J Cross Cult Gerontol (2015) 30:439–450

DOI 10.1007/s10823-015-9274-9

O R I G I N A L A RT I C L E

Psychiatric Morbidity and Subjective Burden

Among Carers of Outpatients of a Psychogeriatric
Clinic in Southwestern Nigeria

Olukayode Abayomi 1 & Akinwande O Akinhanmi 2 &

Adegoke O Adelufosi 1

Published online: 24 October 2015

# Springer Science+Business Media New York 2015

Abstract Few studies in Nigeria have investigated the burden of caring for elderly persons with
mental illness. The aim of this study was to examine psychiatric morbidity and burden of care
among caregivers of outpatients of a psychogeriatric clinic. Burden of care was evaluated with
Zarit Burden Interview. A questionnaire was also used to elicit caregivers’ sociodemographic
and caregiving variables while psychological well-being was assessed with the General Health
Questionnaire (GHQ). Overall, 52.3 % had high care burden. High care burden was associated
with financial difficulty (χ2 =9.37; df=1; p=0.002; OR=3.1; 95 % CI=1.50–6.4), restrictions
on caregivers’ social activity (χ2 =4.87; df=1; p=0.027; OR=2.4; 95 % CI=1.09–5.27), lack of
support from relatives (χ2 =6.85; df=1; p=0.009; OR=6.3; 95 % CI=1.35–29.6), physical
health problems (χ2 =10.52; df=1; p=0.001; OR=4.7; 95 % CI=1.75–12.7), and psychiatric
morbidity (χ2 =4.05; df=1; p=0.044; OR=2.62; 95 % CI=1.00–6.85). Psychiatric morbidity
was predicted by physical health problems (OR=3.0; 95 % CI=1.1–8.1), financial difficulty
(OR=17.2; 95 % CI=3.8–77.5), and job loss (OR=5.3; 95 % CI=2.0–13.8). Care burden is a
significant problem among caregivers of elderly persons with mental illness attending the clinic.
This may have important implications for the mental well-being of the patients.

Keywords Psychiatric morbidity . Caregiver . Subjective burden . Geriatric . Nigeria

Introduction

Globally, the proportion of persons aged 60 years or over is expected to increase from
12 % in 2014 to 21 % by 2050 (United Nations Report Population Division 2014). A

* Olukayode Abayomi
abayomikay@gmail.com

1
Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
2
Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria
440 J Cross Cult Gerontol (2015) 30:439–450

review of the global demographic profile showed that irrespective of geographic location,
the oldest (persons aged 80 years and above) constitute the fastest growing proportion of
the population (United Nations Report Population Division 2014. In order to meet
important physical and psychological needs, many elderly people with chronic illnesses
are dependent on others (Pinquart and Sörensen 2003; Fortinsky et al. 2007). While a
formal framework of support is provided for the elderly in developed countries, there is a
lot of reliance on informal systems (i.e., the extended family) in developing countries.
This is due to the dearth of institutions and specialist manpower for taking care of the
elderly in such countries (Abdulraheem 2005; Ferreira and Kalula 2009). The material,
emotional, and social support available to the mentally ill and elderly are often limited to
family members who provide caregiving for extended periods of time (Ohaeri 2001).
Caregiving is a normal family activity. Nevertheless, the demands of chronic illnesses
often exceed boundaries of normal or usual care. This is because caregiving in chronic
illness involves a significant expenditure of time and energy over extended periods of time
and involves unpleasant tasks. Often, the caregiver fails to anticipate this role which may
exacerbate the stress (Donaldson and Burns 1999; Schultz and Sherwood 2008).
Caring for the elderly often impacts significantly on the caregiver’s personal, social,
and work life (Brody 1985; Robison et al. 2009). It is described as a stressful experience
that may severely affect the physical and psychological health of the caregiver
(Aneshensel et al. 1995; Schultz and Sherwood 2008). According to Fredman et al.
(1995), caregiver burden is the negative psychological, economic, and physical effects
of caring for a person who is impaired. The burden of care giving can be attributed to the
care recipient’s behavior problems, his or her physical and cognitive impairments, and the
amount of care provision involved (Pinquart and Sörensen 2003). Since caregiving,
regardless of a variety of situational variables, appears to involve significant mental health
risks, greater understanding of the mechanisms through which it promotes mental illness is
critical, especially as the population ages (Dura et al. 1991).
In countries marked by lower income and higher poverty rates, the burden of caregiving
may be relatively high (Aranda and Knight 1997). This may sometimes be influenced by
ethnic differences (Sorensen and Pinquart 2005). In several countries, informal caregivers
play a significant role in supporting persons with functional disabilities (Robison et al.
2009). Caregivers in developing countries like Nigeria experience burden in caring for the
mentally ill despite their extended family system and more supportive family atmosphere
(Martyne- Yellowe 1992). Though the burden of care is alleviated through social welfare
programs in industrialized countries, this is not available in Nigeria. Many developed
countries have established care support programs for the disabled elderly, e.g., Carers UK,
(www.carersUK.org). These organizations aim to increase public awareness, influence
policies, and stimulate caregiver research and interventions. Despite the acknowledged
role of such support groups, structured support for the elderly and those with mental illness
is virtually nonexistent in many developing countries (National Mental Health 1991;
Baiyewu et al. 1997).
Many patients living in the community need a lot of practical help and emotional
support in order to manage their everyday lives. Given the limited resources available in
developing countries, support is often provided by the family members of the person
(Oche 2009). Unfortunately, the resources and support available through the traditionally
strong extended family system in developing countries have been depleted by political
instability, acculturation (e.g., urbanization and education), and poverty (Ohaeri 1998).
J Cross Cult Gerontol (2015) 30:439–450 441

