ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

eISSN: 3023-655X
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Relationship between caregiver burden and levels of depression, anxiety, and stress among palliative care caregivers
Abstract
Aims: To assess the relationship between caregiver burden and levels of depression, anxiety, and stress among primary caregivers of patients hospitalized in a palliative care unit.
Methods: In this descriptive cross-sectional study, 96 primary caregivers were enrolled. Data were obtained through face-to-face interviews using a sociodemographic data form, the 19-item Zarit Caregiver Burden Interview (ZBI-19), and the Depression Anxiety Stress Scale-21 (DASS-21). Nonparametric group comparisons were conducted with the Mann–Whitney U test and the Kruskal–Wallis test, followed by appropriate post-hoc pairwise analyses when needed. Relationships between variables were assessed using Spearman’s rank correlation. Independent predictors of caregiver burden were identified using multiple linear regression models.
Results: Participants were predominantly female (72.9%), married (72. 9%), and unemployed (58.3%), with a mean age of 52.2 ± 11.7 years. Moderate-to-extremely severe symptoms were observed in 31.3% for depression, 39.6% for anxiety, and 18.8% for stress. Moderate-to-severe and severe caregiver burden was present in 33.3%. Female sex was associated with higher depression and anxiety scores, whereas unemployment, lower education, and lower income level were associated with higher psychological distress and higher caregiver burden (p < 0.05). In multivariable analysis, higher depression scores (p < 0.001) and longer caregiving duration (p = 0.050) independently predicted increased caregiver burden, explaining nearly half of the variance in burden scores.
Conclusion: Primary caregivers in palliative care experience substantial psychological distress and caregiver burden, particularly those with socioeconomic vulnerabilities. Depression severity and caregiving duration are key determinants, highlighting the need for routine screening and targeted psychosocial support in clinical practice.

Keywords : Palliative care, caregivers, caregiver burden, depression, anxiety, stress

