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Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden
Open accessAbstract
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 remains one of the most widely validated measures in caregiving research (Hébert et al., 2000; Seng et al., 2010).”
From Mindfulness and rumination: stress pathways for caregivers of persons living with dementia. (2026) · cites this paper as Seng et al., 2010
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“[16,17] These self-report questionnaires examine the perceived burden of caring (ZBI) and symptoms of low mood and anxiety during the previous four-week period (HADS).”
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“The ZBI total scores of caregiver burden were categorized as follows: little or no burden (0–20), mild-to-moderate burden (21–40), moderate-to-severe burden (41–60) and severe burden (61–88) (Seng et al., 2010).”
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“The Zarit Burden interview (ZBI) assessed the level of caregiver burden [32] and has been shown to be a reliable and valid measure of caregiver burden [33, 34].”
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“Zarit Burden Interview (ZBI) is the most widely used tool to assess the care burden of family caregivers, designed by Zarit et al. (1986) (Bédard et al., 2001; Yap, 2010).”
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“The results of the validity test for knowledge instruments were 0.313 - 0.904 and perceptions were 0.672 - 0.765 while the reliability for knowledge, perception and zarit burden interview were 0.781, 0.765, and 0.830 (Yap, 2010) consecutively.”
BackgroundInfluentialFeasibility and Acceptability of a Novel Online Program for Mental Health Carers
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Does self-awareness influence caregiver burden?
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“This is supported by a randomized study which found that an intervention involving psychoeducation was effective in reducing caregiver burden and improving quality of life, and these effects lasted for about 6 months.[20]”
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“…was shown to have high internal reliability (Cronbach’s a D .92) in a sample of caregivers for patients with heart failure (Al-Rawashdeh, Lennie, & Chung, 2016), and two-week test–retest reliability of r D .89 in a sample of caregivers of patients with dementia in Singapore (Seng et al., 2010).”
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Abdelhalim, D., Ahmed, M., Hussein, H. A., Sarhan, M. D., & Khalaf, O. O. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-025-02985-x · Cited by 9
“The resulting score reflects the overall symptom burden, with a potential range of 0 to 36 [15, 16 ].”
Evde Yatağa Bağımlı Hastaya Bakım Veren Bireylerde Bakım Yükü ve Spiritüel İyi Oluş İlişkisi
KAPLAN, E., & Beydağ, K. D. (2022) · Fenerbahçe Üniversitesi Sağlık Bilimleri Dergisi · doi:10.56061/fbujohs.1104915 · Cited by 7
Persons with Diabetes’ Perceptions of Family Burden and Associated Factors
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“Family caregivers often have to contend with the emotional, social, physical, and financial strains of caregiving [40, 41].”
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Skundberg‐Kletthagen, H., Hedelin, B., Wangensteen, S., & Hall‐Lord, M. (2015) · Open Journal of Nursing · doi:10.4236/ojn.2015.53020 · Cited by 7
“This is supported by other studies of relatives to mentally ill persons with schizophrenia [40] [41] and dementia [42].”
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“In addition, reduced independence in activities of daily living requires assistance from carers, and as such, we will also measure the level of burden experienced by the carers using the Zarit Burden Interview, a 22-item questionnaire validated for carers for PwP [36, 50, 51].”
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“The ZBI has high internal consistency estimates (Cronbach ’ s alpha = 0.93), high test-retest reliability (0.89), and high convergent validity with other measures of burden and health (Seng et al., 2010).”
InfluentialA conceptual framework for understanding financial burden during serious illness
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Gagnon‐Roy, M., Bier, N., Giroux, S., Couture, M., Pigot, H., Dorze, G. L., Gosselin, N., Zarshenas, S., Hendryckx, C., & Bottari, C. L. (2023) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2023.2264326 · Cited by 6
“…to complete the task, a score of 1 corresponds to a need for both physical and verbal assistance to complete the task and a score is 0 corresponds to dependent [13]. b Where a lower score is associated with a higher level of self-awareness [55] and a lower caregiver burden [56,57]. c Notes.”