Therefore, caring for patients with severe mental illness, particularly in the community, is
becoming increasingly challenging. The result is that family members experience
caregiving-related burden and distress (Oche 2009).
In examining the psychopathological consequences of caregiving for mentally ill
geriatric patients, this study focused on care burden and psychiatric morbidity in
caregivers.

Methods

The study was carried out at the outpatient clinic of the Neuropsychiatric Hospital Aro,
Abeokuta, Ogun State, Nigeria. This is a Federal Government-owned psychiatric hospital
established in 1954. Even though it has a nationwide catchment area, majority (89 %) of its
patients are from southwestern Nigeria (Neuropsychiatric Hospital report 2010). It pro-
vides in-patient, outpatient, and 24-h emergency services to mentally ill patients and
primary care facilities to neighboring communities. It has a psychogeriatric clinic
established in July 2008. All patients aged 60 years and above are referred to this clinic.
Most of the attending patients have major psychiatric disorders including schizophrenia,
affective disorders, and dementia. At the time of the study, 179 geriatric patients attended
the clinic which runs twice a week. On each clinic day, the average attendance was 20
patients. Data collection occurred over a 7-month period (December 2010–June 2011). For
the purpose of this study, a caregiver was defined as someone who through family
relationship or friendship provides unpaid care by looking after a frail older person or
someone with a disability or chronic illness (Australian Department of Health and Ageing
2006). Caregivers of consecutive patients that were at least 60 years old and had been ill
for at least 6 months were recruited. The caregivers also met the following inclusion
criteria:

Shared the same living arrangements with care recipient for at least 3 months before
interview.
Monitored or assisted with the household and social tasks and/or self-care functions.
Spent a minimum of 4 h a week caring for the patient.

Using Fishers’ sample size formula (n= Z2pq/d2, where p=prevalence, Z= standard
normal deviate, d was the degree of accuracy, and q=1−p), a minimum size of 122 was
calculated (Araoye 2003). This was increased by 10 % (134) to allow for possible refusal,
missing, or inconsistent results
The case notes of outpatients were sorted after registration at medical records depart-
ment. All patients aged 60 years and above were initially recruited after ascertaining the
age. Each eligible outpatient was approached, and verbal informed consent was obtained
after stating the study objectives. Patients and their caregivers who met the inclusion
criteria were recruited consecutively from the outpatient clinic until the required sample
size was reached. Anonymity and confidentiality was assured by using serial numbering of
questionnaires instead of names.
The ICD-10 research criteria were used to confirm the case note diagnosis. Ethical
approval was obtained from the Research Ethics Committee of the Neuropsychiatric
Hospital, Abeokuta.
442 J Cross Cult Gerontol (2015) 30:439–450

Instruments

Interview Schedule for Primary Caregiver

This interview schedule covered caregiver’s sociodemographic characteristics and care-

giving experience. It also assessed living arrangements, number of other disabled relatives,
number of relatives in a position to offer support, how often this was available, and if not,
why it was not available.
This was divided into two sections A and B drawn up by the researcher.

Section A (Sociodemographic): Items 1–9 covered caregiver’s sociodemographic charac-

teristics such as age, sex, religion, ethnicity, marital status, occupation, and employment status.