Download Article


1. World Health Organization. Palliative care [Internet]. 5 August 2020. Accessed October 15, 2025. https://www.who.int/news-room/fact-sheets/detail/palliative-care
2. Surges SM, Brunsch H, Jaspers B, et al. Revised European Association for Palliative Care (EAPC) recommended framework on palliative sedation: an international Delphi study. <em>Palliat Med</em>. 2024;38(2):213-228. doi: <a href="https://doi.org/10.1177/02692163231220225">10.1177/02692163231220225</a>
3. Kircher CE, Hanna TP, Tranmer J, et al. Defining “early palliative care” for adults diagnosed with a life-limiting illness: a scoping review. <em>BMC Palliat Care</em>. 2025;24(1):93. doi: <a href="https://doi.org/10.1186/s12904-025-01712-7">10.1186/s12904-025-01712-7</a>
4. Kaya Akdoğan H, İlhan N. Factors associated with caregiver burden in family caregivers of older adults: a cross-sectional study. <em>Florence Nightingale J Nurs</em>. 2024;32(3):254-260. doi: <a href="https://doi.org/10.5152/FNJN.2024.24090">10.5152/FNJN.2024.24090</a>
5. Losada-Baltar A, Márquez-González M, Mausbach BT, et al. Longitudinal support to the sociocultural stress and coping model. A 4-year follow-up of family caregivers of people with dementia. <em>Int Psychogeriatr</em>. 2025;37(4):100079. doi: <a href="https://doi.org/10.1016/j.inpsyc.2025.100079">10.1016/j.inpsyc.2025.100079</a>
6. Chang HY, Chiou CJ, Chen NS. Impact of mental health and caregiver burden on family caregivers’ physical health. <em>Arch Gerontol Geriatr</em>. 2010;50(3):267-271. doi: <a href="https://doi.org/10.1016/j.archger.2009.04.006">10.1016/j.archger.2009.04.006</a>
7. Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden. <em>JAMA</em>. 2014;311(10):1052. doi: <a href="https://doi.org/10.1001/jama.2014.304">10.1001/jama.2014.304</a>
8. Liu Z, Heffernan C, Tan J. Caregiver burden: a concept analysis. <em>Int J Nurs Sci</em>. 2020;7(4):438-445. doi: <a href="https://doi.org/10.1016/j.ijnss.2020.07.012">10.1016/j.ijnss.2020.07.012</a>
9. Karimi Moghaddam Z, Rostami M, Zeraatchi A, Mohammadi Bytamar J, Saed O, Zenozian S. Caregiving burden, depression, and anxiety among family caregivers of patients with cancer: an investigation of patient and caregiver factors. <em>Front Psychol</em>. 2023;14. doi: <a href="https://doi.org/10.3389/fpsyg.2023.1059605">10.3389/fpsyg.2023.1059605</a>
10. del-Pino-Casado R, Priego-Cubero E, López-Martínez C, Orgeta V. Subjective caregiver burden and anxiety in informal caregivers: a systematic review and meta-analysis. <em>PLoS One</em>. 2021;16(3):e0247143. doi: <a href="https://doi.org/10.1371/journal.pone.0247143">10.1371/journal.pone.0247143</a>
11. Celik E, Aslan MS, Sengul Samanci N, et al. The relationship between symptom severity and caregiver burden in cancer patients under palliative care: a cross-sectional study. <em>J Palliat Care</em>. 2022;37(1):48-54. doi: <a href="https://doi.org/10.1177/08258597211045780">10.1177/08258597211045780</a>
12. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. <em>Behav Res Methods</em>. 2009;41(4):1149-1160. doi: <a href="https://doi.org/10.3758/BRM.41.4.1149">10.3758/BRM.41.4.1149</a>
13. Litzelman K, Berghoff A, Stevens J, Kwekkeboom K. Predictors of psychoneurological symptoms in cancer caregivers over time: role of caregiving burden, stress, and patient symptoms. <em>Supportive Care in Cancer</em>. 2023;31(5):274. doi: <a href="https://doi.org/10.1007/s00520-023-07741-3">10.1007/s00520-023-07741-3</a>
14. Güdük Ö, Selimoğlu Namoğlu S, Tekin BN. The relationship of care burden, stress and perceived social support of relatives of patients receiving hemodialysis treatment: a cross-sectional research. <em>Turkiye Klin J Health Sci. </em>2022;7(2):544-553. doi: <a href="https://doi.org/10.5336/healthsci.2021-85223">10.5336/healthsci.2021-85223</a>
15. Özlü A, Yıldız M, Aker T. Zarit Bakıcı Yük Ölçeğinin şizofreni hasta yakınlarında geçerlilik ve güvenilirlik çalışması. <em>Nöropsikiyatri Arşivi</em>. 2009;46:38-42. doi: 10.1093/geront/20.6.649
16. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. <em>Gerontologist</em>. 1980;20(6):649-655. doi: <a href="https://doi.org/10.1093/geront/20.6.649">10.1093/geront/20.6.649</a>