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Identifying solutions to meet unmet needs of family caregivers using human-centered design
Termglinchan, V., Daswani, S., Duangtaweesub, P., Assavapokee, T., Milstein, A. S., & Schulman, K. A. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-02790-5 · Cited by 7
“Caregiver burden assessment Given that there is no validated caregiver burden tool in the Thai language, the 22 item Zarit Burden Interview was professionally translated into Thai for use in this study [17, 18].”
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“Then the caregivers were stratified according to their score into four categories as following: 0–20: little to no stress, 21–40: mild to moderate stress, 41–60: moderate to severe stress, 61–80: severe stress.(17) The second phase included gathering of the patients’ most recent biochemical and clinical data by the re…”
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“The purpose of the ZBI-22 is to measure a caregiver's perceived burden and items focus on psychological burdens such as the caregiver's health, social life, and the relationship between the caregiver and the patient.(20) The 5-point Likert scale response options include: 0 = never, 1 = rarely, 2 = sometimes, 3 = quite…”
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BackgroundMethodInfluentialChallenges in Using Insurance Claims Data to Identify Palliative Care Patients for a Research Trial
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“The ZBI displays excellent internal reliability ( α = 0.94) (Hébert et al. 2010), test–retest reliability (ICC = 0.89), and adequate concurrent validity ( r = 0.53–0.73) (Seng et al. 2010).”
BackgroundInfluentialCorsonello, A., Mattace-Raso, F. U. S., Tap, L., Maggio, M. G., Zerbinati, L., Guarasci, F., Cozza, A., D’Alia, S., Soraci, L., Corigliano, V., et al. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01755-1 · Cited by 5
“1 3 analysis [58, 59]; hand grip strength [60]; health-related quality of life [61], healthcare resource consumption (see below); caregiver burden [62]; dependency in instrumental activities of daily living [63].”
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de Kuijper, G. M., Ravenswaaij, J. J. C. D. B., Hoekstra, P. J., & de Bildt, A. A. (2022) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.13067 · Cited by 5
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“[12] Caregiver burden was assessed using the Zarit scale.[13] Qualitative variables were presented as absolute and relative frequencies and quantitative variables with means and standard deviations.”
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“The items investigate how the patient disability impacts on the QOL, suffering psychological, guilt, financial difficulties, shame and social and family difficulties of caregivers.[34] ● Beck depression inventory.”
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“ZBI is a reliable burden measure ( α > .90) (Chattat et al., 2011; Ko et al., 2008; Seng et al., 2010) and found to be strongly correlated with depressive mood of the caregivers ( r = .59) (Hébert et al., 2000).”
ResultThe Value of the Life Course Perspective in the Design of Mobile Technologies for Older Adults
Foong, P. S. (2016) · Mobile communication in Asia · doi:10.1007/978-94-017-7441-3_10 · Cited by 5
Hubungan Beban Dengan Depresi pada Keluarga yang Merawat Pasien Stroke
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“Se resalta que usando la teoría clásica de los test, estudios desarrollados en diferentes países entre los que se incluyen España [19], Brasil [20], México [8,10], Chile [21], Estados Unidos [15], Singapur [22]; han mostrado que la escala de Zarit es un instrumento válido y confiable para evaluar la carga de cuidado e…”
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Implementing intensive comprehensive aphasia programs in Brazil: Challenges and solutions
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“The multidisciplinary orientation group was designed and developed, and the Zarit Burden Interview Scale (Yap, 2010) and the Knowledge of Aphasia Questionnaire (Palma, 2014) were used before and after participation in the group.”
Mohamed, N. A., Mohamed, H., & Hafez, S. H. (2021) · NILES Journal forGeriatric and Gerontology/NILES Journal for Geriatric and Gerontology · doi:10.21608/niles.2022.197285 · Cited by 4
Association of disrupted sleep with 24-hour blood pressure variability in caregivers
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“There are various tools currently available to measure care burden, which is one of the dimensions of the studied questionnaire,[53,54] but there is no specific tool that can assess the care tensions of caregivers, particularly those of hemodialysis patients.”
Thomas, K. S., Venkateswaran, C., & Alexander, A. V. (2020) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20203043 · Cited by 3
“The validity of the scale correlated against burden assessment scale.(16) The Malayalam version of the tool was used in the study.”
MethodGhosh, 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/s0714980819000552 · Cited by 4
Agadi, S., & Uthayya, S. A. (2025) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_890_24 · Cited by 3
“[21] The PSS-10 has been reported to have a Cronbach’s alpha of 0.78, indicating acceptable internal consistency reliability.”
