Caregivers of people with Severe Persistent Mental Illness (SPMI) face substantial challenges that can elevate burden, depression, and anxiety and reduce quality of life (QoL). This cross-sectional study assessed caregiver burden and its relationship with socio-demographic factors, depressive and anxiety symptoms, and QoL among 120 caregivers recruited from the psychiatry outpatient clinics at King Saud University Medical City (KSUMC) in Riyadh between February and April 2024. Validated Arabic instruments were used: the abridged Zarit Burden Interview (ZBI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and WHOQOL-BREF. Caregiver burden correlated positively with depression and anxiety (p < 0.001). Higher burden was associated with female caregivers (p = 0.04), living with the patient (p = 0.002), greater perceived severity of the patient’s illness (p = 0.001), and being a spouse or child (p = 0.036). Multivariable analysis identified caregiver anxiety and perceived illness severity as independent predictors of greater burden, while depressive and anxiety symptoms independently associated with poorer QoL. Burden showed a significant negative correlation with physical and psychological QoL domains (p < 0.001 and p = 0.013, respectively). The findings emphasize the need for targeted support interventions for caregivers of individuals with SPMI in Saudi Arabia.
The term SPMI covers a range of chronic mental disorders that often begin in early adulthood and carry long-term functional impairment and caregiving demands. There is no single universally accepted definition because dimensions such as diagnosis, disability, and duration are operationalized differently across contexts. Disorders included under SPMI in this study span schizophrenia, bipolar disorder, major depressive disorder, personality disorders, persistent depressive disorder, obsessive-compulsive disorder, and selected neurodevelopmental disorders including autism spectrum disorder and attention-deficit hyperactivity disorder.
Globally, mental disorders are common and substantially affect individuals and families. National data cited in the study indicate notable prevalence of mental illness in Saudi Arabia, with anxiety and mood disorders among the most frequent diagnoses. The concept of caregiver burden describes the multifaceted stress experienced by family members who provide ongoing support, while QoL reflects personal evaluations of one’s life position in relation to cultural expectations and values. Prior research has documented increased rates of depression, anxiety, and other adverse outcomes among caregivers of people with severe mental illness, and certain socio-demographic factors—such as cohabitation with the patient and low income—have been associated with higher burden. Evidence from Saudi Arabia is limited, motivating this investigation into how caregiver burden relates to depression, anxiety, and QoL in a local clinical sample.
This was a cross-sectional convenience sample of caregivers attending the psychiatry outpatient clinic at KSUMC, Riyadh, Saudi Arabia, over a three-month period (February–April 2024). Caregivers were defined as adult family members or significant others aged 18 years or older who provided unpaid physical, emotional, supervisory, or practical support to an individual with SPMI and who were involved in regular care. Caregivers had to be able to read and understand Arabic. Diagnoses grouped as SPMI included schizophrenia, bipolar disorder, major depressive disorder, personality disorders, persistent depressive disorder, obsessive-compulsive disorder, and selected neurodevelopmental disorders such as autism and ADHD. Caregivers of patients with neurocognitive disorders (for example, Alzheimer’s disease) were excluded; the source text truncates at the exclusion description and additional eligibility specifics beyond this were not reported in the provided excerpt.
Data collection used validated Arabic-language measures: the abridged Arabic Zarit Burden Interview (ZBI) to evaluate caregiver burden, PHQ-9 to assess depressive symptoms, GAD-7 to assess anxiety symptoms, and the WHOQOL-BREF to measure QoL across domains. The study analyzed associations between burden and socio-demographic variables, symptom scores, perceived illness severity, and caregiver–patient relationship. Multivariable analyses were performed to identify independent associations.
A total of 120 caregivers participated. Key findings reported in the source are:
There was a significant positive correlation between caregiver burden and both depression and anxiety scores (p < 0.001).
Female caregivers reported significantly higher burden than male caregivers (p = 0.04).
Caregivers who resided with the patient had higher burden levels (p = 0.002).
Greater perceived severity of the patient’s mental illness was associated with increased caregiver burden (p = 0.001).
Spouses and children reported significantly higher burden compared with other caregiver categories (p = 0.036).
In multivariable analyses, caregiver anxiety and perceived illness severity remained independently associated with higher caregiver burden, while both depressive and anxiety symptoms were independently associated with poorer QoL.
Caregiver burden correlated negatively with the physical QoL domain (p < 0.001) and the psychological QoL domain (p = 0.013), indicating that greater burden was linked to worse physical and psychological quality of life.
The source article includes tables and figures that detail these analyses; specific numerical effect sizes, confidence intervals, and full model parameters were not reproduced in the provided excerpt.
The study situates its findings within broader literature documenting elevated psychological distress and reduced QoL among caregivers of individuals with severe mental illness. The observed associations—particularly the positive relationships between burden and both depression and anxiety and the negative associations with physical and psychological QoL domains—mirror patterns reported in international studies. The higher burden among those living with the patient and among spouses and children highlights the influence of close, daily caregiving responsibilities. The identification of caregiver anxiety and perceived illness severity as independent predictors of burden suggests that interventions addressing caregiver anxiety and providing support when illness is severe may reduce burden and improve QoL. The authors recommend targeted support interventions tailored to the cultural and social context of caregivers in Saudi Arabia.
The study used a cross-sectional convenience sample at a single tertiary care outpatient clinic, which limits generalizability and prevents causal inference. The excerpted source does not provide full detail on sampling methodology beyond the convenience approach, response rates, or the breakdown of diagnoses among care recipients; those specifics were not reported in the provided text. Additionally, while validated Arabic measures were used, the reliance on self-report instruments can introduce reporting bias.
Caregivers of people with SPMI in this Riyadh outpatient sample experienced significant burden associated with higher depression and anxiety and with reduced physical and psychological QoL. Female caregivers, those living with the patient, spouses, children, and those perceiving greater illness severity were at higher risk of burden. Multivariable analyses identified caregiver anxiety and perceived illness severity as independent correlates of burden, and depressive and anxiety symptoms as independent correlates of poorer QoL. The authors conclude these findings underscore an urgent need for culturally appropriate, targeted caregiver support services in Saudi Arabia, particularly interventions addressing anxiety, depression, and challenges tied to severe mental illness.