Depression, Anxiety, and Stress Among Caregivers of Patients with Schizophrenia

Depression, Anxiety, and Stress in Schizophrenia Caregivers

Abstract

Psychological distress in family caregivers of schizophrenia often remains unnoticed in outpatient services. Objective: To determine the frequency and severity of depression, anxiety, and stress among informal family caregivers of patients with schizophrenia, and to identify contributing factors. Method: A cross-sectional study was conducted at the outpatient psychiatry clinic of PIMH, Lahore, from May to December 2025. Consecutive informal primary caregivers aged 18–55 years (n=194) were interviewed. Depression Anxiety Stress Scale 21-item version scores were doubled; clinically significant depression, anxiety, and stress were defined as ≥14, ≥10, and ≥19. Chi-square tests and multivariable models were applied. Results: Caregiver mean age was 41.4 ± 9.6 years. Clinically significant depression, anxiety, and stress were present in 63.4%, 67.5%, and 66.0%. Depression was higher in male caregivers (72.2% vs 54.6%), unemployed caregivers (74.4% vs 54.6%), those with higher education (90.4%), and those with illness duration ≥5 years (75.6%) (p<0.05). Anxiety was higher in female caregivers (78.4%), higher education (82.7%), and illness duration ≥5 years (72.6%) (p<0.05). Stress was higher in males (77.3%), unemployed caregivers (77.9%), higher education (78.8%), and spouses or parents (77.1% and 75.0%) (p<0.05). In adjusted multivariate analyses, caregiver sex remained the most consistent predictor across depression, anxiety, and stress, while higher education independently predicted depression and stress; caregiver relationship to the patient independently associated with stress. Conclusion: Clinically significant distress was present in nearly two-thirds of caregivers, supporting routine screening within outpatient services and the provision of targeted, family-focused psychosocial support.