Review Article| Volume 16, ISSUE 12, P1034-1041, December 01, 2015

Prevalence of Mental Health Disorders Among Caregivers of Patients With Alzheimer Disease



      The overall prevalence of mental health disorders among caregivers of patients with Alzheimer disease (AD) remains unclear. This meta-analysis aims to evaluate the prevalence of various mental health disorders among caregivers of patients with AD globally and to determine factors that predispose to development of the aforementioned, namely gender of caregiver, gender of patient, and caregiver-patient relationship.


      A total of 17 studies were eligible for systematic review and meta-analysis. A meta-analysis of published work was performed using the random effect model. Data analysis was done with RevMan 5.3. A total of 10,825 caregivers were assessed.


      The aggregate prevalence of depression among caregivers was 34.0%, anxiety at 43.6%, and use of psychotropic drugs at 27.2%. Meta-analysis revealed the odds of having of depression was 1.53 times higher in female caregivers (95% confidence interval [CI] 1.29–1.83; I2 = 7%; Z = 4.78; P < .001), 1.86 times higher in caregivers to male care-recipients (95% CI 1.66–2.08; I2 = 40%; Z = 10.86; P < .001), and 2.51 times higher in spousal caregivers (95% CI 1.68–3.76; I2 = 55%; Z = 4.49; P < .001).


      Caregivers of patients with AD have a higher prevalence of mental health disorders, particularly depression and anxiety, as compared with the general population and with their counterparts caring for patients with other illnesses. The higher prevalence is mainly observed in female caregivers, caregivers with male care-recipients, and caregivers who have a spousal relationship with care-recipients. Prevalence of anxiety was also notably higher in this cohort but more research needs to be done in this area.


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        • Zarit S.
        • Orr N.
        • Zarit J.
        The hidden victims of Alzheimer’s Disease: Families under stress.
        New York University Press, New York, NY1985
        • Gonzalez-Salvador M.T.
        • Arango C.
        • Lyketsos C.G.
        • Barba A.C.
        The stress and psychological morbidity of the Alzheimer patient caregiver.
        Int J Geriatric Psychiatry. 1999; 14: 701-710
        • Alzheimers Association
        2015 Alzheimer’s disease facts and figures.
        Alzheimers Dement. 2015; 11: 332-384
        • Eagles J.M.
        • Craig A.
        • Rawlinson F.
        • et al.
        The psychological well-being of supporters of the demented elderly.
        Br J Psychiatry. 1987; 150: 293-298
        • Pinquart M.
        • Soerensen S.
        Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis.
        Psychol Aging. 2003; 18: 250-267
        • Blansjaar B.A.
        • Thomassen R.
        • Van Schaick H.W.
        Prevalence of dementia in centenarians.
        Int J Geriatr Psychiatry. 2000; 15: 219-225
        • Aguglia E.
        • Onor M.
        • Trevisiol M.
        • et al.
        Stress in the caregivers of Alzheimer’s patients: An experimental investigation in Italy.
        Am J Alzheimers Dis Other Demen. 2004; 19: 248-252
        • Terry R.
        • Salmon P.
        World Development Report.
        Oxford, New York1993
        • Pearlin L.
        • Mullan J.
        • Semple S.J.
        • et al.
        Caregiving and the stress process: An overview of concepts and their measure.
        Gerontologist. 1990; 30: 583-595
        • Covinsky K.
        • Newcomer R.
        • Fox P.
        • et al.
        Patient and caregiver characteristics associated with depression in caregivers of patients with dementia.
        J Gen Intern Med. 2003; 18: 1006-1014
        • Colvez A.
        • Joel M.E.
        • Ponton-Sanchez A.
        • Royer A.C.
        Health status and work burden of Alzheimer patients’ informal caregivers, Comparison of five difference care programs in the European Union.
        Health Policy. 2002; 60: 219-233
        • Garcia-Alberca J.M.
        • Cruz B.
        • Lara J.P.
        Anxiety and depression are associated with coping strategies in caregivers of Alzheimer’s disease patients: results from the MALAGA-AD study.
        Int Psychogeriatr. 2012; 24: 1325-1334
        • Mahoney R.
        • Regan C.
        • Katona C.
        • Livingston G.
        Anxiety and Depression in Family Caregivers of People With Alzheimer Disease: The LASER-AD Study.
        The American Journal of Geriatric Psychiatry. 2005; 13: 795-801
      1. Joanna Briggs Institute. Welcome. Available at: Accessed May 29, 2015.