Section B (Caregiving Experience): Items 1–10 dealt with caregiver’s relationship with
index patient; the quality of this relationship was further rated by caregiver as Bpoor,^
Bfair,^ Bgood,^ and Bexcellent.^ It was adapted from the Quality of Life for patients with
Alzheimer’s disease (Qol-AD) scale (Lodgsdon et al. 1999). It also included a question,
BWhat was the main kind of care that you provided for the patient?^ Responses included a
list of self-care tasks (e.g., bathing), household tasks (e.g., washing and meal preparation),
and financial tasks. The median caregiving duration was used to dichotomize responses
into short duration of care (those that had spent less or equal to the median duration of
caregiving) and long duration of care (those that had spent more than the median duration
of care). To assess impact on caregivers, questions asked included BDo you have difficulty
financing patient’s upkeep?^ and BHave you given up any employment, trade, or activity
to care for the patient?^

Zarit Burden Interview

The Zarit Burden Interview (ZBI) is a 22-item instrument widely used to assess the level of
burden in caregivers. It evaluates five domains of caregiver burden, i.e., burden in the
relationship, emotional well-being, social life, finances, and loss of control over one’s life
(Zarit et al. 1980) These domains examine the impact of caregiving on different aspects of
the caregiver’s life.
In determining the level of caregiver burden, the total ZBI scores were further divided into
two: caregivers that had equal or more than the median ZBI score were classified as having
high burden of care while those with scores below the median ZBI scores were classified as
having low burden of care (Nuhu et al. 2010). This instrument has been validated and used in
Nigeria (Ukpong 2006; Akinbiyi 2001). It has been reported to have good internal consistency
(0.88–0.91) and construct validity (0.71) (Zarit et al. 1980). The ZBI had high internal
consistency (0.86) and correlated moderately with the General Health Questionnaire (r=0.42;
p<0.0001). A mean ZBI score of 18.3 (SD=13) and a median of 16 (range 0–59) were found.

General Health Questionnaire Version 28

The General Health Questionnaire (GHQ) (Goldberg and Hiller 1979) was used to assess
psychiatric morbidity in caregivers. It is a self-administered screening instrument used to
J Cross Cult Gerontol (2015) 30:439–450 443

screen for psychiatric disorders in the general population and within community or non-
psychiatric clinical settings such as primary care or general medical outpatients. It assesses
the respondent’s current state and asks if that differs from his or her usual state (Goldberg
and Hiller 1979). The original version consisted of 60 items. Successive shorter versions
of 30, 28, 20, and 12 items have been developed. The 28-item version (GHQ-28) was used
for this study. GHQ-28 consists of four subscales measuring somatic symptoms, anxiety
and insomnia, social dysfunction, and severe depression. It has been demonstrated to have
high sensitivity and specificity (Aderibigbe and Gureje 1992; Morakinyo 1979). A binary
method of scoring was used in this study. A score of 0 was assigned to the first two of the
four responses to each item while a score of 1 was assigned to the last two responses.
In this study, a score of 5 and above was used to represent psychological distress. It has
been used in several countries including Nigeria (Aderibigbe and Gureje 1992; Morakinyo
1979). In Ibadan, Nigeria, sensitivity, specificity, and positive predictive values of 80.8,
75.6, and 51.2 %, respectively, were reported (Aderibigbe and Gureje 1992). The GHQ-28
has been translated to Yoruba and used in a previous study in Nigeria (Aderibigbe and
Gureje 1992).
Both the Zarit and GHQ-28 were readily available and had been used in previous local studies.

Data Analysis

The study data was analyzed using Statistical Package for Social Sciences (5) Programme
version 15 (SPSS, Chicago, IL, USA) Data is presented with simple frequency distribution
tables. For further analysis, duration of care less or equal to 36 months was classified as
Bshort^ while duration of care more than 36 months was classified as Blong.^ Differences
between groups were examined for statistical significance using the Chi-squared test for
categorical variables with Yates’ correction or Fisher exact test (FET) implemented where
appropriate while continuous variables were analyzed with t test. Significant variables
were entered into a logistic regression analysis to determine variables independently
associated with caregiver burden and psychiatric morbidity. Odds ratio (OR) with 95 %
confidence interval (CI) were then calculated for the independently associated variables.