17. SARıÇAM H. The psychometric properties of Turkish version of Depression Anxiety Stress Scale-21 (DASS-21) in community and clinical samples.<em> J Cognitive-Behav Psychotherapy Res</em>. 2018:1. doi: <a href="https://doi.org/10.5455/JCBPR.274847">10.5455/JCBPR.274847</a>
18. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. <em>Behav Res Ther</em>. 1995; 33(3):335-343. doi: <a href="https://doi.org/10.1016/0005-7967(94)00075-U">10.1016/0005-7967(94)00075-U</a>
19. Soh XC, Hartanto A, Ling N, Reyes M, Sim L, Majeed NM. Prevalence of depression, anxiety, burden, burnout, and stress in informal caregivers: an umbrella review of meta-analyses. <em>Arch Gerontol Geriatr Plus.</em> 2025;2(3):100197. doi: <a href="https://doi.org/10.1016/j.aggp.2025.100197">10.1016/j.aggp.2025.100197</a>
20. Duran S, KaynaK S, Karadas A. Depression, anxiety and stress levels in caregivers of palliative patients: a descriptive, cross-sectional study. <em>Fam Pract Palliat Care</em>. 2019;4(3):120-125. doi: <a href="https://doi.org/10.22391/fppc.532571">10.22391/fppc.532571</a>
21. Ekiz M, Özçelik H. Palyatif bakım alan hasta yakınlarının bakıma hazır olma düzeyleri ve bakım yüklerinin belirlenmesi. <em>Health Care Acad. J</em>. 2024;11(3):215-222. doi: <a href="https://doi.org/10.52880/sagakaderg.1439491">10.52880/sagakaderg.1439491</a>
22. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Palliative Care. Version 2.2025 [Internet]. Fort Washington (PA): NCCN; 2025. Accessed October 15, 2025. https://www.nccn.org/guidelines/guidelines-detail?id=1454
23. Ankri J, Andrieu S, Beaufils B, Grand A, Henrard JC. Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. <em>Int J Geriatr Psychiatry</em>. 2005;20(3):254-260. doi: <a href="https://doi.org/10.1002/gps.1275">10.1002/gps.1275</a>
24. Bussè C, Barnini T, Zucca M, et al. Depression, anxiety and sleep alterations in caregivers of persons with dementia after 1-year of COVID-19 pandemic. <em>Front Psychiatry</em>. 2022;13. doi: <a href="https://doi.org/10.3389/fpsyt.2022.826371">10.3389/fpsyt.2022.826371</a>
25. Wagle S, Yang S, Osei EA, Katare B, Lalani N. Caregiving intensity, duration, and subjective financial well-being among rural informal caregivers of older adults with chronic illnesses or disabilities. <em>Healthcare</em>. 2024;12(22):2260. doi: <a href="https://doi.org/10.3390/healthcare12222260">10.3390/healthcare12222260</a>
26. Public Policy Institute A, National Alliance for Caregiving the. National Alliance for Caregiving (NAC), AARP. Caregiving in the U.S. 2025. doi: <a href="https://doi.org/10.26419/ppi.00373.001">10.26419/ppi.00373.001</a>
27. Kushlev K, Dunn EW, Lucas RE. Higher income is associated with less daily sadness but not more daily happiness. <em>Soc Psychol Personal Sci</em>. 2015;6(5):483-489. doi:<a href="https://doi.org/10.1177/1948550614568161">10.1177/1948550614568161</a>
28. Schieman S, Whitestone YK, Van Gundy K. The nature of work and the stress of higher status. <em>J Health Soc Behav</em>. 2006;47(3):242-257. doi: <a href="https://doi.org/10.1177/002214650604700304">10.1177/002214650604700304</a>
29. Barrero-Mejias MA, Gómez-Martínez S, González-Moreno J, Rueda-Extremera M, Izquierdo-Sotorrio E, Cantero García M. Effectiveness of psychological interventions for reducing depressive symptomatology and overload and improving quality of life in informal caregivers of non-institutionalized dependent elderly: a systematic review. <em>Front Med (Lausanne)</em>. 2024;11:1394640. doi: <a href="https://doi.org/10.3389/fmed.2024.1394640">10.3389/fmed.2024.1394640</a>
30. Wang Z, Yu S, Liu Y, Han Y, Zhao W, Zhang W. Effectiveness of family centred interventions for family caregivers: a systematic review and meta-analysis of randomized controlled trials. <em>J Clin Nurs</em>. 2024;33(5): 1958-1975. doi: <a href="https://doi.org/10.1111/jocn.17091">10.1111/jocn.17091</a>
Article available in :
Volume 5, Issue 4, 2026
Page : 102-108
https://doi.org/10.51271/ANKMJ-0077
Article Information
Received : 06 Mar 2026
Accepted : 23 Apr 2026
Published : 06 Oct 2026
Corresponding Author :

Gamze Gülşen Eryılmaz: Department of Family Medicine, İzmir City Hospital, İzmir, Turkiye

[email protected]
Citation : Eryılmaz GG, Tuncer Ö, Eryılmaz İ. Relationship between caregiver burden and levels of depression, anxiety, and stress among palliative care caregivers. Ank Med J. 2026;5(4):102-108. doi: 10.51271/ANKMJ-0077

Read: 5
Download : 1
Cited: 0
_Footer