InfluentialMarega, J., & Bah, H. T. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-024-02634-0 · Cited by 4
“Item scores are summed to give a total score ranging from 0 to 100, with higher scores indicating greater burden [19].”
Amro, N. (2024) · Revista de Gestão Social e Ambiental · doi:10.24857/rgsa.v18n7-180 · Cited by 3
“The Cronbach's alpha value for the ZBI items was 0.93(Yap, 2010).”
MethodInfluentialTulloch, H. E., Greenman, P. S., Reed, J. L., Susinski, S., Kasos, E., Tasca, G. A., Mielniczuk, L. M., Wells, G. A., Sun, L. Y., & Johnson, S. M. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1564666 · Cited by 3
“As noted, all the mental health scales have been validated and used with patients with cardiovascular disease (Al-Rawashdeh et al., 2016; Van Beek et al., 2012; Seng et al., 2010; Blanchard et al., 1996; Hammash et al., 2013; Moullec et al., 2015; Löwe et al., 2008).”
Koh, Y. S., Koh, G. C., Matchar, D. B., Hong, S.-I., & Tai, B. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312310 · Cited by 3
“The total score for the scale ranges from 0 to 48, with a higher score representing a higher caregiver burden [28].”
BackgroundO’Neill, M., Kornas, K., Liang, C. Y., Diemert, L. M., Ayanian, T., Chang, M., & Rosella, L. C. (2023) · International Journal of Integrated Care · doi:10.5334/ijic.6540 · Cited by 3
Technological Readiness as Mediator to Adoption of E-Governemnt Services in Zanzibar SMEs
Makame, M. A., Kuppusamy, M., & Sannasai, A. (2023) · Journal of Computer and Communications · doi:10.4236/jcc.2023.1111002 · Cited by 3
Kim, E. A., Shin, S. S., & Lee, J. (2024) · Clinical Nursing Research · doi:10.1177/10547738241235695 · Cited by 3
“With 22 items measuring caregivers’ responses to questions about physical and emotional strain, scores are summed to yield a total ranging from 0 to 88, with 88 representing the highest level of burden (Yap, 2010).”
BackgroundOnyia, C. O., Lethole, J. S., Olorunfemi, G., & Ngene, N. C. (2024) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v30i0.2252 · Cited by 3
“The ZBI-22 questionnaire 27,34 was administered to each participant by the principal investigator through one-to-one interviewing.”
MethodDeFeis, B. L., Ying, G., Kurasz, A. M., Wit, L. D., Amofa, P., Chandler, M. J., Locke, D. E. C., Shandera‐Ochsner, A. L., Phatak, V. S., & Smith, G. E. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-210582 · Cited by 3
“The measure has demonstrated a test-retest reliability of 0.89 and strong correlation (r = 0.53–0.73) with other caregiver well-being measures, such as the Burden Assessment Scale (BAS) [38].”
InfluentialHategan, A., Bourgeois, J. A., Cheng, T. Z., & Young, J. (2018) · Springer eBooks · doi:10.1007/978-3-319-77128-1_19 · Cited by 3
Khan, S., Batool, I., & Akhtar, N. (2021) · Khyber Medical University Journal · doi:10.35845/kmuj.2021.19861 · Cited by 4
Jiang, W., Chen, J., Sun, W., & Wang, Y. (2024) · Health & Social Care in the Community · doi:10.1155/2024/7283967 · Cited by 2
“Te total score ranged from 22 to 110, with higher scores indicating a greater burden [33].”