Results

One hundred thirty-two caregivers were consecutively approached for participation in the
study. One of the subjects refused consent while three questionnaires were rejected due to
incomplete or inconsistent responses. This yielded 128 questionnaires (96.9 %) for analysis.
The caregivers had an age range of 16–75 years and mean age of 42.1 years (±12.9).
A majority were females (53.1 %), married (81.3 %), employed (91.4 %), and educated
(93 %) (Table 1). About 69.5 % (89) of the caregivers were children of the patients, 13.3 %
(17) were spouses, while other relatives including uncles, nephews, and nieces comprised
17.2 % (22) of the caregivers.
Sixty-two patients (48.4 %) had an ICD-10 diagnosis of schizophrenia followed by 30
patients (23.4 %) with mood disorders, 18 (14.1 %) with dementia, 10 (7.8 %) with psychosis
unspecified, and 8 (6.3 %) with other psychiatric disorders, e.g., Somatoform disorders and
seizure disorders.
444 J Cross Cult Gerontol (2015) 30:439–450

Table 1 Sociodemographic char-

acteristics of caregivers Total number of respondents (N=128)

Variable N %
Age distribution
16–29 21 16.4
30–44 60 46.9
45–59 29 22.6
≥60 18 14.1
Age (years)
Mean±SD=42.1±12.9
Age range 16–75
Sex
Male 60 46.9
Female 68 53.1
Marital status
Never married 20 15.6
Married 104 81.3
Previously married * 4 3.1
Ethnicity
Yoruba 123 96.1
Igbo 3 2.3
Others 2 1.6
Religion
Christianity 79 61.7
Islam 49 38.3
Employment status
Employed 117 91.4
Unemployed 11 8.6
Educational attainment
No formal education 9 7.0
Below secondary 41 32.0
*Widowed, separated, or Secondary and above 78 61.0
divorced

The caregiving variables related to burden of care are presented in Table 2. Sixty-seven
caregivers (52.3 %) had high care burden compared with 61(47.7 %) reporting low care
burden. Twenty-four caregivers (18.8 %) had psychiatric morbidity (GHQ≥5) compared with
104 caregivers (81.2 %) that had no psychiatric morbidity (GHQ<5). High care burden was
associated with financial difficulty (χ2 =9.37; df=1; p=0.002), restrictions on caregivers’
social activity (χ2 =4.87; df=1; p=0.027), lack of support from relatives (χ2 =6.85; df=1;
p=0.009), physical health problems (χ2 =10.52; df=1; p=0.001), and psychiatric morbidity
(χ2 =4.05; df=1; p=0.044) (Table 2). Psychiatric morbidity was associated with financial
difficulty (χ2 =21.5; df=1; p<0.001), physical health problems (χ2 =5.14; df=1; p=0.023),
and giving up a trade or job (χ2 =12.9; df=1; p<0.001) (Table 3). Persons reporting high care
burden were found to have significantly higher mean scores in only three GHQ subscales,
namely, anxiety/insomnia (t=−2.52; p=0.013), social dysfunction (t=−2.46; p=0.015),
J Cross Cult Gerontol (2015) 30:439–450 445

Table 2 Caregiving variables and burden of care

Variable, n (%) Burden of care

Low burden High burden χ2 df p OR (95 % CI)

61 (47.7) 67 (52.3)

Main care tasks

Self-care 13 (46.4) 15 (53.6) 2.05 2 0.358
Household tasks 26 (41.9) 36 (58.1)
Financial 21 (56.8) 16 (43.2)
Caregiving duration
Short 30 (47.6) 33 (52.4) 0.17 1 0.680
Long 25 (43.9) 32 (56.1)
Financial difficulty
No 40 (60.6) 26 (39.4) 9.37 1 0.002** 1
Yes 20 (33.3) 40 (66.7) 3.1 (1.5–6.4)
Employment loss
No 45 (53.6) 39 (46.4) 3.58 1 0.058
Yes 15 (35.7) 27 (64.3)
Restrictions on social activities
No 48 (54.5) 40 (45.5) 4.87 1 0.027* 1
Yes 13 (33.3) 26 (66.7) 2.4 (1.09–5.27)
Support from relatives
No 2 (14.3) 12 (85.7) 6.85 1 0.009** 6.3 (1.35–29.6)
Yes 57 (51.4) 54 (48.6) 1
Quality of relationship
Poor/fair 1 (12.5) 7 (87.5) 4.50 1 0.62a
Good/excellent 60 (51.3) 57 (48.7)
Physical health problems
No 54 (56.2) 42 (43.8) 10.52 1 0.001** 1
Yes 6 (21.4) 22 (78.6) 4.7 (1.75–12.7)
Psychiatric morbidity
No 54 (51.9) 50 (48.1) 4.05 1 0.044* 1
Yes 7 (29.2) 17 (70.8) 2.62 (1.00–6.85)

