Suárez, S., Mar, M., Montesinos, R., & Cortijo, P. (2014) · Dementia & Neuropsychologia · doi:10.1590/s1980-57642014dn84000012 · Cited by 19
Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial
Adisso, É. L., Taljaard, M., Stacey, D., Brière, N., Zomahoun, H. T. V., Durand, P. J., Rivest, L., & Légaré, F. (2022) · JMIR Aging · doi:10.2196/39386 · Cited by 18
“Other secondary outcomes included health-related quality of life, assessed only in the frail older adults with the 36 items of the Nottingham Health Profile [33-35], and burden of care, assessed only in the caregivers with the Zarit Burden Inventory scale [36-38].”
Burden of caregiving among caregivers of patients with severe mental illnesses in Benin City, Nigeria
Ofovwe, C. E., & Osasona, S. O. (2022) · African Health Sciences · doi:10.4314/ahs.v22i2.75 · Cited by 18
Lonely in a Crowd: Social Isolation Profiles and Caregiver Burden Among Family Caregivers of Community-Dwelling Older Adults With Cognitive Impairment
Sung, P., Lee, J., & Chan, A. W.-M. (2022) · Journal of Aging and Health · doi:10.1177/08982643221137939 · Cited by 21
“The next four items were adopted from the ComSA risk screener, which aimed to screen biopsychosocial health and related risks of older Singaporeans (Aw et al., 2020).”
MethodInfluential
Schizophrenia: its psychological effects on family caregivers
Riley-McHugh, D., Brown, C. H., & Lindo, J. (2016) · International Journal of Advanced Nursing Studies · doi:10.14419/ijans.v5i1.5565 · Cited by 17
“The Zarit Burden Questionnaire has been used to measure the caregivers’ perceived burden of providing family care (Seng et al. 2010).”
Method
An exploration of symptom burden and its management, in Saudi Arabian patients receiving haemodialysis, and their caregivers: a mixed methods study protocol
Alshammari, B., Noble, H. R., McAneney, H., & O’Halloran, P. D. (2019) · BMC Nephrology · doi:10.1186/s12882-019-1424-9 · Cited by 17
A Brief, 6-Item Scale for Caregiver Grief in Dementia Caregiving
Liew, T. M., & Yap, P. L. K. (2018) · The Gerontologist · doi:10.1093/geront/gny161 · Cited by 15
“It should correlate strongly ( r > .50 ; Juniper, Guyatt, & Jaeschke, 1996) with scales for caregiver burden (ZBI) and caregiver depression (CES-D) because they measure related, though discriminable, phenomena in caregiving; 2.”
Influential
Psychometric properties of the Hebrew version of the Zarit Caregiver Burden Scale short version
Iecovich, E. (2011) · Aging & Mental Health · doi:10.1080/13607863.2011.596807 · Cited by 15
“Although there are various tools to probe caregiver burden (Visser-Meily, Post, Riphagen, & Lindeman, 2004), the most commonly used on an international level is the Zarit Burden Interview (ZBI) and the short version of the ZBI (Bédard et al., 2001; Martı́nCarrasco et al., 2010; Seng et al., 2010).”
Method
Care Burden and Coping Strategies among Caregivers of Paediatric HIV/AIDS in Northern Uganda: A Cross-Sectional Mixed-Method Study
Mujjuzi, I., Mutegeki, P., Nabuwufu, S., Wosukira, A., Namata, F., Alayo, P., Amanya, S. B., & Nyeko, R. (2021) · AIDS Research and Treatment · doi:10.1155/2021/6660337 · Cited by 14
“, which showed a lower care burden among caregivers who had fewer financial problems [22].”
BackgroundMethodResult
Determinants of caregiver burden in male patients with epilepsy following penetrating traumatic brain injury
Kermani, R. J. N., Cohen‐Zimerman, S., Wagner, A. K., & Grafman, J. H. (2021) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2021.107768 · Cited by 14
Burden and resilience in caregivers of patients on maintenance haemodialysis
Joy, J., J., H. K. T., Abraham, P. M., & Gopalakrishnan, S. (2019) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20194586 · Cited by 14
“More the score, greater is the burden perceived.(11)”
Background
Quality-of-Life (QoL) of Indonesian Children Living with HIV: The Role of Caregiver Stigma, Burden of Care, and Coping
Putera, A. M., Irwanto, I., & Maramis, M. M. (2020) · HIV/AIDS - Research and Palliative Care · doi:10.2147/hiv.s269629 · Cited by 14
Variables Associated with High Caregiver Stress in Patients with Mild Cognitive Impairment or Alzheimer’s Disease: Implications for Providers in a Co-Located Memory Assessment Clinic
Hall, D., Wilkerson, J., Lovato, J. F., Sink, K. M., Chamberlain, D., Alli, R., Clarke, P., Rogers, S. D., Villalba, J., Williams, J. H., et al. (2014) · Journal of Mental Health Counseling · doi:10.17744/mehc.36.2.l880r8h860071414 · Cited by 17
“93) and test-retest reliability (r = 0.89; Seng et al., 2010).”
Influential
Measures of financial burden for families dealing with serious illness: A systematic review and analysis
Lee, J., & Cagle, J. G. (2020) · Palliative Medicine · doi:10.1177/0269216320973161 · Cited by 14
Improving Daily Life Skills in People with Dementia: Testing the STOMP Intervention Model
Dao, H. D. (2014) · Journal of Alzheimer’s Disease & Parkinsonism · doi:10.4172/2161-0460.1000165 · Cited by 13
“89 [55].”
The three dimensions of caregiver grief in dementia caregiving: Validity and utility of the subscales of the Marwit‐Meuser Caregiver Grief Inventory
Chan, I., Yap, P. L. K., Wee, S. L., & Liew, T. M. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5238 · Cited by 15
Combining a variable‐centered and a person-centered analytical approach to caregiving burden – a holistic approach
Yuan, Q., Tan, G. T. H., Wang, P., Devi, F., Goveas, R. R., Magadi, H., Ng, L. L., Chong, S. A., & Subramaniam, M. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02238-2 · Cited by 15
“This 22-item scale was first developed in 1980, and has been validated in various countries including Singapore [11].”
Method
Caregiver burden in children with intellectual disability: Does special school education help?
Ramasubramanian, V., Chellamuthu, R., Selvikumari, R., Pandian, P. R. S., & Gopi, R. (2019) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_7_15 · Cited by 12
Comparison Between Burden of Care Partners of Individuals with Alzheimer’s Disease Versus Individuals with Other Chronic Diseases
Demirbas, M., Hahn‐Pedersen, J. H., & Jørgensen, H. L. (2023) · Neurology and Therapy · doi:10.1007/s40120-023-00493-6 · Cited by 13
“The overall score of the ZBI ranges from 0 to 88 points [11, 26] and has four levels of burden: no or little burden (0–20 points), mild to moderate burden (21–40 points), moderate to severe burden (41–60 points) and severe burden (61–88 points) [27].”
Background
The Longitudinal Effects of Caregiver Grief in Dementia and the Modifying Effects of Social Services: A Prospective Cohort Study
Liew, T. M., Tai, B. C., Wee, S. L., Koh, G. C., & Yap, P. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16717 · Cited by 12
“ZBI is a widely used scale to assess perceived burden of caregivers of older persons.(9) Its 22 items are rated on five-point Likert scales, and summed to generate total scores ranging from 0 to 88 (higher scores indicate greater burden).”
Background
The associations between caregivers’ psychosocial characteristics and caregivers’ depressive symptoms in stroke settings: a cohort study
Koh, Y. S., Subramaniam, M., Matchar, D. B., Hong, S.-I., & Koh, G. C. (2022) · BMC Psychology · doi:10.1186/s40359-022-00828-2 · Cited by 12
“It is a 12-item instrument that allows respondents to rate negatively phrased questions on caregiving from 0 = Never to 4 = Nearly always [25].”
Background
Burden on Caregivers of Adults with Multiple Chronic Conditions: Intersectionality of Age, Gender, Education level, Employment Status, and Impact on Social Life
Ghosh, S., Choi, W. Y., Williams, A., Duggleby, W., Ploeg, J., Markle‐Reid, M., & Peacock, S. (2019) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s071498081900045x · Cited by 13
“The ZBI has been proven to be a valid and reliable tool for determining caregiver burden by Seng et al. (2010).”
Influential
Sociodemographic Profiles of Caregivers and Their Association with Burden of Care in Dementia
Rosdinom, R., Norzarina, M. Z., Zanariah, M. S., & ZamZam, R. (2011) · The Malaysian journal of psychiatry · Cited by 12
Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers
Byrne, A., Sivell, S., de Moraes, F. Y., Bulbeck, H., Torrens‐Burton, A., Bernstein, M., Nelson, A., & Fielding, H. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013440 · Cited by 12
Validation of the Needs Assessment of Family Caregivers-Cancer scale in an Asian population
Yang, W. F. Z., Liu, J., Chan, Y. H., Griva, K., Kuparasundram, S., & Mahendran, R. (2020) · BMC Psychology · doi:10.1186/s40359-020-00445-x · Cited by 15
“While the ZBI was originally developed to assess burden experienced by caregivers of persons with dementia, it has now been widely used in many clinical contexts, such as Parkinson’s disease and chronic diseases, [33–36] and also shown to be reliable and valid for use in cancer caregivers [37, 38] and in an Asian popu…”
Method