        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Berger G.
        • Bernhardt T.
        • Weimer E.
        • et al.
        Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients.
        J Geriatr Psychiatry Neurol. 2005; 18: 119-128
        • Marcus M.
        • Taghi Yasamy M.
        • van Ommeren M.
        • et al.
        Depression: A global public health concern.
        World Health Organization, 2012 (Available at:) (Accessed May 28, 2015)
        • Thunyadee C.
        • Sitthimongkoi Y.
        • Sangon S.
        • et al.
        Predictors of depressive symptoms and physical health in caregivers of individuals with schizophrenia.
        J Nurs Health Sci. 2015; 17: 412-419
        • Atteih S.
        • Mellon L.
        • Hail P.
        • et al.
        Implications of stroke for caregiver outcomes: Findings from the ASPIRE-S study.
        Int J Stroke. 2015; 10: 918-923
        • Clyburn L.D.
        • Stones M.J.
        • Hadjistavropoulos T.
        • Tuokko H.
        Predicting caregiver burden and depression in Alzheimer’s disease.
        J Gerontol. 2000; 55B: S2-S13
        • Bell C.M.
        • Saraki S.
        • Neumann P.J.
        The association between caregiver burden and caregiver health-related quality of life in Alzheimer’s disease.
        Alzheimer Dis Assoc Disord. 2001; 15: 129-136
        • Conde-Sala J.L.
        • Garre-Olmom J.
        • Turro-Garriga O.
        • et al.
        Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer’s disease: An exploratory comparative design.
        Int J Nurs Stud. 2010; 47: 1262-1273
        • Coen R.F.
        • O’Boyle C.A.
        • Coakley D.
        • Lawlor B.A.
        Individual quality of life factors distinguishing low-burden and high-burden caregivers of dementia patients.
        Dement Geriatr Cogn Disord. 2012; 13: 164-170
        • Andren S.
        • Elmstahl S.
        Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: A cross-sectional community-based study.
        Int J Nurs Stud. 2007; 44: 435-446
        • Molyneux G.J.
        • McCarthy G.M.
        • McEniff S.
        • et al.
        Prevalence and predictors of carer burden and depression in carers of patients referred to an old age psychiatric service.
        Int Psychogeriatr. 2008; 20: 1193-1202
        • Berger G.
        • Bernhardt T.
        • Weimer E.
        Longtitudinal study on the Relationship Between Sympatomatology of Dementia and Levels of subjective Burden and Depression Among Family Caregivers in Memory Clinic patients.
        J Geriatr Psychiatry Neurol. 2005; 18: 119-128
        • Coon D.W.
        • Rubert M.
        • Solano N.
        Well-being, appraisal, and coping in Latina and Caucasian female dementia caregivers: findings from the REACH study.
        Aging Ment Health. 2004; 8: 330-345
        • Garcia-Alberca J.M.
        • Lara J.P.
        • Betheir M.L.
        Anxiety and Depression in caregivers are associated with patient and caregiver characteristics in Alzheimer’s Disease.
        Int J Psychiatry Med. 2011; 41: 57-69
        • Haley W.E.
        • Gitlin L.N.
        • Wisniewski S.R.
        Well-being, appraisal, and coping in African-American and Caucasian dementia caregivers: findings from the REACH study.
        Aging & Mental health. 2010; 8: 316-329
        • Jang Y.
        • Clay O.J.
        • Roth D.L.
        • et al.
        Neuroticism and Longitudinal Change in Caregiver Depression: Impact of a Spouse-Caregiver Intervention Program.
        Gerontologist. 2004; 44: 311-317
        • Luchsinger J.A.
        • Tipiani D.
        • Torres-Patino G.
        Characteristics and Mental Health of Hispanic Dementia Caregivers in New York City.
        Am J Alzheimers Dis Other Dement. 2015; 30: 584-590
        • Papastavrau E.
        • Andreou P.
        • Nicos M.