*p<0.05; **p<0.01
a
Fisher’s exact test

and severe depression (t = −2.96; p = 0.004). No association was found with somatic
symptoms (t=−1.430; p=0.155).
The logistic regression analyses revealed that the independent predictors of care burden
were financial difficulty (OR=3.1; 95 % CI=1.50–6.4), restrictions on social activities
(OR=2.4; 95 % CI=1.09–5.27), lack of support (OR=6.3; 95 % CI=1.35–29.6), physical
health problems (OR=4.7; 95 % CI=1.75–12.7), and psychiatric morbidity (OR=2.62;
95 % CI=1.00–6.85). Psychiatric morbidity was predicted by physical health problems
(OR=3.0; 95 % CI=1.1–8.1), financial difficulty (OR=17.2; 95 % CI=3.8–77.5), and job
loss (OR=5.3; 95 % CI=2.0–13.8).
446 J Cross Cult Gerontol (2015) 30:439–450

Table 3 Caregiving variables and psychiatric morbidity

Variable, n (%) GHQ<5 GHQ≥5 χ2 df p OR (95 % CI)

N=104 N=24

Care tasks
Self-care 22 (78.6) 6 (21.4) 0.299 2 0.861
Household tasks 50 (80.6) 12 (19.4)
Financial 31 (83.8) 6 (16.2)
Caregiving duration
<36 months 51 (81.0) 12 (19.0) 0.075 1 0.784
≥36 months 45 (78.9) 12 (12.1)
Financial difficultya
No 64 (97.0) 2 (3.0) 21.5 1 0.0001*** 1
Yes 39 (65.0) 21 (35.0) 17.2 (3.8–77.5)
Employment lossa
No 76 (90.5) 8 (9.5) 12.9 1 0.0001** 1
Yes 27 (64.3) 15 (35.7) 5.3 (2.0–13.8)
Restrictions on social activities
No 75 (85.2) 13 (14.8) 3.18 1 0.074
Yes 28 (71.8) 11 (28.2)
Support from relatives
No 10 (71.4) 4 (28.6) 0.893 1 0.345
Yes 91 (82.0) 20 (18.0)
Quality of relationshipa
Poor/fair 5 (62.5) 3 (37.5) 2.08 1 0.150
Good/excellent 97 (82.9) 20 (17.1)
Physical health problemsa
No 83 (86.5) 13 (13.5) 5.14 1 0.023* 1
Yes 19 (67.9) 9 (32.1) 3.0 (1.1–8.1)

*p<0.05; **p<0.01; ***p<0.001

a
n is not equal to 128 on account of missing data

Discussion

The aim of this study was to assess the burden of caring for elderly persons with mental illness.
In assessing the burden of care, the financial and emotional impact of caring and restrictions on
caregivers’ social life were evaluated. Though previous studies have examined the burden of
caring for persons with mental illness locally (Adeosun 2013; Ukpong 2006; Abdulraheem
2005; Amoo 1998), few have focused on the care of the elderly persons with mental disorders
(Uwakwe 2006).
Sociodemographic characteristics of caregivers like age, gender, marital status, employment
status, and relationship to patients were not significantly associated with high care burden in
this study. Previous studies have also reported the lack of significant relationship between high
care burden and variables like age and marital status (Rudnick 2004; Molyneux et al. 2008;
Yusuf et al. 2009; Nuhu et al. 2010). However, mixed findings have been reported in terms of
gender differences and relationship to patients. No gender difference in care burden was found
J Cross Cult Gerontol (2015) 30:439–450 447

in a study of caregivers of elderly patients in Belgium (Schoenmakers et al. 2004) and

caregivers of persons with dementia in Nigeria (Akinbiyi 2001) in contrast to significantly
higher care burden reported in female caregivers in some other studies (Rudnick 2004;
Donaldson and burns 1999).