Authors: Seng, B. K., Luo, N., Ng, W. Y., Lim, J., Chionh, H. L., Goh, J., & Yap, P.
Affiliations: National University of Singapore (SG)
Alexandra Hospital (SG)
ORCID: Seng, Boon Kheng
Luo, Nan
Yap, Philip
Venue: Annals of the Academy of Medicine Singapore
Publisher: Academy of Medicine, Singapore
Published: 2010-10-15
Volume: 39
Issue: 10
Pages: 758-763
ISSN: 0304-4602 (ISSN-L)
DOI: 10.47102/annals-acadmedsg.v39n10p758
OpenAlex: W126441541
Cited by: 288
References: 32
Citations by year: 2026: 20 · 2025: 22 · 2024: 25 · 2023: 41 · 2022: 27 · 2021: 28 · 2020: 31 · 2019: 22 · 2018: 16 · 2017: 10 · 2016: 10 · 2015: 15 · 2014: 13 · 2013: 3 · 2012: 2
FWCI: 1.73
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Annals of the Academy of Medicine Singapore (publishedVersion)
PubMed (publishedVersion)
National University of Singapore (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Nursing › Research and Theory › Nursing care and research
Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
Keywords: Zarit Burden Interview, caregiver burden, dementia, family caregivers, psychometric validation, test-retest reliability, Singapore
MeSH terms: Adult, Dementia, Female, Humans, Interview, Psychological, Male, Middle Aged, Psychiatric Status Rating Scales, Stress, Psychological, Caregivers, Cost of Illness

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Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden

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