BackgroundMethodValiditas Alat Ukur Zarit Burden Interview (ZBI) Menggunakan Model Rasch pada Populasi Indonesia
Larantukan, A. M. F., & Yudiarso, A. (2025) · Humanitas (Jurnal Psikologi) · doi:10.28932/humanitas.v9i1.11007 · Cited by 2
Shahbazi, M., Mihan, R., Sadighi, G., & Alikhani, R. (2025) · Psychiatric Quarterly · doi:10.1007/s11126-025-10189-9 · Cited by 2
Bai, D. L., Chiu, H. L., Lin, S.-C., Kian, K. T. C., Hsu, Y., & Lin, G. (2025) · Innovation in Aging · doi:10.1093/geroni/igaf145 · Cited by 2
The Impact of Burden on Quality of Life in Caregivers of Children with Cerebral Palsy
Agni, P. N., Muley, P., & Bhatt, G. D. (2026) · Advances in Human Biology · doi:10.4103/aihb.aihb_167_25 · Cited by 2
Thongthammarat, Y., & Yamarat, K. (2022) · Journal of Public Health and Development · doi:10.55131/jphd/2022/200312 · Cited by 2
Sung, P., Lim‐Soh, J., & Chan, A. W.-M. (2023) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000530606 · Cited by 2
Family Caregiver Support Interventions’ Effectiveness Before and During the COVID-19 Pandemic
Linton, K. F., Aharon-Ezer, J., Ramirez, M., Hodge, M., Hernandez, R., Supple, K., Rumbo, B., & Kao, R. (2023) · Social Work in Public Health · doi:10.1080/19371918.2023.2259896 · Cited by 2
“The 11-item Zarit Burden Interview was used after the COVID-19 pandemic, which has demonstrated the validity and test–retest reliability (α = .89; Seng et al., 2010).”
MethodRhodes, E., Mechanic-Hamilton, D. J., Phillips, J. S., Bahena, A., Vitali, N., Hlava, Q., Cook, P. A., Gee, J. C., Grossman, M., McMillan, C. T., et al. (2023) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acad079 · Cited by 2
Ju, E., Guo, Y., Burton, C. W., Kim, J. J., & Lee, J. (2024) · Research in Gerontological Nursing · doi:10.3928/19404921-20240911-03 · Cited by 2
Liang, W., Cao, S., Suo, Y., Zhang, L., Yang, L., Wang, H., Wang, H., & Jin, X. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-03590-x · Cited by 2
“ZBI-22 has been used to assess the caregiver burden of different populations including NF1 patients and proved to be valid and reliable [50–55].”
Chung, Y.-E., Angus, D. E., & Backman, C. (2020) · Journal of Primary Care & Community Health · doi:10.1177/2150132720940504 · Cited by 2
“Interpretation of scores is as the following: “little or no burden” (0-20), “mild to moderate burden” (21-40), “moderate to severe burden” (41-60), and “severe burden” (61-88).”
BackgroundThe role of GPs in helping caregivers of persons with dementia
Chai, D. S. C., & Kiat, P. Y. L. (2013) · The Singapore Family Physician · Cited by 2
KELOMPOK DUKUNGAN UNTUK CAREGIVER ORANG DENGAN SKIZOFRENIA
Menaldi, A., & Dewi, H. C. (2019) · Jurnal Psikologi · doi:10.14710/jp.18.1.13-28 · Cited by 2
Kaliya-Perumal, A.-K., Korlakunta, A., Kharlukhi, J., & Devireddy, S. (2020) · Korean Journal of Family Medicine · doi:10.4082/kjfm.19.0063 · Cited by 2
The Effect of Seoul Dementia Healing Design Project on Cognition and Social Engagement
Chun, M. Y., Hwang, J., Yun, J. Y., Sim, G. Y., Choi, G.-S., Kim, G. H., & Jeong, J. H. (2020) · Dementia and Neurocognitive Disorders · doi:10.12779/dnd.2020.19.4.140 · Cited by 2
El-Soud, F. A. A., Alotaibi, M. N., Suhaim, E. M. B., & Alotaibi, N. A. (2020) · International Journal of Nursing Research · doi:10.31690/ijnr/96 · Cited by 2
Caregiver Burden and Psychiatric Morbidity Among Caregivers of Children with Thalassemia Major
Prajapati, N., Samani, M. J., & Jani, A. M. (2021) · Annals of Indian Psychiatry · doi:10.4103/aip.aip_95_20 · Cited by 2
Caregiver burden assessment of children with neurodevelopmental disorders in a tertiary care centre
Narayan, A., & Kesavan, A. (2023) · IP International Journal of Medical Paediatrics and Oncology · doi:10.18231/j.ijmpo.2023.011 · Cited by 2
Byun, E. (2013) · ScholarlyCommons (University of Pennsylvania) · Cited by 2
Metadata
- 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)
- 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)
- 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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