Psychosocial Variables and Caregiving

A high proportion of caregivers (47.6 %) reported financial difficulty in caring for patients in
this study. This is consistent with previous caregiver studies in Nigeria (Ohaeri 1998; Yusuf
et al. 2009). Financial difficulty in the context of caring for the mentally ill elderly may be due
to a number of reasons. First, the financial cost of hospital admissions, drugs, and clinic
appointments are borne by caregivers who often pay out of pocket in the absence of a
functional insurance scheme (Amoo 1998; Yusuf et al. 2009). This contrasts with the situation
in western countries which operate welfare programs (e.g., free drugs, health insurance, and
social security) (Ohaeri 1998). Such support framework may significantly reduce the financial
burden of caregiving in western countries (Midence and Elander 1996). Second, as a result of
retirement, high unemployment, and irregular pensions in developing countries, many elderly
persons are financially dependent on younger, more productive family members for their
personal needs. Third, the time spent on caring for the elderly person with mental illness may
disrupt work or trade, limiting sources of income and the earning power of caregivers. For
instance, up to a third of caregivers assessed in this study had given up employment or trade to
care for their mentally ill elderly relatives. This is not surprising, since older caregiving often is
known to interfere with paid employment (Feinberg and Choula 2012),

Burden of Care

High care burden was reported by 52.3 % of caregivers in this study. It falls within the range of
43 to 61 % reported among caregivers of persons with mental illness attending outpatient
clinics in recent studies in Nigeria (Adewuya et al. 2011; Yusuf et al. 2009; Ukpong 2006).
Relatively high rates have been reported in western countries. For example, Schoenmakers
et al. (2004)) reported a prevalence rate of 64 % among caregivers of a group of elderly
persons with mental illness in a community in Belgium. The consistently high rates reported
locally and internationally suggests that burden associated with caring for elderly persons with
mental illness transcends cultural boundaries. High care burden was significantly associated
with lack of support from relatives. Connell et al. (2001)) found a significant association
between lower levels of social support and care burden. A larger support network and
satisfaction with social support have also been linked with positive caregiving outcomes
including better satisfaction with life, fewer health problems, and lower rates of depression.
Caregivers receiving adequate social support may perceive situations as less stressful due to
availability of emotional, material, and informational support from their social networks
(Connell et al. 2001). In view of poor availability of structured support for care of impaired
elderly in Nigeria, caregivers rely heavily on friends, extended family members, workmates,
members of their religious organizations, and so on (Ogunniyi et al. 2005; Uwakwe 2000;
Ohaeri 1998). Apart from financial support, these offer practical help (e.g., housekeeping),
encouragement, and hope. Nevertheless, as reported in a previous study, it is quite possible that
a caregiver’s satisfaction with support network and perceived availability of support may be
more important than actual informal support available (Lawton et al. 1991).
448 J Cross Cult Gerontol (2015) 30:439–450

The finding of an association between restrictions on caregivers’ social activities and high
burden suggests that apart from availability of social support network, accessibility may be
limited by increasing demands on the time of the caregiver. This is supported by the findings of
a longitudinal study which reported decreasing caregiver satisfaction with social support as
care recipients’ level of function decreases (Pushkar et al. 1995). This may explain the
significant association between reduced involvement in social activities and high care burden
found in this study. The association between care burden and psychiatric morbidity is
consistent with previous findings (Crespo et al. 2005). This may be explained by the stress-
vulnerability model (Finlay-Jones and Brown 1981). The demands of caregiving may drain the
individuals’ emotional, physical, and financial resources. This may have significant psycho-
logical implications for persons that are vulnerable.

Limitations of the Study

This study had its limitations. First, only one caregiver from each family was interviewed.
Since caregiving is usually a shared responsibility, other family members not assessed may
also experience burden of care. The measure of caregiving tasks used in the study did not
provide a global view of tasks because the responses were limited in range of tasks. Second,
since level of burden may fluctuate with patient’s current state, multiple assessments over a
period of time may be more appropriate. Third, the non-random sampling method and the
hospital-based nature of the study limit the applicability of the findings. Nevertheless, the
strengths of this study include its naturalistic design and clinical setting which may provide
strong external validity. It also provides baseline data for developing interventions for care-
givers of geriatric patients with mental illness. The findings of this study contribute to the
growing body of knowledge on the burden of caregivers who play a crucial role in providing
support for geriatric individuals with mental illness in resource-constrained settings. The study
raises awareness about the effects of informal caregiving. It also has the potential to demon-
strate to policymakers that caregiving is a major public health issue that needs to be addressed.
It highlights the magnitude of psychosocial burden on caregivers of elderly patients with
mental illness which has the potential of facilitating formulation of policies for adequate and
efficient mental health delivery.

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