Factors Affecting Psychological Burden on the Informal Caregiver of Patients With Cirrhosis: Looking Beyond the Patient

Abstract

Background and aims: Cirrhosis leads to considerable morbidity and mortality, compromises quality of life, and often necessitates assistance in activities of daily living. An informal caregiver bears the psychological burden of coping with the needs of the patient and the knowledge of morbid prognosis of a loved one. This aspect is rarely recognized and almost never addressed in a clinical practice.

Methods: This cross-sectional study assessed the factors influencing psychological burden of cirrhosis on the caregivers in a predominantly lower-middle socioeconomic class Indian population. Patients underwent psychometric tests [Psychometric Hepatic Encephalopathy Score (PHES)], and questionnaires for quantifying caregiver burden [Perceived Caregiver Burden (PCB) and Zarit Burden Interview (ZBI)] and assessing depression [Beck Depression Inventory (BDI)] and anxiety [Beck Anxiety Inventory (BAI)] were administered.

Results: One hundred patients with cirrhosis [70% male, 27% with past hepatic encephalopathy (HE), and 53% with minimal HE] and their caregivers (66% women, 81% spouse, 26.51 years of mean relationship) were evaluated. Caregiver burden scores were higher in patients with previous overt HE than in those without previous overt HE [PCB (74.63 vs. 66.15, P = 0.001), ZBI (27.93 vs. 21.11, P = 0.023), BDI (11.63 vs. 8.96, P = 0.082), and BAI (11.37 vs. 8.12, P = 0.027)]. Similarly, caregivers of patients with minimal HE had higher caregiver burden that those of patients who did not have minimal HE [PCB (70.74 vs. 65.85, P = 0.027), ZBI (26 vs. 19.51, P = 0.015)]. Burden scores correlated well with each other and with liver disease severity scores and negatively correlated with socioeconomic status. Repeated hospital admissions, alcohol as etiology, and lower socioeconomic status were the independent predictors of caregiver burden.

Conclusion: Higher perceived burden is common in caregivers of patients with cirrhosis. Repeated hospital admissions, alcoholism, and lower socioeconomic status influence caregiver burden.

Keywords: ANOVA, Analysis of Variance; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; CI, Confidence interval; HE, Hepatic Encephalopathy; PCB, Perceived Caregiver Burden; PHES, Psychometric Hepatic Encephalopathy Score; ZBI, Zarit Burden Interview; caregiver burden; cirrhosis; minimal hepatic encephalopathy.

Figure 1

Impact of (A) past hepatic encephalopathy and (B) minimal hepatic encephalopathy on caregiver burden, anxiety, and depression scores. HE, hepatic encephalopathy; PCB, Perceived Caregiver Burden; BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; ZBI, Zarit Burden Interview.

Figure 2

Impact of independent predictors of caregiver burden. Group comparison: Solid lines, statistically significant difference. Dotted lines, nonsignificant difference. PCB, Perceived Caregiver Burden; ZBI, Zarit Burden Interview.