        Factors associated with quality of life among family members of patients with dementia in Cyprus.
        Int Psychogeriatr. 2014; 26: 443-452
        • Roth D.L.
        • Ackerman M.L.
        • Okonkwo O.C.
        • Burgio L.D.
        The Four-Factor Model of Depressive Symptoms in Dementia caregivers: A Structural Equation Model of Ethnic Differences.
        Psychol Aging. 2008; 23: 567-576
        • Sansoni J.
        • Vellone E.
        • Piras G.
        Anxiety and depression in community-dwelling, Italian Alzheimer’s disease caregivers.
        Int J Nurs Pract. 2004; 10: 93-100
        • Shua-Heim J.R.
        • Haim T.
        • Shi Y.
        Depression among Alzheimer’s caregivers: identifying risk factors.
        Am J Alzheimers Dis Other Demen. 2001; 16: 353-359
        • Truzzi A.
        • Valente L.
        • Ulstein I.
        Burnout in familial caregivers of patients with dementia.
        Rev Bras Psiquiatr. 2012; 32: 405-412
        • Valente L.E.
        • Truzzi A.
        • Souza W.F.
        Health self-perception by dementia family caregivers.
        Arq Neuropsiquiatr. 2011; 69: 739-744
        • Wisniewski S.R.
        • Belle S.H.
        • Marcus S.M.
        The Resources for Enhancing Alzheimer’s Caregiver Health (REACH): Project Design and Baseline Characteristics.
        Psychol Aging. 2003; 18: 375-384
        • Montgomery R.J.
        • Kosloski K.
        A longitudinal analysis of nursing home placement for dependent elders cared for by spouses vs. adult children.
        J Gerontol A Soc Sci Psychol Sci. 1994; 49: S62-S74
        • Rinaldi P.
        • Spazzafumo L.
        • Mastriforti R.
        • et al.
        Predictors of high level of burden and distress in caregivers of demented patients: Results of an Italian multicentre study.
        Int J Geriatr Psychiatry. 2005; 20: 168-174
        • Serrano-Aguilar P.G.
        • Lopez-Bastida J.
        • Yanes-Lopez V.
        Impact on health-related quality of life and perceived burden of informal caregivers of individuals with Alzheimer’s disease.
        Neuroepidemiology. 2006; 27: 136-142
        • Ennis N.
        • Rosenbloom B.N.
        • Canzian S.
        • Topolovec-Vranic J.
        Depression and anxiety in parent versus spouse caregivers of adult patients with traumatic brain injury: A systematic review.
        Neuropsychol Rehabil. 2013; 23: 1-18
        • Breslau N.
        • Schlutz L.
        • Peterson E.
        Sex differences in depression: A role of pre-existing anxiety.
        Psychiatry Res. 1995; 1: 1-12
        • Canino G.J.
        • Bird H.R.
        • Shrout P.E.
        • et al.
        The prevalence of specific psychiatric disorders in Puerto Rico.
        Arch Gen Psychiatry. 1987; 44: 727-735
        • Kessler R.X.
        • McGonagle K.A.
        • Zhao S.
        • et al.
        Lifetime and 12 month prevalence of DSM-HI-R psychiatric disorders in the United States.
        Arch Gen Psychiatry. 1994; 51: 8-19
        • Weissman M.M.
        • Bland R.
        • Joyce P.R.
        • et al.
        Sex differences in rates of depression: Cross-national perspectives.
        J Affect Disord. 1993; 29: 77-84
        • Gray A.L.
        • Hyde T.M.
        • Deep-Soboslay A.
        • et al.
        Sex differences in glutamate receptor gene expression in major depression and suicide.
        Mol Psychiatry. 2015; 20: 1057-1068
        • Silverstein B.
        • Lynch A.D.
        Gender differences in depression: The role played by paternal attitudes of male superiority and maternal modelling of genderrelated limitations.
        Sex Roles. 1998; 38: 539-555
        • Savva G.M.
        • Zaccai J.
        • Matthews F.E.
        • et al.
        Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population.
        Br J Psychiatry. 2009; 194: 212-219