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Factors associated with anxiety, stress, depression and burden among informal caregivers of patients with dementia: a cross-sectional study

Sofía Garrido,Sónia Teixeira,Gerard Mora-Lopez,Francisco Sampaio

Published 2025 in BMC Nursing

ABSTRACT

In Europe, demographic ageing and an increase in the prevalence of dementia are expected. Portugal, along with other Mediterranean and Southeastern European countries, exceeds the European trend placing growing pressure on health and social care systems. Informal caregivers play a crucial role in meeting these demands, despite the impact on their own mental health. The emerging and multifaceted nature of informal caregiving, combined with the limited evidence from Southern European contexts, motivated this study. This research aimed (1) to identify the levels of anxiety, stress, depressive symptoms, and burden among informal caregivers of people with dementia in Portugal, and (2) to identify which sociodemographic and/or clinical factors are associated with anxiety, depression, stress symptoms, and burden in these caregivers. A survey was conducted among informal caregivers of non-institutionalized dementia patients. The survey encompassed a sociodemographic and clinical assessment using the Positive Mental Health Questionnaire (PMHQ), the Psychological Vulnerability Scale (PVS), the Caregiver Burden Scale (CBS), and the Depression, Anxiety, and Stress Scale – 21 items (DASS21). Linear regressions were performed using caregivers’ data on depression, anxiety, stress, and burden as dependent variables. A total of 414 caregivers participated. They exhibited normal intensity of depression, anxiety, and stress symptomatology. Several variables significantly related to these outcomes were identified and quantified. The mean CBS score was 54.3 ± 17.8 (range 22–110) and was associated to caregiver age, years in the caregiver role, hours of daily care, and participation in leisure or relaxation activities. Positive mental health and psychological vulnerability were significant explanatory factors for all assessed outcomes. Greater time dedicated to caregiving and reduced engagement in leisure or relaxation activities were significantly associated with higher burden. The level of positive mental health is a robust associated factor of mental health issues among caregivers.

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